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Objective: to investigate both muscular manifestations and CK levels of a large cohort of patients with COVID-19 infection and to determine whether hyperckemia is associated with morbidity and mortality.Methods: Data of 615 patients discharged from ASST Ovest Milanese (Milan, Lombardy, Italy) with final diagnosis of COVID-19 infection were retrospectively extracted from electronical medical records from 21 February to 1 May 2020. Patients were descriptively analyzed with respect to the following variables: sex, age, muscular manifestations (including myalgia/arthralgia and fatigue), respiratory involvement (SARS pneumonia or respiratory failure) and history of falls. Association between patients’ characteristics and CK levels was investigated. In addition, the proportion of patients who died following access to the ER was calculated. Finally, the effect of CK levels and other patients’ features on mortality was estimated using a logistic regression model.Results: 176 (28.6%) patients had raised serum CK levels. 88 (14.3%) had muscular manifestations, of which 81 (13.2%) complained fatigue and 17 (2.8%) had myalgia and/or arthralgia. CK levels were significantly associated with respiratory involvement and fatal outcome.Conclusions: Our study provides preliminary evidence that hyperckemia is a predictor of respiratory involvement and fatal outcome in patients with COVID-19 infection. For patients with muscle damage symptoms, screening for COVID-19 infection is recommended together with the dosage of CK level.

[Purpose] This study aimed to investigate the effects of branched-chain amino acid (BCAA) supplement on delayed onset muscle soreness (DOMS) by analyzing the maximum muscle strength and indicators of muscle damage. [Methods] Twelve men with majors in physical education were assigned to the BCAA group and placebo group in a double-blinded design, and repeated measurements were conducted. DOMS was induced with an isokinetic exercise. Following BCAA administration, the changes in the knee extension peak torque, flexion peak torque, aspartate aminotransferase (AST), creatine kinase (CK), and lactate dehydrogenase (LDH) concentrations were analyzed. The maximum knee muscle strength was measured at the baseline (pre-D0) following BCAA administration for 5 days before exercise (-D5, -4D, -3D, -2D, -1D). In contrast, the post-treatment measurements (D3) were recorded after BCAA administration for 3 days (post-D0, D1, D2). Blood samples were obtained before (pre-D0), immediately after (post-D0), 24 h (D1), 48 h (D2), and 72 h (D3) after the exercise to analyze the indicators of muscle strength. BCAA was administered twice daily for 8 days (5 days and 3 days before inducing DOMS and during the experimental period, respectively). [Results] There was no difference in the flexion peak torque between the groups. However, the BCAA group showed a significantly higher extension peak torque at D3 (second isokinetic exercise), compared to the placebo group (p

Summary Study aim: To investigate the effect of cold water immersion (CWI) on muscle damage indexes after simulated soccer activity in young soccer players. Material and methods: Eighteen professional male soccer players were randomly divided into two groups: CWI (n = 10, age 19.3 ± 0.5, body mass index 22.2 ± 1.3) and control (n = 8, age 19.4 ± 0.8, body mass index 21.7 ± 1.5). Both groups performed a simulated 90-minute soccer-specific aerobic field test (SAFT90). Then, the CWI group subjects immersed themselves for 10 minutes in 8°C water, while the control group subjects sat passively for the same time period. Blood samples were taken before, immediately after, 10 minutes, 24 hours and 48 hours after the training session in a fasted state. Blood lactate, creatine kinase (CK) and lactate dehydrogenase (LDH) enzyme levels were measured. Results: Lactate, CK and LDH levels increased significantly after training (p < 0.001). There were significant interactions between groups and subsequent measurements for CK (p = 0.0012) and LDH (p = 0.0471). There was no significant difference in lactate level between the two groups at any aforementioned time. Conclusion: It seems that CWI after simulated 90-minute soccer training can reduce the values of muscle damage indexes in soccer players.

Muscle injuries frequently occur in contact sports events. The current treatment options for soft tissue injuries remain suboptimal and often result in delayed or incomplete recovery of damaged muscles. Resveratrol (RES) is a phenolic phytochemical, well-known for its antioxidant and anti-inflammatory properties. The purpose of this study is to evaluate the potential beneficial effects of RES supplementation on inflammation and regeneration in skeletal muscle after a contusion injury, in comparison to a conventional treatment of nonsteroidal anti-inflammatory drugs (NSAID). After one week of acclimation, forty eight -week-old male ICR mice were randomly divided into the five groups (n=8 per group): 1) normal control (NC), 2) mass-drop injury without any treatment (mass-drop injury, MDI), 3) post-injury NSAID treatment (MDI+ 10mg/kg NSAID), 4) post-injury RES supplementation (MDI+ 25mg/kg/day RES) and 5) post-injury treatment with RES and NSAID (MDI + resveratrol+ NSAID). After muscle contusion injury of the left gastrocnemius muscle, RES or NSAID were orally administered post-injury once a day for 7 days. Results showed that the MDI group had significantly higher serum uric acid (UA), CREA (creatinine), LDH (lactic dehydrogenase) and creatine kinase (CK) than the normal control group. Treatment with resveratrol reduced muscle damage as evidenced by the significantly decreased serum levels of UA, CREA, LDH and CK after contusion-induced muscle injuries in mice. In addition, RES and RES + NSAID groups promoted muscle satellite cell regeneration with increase in desmin protein after injury. Our results suggest that resveratrol combined with NSAID potentially improve muscle recovery and may be a potential candidate for further development as an effective clinical treatment for muscle repair.

A 4-year-old, male-castrated, mixed breed dog was presented for a routine wellness examination at which time a moderate increase in serum creatine kinase (CK) enzyme activity (hyperCKemia) (15,137 IU/L; reference interval 10–200 IU/L), and moderate increases in alanine transaminase and aspartate aminotransferase enzyme activities were first identified. There was no history of clinical abnormalities (e.g., lethargy, lameness, anorexia, dysphagia, weakness, gait abnormalities, or exercise intolerance) and the physical examination was unremarkable. The dog was screened for several relevant potential infectious diseases known to cause inflammatory myopathies and was treated empirically with clindamycin. The serum total CK enzyme activity remained increased, which prompted recommendations for an echocardiogram, electromyogram (EMG), and muscle biopsy acquisition. The echocardiogram and electrocardiographic monitoring were unremarkable. The EMG and muscle biopsies were declined by the owner. The dog was evaluated several times in the subsequent 5 years and remained subclinical with unremarkable physical examinations despite a persistent moderate-to-severe hyperCKemia. Differential diagnoses considered most likely in this dog were an occult/latent hereditary muscular dystrophic disorder or idiopathic hyperCKemia, a phenomenon not yet reported in the veterinary literature. This report describes for the first time, clinical and diagnostic features of a subclinical dog with persistent moderate-to-severe hyperCKemia.

Objectives:The aim of this study was to determine the relationship between disease activity in adult patients with dermatomyositis (DM) and other biomarkers of disease activity such as C-reactive protein creatinine kinase and nailfold video capillaroscopy (NVC).Methods:We performed a prospective single center study of 15 adult patients with DM. Study participants underwent two assessments at least 9 months apart including clinical, laboratory and NVC evaluations. Patients received immunosuppressive medications for their dermatomyositis, and ongoing disease activity was measured by the Myositis Intention to Treat Index (MITAX). NVC evaluation included assessment of capillary density, capillary apical diameter (mm), and the number of microhemorrhages per digit.Results:Microvascular abnormalities were present in most DM patients. Of these, capillary density (4.71 vs. 6.84,p= 0.006) and mean apical diameter (56.09 vs. 27.79 μm,p= 0.003) significantly improved over the study period in concordance with improving disease control (MITAX 8.53 vs. 2.64,p= 0.002). Longitudinal analysis demonstrated that capillary density was independently associated with MITAX (β = −1.49 [CI −2.49, −0.33],p= 0.013), but not other parameters such as C-reactive protein and creatinine kinase.Conclusions:Nailfold capillary density is a dynamic marker of global disease activity in adult DM. NVC may be utilized as a non-invasive point-of-care tool to monitor disease activity and inform treatment decisions in patients with DM.

