Increased Serum Creatine Phosphokinase Research Articles

Acetamiprid induces cardiotoxicity in rats by dysregulating α7 nAChR and its downstream targets: The ameliorative role of resveratrol

Acetamiprid (ACP) is a novel neonicotinoid insecticide used for controlling insect pests. Resveratrol (RSV) is a natural polyphenol that possesses anti-oxidant, anti-inflammatory and anti-apoptotic actions. The current research explores the mechanism of ACP-induced cardiotoxicity and the alleviative effects of RSV. Male rats were allocated to four groups of ten each. Rats were treated daily for 90 days via oral route. Control rats received distilled water, ACP rats received 25 mg acetamiprid/kg, RSV rats received 20 mg resveratrol/kg and ACP + RSV rats received both ACP and RSV. ACP exposure increased serum creatine phosphokinase activity and cardiac troponin level. It also induced oxidative stress, as evidenced by the glutathione reduction, and malondialdehyde elevation, as well as the detrimental histopathological and immunohistochemical changes in the myocardium. Gene expression analysis revealed down-regulation in the mRNA expression of the survival-related genes α7 nAChR, Erk and Bcl-2, and up-regulation in the apoptosis-related genes Jnk, Bax and Caspase-3. Conversely, the concomitant administration of ACP with RSV alleviated most of the aforementioned toxic impacts. It can be concluded that ACP induces cardiotoxicity by dysregulating the mRNA expression of α7 nAChR and its downstream targets. Additionally, RSV is proved to be a promising ameliorative agent against ACP-induced cardiotoxicity.

Real-world effectiveness and safety of baricitinib including its effect on biomarkers and laboratory data in Japanese adult patients with atopic dermatitis: a single-center retrospective study

Baricitinib demonstrated efficacy and tolerable safety in clinical trials for atopic dermatitis (AD); however, real-world data are limited. We examined effectiveness and safety of baricitinib, and laboratory data in AD patients treated with baricitinib in our department. We also evaluated baseline clinical severity in responders and non-responders. All adult AD patients treated with baricitinib in our department between January 2021 and February 2023 were included. Data on 30 Japanese AD patients were analyzed. Objective severity scores and patient-reported outcomes improved at one and 3 months, except for the affected body surface area at 1 month. The proportions of patients who achieved eczema area and severity index-50% improvement were 30.0% (9/30) at 1 month and 53.3% (16/30) at 3 months. There were no significant changes in AD biomarkers. No significant difference was observed in baseline clinical severity between responders and non-responders. No significant changes were observed in laboratory results except for increased serum creatine phosphokinase levels at 3 months. One case of herpes zoster and one case of ocular herpes were observed. Baricitinib showed mild effectiveness and favorable safety including laboratory findings. Biomarkers did not reflect clinical improvement. Further study is needed to identify characteristics of responders.

Study of serum creatine phosphokinase (CPK) as a prognostic indicator in patients with organophosphorus compound poisoning

Organophosphorus (OP) is an easily accessible pesticide which has a high morbidity and mortality on human exposure. Serum cholinesterase (SChE) is usually used for assessing the severity of poisoning, in this study we assess the role of serum creatine phosphokinase (CPK) as an alternative prognostic marker. This was a single centred, hospital-based, prospective and observational study, conducted on 88 patients with a history of OP compound consumption who were admitted to the ICU of tertiary care hospital, from the time period October 2019 to March 2021. The patients were clinically categorized into mild, moderate and severe categories according to Peradeniya Organophosphorus Poisoning (POP) scale and before initiation of treatment, the samples were sent for estimation of SChE and serum CPK. Out of the 88 patients, OP poisoning was more common in the age group of 21-30 years and males had a higher incidence. Chlorpyriphos (62.5%) was the most common compound. A higher POP score, marked reduction in SChE levels, and increased serum CPK levels were observed to have increased the duration of hospital stay, increased the severity of poisoning, increased the need for ventilator support and also increased the mortality.

Acute renal failure with severe loin pain and patchy renal vasoconstriction in a patient with march hemoglobinuria.

