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The etiology of rhabdomyolysis in adults is multifaceted, with one cause being physical exertion, termed exertional rhabdomyolysis (ERM). Characterized primarily by the destruction of muscle cells, ERM results in the release of intracellular contents into the bloodstream, leading to a spectrum of symptoms, including myalgia, dark urine, weakness, and marked elevations in serum creatine kinase (CK) and myoglobin levels. Some patients experience recurrent symptoms, persistently high serum CK levels (exceeding 50 times the normal upper limit), or unexplained severe manifestations. Despite this, the underlying pathogenesis remains elusive in numerous cases. Recent studies have implicated mutations in the RYR1 gene as a potential cause of exercise-induced ERM. This report describes a patient presenting with ERM and a heterozygous RYR1 gene missense mutation. Following treatment with fluid resuscitation, metabolic optimization, and antioxidant therapy, the patient exhibited clinical and biochemical improvement.

Abstract Background Skin conditions are common in patients on maintenance hemodialysis and those with pancreatitis. However, there is a lack of research on dermatological issues in patients who have both hemodialysis and pancreatitis concurrently. Case presentation A 62-year-old male patient with a 4-year history of maintenance hemodialysis (MHD) presented with pain and was diagnosed with acute pancreatitis and gallbladder stones. Markedly elevated blood amylase, creatine kinase, and myoglobin were noted, alongside a purplish-red skin discoloration. Treatment included inhibition of digestive fluid secretion, anti-infection measures, blood purification, fasting, rehydration, and symptomatic care. Notably, continuous renal replacement therapy (CRRT) combined with hemoperfusion (HP) was employed. The patient’s dialysis effluent initially appeared red. Upon examination of the patient’s peripheral blood smear, red blood cell debris was not observed. The dialysis effluent (on Day 0) was analyzed, revealing no hemoglobin (0 g/L) but an elevated myoglobin concentration of 80.4 U/L. After the therapeutic intervention, the indicators, including the blood amylase, C-reactive protein, total bilirubin, creatine kinase, and myoglobin were improved. The patient experienced resolution of sternal and upper abdominal pain within two days. After four consecutive days of CRRT and HP treatment, the skin color returned to normal, alongside improved clarity of the dialysis effluent. Subsequently, the patient’s method of blood purification was reverted to conventional hemodialysis. On the eighth day of hospitalization, the patient resumed normal diet and was discharged. Conclusions In the case of the current patient with acute pancreatitis undergoing MHD, it is noteworthy to report the observation of a unique purplish-red skin discoloration. This phenomenon may be attributable to inflammation resulting from acute pancreatitis, and the retention of myoglobin within the body.

OBJECTIVE: Cold water immersion methods are not standardized in terms of operational indicators such as immersion temperature, duration and depth, leading to controversy over the efficacy of recovery from exercise fatigue in skeletal muscle. In this article, we analyze the effects of cold water immersion on muscle injury, muscle soreness and muscle strength recovery under different factors, in order to find the best immersion implementation plan, and thus provide evidence for the recovery of muscle fatigue. METHODS: A search of CNKI, WanFang Data, Web of Science, and PubMed databases was conducted for relevant literature published from January 1, 2000 to August 15, 2023. A total of 4 759 articles were initially retrieved, with 4 735 articles excluded through screening and 24 articles finally included. The Physical Therapy Evidence Database Scale was used to assess the methodological quality of the included literature, and Stata-MP 16 software was used to perform effect size combinations, subgroup analyses, Meta-regression, sensitivity tests, and publication bias analyses. RESULTS: (1) The article included a total of 24 randomized controlled trial studies, including 617 subjects, with overall high legal quality. (2) Meta-analysis showed that cold water immersion can significantly reduce creatine kinase blood value [standardized mean difference (SMD)=-0.17, 95% confidence interval (CI): -0.29 to -0.05, P < 0.01], alleviate muscle pain (SMD=-0.60, 95% CI: -0.81 to -0.38, P < 0.01), and promote maximum muscle strength recovery (SMD=0.17, 95% CI: 0.05 to 0.30, P < 0.01). (3) Subgroup analysis showed that: The immersing regimen with water temperature > 14 °C (SMD=-0.48, 95% CI: -0.76 to -0.20, P < 0.01) and duration of 12-14 minutes (SMD=-0.38, 95% CI: -0.61 to -0.15, P < 0.01) had the best effect in reducing creatine kinase blood values, and had a more significant intervention effect on endurance exercise (SMD=-0.45, 95% CI: -0.71 to -0.20, P < 0.01), while the immersion regimen with water temperature < 10 °C (SMD=-0.61, 95% CI: -0.79 to -0.43, P < 0.01), duration < 12 minutes (SMD=-0.76, 95% CI: -0.98 to -0.53, P < 0.01), and immersion depth above the iliac spine (SMD=-0.74, 95% CI: -0.97 to -0.52, P < 0.01) had the best effect on relieving muscle soreness, and had a more significant analgesic effect after endurance exercise (SMD=-0.42, 95% CI: -0.61 to -0.22, P < 0.01). (4) Meta regression showed that immersion water temperature, immersion duration, and exercise type were important regulatory factors affecting the effect size of creatine kinase; immersing water temperature and immersing depth were important regulatory factors affecting the effect size of visual analogue scale score, while exercise type was an important regulatory factor affecting the maximum isometric muscle strength effect size. CONCLUSION: (1) Evidence of extremely low to moderate strength suggests that cold water immersion can effectively reduce muscle damage, alleviate muscle soreness, and promote muscle strength recovery. (2) In terms of reducing muscle injury, immersion water temperature, immersion duration, and exercise type are significant regulatory factors that affect the efficacy of immersing. Among them, immersion water temperature > 14 °C and duration of 12-14 minutes are the best solutions to reduce muscle injury after exercise, and the immersing effect is better for endurance exercise. (3) In terms of reducing muscle soreness, immersion water temperature and immersion depth are important regulatory factors that affect the intervention effect. Among them, immersion water temperature < 10 °C, duration < 12 minutes, and immersing depth above the iliac spine are the best solutions to reduce muscle soreness, and have a better analgesic effect after endurance exercise. (4) In terms of promoting muscle strength recovery, exercise type is a key regulatory factor that affects the maximum isometric muscle strength effect. [ABSTRACT FROM AUTHOR]

Copyright of Retos: Nuevas Perspectivas de Educación Física, Deporte y Recreación is the property of Federacion Espanola de Asociaciones de Docentes de Educacion Fisica and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

BACKGROUND: The first evidence of blood biochemical and proteomic changes in slow‐growing broiler chicken subjected to ritual slaughter like halal (HS) and jhatka (JS) without stunning and commercial slaughter with electrical stunning (ES) was decoded. RESULTS: Significant stress indicators like cortisol and triiodothyronine were markedly elevated in JS birds, whereas increased (P < 0.05) levels of lactate dehydrogenase and creatine kinase were observed in JS and ES birds. Two‐dimensional gel electrophoresis coupled to MALDI‐TOF MS elucidated the overabundance of glyceraldehyde‐3‐phosphate dehydrogenase and l‐lactate dehydrogenase that are positively correlated with stress in JS broilers. Bioinformatic analysis explored the multifaceted landscape of molecular functions. CONCLUSION: The study has uncovered that ritual slaughter performed without stunning against commercial slaughter with ES practices elicit varying levels of stress as evident from blood biochemistry and novel protein markers. © 2024 Society of Chemical Industry. [ABSTRACT FROM AUTHOR]

The Caspian pond turtle, Mauremys caspica, is an important reptile species in the southern basin of Caspian Sea. Haematological indices and serum biochemistry can be utilised as valuable screening tools for the health status of many domestic and wild animals. In this study, the blood parameters were measured in male and female turtles to establish physiologic reference ranges of selected haematological and serum biochemical parameters in M. caspica. For this purpose, blood samples were collected from 60 Caspian pond turtles (30 males and 30 females) from the southern basin of Caspian Sea. Significant differences were observed in some haematological indices (i.e. haemoglobin and haematocrit) and serum biochemical indices (i.e. alkaline phosphatase, aspartate aminotransferase, and creatine kinase) between the male and female turtles (P<0.05). However, further research is necessary to elucidate the influence of size, sex, season, and habitat variations on haemato-biochemical parameters in the Caspian pond turtle. [ABSTRACT FROM AUTHOR]