Background Duchenne muscular dystrophy (DMD) and Becker muscular dystrophy (BMD) are allelic X-linked recessive diseases caused by mutations in the dystrophin (DMD) gene. To our knowledge, molecular analysis to differentiate between DMD and BMD has never been performed in Indonesia. Objective To elaborate the clinicopathologic and molecular profiles of DMD/BMD patients in Yogyakarta, Indonesia. Methods Eighteen muscle biopsy specimens of patients clinically suspected to have DMD/BMD were collected. Possible associations of clinical manifestations, histopathological grading, and immunohistochemistry (IHC) results were analyzed. Polymerase chain reaction (PCR) was performed to identify mutations in exon 52. Results. Positive Gower’s sign and high serum creatine kinase (CK) were observed in most patients. The IHC of dystrophin in two female patients suggested that they were manifesting carriers. Of the 16 male patients, 12 showed negative IHC staining, indicating DMD, while 4 patients demonstrated weak expression of dystrophin, indicating BMD. There was a significant association between high CK level and IHC results (P=0.005), indicating higher CK level in DMD patients. Histopathological grading of muscle biopsy was significantly associated with diagnosis of DMD/BMD using IHC (P=0.01), showing more severe tissue damage in DMD patients. None of the subjects had the single exon 52 deletion. Conclusion This is the first report of a clinicopathologic and molecular profile of DMD/BMD in an Indonesian population. Serum CK level and histopathological grading of muscle biopsy are useful in distinguishing DMD from BMD in settings where an IHC assay is not available.

The authors report a case of fulminant myocarditis from an influenza A (H3N2) infection in a healthy individual who experienced cardiac arrest…, The authors report a case of fulminant myocarditis from an influenza A (H3N2) infection in a healthy individual who experienced cardiac arrest requiring extracorporeal membrane oxygenation (ECMO). The case highlights the management of complications arising from the use of ECMO including differential hypoxia and left ventricular overload requiring left ventricular venting. (Level of Difficulty: Beginner.), Central Illustration

Better understanding of survival factors in amyotrophic lateral sclerosis (ALS) could help physicians and patients schedule therapeutic interventions. We conducted a study to evaluate the predictive factors associated with longer survival and construct prognostic nomogram in ALS patients. A total of 553 ALS patients were enrolled and divided into 2 groups: a training set and a validation set. Risk factors for survival were identified using logistic regression analysis, and a nomogram created by R program was performed to predict the probability of longer survival in the training set; then receiver operating characteristic (ROC) analysis was applied to assess predictive value of the nomogram model. The median survival time was 3.2 years for all patients. Multivariate analyses revealed that age of onset, rate of disease progression, hemoglobin A1c (HbA1c) level, body mass index, creatinine, creatine kinase (CK), and non-invasive positive pressure ventilation (NIPPV) were independent predictors of longer survival. A nomogram based on the above seven predictive factors was developed to predict the possibility of longer survival. The ROC curve of the nomogram demonstrated good discrimination ability with an AUC of 0.92 (95% CI: 0.88-0.96) in the validation set. In ALS, serum CK, creatinine and HbA1c levels at baseline were independent biomarkers of longer survival. The prognostic nomogram model that integrated all significant independent factors for those who survived longer than 3 years provides an effective way to predict the probability of longer survival and can help doctors evaluate the disease progression and give personalized treatment recommendations.

Rationale & Objective Low serum magnesium level has been shown to be associated with increased mortality, but its role as a predictor of cardiovascular disease is unclear. This study evaluates the association between serum magnesium level and cardiovascular events and all-cause mortality in a large cohort of individuals with chronic kidney disease (CKD). Study Design Prospective cohort study. Setting & Participants 3,867 participants with CKD, enrolled in the Chronic Renal Insufficiency Cohort (CRIC) Study. Exposures Serum magnesium measured at study baseline. Outcomes Composite cardiovascular events (myocardial infarction, cerebrovascular accident, heart failure, and peripheral arterial disease) and all-cause mortality. Analytical Approach Cox proportional hazards models adjusted for demographic, clinical, and laboratory characteristics. Results During the 14.6 (4.4) years (standard deviation) of follow-up, 1,384 participants died (36/1,000 person-years), and 1,227 (40/1,000 person-years) had a composite cardiovascular event. There was a nonlinear association between serum magnesium level and all-cause mortality. Low and high magnesium levels were associated with greater rates of all-cause mortality after adjusting for demographics, comorbid conditions, medications including diuretics, estimated glomerular filtration rate, and proteinuria (P 2.1 mg/dL was associated with increased risk for all-cause mortality. Low magnesium level was associated with incident atrial fibrillation but not with composite cardiovascular disease events. Further studies are needed to determine the optimal range of serum magnesium in CKD to prevent adverse clinical outcomes., Graphical abstract

Objective: Researching the prognostic value of myocardial enzymes in COVID-19 patients. Materials & methods: We collected 113 confirmed COVID-19 patients. The dynamic changes of CK, LDH and α-HBDH in patients were studied retrospectively, the correlation between myocardial enzyme index, clinical classification and outcome of patients and its significance to prognosis. Results: There are significant statistical differences between LDH, α-HBDH, CK and the clinical classification, and patient’s outcome. In the receiver operating characteristic curve analysis, LDH, α-HBDH and CK have a good diagnostic value for the death outcome of patients. Conclusion: LDH, α-HBDH and CK were the components of myocardial enzyme profiles, and our results found that they were significantly positively correlated with clinical classification and prognosis of COVID-19 patients. The values of LDH, α-HBDH and CK increased with the increase of the severity of admission clinical classification and the deterioration of outcome. Therefore, we propose that continuous monitoring of LDH, α-HBDH and CK indicators can warn the deterioration of COVID-19 to a certain extent, regardless of whether patients with cardiovascular diseases are combined or not, and prompt early intervention.

Early reports from Asia suggested that increased serum levels of the muscular enzyme creatine-(phospho)-kinase (CK/CPK) could be associated with a more severe prognosis in COVID-19. The aim of this single-center retrospective cohort study of 331 consecutive COVID-19 patients who were hospitalized during Italy’s “first wave” was to verify this relationship, and to evaluate the role of possible confounding factors (age, body mass index, gender, and comorbidities). We subdivided our cohort in two groups, based on “severe” (n = 99) or “mild” (n = 232) outcomes. “Severe” disease is defined here as death and/or mechanical invasive ventilation, in contrast to “mild” patients, who were discharged alive with no need for invasive ventilation; this latter group could also include those patients who were treated with non-invasive ventilation. The CK levels at admission were higher in those subjects who later experienced more severe outcomes (median, 126; range, 10–1672 U/L, versus median, 82; range, 12–1499 U/L, p = 0.01), and hyperCKemia >200 U/L was associated with a worse prognosis. Regression analysis confirmed that increased CK acted as an independent predictor for a “severe” outcome. HyperCKemia was generally transient, returning to normal during hospitalization in the majority of both “severe” and “mild” patients. Although the direct infection of voluntary muscle is unproven, transient muscular dysfunction is common during the course of COVID-19. The influence of this novel coronavirus on voluntary muscle really needs to be clarified.

International audience; Hepatocholangiocarcinoma, fibrolamellar carcinoma, hepatic haemangioendothelioma and hepatic angiosarcoma represent less than 5% of primary liver cancers. Fibrolamellar carcinoma and hepatic haemangioendothelioma are driven by unique somatic genetic alterations (DNAJB1-PRKCA and CAMTA1-WWTR1 fusions, respectively), while the pathogenesis of hepatocholangiocarcinoma remains more complex, as suggested by its histological diversity. Histology is the gold standard for diagnosis, which remains challenging even in an expert centre because of the low incidences of these liver cancers. Resection, when feasible, is the cornerstone of treatment, together with liver transplantation for hepatic haemangioendothelioma. The role of locoregional therapies and systemic treatments remains poorly studied. In this review, we aim to describe the recent advances in terms of diagnosis and clinical management of these rare primary liver cancers.