Acute renal failure (ARF) with severe loin pain and patchy renal vasoconstriction is a rare syndrome described as an anaerobic exercise-induced acute kidney injury (AKI) without rhabdomyolysis. The characteristic computed tomography (CT) finding is multiple patchy wedge-shaped delayed contrast enhancement in the kidney. The syndrome is named as a clinical syndrome of ARF with severe loin pain after anaerobic exercise (ALPE). A 16-year-old Japanese boy was admitted to our hospital for vomiting and severe loin pain after Japanese fencing. He had kidney dysfunction with slightly increased serum creatine phosphokinase and was eventually diagnosed with ALPE based on the characteristic finding on delayed renal CT scans. He had no predisposing factors for ALPE, such as renal hypouricemia or analgesic use prior to the exercise; however, he had pigmenturia at the onset, which is an unusual finding for ALPE. The pigmenturia proved to be hemoglobinuria due to intravascular hemolysis, indicated by increased serum levels of indirect bilirubin and lactate dehydrogenase, an undetectable level of serum haptoglobin, and absence of red blood cells and myoglobin in the urine. The hemolysis following strenuous steps on a hard floor suggested that the phenomenon was march hemoglobinuria. Our patient is the first reported example in which ALPE developed in the setting of hemoglobinuria due to mechanical intravascular hemolysis.

Unusal Presentation of Dengue Fever as Pyomyositis

Dengue is the most common and widespread arthropod-borne arboviral infection. Symptoms include fever, headache, muscle, and joint pains, and a characteristic skin rash. Although viral myositis is common, myositis caused by the dengue virus is not commonly reported. The case of serologically confirmed dengue fever complicated by pyomyositis associated with a tenfold increase in serum creatine phosphokinase is presented.

Rabdomyolysis as a serious complication of COVID-19

<abstract> Rhabdomyolysis is an acute condition with skeletal muscle damage and release of toxins produced by myocytes with variable clinical presentation. Laboratory diagnosis is based on an increase in serum creatine phosphokinase (CPK), which can trigger irreversible renal impairment. The aim was to describe the association of COVID-19 with rhabdomyolysis as a serious complication, in order to promote early diagnosis and treatment. Case description: Female patient, 18 years old, grade 3 obesity, complaining of dry cough for 7 days, associated with continuous fever for 4 days, myalgia of the lower limbs and moderate dyspnea for 2 days, was admitted to the emergency room and sent to the Intensive Care Unit (ICU), with positive PCR-RT. After 12 hours of admission, the patient developed severe hypoxemic acute respiratory failure. On the second day of hospitalization, an exponential increase in CPK was found and measures of volume optimization were initiated. On the seventh day of hospitalization, associated with increased CPK, a decline in renal function was observed, evolving to the need for renal replacement therapy. On the ninth day of hospitalization, she presented with multiple organ dysfunction and death. In conclusion, COVID-19 can generate rhabdomyolysis by direct myocyte injury by SARS-CoV-2, an exacerbated immune response to the virus resulting in a cytokine storm with concomitant muscle damage and through direct injury by circulating viral toxins. However, as it is an uncommon manifestation and presents a nonspecific clinical condition, early diagnosis is not always performed. This conclusion was based on the case report presented and not only on the results of the literature review, since the clinical case is in accordance with the literature and can contribute to the recognition of these conditions, leading to better management in the treatment. </abstract>

Alteration in Serum Creatine Phosphokinase in Hypothyroid Female Subjects of Reproductive Age Group in an Urban Population in Eastern India: A Cross Sectional Observational Study