Copyright of Retos: Nuevas Perspectivas de Educación Física, Deporte y Recreación is the property of Federacion Espanola de Asociaciones de Docentes de Educacion Fisica and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Azadirachta indica A. Juss (Meliaceae) (AI) and Curcuma longa L. (Zingiberaceae) (CL) are used for malaria treatment but their anti-glycolytic and host mitochondrial effects have not been studied. The AI stem-bark and CL rhizomes were extracted with methanol. Methanol extract of CL (Turmeric) was partitioned to yield methanol fraction (MF). Swiss mice infected with Plasmodium berghei (NK 65 strain) were treated with 200 and 400 mg/kg of AI and turmeric for seven days. Turmeric and MF (200 and 400 mg/kg) were combined with 400 mg/kg AI to treat mice infected with Plasmodium berghei (ANKA strain) for four days. Drug and infected controls mice were treated with artemether lumefantrine (10 mg/kg) and distilled water (10 mL/kg), respectively. Serum lactate dehydrogenase (LDH) and aldolase activities were determined. Liver mitochondria were obtained for mitochondrial permeability transition (mPT) pore opening and FoF1 ATPase assays. The curcumin content of turmeric was determined using HPLC while LD50 of Turmeric and AI was also determined. The AI, and its combination with turmeric decreased parasite load and increased chemosuppression in both sensitive and resistant studies while MF and its combinations with AI induced mPT pore opening. In the resistant experiment, AI + Turmeric 400 mg/kg decreased FoF1 ATPase, LDH and aldolase activities against the infected control. The LD50 values of both extracts were above 2000 mg/kg while the MF had the highest curcumin content. Antiplasmodial mechanisms of action of AI, CL and their combinations involve anti-glycolytic effects. Their composite formulations are more potent in malaria treatment. [ABSTRACT FROM AUTHOR]

Abstract Among athletes, foam rolling is popular technique of myofascial release aimed to support recovery processes and counteract delayed onset muscle soreness. However, there is no consensus on the optimal parameters of the roller texture used in the procedure. The study aimed to determine whether using rollers with different textures and hardness (smooth/soft, grooved/mid, serrated/hard) in myofascial release affects post-exertional restitution rate and the level of perceived DOMS (Delayed Onset Muscle Soreness) after intense anaerobic exercise. The study involved 60 healthy and physically active men randomly divided into three experimental groups and one control group (passive rest)—each consisting of 15 individuals: STH—rolling with a smooth roller; G—rolling with a grooved roller; TP—rolling with a serrated roller; Pass—passive rest group. After performing a exercise test (one-minute high-intensity squat), blood lactate (LA), creatine kinase (CK) and pain perception (VAS Scale) were monitored. The analysis of the average LA concentration in the blood 30 min post-exercise showed a statistical difference for all rolling groups compared to the passive rest group: STH (p

Background and Aim: Vitamin D has been shown to reduce exercise-induced muscle damage and muscle soreness; however, further research is needed to establish definitive conclusions. The aim of this study was to investigate the effect of vitamin D supplementation on muscle soreness and recovery after exercise. Methods: A systematic review and meta-analysis was conducted to evaluate the effects of vitamin D intake on muscle soreness and biochemical markers of muscle damage, including myoglobin (MB), creatine kinase (CK), lactate dehydrogenase (LDH), and inflammatory factors such as TNFα and IL-6. Data were sourced from PubMed, Scopus, and Web of Science databases up to February 2024. Analyses were performed to compare vitamin D with placebo, and weighted mean differences (WMD) were calculated. Results: A total of 11 studies involving 358 athletes and non-athletes were examined. Changes in muscle soreness immediately after exercise due to vitamin D intake were not statistically significant [P=0.70, WMD=-0.07]. However, vitamin D significantly reduced muscle soreness 24 hours after exercise [P=0.04, WMD=-0.40]. No significant changes were observed in CK [P=0.30, WMD=-3.22 U/L], LDH [P=0.30, WMD=-11.86 U/L], or MB [P=0.50, WMD=10.66 ng/ml] immediately after exercise. Conclusion: Vitamin D may be effective in reducing muscle soreness 24 hours post-exercise, but it does not appear to significantly affect markers of muscle damage, including CK, MB, and LDH, in the timeframes studied. Further research in this area is recommended.

The aim of this study was to investigate the short-term effects of statins on rat skeletal muscle with the use of electrophysiological methods. A total of 28 adult male Wistar albino rats were given atorvastatin, rosuvastatin, and pravastatin (40 mg/kg each) intragastrically for four weeks. At the end of the study, the gastrocnemius muscle was isolated from the surrounding tissues under deep anaesthesia. It was tied with silk thread in the Achilles tendon area and then connected to an isometric force transducer. The contractile properties of the gastrocnemius muscle were assessed. Serum levels of total cholesterol and creatine kinase (CK) were measured. The muscle tissue samples were stained with hematoxylin eosin and histopathologically evaluated under light microscope. The findings revealed that cholesterol levels were significantly lower in all groups except the control group, whereas CK levels were higher in the statin groups than the control group. All three statins decreased the contractile strength and caused fatigue quickly in the gastrocnemius muscle. Histopathological changes in gastrocnemius muscle were more related to early moderate necrosis in rats that were received statins. This study demonstrates that all three statins decrease the ability of skeletal muscle to generate force and its resistance to fatigue in rats.

Objective To investigate the characteristics of exertional rhabdomyolysis (ERB) and the predictive value of creatine kinase (CK), myoglobin/creatine kinase (Mb/CK) ratio and other indicators for ERB patients with acute renal injury (AKI). Methods The clinical data of 154 patients with ERB admitted to the Affiliated Hospital of Qingdao University from January 2013 to September 2022 were retrospectively analyzed. The patients were divided into AKI group (n=35) and non-AKI group (n=119) according to whether AKI was combined. Creatinine, CK and other laboratory indicators were collected. Univariate and multivariate logistic regression models were used to analyze the risk factors for AKI in ERB patients. Receiver operating characteristic (ROC) curve was used to evaluate the predictive value of related indicators, and the correlation between each indicator and serum creatinine was analyzed by Spearman correlation analysis. Results The main clinical manifestations of 154 ERB patients were muscle pain (140 cases), limb weakness (69 cases), and dark brown urine (36 cases). The levels of CK, creatine kinase isoenzyme (CK-MB), aspartate aminotransferase (AST) and alanine aminotransferase (ALT) in non-AKI group were significantly higher than those in AKI group (P＜0.05). The levels of creatinine, lactate dehydrogenase (LDH), cystatin C, Mb/CK and creatinine/cystatin C in AKI group were higher than those in non-AKI group, and the differences were statistically significant (P

Abstract Creatine kinase (CK) has been associated with neuropathy, but the mechanisms are uncertain. We hypothesized that peripheral nerve function is impaired in subjects with persistent CK elevation (hyperCKemia) compared to age- and sex matched controls in a general population. The participants were recruited from the population based Tromsø study in Norway. Neuropathy impairment score (NIS), nerve conduction studies (NCS) and electromyography (EMG) in subjects with persistent hyperCKemia (n = 113; 51 men, 62 women) and controls (n = 128; 61 men, 67 women) were performed. The hyperCKemia group had higher NIS score than the controls (p = 0.050). NCS of the tibial nerve showed decreased compound motor action potential amplitude (p

Introduction: We present a systematic review of phenotypes of McLeod syndrome (MLS) and a case of a 73-year-old female carrier of the genetic alteration leading to MLS with the typical progressive supranuclear palsy (PSP) phenotype. Methods: To facilitate clinical reasoning and enable targeted diagnosis, we conducted a systematic review of the papers describing symptomatic cases of confirmed McLeod syndrome. This review follows the PRISMA 2020 statement: an updated guideline for reporting systematic reviews (Page et al in Syst Rev 10(1):89, 2021). Results: The average onset of MLS was at 40.2 years of age with chorea (46%), seizures and psychiatric changes (each 13%). Very common are weakened Kell antigen (100%), changes in muscle biopsy (100%), genetic alterations in XK (100%), elevated creatine kinase (97%), acanthocytes (96%), MRI changes (95%), chorea (84%) and hyporeflexia (82%). Conclusion: This review of 65 males and 11 females gives a concise overview of clinical phenotypes in MLS, reinforcing our view that this female patient had PSP independent of MLS carrier status. This report highlights the pitfalls of anchoring in medical decision-making, particularly the possible diagnostic bias of a known genetic carrier status of a very rare disease. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to describe the successful identification and treatment of severe hyperkalemia, cardiac arrhythmia, rhabdomyolysis, and acute kidney injury (AKI) in a domestic cat that underwent general anesthesia for abdominal exploratory surgery. The definitive underlying cause remains unknown; however, a reaction to propofol is suspected. Case summary: A 6-month-old intact male domestic short-hair cat underwent general anesthesia and developed severe intraoperative rhabdomyolysis, hyperkalemia, ventricular fibrillation, and AKI during surgery despite a documented mild hypokalemia and normal creatinine before inducing anesthesia. Propofol was administered as part of the anesthetic protocol. The patient was resuscitated successfully and responded well to advanced medical intervention. The hyperkalemia and AKI were resolved within less than 24 h from surgery and rhabdomyolysis was resolved at the time of recheck 5 days later. New or unique information provided: While previously suspected in dogs, to the authors' knowledge, propofol-related infusion syndrome (PRIS) has not been reported in domestic cats. Veterinary professionals should be aware that drug-induced intraoperative rhabdomyolysis and hyperkalemia can develop unexpectedly and should remain a differential for acute cardiac arrhythmias or cardiac arrest and AKI. [ABSTRACT FROM AUTHOR]