Introduction: Serum Creatinine Kinase (CK) is a non-specific marker of muscle damage. There has been limited investigation of the association between peripheral neuropathy and CK elevation (hyperCKemia).Methods: We performed a chart review to investigate the CK level in peripheral neuropathies. Demographics, clinical history, physical exam, electrodiagnostic data, CK level, statin use, etiology of neuropathy, and concomitant neuromuscular disorders were recorded. HyperCKemia was defined using our laboratory cutoff values of >180 U/L (women) and >220 U/L (men).Results: We identified 450 patients with peripheral neuropathy who had CK testing, 92 (20.4%) of whom had hyperCKemia. Sixty-one of those patients (13.5% of the total figure) had a concomitant etiology that could explain the CK elevation. Thirty-one patients (6.9%) had no other identifiable etiology for their hyperCKemia beyond the neuropathy. The average CK level in the latter cohort with hyperCKemia was 376 U/L (women: 312 U/L; men: 444 U/L). The frequency of cramping was greater in patients with elevated vs. normal CK (p < 0.0001).Discussion: HyperCKemia can occur in patients with peripheral neuropathy and appears to associate with cramping.

Supplemental Digital Content is available in the text, Purpose: Rhabdomyolysis (RM) has been associated with many viral infectious diseases, and associated with poor outcomes. We aim to evaluate the clinical features and outcomes of RM in patients with coronavirus disease 2019 (COVID-19). Method: This was a single-center, retrospective, cohort study of 1,014 consecutive hospitalized patients with confirmed COVID-19 at the Huoshenshan Hospital in Wuhan, China, between February 17 and April 12, 2020. Results: The overall incidence of RM was 2.2%. Compared with patients without RM, those with RM tended to have a higher risk of deterioration. Patients with RM also constituted a greater percentage of patients admitted to the intensive care unit (90.9% vs. 5.3%, P 1,000 IU/L (HR = 6.46, 95% CI: 3.02–13.86) and peak serum myoglobin concentrations > 1,000 ng/mL (HR = 9.85, 95% CI: 5.04–19.28), were independent risk factors for in-hospital death. Additionally, patients with COVID-19 that developed RM tended to have delayed viral clearance. Conclusion: RM might be an important contributing factor to adverse outcomes in COVID-19 patients. The early detection and effective intervention of RM may help reduce mortality among COVID-19 patients.

Introduction Mitochondrial fatty acid oxidation disorders (FAODs) are a heterogeneous group of hereditary autosomal recessive diseases included in newborn screening (NBS) program in Italy. The aim of this study was to analyse FAODs cases, identified either clinically or by NBS,for clinical and genetic characterization and to evaluate a five years' experience of NBS, in the attempt to figure out the complexity of genotype-phenotype correlation and to confirm the clinical impact of NBS in our centre experience. Materials and methods We analysed FAODs patients diagnosed either by NBS or clinically, followed since February 2014 to April 2019 at the Regional Screening Centre and Inherited Metabolic Diseases Unit of Verona. Diagnosis was confirmed by plasma acylcarnitines, urinary organic acids, enzymatic and genetic testing. For not clear genotypes due to the presence of variants of uncertain significance, in silico predictive tools have been used as well as enzymatic activity assays. Patients underwent clinical, nutritional and biochemical follow up. Results We diagnosed 30 patients with FAODs. 20 by NBS: 3 CUD, 6 SCADD, 5 MCADD, 4 VLCADD, 2 MADD. Overall incidence of FAODs diagnosed by NBS was 1:4316 newborns. No one reported complications during the follow up period. 10 patients were diagnosed clinically: 2 CUD, 2 CPT2D, 1 VLCADD, 5 MADD. Mean age at diagnosis was 29.3 years. Within this group, complications or symptoms were reported at diagnosis, but not during follow-up. 12 mutations not previously reported in literature were found, all predicted as pathogenic or likely pathogenic. Discussion and conclusions Our study highlighted the great phenotypic variability and molecular heterogeneity of FAODs and confirmed the importance of a tailored follow up and treatment. Despite the short duration of follow up, early identification by NBS prevented diseases related complications and resulted in normal growth and psycho-motor development as well., Highlights • Early identification by newborn screening prevents disease related complications. • Newborn screening is changing prevalence clinical and molecular heterogeneity of FAODs. • Genotype-phenotype correlation helps to achieve personalized follow-up and treatment. • Enzymatic assay may be pivotal in predicting phenotype and symptoms severity. • Diagnosis on clinical grounds is anyway important to change disease course.

This work proposes an approach based on dynamic Bayesian networks to support the cybersecurity analysis of network-based controllers in distributed energy plants. We built a system model that exploits real world context information from both information and operational technology environments in the energy infrastructure, and we use it to demonstrate the value of security evidence for time-driven predictive and diagnostic analyses. The innovative contribution of this work is in the methodology capability of capturing the causal and temporal dependencies involved in the assessment of security threats, and in the introduction of security analytics supporting the configuration of anomaly detection platforms for digital energy infrastructures.

Mazen M Sinjab,1,2 Roy S Rubinfeld,3,4 Kirsten Wagner,5,6 Edward C Parsons Jnr,7 Arthur B Cummings,8 Michael W Belin9 1Dr. Mazen Eye Clinic, Medcare Hospitals and Centres, Dubai, United Arab Emirates; 2Al Zahra Medical Group, Damascus, Syria; 3Department of Ophthalmology, Georgetown University Medical School/Washington Hospital Center, Washington, DC, USA; 4Re:Vision Private Practice, Rockville, MD, USA; 5Department of Ophthalmology, Medstar Georgetown University Hospital, Washington, DC, USA; 6Department of Ophthalmology, Medstar Washington Hospital Center, Washington, DC, USA; 7CXL Ophthalmics, Encinitas, CA, USA; 8Wellington Eye Clinic, Dublin, Ireland; 9Department of Ophthalmology, University of Arizona, Tucson, AZ, USACorrespondence: Roy S Rubinfeld 3131 Connecticut Ave, NW, #2809, Washington, DC, 20008, USAEmail Doctor@revisedeye.comPurpose: To assess the effectiveness of a novel treatment for patients with advanced corneal ectasia and loss of visual acuity (VA). Conductive keratoplasty (CK) is performed to improve VA followed by epithelium-on (epi-on) corneal crosslinking (CXL) to stabilize the cornea after CK.Methods: Retrospective, exploratory cohort study. Patients with keratoconus or postsurgical ectasia and best spectacle-corrected distance VA (CDVA) ≤ 20/40 were included. Conductive keratoplasty was performed (ViewPoint CK System, Refractec, Inc., Bloomington, MN); followed a day later by epi-on CXL (CXLUSA/CXLO, Bethesda, MD/CXLO Encinitas, CA). Measures included uncorrected distance visual acuity (UDVA) and CDVA, as well as refractive and tomographic measures and tomographic indices.Results: Data from 50 eyes of 45 patients were analyzed. Mean follow-up was 15.1 ± 12.2 months (range: 2 to 51). Overall, UDVA and CDVA improved postoperatively. Subjective refraction and tomographic metrics did not show consistent changes, but changes in tomographic indices were associated with treatment follow-up time. At the 1-year visit, mean UDVA significantly improved over baseline (P = 0.009) by approximately 3 lines; mean CDVA improved significantly (P = 10− 5) by approximately 2 lines. No eye lost lines of CDVA. Change in the Index of Surface Variance (ISV) was associated with treatment, and the D-Index trended over follow-up time.Conclusion: Conductive keratoplasty with a proprietary epi-on CXL treatment improved vision in patients with advanced ectasia This CK/epi-on CXL treatment offers the possibility of improved VA for patients with compromised vision due to ectasia.Keywords: conductive keratoplasty, CK, corneal crosslinking, crosslinking, keratoconus, ectasia, thermokeratoplasty

Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease with no recognized clinical prognostic factor. Creatinine kinase (CK) increase in these patients is already described with conflicting results on prognosis and survival. In 126 ALS patients who were fast or slow disease progressors, CK levels were assayed for 16 months every 4 months in an observational case-control cohort study with prospective data collection conducted in Italy. CK was also measured at baseline in 88 CIDP patients with secondary axonal damage and in two mouse strains (129SvHSD and C57-BL) carrying the same SOD1G93A transgene expression but showing a fast (129Sv-SOD1G93A) and slow (C57-SOD1G93A) ALS progression rate. Higher CK was found in ALS slow progressors compared to fast progressors in T1, T2, T3, and T4, with a correlation with Revised Amyotrophic Lateral Sclerosis Functional Rating Scale (ALSFRS-R) scores. Higher CK was found in spinal compared to bulbar-onset patients. Transgenic and non-transgenic C57BL mice showed higher CK levels compared to 129SvHSD strain. At baseline mean CK was higher in ALS compared to CIDP. CK can predict the disease progression, with slow progressors associated with higher levels and fast progressors to lower levels, in both ALS patients and mice. CK is higher in ALS patients compared to patients with CIDP with secondary axonal damage, the higher levels of CK in slow progressors patients, but also in C57BL transgenic and non-transgenic mice designs CK as a predisposing factor for disease rate progression.