Background: Serum creatine phosphokinase (CPK) acts as important clinical parameter in muscle damage. Hypothyroid subjects may have elevated serum CPK level but correlation of the two is not well established till date. Aims: To assess the significance of increased serum CPK level as biochemical tool in hypothyroidism in an urban young female population of reproductive age group in eastern India. Materials & methods: This cross sectional study was conducted on 200 hypothyroid subjects in Burdwan Medical College in a period of 12 months after taking Institutional Ethical Clearance.100 subjects were enrolled in the study as control. Serum TSH, FT4 and CPK levels were estimated. The subjects were age matched. The computer software SPSS, version 16.0 was used for analyzing data. Results: Among 200 hypothyroid subjects enrolled in the study, 50 hypothyroid patients had increased Serum CPK level (25%). Significant difference was observed between control and hypothyroid subjects for mean TSH (P<0.0001), mean FT4 (P<0.0001) and mean CPK (P<0.0001).Serum CPK level was positively correlated with TSH levels (r=0.761, P<0.00001) and Serum CPK was negatively correlated with Sr. FT4(r= -0.328; P<0.00001). Conclusions: It may be concluded from our study that Hypothyroid females in reproductive age group may have significant increase in serum CPK levels as compared to normal subjects and may be considered as important biochemical tool for the screening of muscle damage in hypothyroid individuals.

The Effect of Remifentanil on Succinylcholine Induced Changes in Serum Potassium and Creatine Kinase: A Prospective Randomized Double blind Study.

Succinylcholine is still included as drugs favored by anesthetists because of its rapid onset and short duration of action. However, it can bring about complications such as hyperkalemia and increased serum creatine phosphokinase (CPK). This study aims at evaluating the effects of remifentanil on succinylcholine-induced postoperative changes in serum potassium and CPK. In this study, 59 patients with short term lower abdominal surgery were randomly divided into two groups. In the first group (control group), 2 ml normal saline was used before injecting anesthetic drugs while in the second group (study group), 1 mcg/kg of remifentanil was injected. The patients were anesthetized with a combination of fentanyl (1 mg/kg) and propofol (2 mg/kg). Besides, succinylcholine (1.5 mg/kg) was used for muscle relaxation and tracheal intubation. Serum potassium (before and 5 min after tracheal intubation), CPK (before anesthetic injection and 24 h after surgery) and hemodynamic parameters (including systolic, diastolic and mean arterial blood pressure and heart rate) were recorded. Serum levels of potassium and CPK before and after induction of anesthesia showed no significant difference in both groups. Systolic, diastolic, and mean arterial blood pressure and heart rate in both groups after induction significantly changed. Compared to saline, remifentanil significantly stabilized hemodynamic changes after intubation. The results suggest that remifentanil has no prophylactic effect on succinylcholine-induced CPK and potassium levels. However, it improves stability of hemodynamic variables.

The effect of remifentanil on succinylcholine induced changes in serum potassium and creatine kinase: a prospective randomized double blind study

Background and aim of the work:Succinylcholine is still included as drugs favored by anesthetists because of its rapid onset and short duration of action. However, it can bring about complications such as hyperkalemia and increased serum creatine phosphokinase (CPK). This study aims at evaluating the effects of remifentanil on succinylcholine-induced postoperative changes in serum potassium and CPK.Methods:In this study, 59 patients with short term lower abdominal surgery were randomly divided into two groups. In the first group (control group), 2 ml normal saline was used before injecting anesthetic drugs while in the second group (study group), 1 mcg/kg of remifentanil was injected. The patients were anesthetized with a combination of fentanyl (1 μg/kg) and propofol (2 mg/kg). Besides, succinylcholine (1.5 mg/kg) was used for muscle relaxation and tracheal intubation. Serum potassium (before and 5 min after tracheal intubation), CPK (before anesthetic injection and 24 h after surgery) and hemodynamic parameters (including systolic, diastolic and mean arterial blood pressure and heart rate) were recorded.Results:Serum levels of potassium and CPK before and after induction of anesthesia showed no significant difference in both groups. Systolic, diastolic, and mean arterial blood pressure and heart rate in both groups after induction significantly changed. Compared to saline, remifentanil significantly stabilized hemodynamic changes after intubation.Conclusions:The results suggest that remifentanil has no prophylactic effect on succinylcholine-induced CPK and potassium levels. However, it improves stability of hemodynamic variables. (www.actabiomedica.it)

Effects of dietary supplementation of the osmolyte betaine on growing pig performance and serological and hematological indices during thermoneutral and heat-stressed conditions.