AbstractDoxorubicin (Dox) is an effective and commonly used anticancer drug; however, it leads to several side effects including cardiotoxicity which contributes to poor quality of life for cancer patients. Creatine (Cr) is a promising intervention to alleviate Dox-induced cardiotoxicity. This study aimed to examine the effects of Cr beforeDox on cardiac mitochondrial creatine kinase (MtCK). Male rats were randomly assigned to one of two 4-week Cr feeding interventions (standard Cr diet or Cr loading diet) or a control diet (Con, n = 20). Rats in the standard Cr diet (Cr1, n = 20) were fed 2% Cr for 4-weeks. Rats in the Cr loading diet (Cr2, n = 20) were fed 4% Cr for 1-week followed by 2% Cr for 3-weeks. After 4-weeks, rats received either a bolus injection of 15 mg/kg Dox or a placebo saline injection (Sal). Five days post-injections left ventricle (LV) was excised and analyzed for MtCK expression using Western blot and ELISA. A significant drug effect was observed for LV mass (p < 0.05), post hoc testing revealed LV mass of Con + Dox and Cr2 + Dox was significantly lower than Con + Sal (p < 0.05). A significant drug effect was observed for MtCK (p = 0.03) through Western blot. A significant drug effect (p = 0.03) and interaction (p = 0.02) was observed for MtCK using ELISA. Post hoc testing revealed that Cr2 + Dox had significantly higher MtCK than Cr1 + Sal and Cr2 + Sal. Data suggest that a reduction in LV mass and MtCK may contribute to Dox-induced cardiotoxicity, and Cr supplementation may play a potential role in mitigating cardiotoxicity by preserving mitochondrial CK. [ABSTRACT FROM AUTHOR]

Background: Ginseng Radix et Rhizoma (GS) is frequently used as an adjuvant therapy for patients with heart failure (HF). Metoprolol is widely used in patients with HF. However, there is no report on the combined effects of GS and metoprolol in patients with HF. Objective: This study investigated the combined effects of GS and metoprolol in male C57BL/6J mice with HF and the underlying mechanisms. Materials and methods: We utilized a mouse myocardial HF model to measure the serum levels of creatine kinase (CK) and creatine kinase-MB form (CK-MB) using an automated biochemical analyzer. Lactate dehydrogenase (LDH) and cardiac troponin (cTnT) levels were determined using enzyme-linked immunosorbent assays. Autophagy of myocardial cells was evaluated using transmission electron microscopy, and changes in signal pathway proteins related to autophagy were analyzed by Western blotting. Results: GS combined with metoprolol improved heart function, reduced heart damage, and decreased serum levels of CK, CK-MB, LDH, and cTnT. The combination of GS and metoprolol decreased autophagy in myocardial cells by reducing the levels of autophagy-related proteins (LC3, p62, Beclin1, and Atg5) and increasing the ratios of p-PI3K/PI3K, p-Akt/Akt, and p-mTOR/mTOR. Conclusion: GS enhanced the anti-heart failure effect of metoprolol. Its mechanism of action might be related to the inhibition of autophagy mediated by the activation of the PI3K/Akt/mTOR pathway. [ABSTRACT FROM AUTHOR]

Cytokinins (CKs) are a group of phytohormones that are involved in plant growth, development, and disease resistance. The isopentenyl transferase (IPT) and cytokinin oxidase/dehydrogenase (CKX) families comprise key enzymes controlling CK biosynthesis and degradation. However, an integrated analysis of these two gene families in radish has not yet been explored. In this study, 13 RsIPT and 12 RsCKX genes were identified and characterized, most of which had four copies in Brassica napus and two copies in radish and other diploid Brassica species. Promoter analysis indicated that the genes contained at least one phytohormone or defense and stress responsiveness cis-acting element. RsIPTs and RsCKXs were expanded through segmental duplication. Moreover, strong purifying selection drove the evolution of the two gene families. The expression of the RsIPT and RsCKX genes distinctly showed diversity in different tissues and developmental stages of the root. Expression profiling showed that RsCKX1-1/1-2/1-3 was significantly upregulated in club-resistant materials during primary infection, suggesting their vital function in clubroot resistance. The interaction network of CKX proteins with similar 3D structures also reflected the important role of RsCKX genes in disease resistance. This study provides a foundation for further functional study on the IPT and CKX genes for clubroot resistance improvement in Raphanus. [ABSTRACT FROM AUTHOR]

Background Skeletal muscle injury in Ebola virus disease (EVD) has been reported, but its association with morbidity and mortality remains poorly defined. Methods This retrospective study included patients admitted to 2 EVD treatment units over an 8-month period in 2019 during an EVD epidemic in the Democratic Republic of the Congo. Results An overall 333 patients (median age, 30 years; 58% female) had at least 1 creatine kinase (CK) measurement (n = 2229; median, 5/patient [IQR, 1–11]). Among patients, 271 (81%) had an elevated CK level (>380 U/L); 202 (61%) had rhabdomyolysis (CK >1000 IU/L); and 45 (14%) had severe rhabdomyolysis (≥5000 U/L). Among survivors, the maximum CK level was a median 1600 (IQR, 550–3400), peaking 3.4 days after admission (IQR, 2.3–5.5) and decreasing thereafter. Among fatal cases, the CK rose monotonically until death, with a median maximum CK level of 2900 U/L (IQR, 1500–4900). Rhabdomyolysis at admission was an independent predictor of acute kidney injury (adjusted odds ratio, 2.2 [95% CI, 1.2–3.8]; P =.0065) and mortality (adjusted hazard ratio, 1.7 [95% CI, 1.03–2.9]; P =.037). Conclusions Rhabdomyolysis is associated with acute kidney injury and mortality in patients with EVD. These findings may inform clinical practice by identifying laboratory monitoring priorities and highlighting the importance of fluid management. [ABSTRACT FROM AUTHOR]

Major depressive disorder is a mental disorder affecting millions of people worldwide. A considerable proportion of patients demonstrate a lack of response to conventional treatment. With the recent introduction of esketamine, a new treatment option has been approved for treatment-resistant depression. Although the medication is efficacious in a substantial portion of cases, rare, but possibly serious, adverse effects may occur. This case series shows two cases of rhabdomyolysis, a destruction of muscle tissuewith elevated creatine kinase levels, after administration of esketamine. The first case presented is about a 33 year old male patient who suffered from a severe episode of a depressive disorder. He got nasal esketamine as an emergency treatment. While there was an initial improvement regarding the depressive symptoms, the patient developed muscle pain and fatigue after the administration of the fourth dose, with creatine kinase (CK) levels above 22,000 U/L, indicating rhabdomyolysis. Following the discontinuation of esketamine and the implementation of supportive care, the CK levels returned to normal and the depressive symptoms abated. The second case is about a 22-year-old male patient who also suffered from a severe depressive episode and got eketamine as an emergency treatment. Following the tenth dose, the patient exhibited muscle weakness and elevated CK levels (8,032 U/L), which persisted even after dose reduction. Esketamine administration was stopped, and the following monitoring demonstrated a slow return to normal levels of CK and liver enzymes. In both cases, there was no known medical history and both patients developed rhabdomyolysis after administration of esketamine. The temporal connection suggests a possible causal relationship. We found no literature on esketamine-induced rhabdomyolysis following the administration of nasal esketamine. However, these two cases emphasize the need of monitoring for laboratory changes like elevated CK-levels in patients receiving esketamine, especially considering its growing use in treatment-resistant depression. [ABSTRACT FROM AUTHOR]

This letter to the editor discusses the use of sigma metrics in laboratory medicine. The authors analyze data from an external quality assurance program to examine the correlation between sigma metric, analytical imprecision, and bias. They find that sigma metric is more strongly correlated with analytical imprecision than bias. The study highlights the importance of considering both imprecision and bias when assessing laboratory performance. The accompanying table provides data on various laboratory measurements and their correlation with different testing methods, offering valuable information for researchers and library patrons interested in laboratory testing methods and their correlation. However, it is important to interpret the results with caution due to potential differences in sample material and study limitations. [Extracted from the article]