OBJECTIVES This study was to investigate the change of inflammatory markers and fatigue substance of muscle damage on different resistance exercise intensities. METHODS The subjects were 7 students (age, 21.0 ± 1.56) in physical education department C University in Gyeongnam. The same amount of exercise was applied to each subject by low and high intensity resistance exercise. Inflammatory and muscle damage markers were based on IL-6, CRP, Myoglobin, CK and LDH. The changes of inflammatory and muscle damage markers on different exercise intensities were measured pre and immediately post exercise and during recovery periods. Blood was collected at each time and analyzed. RESULTS The IL-6 level was significantly lower (0.526) after 24 hours than before exercise in the high intensity exercise. Regardless of the difference in exercise intensities, the change was significantly higher(p

Introduction: Intense exercise may cause immunological changes and muscle damage. The aim of this study was to investigate the effect of one session of resistance training with and without blood flow restriction on serum levels of creatine kinase (CK) and lactate dehydrogenase (LDH) in female athletes. Materials and Methods: In this semi-experimental study, 30 female basketball players were randomly divided into a traditional resistance training group (without blood flow restriction), a resistance training group (with blood flow restriction) and a control group. Blood samples were taken before the first session and 30 minutes after the last training session. T-test and one-way analysis of variance were used for evaluation of within group and between group differences, respectively. All statistical analyses were performed in SPSS (version 23) at significance level of 0.05. Results: Serum level of CK increased significantly in all group, while serum LDH increased significantly only in the experimental groups when compared with pre-test levels (P

The present study was done to evaluate the role of serum muscular enzymes in the determination of the workload in healthy horses, and diagnosis of rhabdomyolysis (ER) cases. Twenty-one draft horses were assessed under the field conditions during rice seedling seasons. Animals were under complete history, physical examination and laboratory evaluation of serum muscular enzymes. Horses were categorized into 2 main groups; the first group, healthy horses under rice seedling work (n=10). They were examined and sampled 4times/day work. The second group includes horses with exertional rhabdomyolysis under rice seedlings workload (n=11) and they were examined and sampled on admission. Blood samples were collected and as a minimum, serum creatine kinase (CK), lactate dehydrogenase (LDH) and aspartate aminotransferase (AST) were evaluated. The obtained results clarified significant alterations in the vital signs in the exertional rhabdomyolysis group in comparison to healthy horses under the same workload in the four examination periods. Additionally, highly significant increase (P ≤0.001) in serum CK, LDH and AST levels in exertional rhabdomyolysis cases in comparison to the healthy horses and to the normal reference limits. While two or more folds increase in the serum muscular enzymes were recorded in healthy horses during workload and 4 h post-work when compared to the pre-work measurements. This, in turn, reflects the great load in healthy horses during rice seedling seasons.

Dysferlinopathy is a rare autosomal recessive myopathy, resulting in the lack or absence of dysferlin production caused by mutations in the encoding gene. Dysferlin is a sarcolemmal membrane protein involved in the repair of membrane damage caused by calcium. There are four identified phenotypic dysferlinopathies, two of which are relatively frequently observed. Miyoshi myopathy and limb-girdle muscular dystrophy type 2B are frequently observed; the two very rare dysferlinopathies are distal anterior compartment myopathy and scapuloperoneal muscular dystrophy (observed in only one case). Serum CK levels are quite high, even in the pre-clinical period. A muscle biopsy typically shows dystrophic patterns, often accompanied with T-lymphocyte-based inflammatory changes. The clinical course of dysferlinopathy is usually much better than that of other recessive trait muscular dystrophies. Dysferlinopathies should be considered in the differential diagnosis of polymyositis to avoid unnecessary and potentially dangerous medications such as oral steroids or immunosuppressive therapies. Here we report the case a 21-year-old Syrian patient diagnosed with dysferlinopathy who has had serious CK elevations from the age of 1 and who had been diagnosed with polymyositis by a muscle biopsy 7 years ago and who therefore used steroids/azathioprine for the following 3 years.

The Cardiovascular Continuum describes a sequence of events from cardiovascular risk factors to end-stage heart disease. It includes conventional pathologies affecting cardiovascular functions such as hypertension, atherosclerosis or thrombosis and was traditionally considered from the metabolic point of view. This Cardiovascular Continuum, originally described by Dzau and Braunwald, was extended by O'Rourke to consider also the crucial role played by degradation of elastic fibers, occurring during aging, in the appearance of vascular stiffness, another deleterious risk factor of the continuum. However, the involvement of the elastin degradation products, named elastin-derived peptides, to the Cardiovascular Continuum progression has not been considered before. Data from our laboratory and others clearly showed that these bioactive peptides are central regulators of this continuum, thereby amplifying appearance and evolution of cardiovascular risk factors such as diabetes or hypertension, of vascular alterations such as atherothrombosis and calcification, but also nonalcoholic fatty liver disease and nonalcoholic steatohepatitis. The Elastin Receptor Complex has been shown to be a crucial actor in these processes. We propose here the participation of these elastin-derived peptides and of the Elastin Receptor Complex in these events, and introduce a revisited Cardiovascular Continuum based on their involvement, for which elastin-based pharmacological strategies could have a strong impact in the future.

PURPOSE/BACKGROUND: Neuroleptic malignant syndrome (NMS) has been described with most antipsychotics, most commonly first generation. Clozapine has also been associated with NMS.METHODS/PROCEDURES: We conducted a systematic review to identify all studies investigating or describing (a) clozapine rechallenge following suspected NMS associated with clozapine, (b) clozapine use after suspected NMS associated with another antipsychotic, and (c) rechallenge with nonclozapine antipsychotics after suspected clozapine-associated NMS.FINDINGS/RESULTS: We identified 51 reports detailing 67 cases. Thirty-eight described clozapine administration after NMS on a nonclozapine antipsychotic; 12 described a clozapine rechallenge after an NMS on clozapine monotherapy; and 17 described the use of nonclozapine antipsychotics after an NMS on clozapine. The outcome of clozapine rechallenge was favorable (no recurrence of NMS) in 92% (n = 11) of cases after an NMS on clozapine and in 79% (n = 30) of those prescribed clozapine following NMS on a nonclozapine antipsychotic. Most (82%; n = 14) cases after NMS on clozapine had no recurrence of NMS on receiving a nonclozapine antipsychotic.No mortality was reported with any of these interventions.IMPLICATIONS/CONCLUSIONS: Our findings suggest that rechallenge following clozapine NMS is possible, and with careful risk-benefit analysis consideration, a clozapine rechallenge can be made. A publication bias in favor of cases in which rechallenge was successful is probable and is an important limitation.

Here we demonstrated that a single resistance exercise session causes muscle damage, delayed onset muscle soreness (DOMS), higher creatine kinase (CK) and lactate dehydrogenase (LDH) activity, and increased IL-6 concentration without changes in muscle strength. Sixteen healthy untrained subjects performed five exercises consisting of three sets of 10 maximum repetitions for each exercise and 1 minute rest period between sets and exercises. Blood samples were taken after 30 minutes, 24, 48 and 72 hours and before exercise. Muscular performance was assessed by maximum isometric strength (MIS) before, 24h, 48h and 72h exercise session. We have concluded that the single resistance exercise session, performed on this study, led to muscle damage and this variable cannot be evaluated through maximal isometric strength. Among those markers, CK was more sensitive to muscle damage. This information might be important for adequate recovery between training sessions.