The present study was designed to evaluate the effects of dietary betaine on pig performance and serological and hematological indices during thermoneutral and heat-stressed conditions. Individually housed pigs ( = 64; 39.0 ± 1.5 kg BW) were assigned within weight blocks and sex to 1 of 8 treatments. Treatments consisted of 2 environmental conditions (thermoneutral or heat-stressed) and 4 levels of betaine (0, 0.10, 0.15, and 0.20%). Room temperatures followed a daily pattern with a low of 14°C and a high of 21°C for the thermoneutral environment and a low of 28°C and a high of 35°C for the heat-stressed environment. Experimental diets were fed from d -7 (7 d prior to imposing temperature treatments; constant 21°C) until 28. Respiration rate and rectal temperature were measured on d 0, 1, 2, 3, 7, 14, 21, and 28, and blood samples were collected on d 3 and 28. Heat stress reduced ( ≤ 0.008) ADG (0.710 vs. 0.822 kg/d) and ADFI (1.81 vs. 2.27 kg/d) and increased G:F ( = 0.036; 0.391 vs. 0.365). Betaine tended to quadratically increase G:F ( = 0.071; 0.377, 0.391, 0.379, and 0.366 for 0, 0.10, 0.15, and 0.20% betaine, respectively), regardless of environment. Heat stress increased ( ≤ 0.001) respiration rate (48 vs. 23 breaths/30 s) and rectal temperature (39.47 vs. 38.94°C) throughout d 1 to 28. Betaine at 0.10% reduced rectal temperature in heat-stressed pigs but not in control pigs (interaction, = 0.040). Heat stress increased serum cysteine and triglycerides and reduced Ca, alkaline phosphatase, and lipase, regardless of day of sampling ( ≤ 0.048). Heat stress increased serum creatine phosphokinase (CPK) and K and reduced osmolarity, Na, urea N, methionine, homocysteine, the albumin:globulin ratio, and blood eosinophil count on d 3 but not on d 28 (interaction, ≤ 0.013). Heat stress increased serum Mg, globulin, creatinine, amylase, and γ-glutamyltranspeptidase and reduced , the urea N:creatinine ratio, alanine aminotransferase, NEFA, hemoglobin, hematocrit, and red blood cells on d 28 but not on d 3 (interaction, ≤ 0.034). Betaine increased serum osmolarity and NEFA and reduced CPK and K on d 3 but not on d 28 (interaction, ≤ 0.060) and increased serum creatinine and reduced amylase on d 28 but not on d 3 (interaction ≤ 0.057). Heat stress reduced growth, disturbed ion balance, and increased markers of muscle damage. Betaine had a minor impact on alleviating heat stress with the possible exception of early days of heat exposure. The beneficial effect of betaine was diminished by pig adaptation.

Burnt sugarcane harvesting is associated with acute renal dysfunction

Sugarcane harvesting has been associated with an epidemic of chronic kidney disease in Central America mainly affecting previously healthy young workers. Repeated episodes of acute kidney dysfunction are hypothesized to be one of the possible mechanisms for this phenomenon. Therefore, this exploratory study aimed to assess the acute effects of burnt sugarcane harvesting on renal function among 28 healthy non-African Brazilian workers. Urine and blood samples were collected at the beginning and at the end of the harvesting season and before and at the end of a harvesting workday. All individuals decreased their estimated glomerular filtration rate by ∼20% at the end of the daily shift, and 18.5% presented with serum creatinine increases consistent with acute kidney injury. Those changes were associated with increased serum creatine phosphokinase (a known marker for exertional rhabdomyolysis) and oxidative stress-associated malondialdehyde levels, increased peripheral blood white cell counts, decreased urinary and serum sodium, decreased calculated fractional sodium excretion, and increased urine density. Thus, burnt sugarcane harvesting caused acute renal dysfunction in previously healthy workers. This was associated with a combination of dehydration, systemic inflammation, oxidative stress, and rhabdomyolysis.