Background: Patients with central core myopathy (CCM) can be at risk of exercise-induced rhabdomyolysis and myalgia. Despite its possible positive effects, physical training has been long avoided in these patients as no population-specific exercise adaption strategies have been developed. Here we present the case of a 17-year-old male CCM patient who underwent a 3- month training program tailored to a preliminary test aimed at assessing his physical exertion tolerance measured via changes in serum creatine kinase (CK). Methods: The preliminary tolerance test consisted of three 25-minute sessions (one session per week) of physical exercise (aerobic, resistance and mixed) at an intensity quantified as level 6 of the Borg Category Ratio (CR) 0--10 scale. A blood sample to assess CK was conducted 36 h following eachsession. The intervention consisted of a training program (three sessions per week) including both resistance and aerobic exercises concomitant with a personalized nutritional plan. Before and after intervention, a battery of metabolic (indirect calorimetry, bioimpedance) and cardiopulmonary (CPET) tests were performed. Results: After training, improvements of the anaerobic threshold (+6.9%), normalized VO2 max (+15%) and body composition (muscle mass, +1.1 kg; fat mass, -1.1 kg were observed without pain, rhabdomyolysis, and blood CK augmentation compared to pretraining values. Conclusion: Our results highlight that a mixed aerobic/resistance training, properly tailored and supported by a specific nutritional plan, may safely improve the physical fitness and body composition in a CCM patient. Dosing exercise-induced CK serum change following Borg CR-10 intensity assessment, may be useful to correctly tailor physical exercise in these patients. [ABSTRACT FROM AUTHOR]

Deficiency of adipose triglyceride lipase (ATGL) due to mutation in PNPLA2 causes neutral lipid storage disease with myopathy (NLSDM), an autosomal recessive disorder (MIM: #610717). NLSDM patients are mainly affected by progressive myopathy, cardiomyopathy, and hepatomegaly. Cardiac involvement was reported in 40%-50% of NLSDM patients. Patients with cardiac involvement have adult-onset progressive heart failure, mimicking dilated or hypertrophic cardiomyopathy. The clinical characteristics, genotype-phenotype correlation, and prognosis of cardiomyopathy secondary to PNPLA2 mutation are not understood. We reported two male patients carrying a homozygous splicing mutation NM_020376.4 (c.757 + 1G>T) in PNPLA2, presenting with severe dilated cardiomyopathy and mild skeletal muscle involvement. Through the literature review, the ECG and imaging features and the prognosis of 49 previously reported cases of cardiomyopathy caused by the PNPLA2 mutation were summarized. This study suggests that NLSDM should be considered a cause of cardiomyopathy, especially in those with elevated creatine kinase (CK) levels, regardless of whether symptoms such as muscle weakness or atrophy are present. [ABSTRACT FROM AUTHOR]

Aim: Plastics, as diverse polymeric materials, have become an integral part of modern life due to their unique properties, including high resistance to various chemicals, a high strength-to-weight ratio, ease of preparation, and low cost. Millions of tons of these materials are produced annually; however, only a small portion is recycled or reused. By leaving single-use plastics in the environment, these plastics are worn out and fragmented into smaller sizes due to various factors such as UV irradiation and oxidation and finally enter the aquatic and terrestrial ecosystems and based on their size are called Micro and Nanoplastics and may be uptaken by aquatic organisms such as fishes and also shrimps and accumulate in their tissues. They can also be absorbed by the roots of plants and enter the food chain of us humans. Although various in vitro and in vivo studies have been conducted to investigate the different effects of various nanoplastics, and various mechanisms such as oxidative stress and inflammation have been reported for their effects, but subchronic studies have been conducted to investigate the effects of polyethylene terephthalate nanoparticles. It is very important on the tissue of the heart in the body. As a result, it seems important to investigate their toxic effects in vital tissues such as heart tissue. Material and methods: In this experimental study, polyethylene terephthalate Nanoplastics were prepared using aqueous solution and then characterized using Dynamic Light Scattering and Scanning Electronic Microscopy. Four weeks old 12 male wistar rats (Average weight=250 gr) were randomly divided into two groups. Animals in the treatment group received 200 ppm of polyethylene Terephthalate Nanoplastics by gavage daily for 90 days and Control group received only Phosphate Buffer Saline (pH=7.4). After this period, the rats were anesthetized and after collecting the serum, Lactate Dehydrogenase and Creatine Kinase activity levels were measured using commercial colorimetric kit. The level of Lipid Peroxidation was analyzed using Thiobarbituric acid reactive substance formation colorimetric assay, Total Antioxidant Capacity was assessed using Ferric reducing antioxidant power and Catalase Enzyme Activity were also measured in the heart tissue homogenate using specific kit, the results data were analyzed by oneway analysis of variance. Histopathological studies were also performed by hematoxylin and eosin staining using light microscopy. Results: The results demonstrated that long term exposure to polyethylene Terephthalate Nanoplastics caused a significant increase in the levels of Lactate Dehydrogenase and Creatine Kinase. Also, an increase in Lipid Peroxidation, and a decrement in Total Antioxidant Capacity, Catalase Activity were observed in the heart tissue of treatment group animals compared to the control group (P value < 0.05). In histological studies, intermuscular edema and degeneration of myofibrils were evident in the group that received Nanoplastics. Conclusion: Long-term exposure to polyethylene terephthalate nanoplastics causes a change in the redox state of the heart tissue of male Wistar rats, these nanoparticles cause the cardiac antioxidant enzymatic and non-enzymatic defense mechanisms to be overwhelmed, such as reducing the total antioxidant capacity and catalase. which has finally led to irreversible damage to the cardiac tissue, which was confirmed by increasing serum levels of creatine kinase and lactate dehydrogenase enzymes and intramuscular edema and degeneration of myofibrils. [ABSTRACT FROM AUTHOR]

Objective: We retrospectively examined the nephrological conditions of the victims who applied to the Pediatric Nephrology Clinic in our hospital in İzmir after the February 6, 2023 Kahramanmaraş earthquake. Method: Age, gender, time spent under debris, number of crushed extremities, presence of acute kidney injury (AKI), creatine kinase (CK) levels and prognosis of all patients were evaluated. 5% dextrose-0.45% NaCl solution was given as 1500 cc/m2 /day if the CK levels of the children were between 1000-3000 U/L, and as 3000 cc/m2 /day for those >3000 U/L. If the bicarbonate value is <25, alkalinization was achieved by applying NaHCO3 treatment to 50 mEq/L. If CK values fell below 3000 U/L, the amount of fluid was reduced by half, and if it was below 1000 U/L, it was discontinued. If blood gas pH is >7.50 and/or bicarbonate ≥30, alkalinization treatment is discontinued; if 25-30 it is halved. Results: Of the total 33 pediatric patients, 48.5% were girls and 51.5% were boys. The children had a mean age of 9.0±3.9 years. The mean stay under the rubble was 17.00 (4.25-48.00) hours. The CK values of 23 patients were >1000 U/L at the time of admission. Six patients had acute kidney injuries at admission. Four patients received hemodialysis and/or hemodiafiltration treatment. The CK values returned to normal in 5.0 (3.0-8.0) days in the patients who received fluid and alkalinization treatments. The serum creatinine values of all patients normalized. Conclusion: Even in the case of concomitant AKI in crush syndrome developing after an earthquake, full recovery can be achieved with aggressive fluid and alkalinization treatment. [ABSTRACT FROM AUTHOR]

A 57-year-old man developed worsening early morning headaches, muscle cramps and falls over 12 months. He had widespread fasciculation and was diagnosed with motor neurone disease, and treated with nocturnal hypoventilation. Based on this diagnosis, he made significant personal and financial decisions including retiring and selling his house. He subsequently developed a lump in his right breast and was found to have gynaecomastia. This triggered genetic testing for Kennedy's disease leading to the correct diagnosis. This case highlights an unusual presentation of a rare disease leading to misdiagnosis and major repercussions for the patient. Recent genetic analysis from the 100 000 genome project suggests Kennedy's disease may be four times more prevalent in the population than previously thought, highlighting the need to consider genetic testing, especially if there is a suggestion of multisystem disease. [ABSTRACT FROM AUTHOR]

Background & objective: Intensive Care Unit-Acquired Weakness (ICU-AW) is a weakness found in critically ill patients, and this weakness can persist even after discharge from the Intensive Care Unit (ICU). Various rehabilitation medicine procedures have been shown to be effective in prevention as well as managing the established weakness in this cohort of the patients. We analyzed the effect of Neuromuscular Electrical Stimulation (NMES) therapy on the global muscle strength, quadriceps femoris muscle, and creatine kinase examination in patients known to have ICU-AW. Methodology: The type of study used a pre-experimental one-group pre-posttest, and the study population consisted of 23 patients who experienced ICU-AW. Patients were given NMES therapy at the beginning of treatment in the ICU and then evaluated using the Medical Research Council Scale for Muscle Strength (MRC-SS), Manual Muscle Test (MMT), and creatine kinase levels. Results: NMES therapy provides significant results on increasing muscle strength on the fifth day with MRC-SS 42.78 (24-60) and MMT 3.57 (2-5) (P < 0.001), as well as a significant decrease in creatine kinase levels given therapy at the beginning of ICU admission. Conclusion: NMES therapy increases global muscle strength and quadriceps femoris muscle and decreases creatine kinase levels. [ABSTRACT FROM AUTHOR]