The aims of this study were 1) to describe the effects of a 54 km and 111 km ultra-endurance mountain race on the biomarkers of muscle damage and inflammation, 2) to compare the effects between the two races regarding the biomarkers of muscle damage and inflammation. Sixteen ultra-endurance amateur runners volunteered to participate in this study. Ten runners completed a 54 km race (Group 1; age: 27.0 ± 5.7; height: 179.5 ± 5.8 cm; and body mass: 77.3 ± 10.7 kg) and six completed a 111 km race (Group 2; age: 30.5 ± 8.0; height: 179.4 ± 5.5 cm; and body mass: 76.2 ± 9.4 kg). Blood samples were taken at five different points during the investigation, 24 h before the race, immediately post-race, and again at 24, 48, and 72 h after the race. There were increases in leukocyte (Group 1: p ≤ .001, ES = 2.8; Group 2: p = .001, ES = 3.5) and platelet concentrations (Group 1: p ≤ .001, ES = 2.3; Group 2: p = .02, ES = 1.7) post-races. Significant inter-race differences were also observed in leukocyte at 72 h (Group 1: 5.5 ± 0.9, Group 2: 4.2 ± 0.9, p = .012, ES = 1.5). Erythrocytes, hematocrit and hemoglobin concentration decreased after 54 km and 111 km races at 24, 48 and 72 h (p ≤.001, ES = 2.0–3.18). Serum uric acid concentration increased after the 54 km race (pre = 4.9 ± 1.2 – post = 7.3 ± 1.0 8 mg/dl; p ≤ .001, ES = 2.4), and also the 111 km race (pre = 5.3 ± 0.9 – post = 6.7 ± 0.8 mg/dl; p

KUCUK, Mehtap PEHLIVANLAR/0000-0003-2247-4074; KUCUK, Ahmet Oguzhan/0000-0002-6993-0519 WOS: 000440981100015 PubMed: 28717983 The aim of our study was to evaluate the effects of AKI development on mortality with four different classification systems (RIFLE, AKIN, CK, KDIGO) in critically ill trauma patients followed in the intensive care unit. A retrospective review of 2034 patients in our intensive care unit was conducted between July 2010 and August 2013. A total of 198 patients with primary trauma were included in the study to evaluate the development of AKI. When the presence of AKI was investigated according to the four criteria (RIFLE, AKIN, CK, and KDIGO), the highest incidence of AKI was found according to the KDIGO classification (74.2%), followed by AKIN (72.2%), RIFLE (69.7%), and CK (59.1%). It was observed that more AKI developed according to KDIGO in patients with multiple trauma and thoracic trauma (p = 0.031, p = 0.029). Sixty-two (31%) of the 198 trauma patients monitored in the intensive care unit died; mortality was frequently found high in AKI stage 2 and 3 patients. According to the CK classification, there was a significant increase in mortality in patients with AKI on the first day (p = 0.045). AKI classifications by RIFLE, AKIN, CK, and KDIGO were independently associated with the risk of in-hospital death. In this study, the presence of AKI was found to be an independent risk factor in the development of in-hospital mortality according to all classification systems (RIFLE, AKIN, CK, and KDIGO) in critically traumatic patients followed in ICU, and the compatibility between RIFLE, AKIN, and KDIGO was the highest among the classification systems.

Adequate plasmatic Vitamin D levels are crucial to maintain calcium homeostasis and bone metabolism both in the general population and in athletes. Correct dietary supply and a regular sun exposure are fundamental for allowing the desired and effective fitness level. Past studies highlighted a scenario of Vitamin D insufficiency among professional soccer players in several countries, especially in North Europe, whilst a real deficiency in athletes is rare. The typical seasonal fluctuations of Vitamin D are wrongly described transversally in athletes belonging to teams that play at different latitudes and a chronobiologic approach studying the Vitamin D circannual rhythm in soccer players has not been described yet. Therefore, we studied plasma vitamin D, cortisol, testosterone, and creatin kinase (CK) concentrations in three different Italian professional teams training at the same latitude during a period of two consecutive competitive seasons (2013 and 2014). In this retrospective observational study, 167 professional soccer players were recruited (mean age at sampling 25.1 ± 4.7 years) and a total of 667 blood drawings were carried out to determine plasma 25(OH)D, serum cortisol, serum testosterone and CK levels. Testosterone to cortisol ratio (TC) was calculated based as a surrogate marker of overtraining and psychophysical stress and each athlete was drawn until a maximum of 5 times per season. Data extracted by a subgroup of players that underwent at least 4 sample drawings along a year (N = 45) were processed with the single and population mean cosinor tests to evaluate the presence of circannual rhythms: the amplitude (A), acrophase (Φ) and the MESOR (M) are described. In total, 55 players (32.9%) had an insufficient level of 25(OH)D during the seasons and other 15 athletes (9.0%) showed, at least once, a deficiency status of Vitamin D. The rhythmometric analyses applied to the data of Vitamin D revealed the presence of a significant circannual rhythm (p < 0.001) with the acrophase that occurred in August; the rhythms of Vitamin D levels were not different neither among the three soccer teams nor between competitive seasons. Cortisol, testosterone and TC showed significant circannual rhythms (p < 0.001): cortisol registered an acrophase during winter (February) while testosterone and TC registered their peaks in the summer months (July). On the contrary, CK did not display any seasonal fluctuations. In addition, we observed weak but significant correlations between 25(OH)D versus testosterone (r = 0.29 and p < 0.001), cortisol (r = -0.27 and p < 0.001) and TC (r = 0.37 and p < 0.001). No correlation was detected between Vitamin D and CK. In conclusion, the correct chronobiologic approach in the study of annual variations of Vitamin D, cortisol and testosterone could be decisive in the development of more specific supplementation and injury prevention strategies by athletic trainers and physicians.

Neuroleptic malignant syndrome (NMS) is a life-threatening adverse reaction to antipsychotic drugs. Although there is no specific examination able to diagnose NMS, serum creatine kinase (CK) elevation has been reported in over 90% of NMS patients. In this report, we describe a patient who developed NMS but had normal CK levels. The patient presented with hyperthermia of over 38°C, severe muscle rigidity, autonomic dysfunction, and altered mental status. Although serum CK levels were measured three times during the course of NMS, the levels were within the normal range. The patient died of respiratory failure 13 days after the onset of NMS symptoms. As patients without elevated serum CK levels are rarely reported, we discuss potential reasons why the serum CK was not elevated in our patient. This case shows clinicians that although serum CK elevation is a useful indicator for the early detection of NMS, the diagnosis of NMS must be determined by clinical symptoms as otherwise, the appropriate treatment procedures for NMS may be delayed.

The extracorporeal membrane oxygenation (ECMO) is a technique of prolonged cardiopulmonary support, which aims to help the lungs or the heart when these organs present failure processes not responsive to conventional treatments. As it is not a physiological procedure, it represents a major challenge for medicine, which seeks to make it a safer procedure. Thus, this research was carried out to determine the course of the cardiac markers CK and CK-MB of five dogs submitted at ECMO for three hours. Mongrel dogs of various ages, weight and sex were used. Under anesthesic maintenance, the animals were subjected to femoral cannulation for ECMO, in an arterial-venous (AV) deviation. Once the circuit was established, the variables were measured every thirty minutes for a period of three hours. The data were statistically analyzed with Anova, Tukey and Pearson Correlation, with α = 5%. The results showed an increase of serum CK and CK-MB, characterizing a muscular injury during the procedure. The results showed that ECMO induced a cardiac muscle injury by a physiological mechanism. It was concluded that ECMO is a viable technical support and do not induce myocardial injury in dogs during a period of three hours. KEYWORDS: CK, CK-MB, dogs, ECMO, physiology.