Seizure and Rhabdomyolysis: Serious Complications of Tramadol Overdose

To the Editor; Tramadol, a synthetic opioid is mainly used to treat acute and chronic pain. Although this drug is not an over-the-counter medication, it has been illicitly accessible to and abused by opium addicts (1-3). Studies showed excessive and widespread use of tramadol in Iran (1-4). Tramadol may cause constipation, drowsiness, tachycardia and respiratory distress, while the most severe complications of tramadol overdose include refractory seizures, rhabdomyolysis and renal failure (1-5). These serious complications may occur in sequence in tramadol overdose, as seizure can induce rhabdomyolysis, and renal failure mostly results from rhabdomyolysis (2,3). It has been reported that seizure develops in approximately one-third of cases with tramadol overdose (1,3,4). Rhabdomyolysis is likely to occur following multiple seizures (2,5). Clinical diagnostic triad of rhabdomyolysis is muscle weakness, muscle pain and dark urine (6,7). Presence of myoglobinuria is highly suggestive of rhabdomyolysis, though it is not adequately sensitive. The level of serum creatine phosphokinase (CPK) has been considered as the most reliable diagnostic test for rhabdomyolysis (6). Over 5 times increase in serum CPK in the presence of muscular symptoms, establishes the diagnosis of rhabdomyolysis (6). Among poisonings, the most common causes of rhabdomyolysis are opium, alcohol and tramadol (2,3,5,7). Rhabdomyolysis results in rise of CPK, hyperkalemia, arrhythmia, disseminated intravascular coagulation and renal failure. Highly increased CPK has been shown to be related to rise of serum creatinine and subsequently renal failure (6). Rhabdomyolysis can be treated by aggressive hydration and sodium bicarbonate (6). The overall prognosis depends on rapidness of diagnosis and treatment (6,7) For patients with tramadol-induced seizures and highly increased CPK, the possibility of development of rhabdomyolysis should always be taken into account.

Alcohol stress on cardiac tissue – Ameliorative effects of Thespesia populnea leaf extract

BackgroundCells are naturally equipped with antioxidant defenses to counterbalance free radical production. Overproduction of free radicals is one of the reasons for a variety of diseases. The current investigation was planned to evaluate chronic alcohol- (for 30 days) induced oxidative stress in the cardiac tissue of rat and to explore the effectiveness of Thespesia populnea (TP)-induced cardio-protection in rat heart by utilizing an in vivo model of cardiac injury by alcohol. MethodsTen groups of rats were maintained and were divided into different groups. Alcohol 20% was administered and Thespesia leaf extracts (TPE) were administered at a dose of 250mg/kg to chronic alcoholic rats for 30 days. The heart tissue was isolated and processed for further analysis, and also blood for estimation of blood alcohol level and serum creatine phosphokinase (CPK). The activities/levels of antioxidant enzymes, malondialdehyde (MDA), and protein carbonyls (PC) were estimated using established protocols. Histopathology was performed as evidence for the work and to establish the results. ResultsActivities of antioxidant enzymes like superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPx), glutathione reductase (GR), and reduced glutathione content (GSH) showed a decrease, while glutathione-S-transferase (GST) activity, MDA, and PC recorded an elevation due to alcohol treatment in the cardiac tissue compared to the control rats. Alcohol-induced myocardial injury was observed, indicated by a significant increase in serum CPK, a well-known biomarker of myocardial injury, and histopathological evidence supported these observations by revealing predominantly extensive edema with vacuolization and severe necrosis. ConclusionTreatment with TPE confers protection on the heart tissue during alcohol-induced oxidative stress, and thereby minimizes oxidative damage to the cardiac tissue as clearly marked in histopathology.