Hypothyroidism is a common clinical condition with nonspecific symptoms such as fatigue, cold intolerance, and constipation. Rarely, severe primary hypothyroidism presents with rhabdomyolysis. We present a 12-year-old boy with several months of fatigue, muscle cramping, and elevated creatine kinase (CK) who was found to have severe primary hypothyroidism. Initial laboratory evaluation was significant for CK 2056 U/L (reference, 0-300 U/L; 34.34 µkat/L) and creatinine 1.39 mg/dL (reference, 0.4-1 mg/dL; 122.88 µmol/L). He was admitted for management of rhabdomyolysis with acute kidney injury. Further biochemical testing revealed profound hypothyroidism--thyrotropin 494 mIU/mL (reference, 0.40-6.00 mIU/mL) and free thyroxine (T4) less than 0.4 ng/dL (reference, 0.80-1.80 ng/dL; <5.15 pmol/L). Thyroglobulin and thyroid peroxidase autoantibodies were positive, confirming autoimmune hypothyroidism. Low-dose levothyroxine was initiated. With aggressive rehydration, creatinine and CK levels improved. The patient was discharged home with instructions to escalate thyroid hormone replacement over 8 weeks. While the etiology of CK elevation in severe hypothyroidism is poorly understood, it is hypothesized that T4 deficiency alters mitochondrial oxidative capacity and glycogenolysis precipitating muscle atrophy and breakdown with CK release. This case highlights that clinicians should consider thyroid function testing in patients with symptoms of muscle pain and unexplained elevations in CK. [ABSTRACT FROM AUTHOR]

• A critical literature review of case reports on statins-induced side effects in various hereditary myopathies. • Setting criteria to assess case reports of statin myotoxicity in hereditary myopathies. • Identification of myopathies with high risk for statin usage (MELAS and other mitochondrial disorders, myotonic dystrophy type 2, McArdle disease). • Suggesting practical management of hyperlipidemia in hereditary myopathies. Hyperlipidemia is not uncommon in patients with hereditary myopathies who get older and also in several conditions in which it is frequently observed. Thus, using the common cholesterol reducing medications of the stains group could be considered. However, the side effects of these drugs include myalgia, myopathy and rhabdomyolysis typically associated with high serum creatine kinase (CK). Because high CK levels are very frequently found in hereditary myopathies, physicians are reluctant to use statins in such patients. Reviewing the literature about statin side effects in hereditary myopathies does not provide a clear evidence about the true risk of these drugs. This review critically describes the reported cases of statin side effects in several genetic myopathies and suggests some guidelines for conditions that are contra indicated for statin usage (particularly in mitochondrial disorders, metabolic myopathies, myotonic dystrophy type 2). Possible solutions to the dilemma of whether to use statins in hereditary myopathies are discussed (prescribing other cholesterol lowering agents and a carefully monitored treatment initiation of statins). [ABSTRACT FROM AUTHOR]

Background: Ultra-trail running races pose appreciable physiological challenges, particularly for glucose metabolism. Previous studies that yielded divergent results only measured glycaemia at isolated times. Objectives: We aimed to explore the impact of an ultra-endurance race on continuously measured glycaemia and to understand potential physiological mechanisms, as well as the consequences for performance and behavioural alertness. Methods: Fifty-five athletes (78% men, 43.7 ± 9.6 years) ran a 156-km ultra-trail race (six 26-km laps, total elevation 6000 m). Participants wore a masked continuous glucose monitoring sensor from the day before the race until 10 days post-race. Blood was taken at rest, during refuelling stops after each lap, and after 24-h recovery. Running intensity (% heart rate reserve), performance (lap times), psychological stress, and behavioural alertness were explored. Linear mixed models and logistic regressions were carried out. Results: No higher risk of hypo- or hyperglycaemia was observed during the exercise phases of the race (i.e. excluding stops for scientific measurements and refuelling) compared with resting values. Laps comprising a greater proportion of time spent at maximal aerobic intensity were nevertheless associated with more time > 180 mg/dL (P = 0.021). A major risk of hyperglycaemia appeared during the 48-h post-race period compared with pre-race (P < 0.05), with 31.9% of the participants spending time with values > 180 mg/dL during recovery versus 5.5% during resting. Changes in circulating insulin, cortisol, and free fatty acids followed profiles comparable with those usually observed during traditional aerobic exercise. However, creatine phosphokinase, and to a lesser extent lactate dehydrogenase, increased exponentially during the race (P < 0.001) and remained high at 24-h post-race (P < 0.001; respectively 43.6 and 1.8 times higher vs. resting). Glycaemic metrics did not influence physical performance or behavioural alertness. Conclusion: Ultra-endurance athletes were exposed to hyperglycaemia during the 48-h post-race period, possibly linked to muscle damage and inflammation. Strategies to mitigate muscle damage or subsequent inflammation before or after ultra-trail races could limit recovery hyperglycaemia and hence its related adverse health consequences. Trial Registration Number: NCT05538442 2022–09-21 retrospectively registered. [ABSTRACT FROM AUTHOR]

Background: Daptomycin is a high‐use intravenous antimicrobial agent affording the convenience of once‐daily dosing. Prior studies suggest an opportunity to use a more operationally convenient fixed rather than weight‐based dosing but this approach has not been studied prospectively. Methods: This study quantified the probability of toxicity and efficacy end points by prospectively testing a fixed dose regimen of daptomycin (750 mg) in obese and non‐obese adults. At least, three daptomycin concentrations were measured at steady‐state for each patient. A population pharmacokinetic model was constructed to evaluate concentration‐time profiles and investigate covariates of daptomycin clearance. Simulations were performed to evaluate the probability of achieving efficacy (24‐h area under the curve (AUC0‐24) ≥ 666 mg∙h/L) and toxicity (minimum concentration (Cmin) ≥24.3 mg/L) targets for fixed (500–1000 mg) and weight‐based (6–12 mg/kg) daptomycin doses. Results: Thirty‐one patients (16 females, 15 males) with median (interquartile range (IQR)) age of 50 (30, 62) years and weight of 74 (54, 156) kg were included in the final analysis. Fixed dose daptomycin (750 mg) resulted in similar exposure across weights with a median (IQR) AUC0‐24 of 819 (499, 1501) mg∙h/L and 749 (606, 1265) mg∙h/L in patients weighing ≤74 kg and >74 kg, respectively. Overall, male sex and increased kidney function necessitate higher fixed and weight‐based doses to achieve efficacy. Creatine phosphokinase elevation was observed in two patients (6.5%) and predicted to be lower with fixed versus weight‐based regimens. Conclusions: Fixed daptomycin dosing adjusted for sex and kidney function is expected to improve the efficacy‐to‐toxicity ratio, transitions of care, and costs compared to weight‐based doses. However, no empiric dosing approach is predicted to achieve ≥90% efficacy while minimizing the risk of toxicity, so therapeutic drug monitoring should be considered on a patient‐specific basis. [ABSTRACT FROM AUTHOR]

This systematic review and meta-analysis examined the impact of exercise-induced muscle damage (EIMD) on cycling performance. The primary outcome measure was cycling performance, whereas secondary outcome measures included creatine kinase (CK), delayed-onset muscle soreness (DOMS), and muscular contractions. Data were extracted and quantified through forest plots to report on the standardized mean difference and p values. The meta-analysis showed no significant change in oxygen consumption at 24-48 hours (p > 0.05) after the muscle damage protocol, although ventilation and rating of perceived exertion significantly increased (p < 0.05) during submaximal cycling protocols. Peak power output during both sprint and incremental cycling performance was significantly reduced (p < 0.05), but time-trial and distance-trial performance showed no change (p > 0.05). Measures of CK and DOMS were significantly increased (p < 0.05), whereas muscular force was significantly reduced following the muscle-damaging protocols (p < 0.05), confirming that cycling performance was assessed during periods of EIMD. This systematic review showed that EIMD affected both maximal and submaximal cycling performance. Therefore, coaches should consider the effect of EIMD on cycling performance when implementing unaccustomed exercise into a cycling program. Careful consideration should be taken to ensure that additional training does not impair performance and endurance adaptation. [ABSTRACT FROM AUTHOR]