Accidental envenomation caused by Tityus serrulatus scorpions is very common in Brazil and may result in serious cardiorespiratory alterations that are frequently fatal to children. In the present study, the effects of T. serrulatus venom on the cardiorespiratory system of recently weaned male Wistar rats were evaluated. Fifteen animals were distributed into three groups (n = 5). The control group A received 400 μL ultrapure water by subcutaneous injection, while the experimental groups B and C were injected with scorpion venom (100 and 450 μg, respectively, in 400 μL water). Electrocardiogram (ECG) traces were obtained prior to the experiment, at five-minute intervals up to 30 minutes after treatment. At 40 minutes after envenomation, the animals had severe acute symptoms and were subsequently anesthetized for blood collection by means of intracardiac puncture. Biochemical profiles for the cardiac muscle were established by colorimetric analysis of creatine kinase (CK) and CK-MB isoenzyme. Semiquantitative analysis of troponin was performed using the immunochromatographic assay. Following euthanasia, the lungs and hearts were removed and subjected to histopathological examination. All experimental animals had ECG alterations compatible with electrolytic imbalance, myocarditis and alterations of the cardiac conduction system. Envenomed animals had accentuated bradycardia at 25 and 30 minutes after venom inoculation. All experimental animals had myocardial lesions, which were confirmed by increased serum levels of CK and CK-MB, although there were no alterations in the serum concentration of troponin. Pulmonary hemorrhage was detected in whole lungs and microscopically confirmed by the presence of congested capillaries and erythrocytes in the alveolar parenchyma. In conclusion, T. serrulatus venom caused great cardiorespiratory damage to weaned rats.

Purpose: This study assessed markers of muscle damage and training adaptations to eccentric-overload flywheel resistance exercise (RE) in men and women. Methods: Dynamic strength (1 RM), jump performance, maximal power at different percentages of 1 RM, and muscle mass in three different portions of the thigh were assessed in 16 men and 16 women before and after 6 weeks (15 sessions) of flywheel supine squat RE training. Plasma creatine kinase (CK) and lactate dehydrogenase (LDH) concentrations were measured before, 24, 48 and 72 h after the first and the last training session. Results: After training, increases in 1 RM were somewhat greater (interaction P < 0.001) in men (25 %) than in women (20 %). Squat and drop jump height and power performance at 50, 60, 70 and 80 % of 1 RM increased after training in both sexes (P < 0.05). Power improvement at 80 % of 1 RM was greater (interaction P < 0.02) in men than women. Muscle mass increased ~5 % in both groups (P < 0.05). CK increased in men after the first training session (P < 0.001), whereas the response in women was unaltered. In both sexes, LDH concentration was greater after the first training session compared with basal values (P < 0.05). After the last session, CK and LDH remained at baseline in both groups. Conclusions: These results suggest that although improvements in maximal strength and power at high loads may be slightly greater for men, eccentric-overload RE training induces comparable and favorable gains in strength, power, and muscle mass in both men and women. Equally important, it appears muscle damage does not interfere with the adaptations triggered by this training paradigm. © 2014 Springer-Verlag Berlin Heidelberg. Language of Original Document: English

Dez potros da raça Puro Sangue de Corrida (PSC), de ambos os sexos, foram avaliados quanto à concentração das enzimas séricas creatino quinase (CK), aspartato aminotransferase (AST) e deshidrogenase lática (DHL). Foram colhidas amostras sangüíneas diariamente do 1º ao 7ºdia de vida e depois aos 15, 30, 60, 90, 120, 150 e 180 dias de idade. A concentração da CK mostrou um decréscimo significativo (p< 0,0003) do1º ao 7º dia de idade, e variação também significativa (p< 0,0044) entre o 15º dia de vida até os seis meses. A AST apresentou elevação significativa (p< 0,0001) até os 102 dias de idade, sofrendo posterior declínio até o 6º mês. A DHL apresentou decréscimo significativo (p< 0,0002) nas suas concentrações entre os 15 e 120 dias de idade, com posterior elevação até o 6º mês. Aos seis meses de idade as concentrações séricas de CK, AST e DHL, estão próximas as de eqüinos adultos. Ten Thoroughbred foals, male and female, had the seric concentration of creatine kinase (CK), aspartate aminotransferase (AST) and lactate dehydrogenase (LDH) determined. Blood samples were collected every day from days 1 to 7 and on days 15, 30, 60, 90, 120, 150 and 180 of age. CK activity decreased significantly (p< 0.0003) in the first week and showed significant variation between day 15 and 6 months of age. AST showed a significant (p< 0.0001) increase in its values until 102 days of age, decreasing subsequently until 6 months of age. LDH values decreased significantly (p< 0.0002) between days 15 and 120, increasing subsequently until 6 months of age. At 6 months of age CK, AST and LDH activities were close to those of adult horses.

Muscle diseases can constitute a large variety of both acquired and hereditary disorders. Myopathies in systemic disease results from several different disease processes including endocrine, inflammatory, paraneoplastic, infectious, drug- and toxin-induced, critical illness myopathy, metabolic, and myopathies with other systemic disorders. Patients with systemic myopathies often present acutely or sub acutely. On the other hand, familial myopathies or dystrophies generally present in a chronic fashion with exceptions of metabolic myopathies where symptoms on occasion can be precipitated acutely. Most of the inflammatory myopathies can have a chance association with malignant lesions; the incidence appears to be specifically increased only in patients with dermatomyositis. In dealing with myopathies associated with systemic illnesses, the focus will be on the acquired causes. Management is beyond the scope of this chapter. Prognosis is based upon the underlying cause and, most of the time, carries a good prognosis. In order to approach a patient with suspected myopathy from systemic disease, a stepwise approach is utilized.

O presente estudo teve por objetivo avaliar a influência do exercício físico de alta intensidade e curta duração (provas de laço em dupla) sobre a lactacidemia e as concentrações séricas de aspartato aminotransferase (AST) e creatinoquinase (CK) em equinos durante competição realizada no estado do Espírito Santo. Para tal foram obtidas amostras de soro e plasma de 20 equinos, da raça Quarto de Milha ou mestiços, em três momentos assim definidos: no repouso, uma semana antes da prova atlética, já com o animal em treinamento (T0); antes da prova atlética (T1) e imediatamente após o término da mesma (T2). As referidas amostras foram encaminhadas ao Laboratório Clínico do Centro Universitário Vila Velha (UVV) para as análises. Na avaliação da lactacidemia, os resultados registrados nos momentos T0, T1 e T2 foram, respectivamente, de 0,49±0,24mmol/L, 0,93±0,16mmol/L e 9,86±2,09mmol/L. Na avaliação da atividade sérica de AST, os resultados registrados nos momentos T0, T1e T2 foram, respectivamente, de 189,1±43,6 UI/L, 210,2±46,7 UI/L e 173,1±33,5 UI/L. Por fim, a avaliação da atividade sérica da CK nos momentos T0,T1 e T2 foram,respectivamente, de 110,9±35,2 UI/L, 51,8±15,4 UI/L e 88,2±33,5 UI/L. A análise dos resultados demonstrou que o exercício físico imposto levou ao aumento significativo de lactato plasmático e CK sérica e não alterou o AST sérico e que a interpretação destes resultados permitiu concluir que os equinos usados estavam aptos ao nível de exercício físico imposto. The aim of the present study was to evaluate the effects of high intensity and short duration physical exercise (roping team competition) on plasma lactate and serum AST and CK concentrations in horses during competition at Espírito Santo state, Brazil. Blood samples were obtained from 20 Quarter Horses, or cross-bred, in three moments: (1) at rest, one week before the competition, with the animals being trained, (2) just before the competition, and (3) immediately after the exercise. The samples were sent to Laboratório Clínico do Centro Universitário Vila Velha for analysis. Plasma lactate concentrations were 0.49±0.24mmol/L, 0.93±0.16mmol/L e 9.86±2.09mmol/L, respectively, on the moments rest and immediately before and after the exercise. Serum concentrations of AST were 189.1±43.6 IU/L, 210.2±46.7 IU/L e 173.1±33.5 IU/L, respectively, on the moments rest and immediately before and after the exercise. Finally, serum concentrations of CK were 110.9±35.2 IU/L, 51.8±15.4 IU/L and 88.2±33.5 IU/L, respectively, on the moments rest and immediately before and after the exercise. Results showed that the imposed physical exercise leaded to a significant elevation of plasma lactate and serum CK without alteration on AST. It was possible to conclude that horses were adapted to the level of exercise performed.