Reactive oxygen species in saliva related acute myocardial infarction

Acute myocardial infarction (AMI) is a highly dynamic event, associated with increasing production of reactive oxygen species (ROS). The imbalance between ROS production and antioxidative defenses, leads to a condition known as oxidative stress that may increase cellular damage. We investigated the presence of an oxidative stress biomarker in saliva of patients after AMI. A prospective study was undertaken. AMI was characterized by laboratory (increased serum creatine phosphokinase (CPK) and troponin T), clinical (chest pain &gt;; 20 minutes at rest) and electrocardiographic (changes in ST/T at least in two contiguous leads) criteria. At 24 and 48 hours, 2′7′ dichlorohydrofluorescein diacetate (DCFH‐DA) levels (spectrofluorimetry), a ROS index generation capacity, were assessed in saliva. Fifteen adult patients were admitted to our hospital with AMI and 12 healthy subjects, as controls. AMI patients showed serum CPK24&gt;;CPK48 (t=3.29 p&lt;0.006). In saliva, AMI group showed &gt;; DCFH‐DA levels (t =3.295; p&lt;0.003) that remained unchanged at 48 hours. In this preliminary study, AMI causes an increase of ROS which was detected in saliva by DCFH‐DA assay. Awarded by UBACyT 2011–2014, C001 and 20020100100613.

A Case of McLeod Phenotype of Neuroacanthocytosis Brain MR Features and Literature Review

Huntington's disease and neuroacanthocytosis may present similar clinical and MRI features. It is important to differentiate these findings since treatment and prognosis vary vastly between them. The aim of this article is to familiarize radiologists with the differentiating features of Huntington's disease and various diseases comprising neuroacanthocytosis. A 40-year-old Indian man with extrapyramidal symptoms was referred for MRI. The clinical diagnosis was Huntington's disease, but there were a few atypical clinical features such as a history of biting the tongue, tics, marked hyporeflexia and lower limb muscle wasting. MR showed atrophy of the caudate nucleus and putamen with iron deposition in the basal ganglia, which can be seen in Huntington's disease and in neuroacanthocytosis. An increased blood acanthocyte level was subsequently confirmed. Further work-up revealed increased serum creatine phosphokinase levels, normal serum lipoprotein levels and depressed K cell antigen activity on serological studies, confirming the diagnosis of McLeod syndrome. McLeod syndrome is one of the distinct phenotypes of neuroacanthocytosis. Neuroacanthocytosis is a group of disorders with increased serum acanthocyte counts and neurological involvement. Various causes of neuroacanthocytosis are discussed. It is important to consider the possibility of neuroacanthocytosis when features typical of Huntington's disease are encountered on imaging.

Polymyositis as presenting manifestation of gallbladder carcinoma: A case report

INTRODUCTIONInflammatory myositis as a paraneoplastic presentation of gallbladder cancer is an extremely rare event. In this paper we reported the first case of gallbladder carcinoma presented as polymyositis. PRESENTATION OF CASEA 68-year-old housewife presented with proximal muscles weakness, pain, significant decrease in force of proximal muscles, and globally decreased deep tendon reflexes. Laboratory studies revealed an anemia, increased acute phase reactants and increased serum creatine phosphokinase (CPK) levels. Electromyography (EMG) and nerve conduction velocity test (NCV) demonstrated mild myopathic changes. Muscle biopsy was suggestive for polymyositis. Corticosteroid therapy initiated and a meticulous search for probable underlying malignancy performed concurrently. Malignancy workup finally revealed a gallbladder tumor. Patient candidated for extended cholecystectomy. Pathologic evaluation of gallbladder tumor demonstrated a moderately differentiated carcinoma. Progressive improvement in clinical conditions and complete normalization of laboratory parameters occurred post-operatively. After 8 months of follow-up patient is still alive and in good state of health. There is no evidence of metastatic or local recurrence of tumor. Musculoskeletal complaints subsided completely. DISCUSSIONGallbladder carcinoma is a rare and usually aggressive malignancy. Its primary presentation by paraneoplastic syndromes especially in the form of paraneoplastic neurological syndromes is an extremely rare event. Some believes that increased association between inflammatory myopathy and malignancy is limited to the dermatomyositis; however, presentation of our patient as polymyositis is contrary to this. This is the first reported case of gallbladder cancer who presented with polymyositis. CONCLUSIONGallbladder cancer though rare, should be considered in patients with inflammatory myositis.