A significant increase in circulating cell‐free DNA (cfDNA) occurs with physical exercise, which depends on the type of exertion and the duration. The aims of this study were as follows: (1) to investigate the time course of cfDNA and conventional markers of muscle damage from immediately after to 96 h after muscle‐damaging exercise; and (2) to investigate the relationship between cfDNA and indicators of primary (low‐frequency fatigue and maximal voluntary isometric contraction) and secondary (creatine kinase and delayed‐onset muscle soreness) muscle damage in young healthy males. Fourteen participants (age, 22 ± 2 years; weight, 84.4 ± 11.2 kg; height, 184.0 ± 7.4 cm) performed 50 intermittent drop jumps at 20 s intervals. We measured cfDNA and creatine kinase concentrations, maximal voluntary isometric contraction torque, low‐frequency fatigue and delayed‐onset muscle soreness before and at several time points up to 96 h after exercise. Plasma cfDNA levels increased from immediately postexercise until 72 h postexercise (P < 0.01). Elevation of postexercise cfDNA was correlated with both more pronounced low‐frequency fatigue (r = −0.52, P = 3.4 × 10−11) and delayed‐onset muscle soreness (r = 0.32, P = 0.00019). Levels of cfDNA change in response to severe primary and secondary muscle damage after exercise. Levels of cfDNA exhibit a stronger correlation with variables related to primary muscle damage than to secondary muscle damage, suggesting that cfDNA is a more sensitive marker of acute loss of muscle function than of secondary inflammation or damaged muscle fibres. What is the central question of this study?How do plasma cell‐free DNA (cfDNA) levels change in response to primary and secondary muscle damage when muscle‐damaging exercise is performed without metabolic stress?What is the main finding and its importance?In this study, we found that cfDNA concentration increases following severe primary and secondary muscle damage after 50 drop jumps. However, acute postexercise increases in cfDNA were higher than following secondary muscle damage and were more correlated with variables related to primary muscle damage (low‐frequency fatigue). This suggests that muscle‐damaging exercise causing no accumulation of metabolites can lead to acute and delayed increases in cfDNA levels. However, they are more sensitive to primary muscle damage. [ABSTRACT FROM AUTHOR]

Objectives: Neurogenic muscle hypertrophy (NMH) is a rare condition characterized by focal muscle hypertrophy caused by chronic partial nervous injury. Given its infrequency, underlying mechanisms remain poorly understood. Inspired by two clinical cases, we conducted a systematic review to gain insights into the different aspects of NMH. Methods: We systematically searched online databases up until May 30, 2023, for reports of muscle hypertrophy attributed to acquired neurogenic factors. We conducted an exploratory analysis to identify commonly associated features. We also report two representative clinical cases. Results: Our search identified 63 reports, describing 93 NMH cases, to which we added our two cases. NMH predominantly affects patients with compressive radiculopathy (68.4%), negligible muscular weakness (93.3%), and a chronic increase in muscle bulk. A striking finding in most neurophysiological studies (60.0%) is profuse spontaneous discharges, often hindering the analysis of voluntary traces. Some patients exhibited features consistent with more significant muscle damage, including higher creatine phosphokinase levels, muscle pain, and inflammatory muscle infiltration. These patients are sometimes referred to in literature as "focal myositis." Treatment encompassed corticosteroid, Botulinum Toxin A, decompressive surgery, antiepileptic medications, and nerve blocks, demonstrating varying degrees of efficacy. Botulinum Toxin A yielded the most favorable response in terms of reducing spontaneous discharges. Interpretation: This systematic review aims to provide a clear description and categorization of this uncommon presentation of an often‐overlooked neurological disorder. Though questions remain about the underlying mechanism, evidence suggests that aberrant fiber overstimulation along with increased workload that promotes focal damage may result in muscle hypertrophy. This may serve as a guide for therapeutic interventions. [ABSTRACT FROM AUTHOR]

Aims: To explore the clinico‐sero‐pathological characteristics and risk prediction model of idiopathic inflammatory myopathy (IIM) patients with different muscular perifascicular (PF) changes. Methods: IIM patients in our center were enrolled and the clinico‐sero‐pathological data were retrospectively analyzed. A decision tree model was established through machine learning. Results: There were 231 IIM patients enrolled, including 53 with perifascicular atrophy (PFA), 39 with perifascicular necrosis (PFN), and 26 with isolated perifascicular enhancement of MHC‐I/MHC‐II (PF‐MHCn). Clinically, PFA patients exhibited skin rashes and dermatomyositis‐specific antibodies (DM‐MSAs, 74.5%) except for anti‐Mi2. PFN patients showed the most severe muscle weakness, highest creatine kinase (CK), anti‐Mi2 (56.8%), and anti‐Jo‐1 (24.3%) antibodies. PF‐MHCn patients demonstrated negative MSAs (48.0%) and elevated CK. Histopathologically, MAC predominantly deposited on PF capillaries in PFA but on non‐necrotic myofiber in PFN (43.4% and 36.8%, p < 0.001). MxA expression was least in PF‐MHCn (36.0% vs. 83.0% vs. 63.2%, p < 0.001). The decision tree model could effectively predict different subgroups, especially PFA and PFN. Conclusions: Three types of PF change of IIMs representing distinct clinico‐serological characteristics and pathomechanism. Undiscovered MSAs should be explored especially in PF‐MHCn patients. The three pathological features could be accurately predicted through the decision tree model. [ABSTRACT FROM AUTHOR]

This study proposes to monitor the physical, immune and cognitive responses and adaptations of elite rugby players throughout the season based on the loads performed. Anthropometric measurements, physical fitness tests (e.g., muscle strength and power, linear and change-of-direction speed, cardiorespiratory fitness) and analyses of serum concentrations of markers of muscle damage (creatine kinase [CK] and lactate dehydrogenase [LDH]) and brain-derived neurotrophic factor (BDNF) were carried out over a sporting season (24 weeks) for 17 elite rugby players (10 forwards and 7 backs) aged 18.91 ± 0.76 years. The physical fitness test results show improvements in the performance of both forwards and backs over the season (p < 0.05), with an advantage for backs compared with forwards in most tests (p < 0.05). Muscle damage markers decreased at the end of the season compared with the baseline levels for forwards (p < 0.05). CK levels were unchanged for the backs, but there were increased LDH concentrations at the end of the season compared with baseline (p < 0.05). Serum BDNF levels decreased for the total group between the second and third sampling (p < 0.05). The muscular and physical capacities of rugby players differ according to their playing position. Immune responses and adaptations, as well as BDNF levels, vary throughout the season and depend on the physical load performed. [ABSTRACT FROM AUTHOR]

Recent evidence suggests the mechanistic role of mitochondria and oxidative stress in the development of celecoxib-induced cardiotoxicity. On the other, it has reported the positive effects of vitamin D on oxidative stress and the maintenance of mitochondrial functions. This current study examined the cardiac effects of celecoxib, doxorubicin, vitamin D, and a combination of them in rats. The effect of 10 days of celecoxib (100 mg/kg/day), doxorubicin (2.5 mg/kg), vitamin D (60,000 U/kg), and their combination was studied on cardiac function according to serum lactate dehydrogenase (LDH), creatine kinase (CK), glutathione (GSH), and malondialdehyde (MDA) levels as well as mitochondrial succinate dehydrogenases (SDH) activity, reactive oxygen species (ROS) production, mitochondrial swelling, and mitochondrial membrane potential (MMP). Results showed that celecoxib and its combination with doxorubicin led to abnormality in paws and limbs, increased pressure in the eyes, blindness and animal death (in about 75% of the animals under study). Moreover, celecoxib and its combination with doxorubicin significantly increased cardiotoxicity biomarkers, oxidative stress markers (GSH and MDA), and mitochondrial toxicity parameters (SDH, ROS formation, MMP collapse, mitochondrial swelling). However, the combination of vitamin D with celecoxib and celecoxib + doxorubicin caused a significant reversal of deformity in paws and limbs, increased pressure in the eye, blindness, and animal death, as well as cardiotoxicity, oxidative stress, and mitochondrial parameters. This study proved for the first time the beneficial effect of vitamin D on celecoxib-induced cardiotoxicity, which is aggravated in the presence of doxorubicin through the maintenance of mitochondrial functions and its antioxidant potential. [ABSTRACT FROM AUTHOR]

Patients with interstitial lung disease (ILD) represent a vulnerable population against an acute SARS-CoV-2 infection. It has been observed that up to 80% of patients with ILD can develop post-COVID-19 symptomatology one year after. This secondary analysis aimed to, 1, compare serological biomarkers before and after surpassing a SARS-CoV-2 infection in individuals with interstitial lung disease (ILD) and, 2, to compare serological biomarkers between ILD patients who develop and those who do not develop post-COVID-19 symptoms. Seventy-six patients with ILD (40.4% women, age: 69, SD: 10.5 years) who survived a SARS-CoV-2 infection participated. High-resolution computerized tomography (CT) of the lungs, two pulmonary function tests (forced vital capacity (FVC) and diffusion value of carbon monoxide (DLCO)) and fourteen serological biomarkers were collected before and after SARS-CoV-2 infection. Participants were asked for the presence of post-COVID-19 symptomatology a mean of twelve (SD: eight) months after infection. Sixty patients (79%) showed post-COVID-19 symptoms (mean: 3.5, SD 1.1), with fatigue (68.4%), dyspnea (31.5%), and concentration loss (27.6%) being the most prevalent. Creatine phosphokinase (CPK) was the only biomarker showing differences in our study. In fact, CPK levels were higher after the acute SARS-CoV-2 infection (mean difference: 41.0, 95%CI 10.1 to 71.8, p = 0.03) when compared to before the infection. Thus, CPK levels were also higher in ILD patients with post-COVID-19 fatigue (mean difference: 69.7, 95%CI 12.7 to 126.7, p = 0.015) or with post-COVID-19 dyspnea (mean difference: 34.8, 95%CI 5.2 to 64.4, p = 0.025) than those patients without these post-COVID-19 symptoms. No significant changes in CT or functional pulmonary tests were observed after COVID-19 in patients with ILD. In conclusion, patients with ILD exhibited an increase in CPK levels after SARS-CoV-2 infection, albeit no changes in other serological biomarkers were identified. Similarly, the presence of post-COVID-19 fatigue or dyspnea was also associated with higher CPK levels in ILD patients. Studies investigating long COVID mechanisms in vulnerable populations such as ILD are needed. [ABSTRACT FROM AUTHOR]