ObjectiveIn clinical situations in which rhabdomyolysis is common, renal dysfunction association with myoglobinemia is well described. After coronary artery bypass grafting, a rapid increase in serum myoglobin concentration is generally seen, but whether it might independently increase the risk of acute kidney injury remains to be determined.MethodsThe study population consisted of 731 consecutive patients undergoing coronary artery bypass grafting. Creatine kinase, myoglobin, and creatinine concentrations were assessed in each patient preoperatively and postoperatively. Acute kidney injury was defined as an absolute increase in serum creatinine concentration of 0.3 mg/dL or greater.ResultsOverall, 295 (40.3%) of 731 patients had acute kidney injury. Patients' risk profiles were significantly worse in those with acute kidney injury, and 31 (4.2%) of 731 patients required dialysis. Acute kidney injury was associated with a higher increase in serum myoglobin concentration after 1 hour from aortic declamping (534 μg/mL [interquantile range, 354–733 μg/mL] vs 377 μg/mL [interquantile range, 278–528 μg/mL], P

A força e a flexibilidade são componentes presentes em um programa de treinamento, e seus valores máximos são obtidos através de testes específicos. No entanto pouco se sabe sobre seus efeitos deletérios no aparelho músculo tendíneo. O objetivo foi verificar as modificações séricas de CK 24h após uma rotina de alongamentos, flexionamento estático e teste de 1-RM. Participaram do estudo 14 indivíduos de ambos os sexos (28±6 anos), divididos em grupo controle (GC N=7) e grupo experimental (GE N7), sendo o último submetido a uma rotina de alongamentos (GE-AL),de flexionamento estático (GE-FLEX) e ao teste de 1-RM (GE-1-RM). A antropometria foi aferida através de uma balança digital com estadiômetro. As coletas de sangue foram obtidas utilizando-se seringas descartáveis e depositadas em recipientes de vidro vedados e enviadas ao laboratório para deteminar os níveis de CK. Utilizou-se a técnica de De Lorme e Watkins nos exercícios Supino Horizontal e Leg Press para determinar a carga de 1-RM. Realizou-se 3 séries de 20s de insistência flexionamento e 3 séries de 6 segundos de insistência para o alongamento. E estatística empregada foi a Prova de Friedman com post hoc de Tukey. Os valores de CK basal e pós 24h no GC e GE (AL;FLEX e 1-RM) foram respectivamente:195,0 ± 129,5 vs. 202,1 ± 124,2;213,3 ± 133,2 vs. 174,7 ± 115,8;213,3 ± 133,2 vs. 226,6 ± 126,7 e 213,3 ± 133,2 vs. 275,9 ± 157,2. Só foi observada diferença significativa(p = 0,02) nos valores do GE-1RM. Conclui-se que apenas os exercícios dinâmicos de força máxima foram capazes de aumentar os níveis de CK pós exercício., Strength and flexibility are common components of a training program and their maximal values are obtained through specific tests. However, little information about the damage effect of these training procedures in a skeletal muscle is known. The aim was to verify a serum CK changes 24h after a sub maximal stretching routine and after the static flexibility and maximal strength tests. The sample was composed by 14 subjects (man and women, 28±6 yr.) physical education students. The volunteers were divided in a control group (CG) and experimental group (EG) that was submitted in a stretching routine (EG-ST), in a maximal flexibility static test (EG-FLEX) and in 1-RM test (EG--1-RM), with one week interval among tests. The anthropometrics characteristics were obtained by digital scale with stadiometer (Filizola, São Paulo, Brasil, 2002). The blood samples were obtained using the IFCC method with reference values 26-155 U/L. The DeLorme and Watkins technique was used to access maximal maximal strength through bench press and leg press. The maximal flexibility test consisted in three 20 seconds sets until the point of maximal discomfort. The stretching was done in normal movement amplitude during 6 seconds. The basal and post 24h CK values in CG and EG (ST; Flex and 1RM) were respectively 195,0 ± 129,5vs. 202,1 ± 124,2; 213,3 ± 133,2 vs.174,7 ± 115,8; 213,3 ± 133,2 vs.226,6 ± 126,7 e 213,3 ± 133,2 vs.275,9 ± 157,2. It was only observed a significant difference (p = 0,02) in the pre and post values inGE-1RM. In conclusion, only maximal strength dynamic exercise was capable to cause skeletal muscle damage.

O objetivo do presente estudo foi avaliar o comportamento de variáveis fisiológicas durante uma sessão de treino de nado sincronizado realizada na fase de preparação para as Olimpíadas de Atenas 2004. MATERIAIS E MÉTODOS: A amostra utilizada foi constituída pelo dueto (24 ± 0 anos) representante do Brasil em Atenas 2004. A coleta de dados foi realizada durante uma sessão de treinamento com duração de 198 minutos. O treino se iniciou com a parte física, seguida da parte técnica. Para a determinação da glicemia e da concentração de beta-hidroxibutirato foi utilizado o monitor Optium® com suas respectivas tiras. As concentrações de cortisol e das enzimas lactato desidrogenase (LDH) e creatina quinase (CK) foram determinadas por radioimunoensaio (DPC©) e kits comerciais (CELM®), respectivamente. O acompanhamento da freqüência cardíaca (FC) foi realizado com o freqüêncimetro Advantage Polar®. RESULTADOS: Foi observada redução (~2%) do peso corporal. A glicemia também apresentou queda (~30%) em comparação ao valor obtido no início do treino. Em contrapartida, foi observada elevação na concentração de cortisol (salivar 22% e plasmática 29%) e de beta-hidroxibutirato (~340%). Não foi observada alteração significativa na concentração plasmática de CK e de LDH. O acompanhamento da FC demonstrou que dos 198 minutos que constituíram a sessão de treino, 36,5 ± 0,7 minutos foram realizados em intensidade leve; 103,5 ± 0,7 minutos em intensidade moderada, 54,0 ± 2,1 minutos em intensidade alta e 4,0 ± 0,0 minutos em intensidade muito alta. CONCLUSÕES: A perda de peso indica que a reposição hídrica não foi adequada. A redução na glicemia e o aumento na concentração de corpos cetônicos e de cortisol reforçam a importância da suplementação de carboidrato durante o treino de longa duração. O comportamento da FC demonstra que a sessão de treinamento foi realizada em uma intensidade moderada, porém com breves momentos de intensidade alta, nos quais foram realizadas as rotinas. The purpose of this study was to evaluate the behavior of physiological variables during a synchronized swimming training session performed in athletes preparing for the Athens 2004 Olympic Games. MATERIALS AND METHODS: The sampling used was constituted by the duet (24 ± 0 years) who was representing Brazil in the Athens 2004 Olympic Games. Data collection was performed during a 198 minute training session. The training started with the physical portion, followed by the technical portion. In order to determine the glycemia and the beta-hydroxybutyrate, it was used an Optium® monitor with its respective stripes. The cortisol and the dehydrogenase lactate enzymes (LDH), concentrations, as well as the kinase creatine (KC) concentration were determined through the radioimmunoassay (RIA©) and through commercially available kits (CELM©), respectively. The follow-up of the heart rate (HR) was performed using an Advantage Polar® heart rate monitor. RESULTS: It was noted a reduction (~2%) in the body weight. The glycemia also presented a fall (~30%) compared to the value attained in the beginning of the training session. Otherwise, it was observed an elevation in the cortisol concentration (salivary, 22%, and plasmatic, 29%) and in the beta-hydroxybutyrate (~340%). No significant changes in the plasmatic concentration of the KC and LDH were observed. The follow-up of the HR showed that from all 198 minutes of the training session, 36.5 ± 0.7 minutes were performed at a light intensity; 103.5 ± 0.7 minutes at a moderate intensity, 54.0 ± 2.1 minutes at a high intensity, and 4.0 ± 0.0 minutes at a very high intensity. CONCLUSIONS: The weight loss indicates that the hydric reposition was not adequate. The reduction in the glycemia and the increase in the ketonic bodies and cortisol concentrations reinforce the importance of a carbohydrate supplement during the long endurance training. The HR behavior shows that the training session was performed at a moderate intensity, but having fast moments of high intensity, in which routines were performed. El objetivo del presente estudio fue el de evaluar la conducta de algunas variables fisiológicas durante una sesión de entrenamiento de nado sincronizado cumplido en la fase de la preparación para los Juegos Olímpicos de Atenas 2004. MATERIALES Y MÉTODOS: La muestra usada se constituyó por el dueto (24 ± 0 años) representante de Brasil en Atenas 2004. La colección de datos fue cumplida durante una sesión de entrenamiento con una duración de 198 minutos. Los entrenamientos empezaron con la parte física, mientras era seguida por la parte técnica. Para la determinación de la glicemia y de la concentración de beta-hidroxibutirato el experimentador usó Optium® con las cintas respectivas. Las concentraciones del cortisol y de las enzimas lactico deshidrogenasa (LDH) y creatinquinase (CK) fueron medidas por el radio-imuno-ensayo (DPC©) con equipos comerciales (CELM®), respectivamente. La asistencia de la frecuencia del corazón (FC) fue cumplida con elfrecuencímetro Polar®. RESULTADOS: La reducción fue observada (~2%) en el peso corporal. La glicemia también presentó una caída (~30%) comparada con el valor obtenido al principio del entrenamiento. En contra de la salida, se observó una elevación en la concentración del cortisol (en saliva 22% y plasmático 29%) y del beta-hidroxibutirato (~340%). No se observó una alteración significante en la concentración plasmática de CK y de LDH. El control de la de FC demostró a los 198 minutos de la sesión de entrenamiento, que 36,5 ± 0,7 minutos eran cumplidos en una intensidad ligera; 103,5 ± 0,7 minutos en una intensidad moderada, 54,0 ± 2,1 minutos en la intensidad alta y 4,0 ± 0,0 minutos en una intensidad muy alta. CONCLUSIONES: La pérdida de peso indica que el remplazo hidrico no se adaptó. La reducción en el glicemia y el aumento en la concentración de los cuerpos cetónicos y de cortisol ellos refuerzan la importancia del suplementación de hidratos de carbono durante el entrenamiento de larga duración. La conducta de FC demuestra que la sesión de entrenamiento fué cumplida en una intensidad moderada, sin embargo en los momentos breves de intensidad alta, mientras, las rutinas eran cumplidas.