Background: Abnormalities in T cell activation play an important role in the pathogenesis of myocarditis, and persistent T cell responses can lead to autoimmunity and chronic cardiac inflammation, as well as even dilated cardiomyopathy. Although previous work has examined the role of T cells in myocarditis in animal models, the specific mechanism for human cardiomyocytes has not been investigated. Methods: In this study, we constructed the human induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs) and established the T cell-mediated cardiac injury model by co-culturing with activated CD4 + T or CD8 + T cells that were isolated from peripheral mononuclear blood to elucidate the pathogenesis of myocardial cell injury caused by inflammation. Results: By combination of quantitative proteomics with tissue and cell immunofluorescence examination, we established a proteome profile of inflammatory myocardia from hiPSC-CMs with obvious cardiomyocyte injury and increased levels of lactate dehydrogenase content, creatine kinase isoenzyme MB and cardiac troponin. A series of molecular dysfunctions of hiPSC-CMs was observed and indicated that CD4 + cells could produce direct cardiomyocyte injury by activating the NOD-like receptor signals pathway. Conclusions: The data presented in our study established a proteome map of inflammatory myocardial based on hiPSC-CMs injury model. These results can provide guidance in the discovery of improved clinical treatments for myocarditis. [ABSTRACT FROM AUTHOR]

Due to the abundance of ACE2 receptors in nervous system cells, the SARS-CoV-2 virus can cause damage to this system. This study aims to examine the prevalence of neurological symptoms in COVID-19 patients. In this cross-sectional observational study, 75 COVID-19 positive patients admitted to Golestan Hospital’s neurology department in Ahvaz, Iran, from March 2020 to March 2023, were investigated. Neurological clinical symptoms were categorized into three groups: central nervous system, peripheral, and muscular symptoms. The relevant information was collected from patient files, including medical history, imaging data, and laboratory test results. Statistical analysis was performed using SPSS software, employing the rank-biserial correlation coefficient (r), Mann–Whitney U tests, Phi correlation, Cramer’s V, and Kendall’s Tau to evaluate the prevalence and significance of neurological symptoms. The most common clinical symptoms observed were hemiparesis, dysarthria, Central Facial Palsy (CFP), ataxia, and nausea, respectively. Among these symptoms, headaches (p = 0.001), seizures (p = 0.024), and nausea (p = 0.046) were found to be more prevalent in younger patients. Additionally, a significant relationship was identified between the level of serum Creatine phosphokinase (CPK) and seizures (p = 0.024), with lower levels observed in individuals with vomiting (p = 0.024), and higher levels observed in individuals with CFP (p = 0.040). This study highlights that patients with COVID-19 may experience serious neurological symptoms. The clinical spectrum and range of neurological symptoms associated with COVID-19 were found to be diverse and extensive, emphasizing the importance of considering this infection as a potential cause of neurological disorders. [ABSTRACT FROM AUTHOR]

Myositis with anti-Ku-autoantibodies is a rare inflammatory myopathy associated with various connective tissue diseases. Histopathological studies have identified inflammatory and necrotizing aspects, but a precise morphological analysis and pathomechanistic disease model are lacking. We therefore aimed to carry out an in-depth morpho-molecular analysis to uncover possible pathomechanisms. Muscle biopsy specimens from 26 patients with anti-Ku-antibodies and unequivocal myositis were analyzed by immunohistochemistry, immunofluorescence, transcriptomics, and proteomics and compared to biopsy specimens of non-disease controls, immune-mediated necrotizing myopathy (IMNM), and inclusion body myositis (IBM). Clinical findings and laboratory parameters were evaluated retrospectively and correlated with morphological and molecular features. Patients were mainly female (92%) with a median age of 56.5 years. Isolated myositis and overlap with systemic sclerosis were reported in 31%, respectively. Isolated myositis presented with higher creatine kinase levels and cardiac involvement (83%), whereas systemic sclerosis-overlap patients often had interstitial lung disease (57%). Histopathology showed a wide spectrum from mild to pronounced myositis with diffuse sarcolemmal MHC-class I (100%) and -II (69%) immunoreactivity, myofiber necrosis (88%), endomysial inflammation (85%), thickened capillaries (84%), and vacuoles (60%). Conspicuous sarcoplasmic protein aggregates were p62, BAG3, myotilin, or immunoproteasomal beta5i-positive. Proteomic and transcriptomic analysis identified prominent up-regulation of autophagy, proteasome, and hnRNP-related cell stress. To conclude, Ku + myositis is morphologically characterized by myofiber necrosis, MHC-class I and II positivity, variable endomysial inflammation, and distinct protein aggregation varying from IBM and IMNM, and it can be placed in the spectrum of scleromyositis and overlap myositis. It features characteristic sarcoplasmic protein aggregation on an acquired basis being functionally associated with altered chaperone, proteasome, and autophagy function indicating that Ku + myositis exhibit aspects of an acquired inflammatory protein-aggregate myopathy. [ABSTRACT FROM AUTHOR]

Objectives: Meta-analysis was conducted to examine the effect of supplemental curcumin intake on skeletal muscle injury status and to propose an optimal intervention program. Methods: In accordance with the procedures specified in the PRISMA statement for systematic reviews and meta-analyses of randomized controlled trials, the Review Manager 5.3 was used to analyze the results of creatine kinase (CK), muscle soreness, interleukin-6 (IL-6), and range of motion (ROM) as outcome indicators in the 349 subjects included in the 14 articles. Results: The effect size of curcumin supplementation on muscle soreness, mean difference (MD) = -0.61; the relationship between curcumin supplementation and muscle soreness for time of measurement (I2 = 83.6%)、the relationship between curcumin supplementation and muscle soreness for period of intervention (I2 = 26.2%)、the relationship between whether one had been trained (I2 = 0%) and supplementation dose (I2 = 0%) were not heterogeneous for the relationship between curcumin supplementation and muscle soreness; The effect size on CK, MD = -137.32; the relationship between curcumin supplementation and CK (I2 = 79.7%)、intervention period (I2 = 91.9%)、whether or not trained (I2 = 90.7%)、and no heterogeneity in the relationship between curcumin supplementation and CK for the time of measurement (I2 = 0%); The effect size MD = 4.10 for the effect on ROM; The effect size for IL-6 was MD = -0.33. Conclusions: This meta-analysis highlights that curcumin supplementation significantly mitigates skeletal muscle damage, with notable improvements in CK levels, muscle soreness, IL-6 levels, and ROM. The results highlight the importance of curcumin dosage and timing, revealing that prolonged supplementation yields the best results, especially for untrained individuals or those less exposed to muscle-damaging exercise. For muscle soreness and ROM enhancement, a pre-emptive, low-dose regimen is beneficial, while immediate post-exercise supplementation is most effective at reducing CK and IL-6 levels. [ABSTRACT FROM AUTHOR]

Nile Tilapia (Oreochromis niloticus) management procedures are directly linked to the final quality of the product. The aim of this study was to evaluate the effect of pre-slaughter density and different stunning methods on biochemical, respiratory and muscle injury parameters associated with quality and sensory characteristics of Nile tilapia fillets. Fish with an average weight of 762±105 g were used, first collected called the control group. The experiment was conducted in a 2 × 2 factorial scheme, with two densities (50 and 300 kg of live weight m−3) and two stunning methods thus totaling four treatments, with 15 repetitions per treatment totaling 75 fish sampled. Blood gas analysis, evaluation of biochemical parameters, analysis of meat quality and sensory analysis were carried out. For blood gas, biochemical and enzymatic parameters, the highest values were obtained for the density of 300 kg m−3 and asphyxia method: partial pressures of CO2; glucose and lactate, the highest values presented were 268.98 and 11.33 mg dL−1 respectively. As well as enzymatic activities, Creatinine kinase (CPK); Creatinine kinase isoenzyme (CKMB) showed higher values (768.93 and 1078.98 mg dL−1 respectively) in the higher density and asphyxia method. Conversely, when evaluating the quality parameters, the highest values were observed for lower density and thermonarcosis. High depuration density (300 kg m−3), combined with the asphyxiation stunning method, promotes changes in respiratory dynamics and provides greater stress, less firm fillet texture and greater weight loss due to cooking, as well as changes in creatine kinase (CK) and its CK-MB isoenzyme, demonstrating greater muscle damage. On the other hand, the density of 50 kg m−3 during pre-slaughter, combined with the method of stunning by thermonarcosis, provide a longer period of permanence in pre rigor mortis, which will result in fillets with a better sensory profile. [ABSTRACT FROM AUTHOR]