Minoru Tomita* Miyuki Watabe* Mitsutoshi Ito Tadahiko TsuruShinagawa LASIK Center, Chiyoda-ku, Tokyo, Japan*Minoru Tomita and Miyuki Watabe contributed equally to this studyPurpose: To evaluate the efficacy and safety of conductive keratoplasty (CK) for the treatment of presbyopia and analyze the differences in the effects between post- and non-laser in situ keratomileusis (LASIK) eyes. Clinical preoperative factors that could affect the predictability of CK were also analyzed.Methods: The visual and refractive outcomes of CK for the treatment of presbyopia in 14 eyes of 13 post-LASIK patients (post-LASIK group mean age 50.9 ± 3.4 years) and those of 25 eyes of 25 non-LASIK patients (non-LASIK group mean age 52.4 ± 4.0 years) were studied. The clinical efficacy, safety, stability, and predictability of CK were statistically evaluated.Results: The mean (logarithm of the minimum angle of resolution [logMAR] ± standard deviation [SD]) of preoperative uncorrected near visual acuity (UNVA) and manifest refraction spherical equivalent (MRSE) were 0.64 ± 0.25 diopter (D) and 0.35 ± 0.48 D, respectively, in the post-LASIK group, and 0.71 ± 0.20 D and 0.64 ± 0.61 D, respectively, in the non-LASIK group. At 6 months after CK, the mean UNVA and MRSE were 0.07 ± 0.13 D and -1.59 ± 0.86 D, respectively, in the post-LASIK group, and 0.07 ± 0.12 D and -1.06 ± 0.56 D, respectively, in the non-LASIK group. At 1 year after CK, the mean UNVA and MRSE were 0.30 ± 0.17 D and -0.58 ± 0.52 D, respectively, in the post-LASIK group, and 0.28 ± 0.34 D and -1.56 ± 0.62 D, respectively, in the non-LASIK group. There was no significant difference between the two groups in either factor at 6 months postoperative (Student’s t-test, P > 0.05). At 1 year after CK, all the treated eyes maintained corrected distance visual acuity better than -0.08 (logMAR). The mean cylindrical errors were within ±1.00 D in 100% of the post-LASIK and non-LASIK patients. As for the preoperative clinical factors evaluated for their potential relationship to the predictability of CK, none showed significant effect on the clinical outcomes.Conclusion: CK is demonstrated to be safe for the treatment of presbyopia in post-LASIK patients as well as in non-LASIK patients, though needed longer observation in terms of factors affecting predictability.Keywords: conductive keratoplasty, post-LASIK, presbyopia, CK

O presente estudo teve por objetivo avaliar a influência do exercício físico de intensidade submáxima sobre as concentrações séricas de aspartato aminotransferase (AST), creatinoquinase (CK) e lactato-desidrogenase (LDH) em muares durante prova de enduro de 100 km realizada no estado do Espírito Santo. Para tal foram obtidas amostras de soro de 20 muares em três momentos assim definidos: no repouso (T0); após 54 km de percurso (T1); após 80 km de percurso (T2); e após 100 km de percurso (T3). As referidas amostras foram encaminhadas ao Laboratório Clínico Veterinário (CEMEVES) para processamento. Na avaliação da atividade sérica de AST, os valores médios registrados nos momentos T0, T1, T2 e T3 foram, respectivamente, de 341,7±73,9 UI/L, 403,1±78,4 UI/L, 410,5±70,5 UI/L e 426,5±66,7 UI/L. Na avaliação da atividade sérica da LDH, os valores médios registrados foram de 423,1±101,8 UI/L, 534,4±131,8 UI/L, 628,5±100,6 UI/L e 823,4±273,2 UI/L, respectivamente, nos momentos T0, T1, T2 e T3. Por fim, na avaliação da atividade sérica da CK os valores de mediana foram de 231,3 UI/L, 310,6 UI/L, 253,2 UI/L e 476,0 UI/L, respectivamente nos momentos T0, T1, T2 e T3. A análise dos resultados demonstrou que o exercício físico imposto levou ao aumento significativo das atividades séricas de AST e LDH e não alterou as concentrações séricas de CK.

Two previously healthy women developed an inflammatory myopathy before the term of their first pregnancy. Skeletal muscle biopsy led to a diagnosis of T cell-mediated polymyositis. Both babies were healthy, but their serum creatine kinase levels remained elevated for a few months after birth. Their mothers did well after corticosteroid treatment.

Background Vitamin D contributes to the optimal functioning of muscles. This study was designed to determine the modulating effect of vitamin D supplementation on the degree of muscle cell damage caused by eccentric exercise in young men. Methods 60 male volunteers (20–24 years old) taking part in this study were divided in two groups - with suboptimal (S) and optimal (O;) 25(OH)D plasma levels. These groups were randomly subdivided into groups with vitamin D supplementation (experimental: SE and OE) and controls (SC and OC). Before the supplementation (Test I) and after 3 months (Test II), participants were subjected to two rounds of eccentric exercise tests on a declined treadmill (running speed corresponded 60% VO2peak determined in each subject in incremental exercise test). During each test, blood samples used for determination of 25(OH)D, Il-1β, myoglobin (Mb) levels and CK, LDH activity were taken at three timepoints: before the test, 1 h and 24 h after it ended. After distribution normality testing (Saphiro-Wilk test), statistical analyses were performed. Non-parametric: Kruskal-Wallis test and the Wilcoxon test were applied, and the Dunn-Bonferroni test as a post-hoc test. Results In all groups, after 3 months, higher concentrations of 25(OH)D were indicated (SE p = 0.005; SC p = 0.018; OE p = 0.018; OC p = 0.028). SE and SC groups showed higher baseline concentrations of Il-1β and significantly higher concentrations of this interleukin after 1 h compared to groups with an optimal 25(OH)D level. After supplementation, the SE group reacted with a similar jump in concentration of Il-1β as the OC and OE groups. The change after 1 h after exercise in Test II was significantly different from that from Test I (p = 0.047) in SE group. Lower Mb concentrations indicated 1 h after exercise in Test II for SC and SE groups were indicated. CK activity did not differentiate the studied groups. Plasma calcium and phosphate disorders were also not indicated. Conclusions The study has shown that vitamin D doses determined from the plasma concentration of 25(OH)D of individuals to match their specific needs can significantly reduce muscle cell damage induced by eccentric exercise.