Myocardial ischemia/reperfusion injury (MIRI) refers to heart muscle failure due to cellular and tissue structural damage following coronary revascularization. Myocardial I/R injury is increasing in cats and dogs, kept as pets. The occurrence of MIRI is complicated, and various pathways are possible. Therefore, it is urgent to further explore the mechanism of disease occurrence and development and find key regulatory factors to achieve the goal for reducing MIRI. In this study, MIRI model was established in SD rats through coronary artery ligation and randomized the rats into the model group (MIRI), the trimetazidine group (TMZ), the trimetazidine combined with diazepam treatment group (TMZ+DZ), and the trimetazidine combined with 5-hydroxytryptamine treatment group (TMZ+5-HD). Experimental results indicated that TMZ+DZ significantly reduced myocardial cell apoptosis and inflammation levels in MIRI rats, lowered Creatine Kinase (CK), Creatine Kinase MB Isoenzyme (CK-MB), Lactate Dehydrogenase (LDH), and ROS levels, and decreased myocardial infarct size and mass. While TMZ and TMZ+5-HD also improved these indicators, the therapeutic effect of TMZ+DZ was notably superior to the other two treatment groups. The results suggest that the combination therapy of trimetazidine and diazepam ameliorated myocardial damage in MIRI rats, providing experimental evidence for the treatment of MIRI with the combination therapy of trimetazidine and diazepam. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate the biochemical indices in the saliva of leisure and sport horses undergoing different levels of workload. The experiment was conducted on 40 horses (4--28 years): sport horses (n = 20), and leisure horses (n = 20). The saliva samples were collected non-invasively 15 min before riding (A), 1 min before riding (B), 1 min after riding (C) and 15 min after riding (D). Albumin (Alb), alkaline phosphatase (ALP), α-amylase (AMY), creatine kinase (CK), creatinine (Crea), glucose (Glc), lactate (Lac), triacylglycerols (TG), total protein (TP), urea and lipid peroxidation (TBARS) were measured in saliva. Riding caused a significant change in many biochemical indices (Alb, CK, Glc, Lac, TBARS and urea) compared to baseline values in leisure horses (P < 0.05) but only in a few indices (Glc, Crea and TBARS) in sport horses. On the other hand, when comparing groups of leisure and sport horses, higher concentrations of Alb, Glc, TG and urea were found in sport horses whereas raised concentrations of CK and Crea were found in leisure horses. The obtained results indicate the adaptation of trained horses to physical effort. Moreover, this study confirms other possibilities of using salivary biochemical properties for physical stress assessment. Other more detailed comparative studies of load response in horses may provide useful information to quantify the reference range of individual stress indices. [ABSTRACT FROM AUTHOR]

Respiratory dysfunction is an important hallmark of amyotrophic lateral sclerosis (ALS). Elevation of creatine kinase (CK) has been reported in 23–75% of ALS patients, but the underlying mechanisms remain unknown. This work aims to enlighten the role of CK as a prognostic factor of respiratory dysfunction in ALS. A retrospective analysis of demographic and clinical variables, CK, functional decline per month (ΔFS), forced vital capacity (%FVC), and mean amplitude of the phrenic nerve compound motor action potential (pCMAP) in 319 ALS patients was conducted. These measurements were evaluated at study entry, and patients were followed from the moment of first observation until death or last follow-up visit. High CK values were defined as above the 90th percentile (CK ≥ P90) adjusted to sex. We analyzed survival and time to non-invasive ventilation (NIV) as proxies for respiratory impairment. Linear regression analysis revealed that high CK was associated with male sex (p < 0.001), spinal onset (p = 0.018), and FVC ≥ 80% (p = 0.038). CK was 23.4% higher in spinal-onset ALS patients (p < 0.001). High CK levels were not linked with an increased risk of death (p = 0.334) in Cox multivariate regression analysis. CK ≥ P90 (HR = 1.001, p = 0.038), shorter disease duration (HR = 0.937, p < 0.001), lower pCMAP (HR = 0.082, p < 0.001), and higher ΔFS (HR = 1.968, p < 0.001) were risk factors for respiratory failure. The association between high CK levels and poorer respiratory outcomes could derive from cellular metabolic stress or a specific phenotype associated with faster respiratory decline. Our study suggests that CK measurement at diagnosis should be more extensively investigated as a possible marker of poor respiratory outcome in future studies, including a larger population of patients. [ABSTRACT FROM AUTHOR]

The article presents a case study of an 81-year-old woman successfully treated with reduced oral steroid dosage for statin-induced anti-3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMGCR) immune-mediated necrotizing myopathy. Topics discussed include the management strategies, clinical outcomes, and therapeutic adjustments in elderly patients experiencing rare immune-mediated muscle disorders associated with statin use.

The aim of this study was to investigate the short-term effects of statins on rat skeletal muscle with the use of electrophysiological methods. A total of 28 adult male Wistar albino rats were given atorvastatin, rosuvastatin, and pravastatin (40 mg/kg each) intragastrically for four weeks. At the end of the study, the gastrocnemius muscle was isolated from the surrounding tissues under deep anaesthesia. It was tied with silk thread in the Achilles tendon area and then connected to an isometric force transducer. The contractile properties of the gastrocnemius muscle were assessed. Serum levels of total cholesterol and creatine kinase (CK) were measured. The muscle tissue samples were stained with hematoxylin eosin and histopathologically evaluated under light microscope. The findings revealed that cholesterol levels were significantly lower in all groups except the control group, whereas CK levels were higher in the statin groups than the control group. All three statins decreased the contractile strength and caused fatigue quickly in the gastrocnemius muscle. Histopathological changes in gastrocnemius muscle were more related to early moderate necrosis in rats that were received statins. This study demonstrates that all three statins decrease the ability of skeletal muscle to generate force and its resistance to fatigue in rats. [ABSTRACT FROM AUTHOR]

The objective was to evaluate the effects of acai supplementation (AS) on markers of muscle damage. Twelve men participated in the 21-day study. All performed the damage protocol (DP) in two moments, separated by 7 days. The DP consisted of 10 sets of 10 CMJs, with a recovery of 1 min between sets. The AS was performed for 7 days with 40 g/day of dehydrated acai (GA) or placebo (GP). Blood parameters (CK, LDH and Trolox-equivalent antioxidant capacity – TEAC) were evaluated at 0 h and 24 h. Ultrasound images (VL, RF and GM), DOMS in lower limbs and isometric peak torque (IPT) of knee extensors and flexors were evaluated at 0 h, 24 h, 48 h and 72 h after DP. A time–treatment interaction was observed for TEAC (p = 0.01), in which the GA presented increases of 11% after 24 h. Similarly, time–treatment interaction was observed for knee flexors IPT (p = 0.02), where GA showed superior recovery after 24 h (GA = 108 ± 23 vs. GP = 92 ± 24 N∙m) and 72 h (GA = 113 ± 31 vs. GP = 98 ± 26 N∙m). No significance was observed in the fatigue index for knee extensors (p = 0.75) and flexors (p = 0.89), indicating similar fatigue in both situations. We concluded that AS increased the TEAC and promoted faster recovery of the knee flexors IPT when compared to GP. [ABSTRACT FROM AUTHOR]

Background: Imatinib treatment for certain cancers can lead to elevated creatine kinase (CK) levels, potentially indicating muscle injury, and ongoing research aims to understand the correlation between imatinib levels and creatine kinase to assess its impact on treatment response. Methods: This single-center observational study involved 76 chronic myeloid leukemia (CML) patients receiving imatinib treatment, focusing on evaluating drug and metabolite levels using liquid chromatography–mass spectrometry (LC–MS-MS) instrumentation. Serum CK and creatine kinase-MB (CK-MB) levels were assessed using Colorimetric kits. Results: CK and CK-MB levels were measured, CK showed a median value of 211.5 IU/l and CK-MB showed a median value of 4.4 IU/l. Comparing low and high CK groups, significant differences were found in peak and trough plasma concentrations of imatinib and its metabolites. Correlations between CK levels and pharmacokinetic parameters were explored, with notable associations identified. Binary logistic regression revealed predictors influencing the therapeutic response to imatinib and categorized expected CK levels into high or low, with peak levels of imatinib emerging as a significant predictor for CK level categorization. Conclusion: The study highlights the link between imatinib's pharmacokinetics and elevated CK levels, indicating a possible correlation between specific metabolites and improved treatment response. Individualized monitoring of CK levels and imatinib pharmacokinetics could enhance care for CML patients. [ABSTRACT FROM AUTHOR]