Increased Serum Creatine Phosphokinase in a Child With Bruising Due to Physical Abuse

Bruising is a frequent and often sentinel injury in children who are victims of physical abuse. Children who are evaluated in an emergency department for bruising, which may be due to abuse, present a challenge to physicians; the injuries themselves are medically minor and their severity can only be described qualitatively with photographs. Nonetheless, bruising in an infant or bruising in unusual locations in young children can indicate violence and risk. These children also present a challenge to the Child Protective Services system because the injuries generally resolve quickly without medical treatment and do not result in long-term sequelae. Creatine phosphokinase (CPK) is released from injured muscle and results in increased serum CPK concentrations. We report on a case of isolated bruising due to child physical abuse in which serum CPK concentrations were markedly increased, demonstrating clinically unsuspected rhabdomyolysis. The increased serum CPK concentrations provided important quantitative information about the seriousness of the bruising. A subsequent chart review of children evaluated by our hospital's child protection team for isolated bruising during a 6-year period demonstrated that there were other children with bruising due to abuse who also had increased serum CPK concentrations. This information suggests that increased serum CPK in children with bruising due to abuse may be more common than previously thought and that this information may have the potential to be used to provide quantitative, objective information about the seriousness of the bruising. We recommend that physicians consider measuring serum CPK in children with bruising due to physical abuse.

Effect of 2 days of intensive resistance training on appetite‐related hormone and anabolic hormone responses

This study was designed to determine endocrine responses during 2days of strenuous resistance training. Ten healthy men performed resistance training twice a day for two successive days to induce acute fatigue (excessive physical stress). The resistance training consisted of four exercises for the lower body in the morning and seven exercises for the upper body in the afternoon. Maximal isometric and isokinetic strengths were measured from day 1 (before the training period) to day 3 (after the training period). Fasting blood samples were taken on days 1-3. Maximal isometric and isokinetic strengths significantly decreased with two successive days of training (P<0·05), with significant increases in serum creatine phosphokinase and myoglobin concentrations (P<0·05). Significant reductions in the fasting concentrations of serum insulin-like growth factor-1, free testosterone, insulin and high-molecular-weight adiponectin were observed on day 3 (P<0·05), whereas there were no changes in the serum cortisol concentration or the free testosterone/cortisol ratio. Plasma active ghrelin and serum leptin concentrations decreased by -20·7±2·8% and -29·6±4·1%, respectively (P<0·05). Two days strenuous resistance training significantly affects the profiles of anabolic hormone and endocrine regulators of appetite and energy balance, such as ghrelin and leptin. The present findings suggest that decreased ghrelin and leptin concentrations might reflect excessive physical stress and may be early signs of accumulated fatigue.

Diagnostic Work-Up and Risk Stratification in X-Linked Dilated Cardiomyopathies Caused by Dystrophin Defects

We sought to describe the diagnostic work-up, phenotype, and long-term evolution of dilated cardiomyopathy (DCM) associated with Dystrophin (DYS) defects. X-linked DCM associated with DYS defects can be clinically indistinguishable from other types of DCM. The series comprises 436 consecutive male patients diagnosed with DCM. Patients underwent endomyocardial biopsy (EMB). Genetic testing employed multiplex polymerase chain reaction and multiple ligation dependent probe assay for deletions and direct sequencing of the 79 exons and flanking regions of the gene for point mutations or small rearrangements. We identified DYS defects in 34 of 436 patients (7.8%) (onset age 34 ± 11 years, age range 17 to 54 years); 30 had proven X-linked inheritance. The 2 phenotypes included DCM with mild skeletal myopathy and/or increased serum creatine phosphokinase (n = 28) or DCM only (n = 6). The EMB showed defective dystrophin immunostain. The DYS defects consisted of 21 in-frame deletions and 11 out-of-frame deletions as well as 1 stop and 1 splice-site mutation. During a median follow-up of 60 months (interquartile range: 11.25 to 101.34 months) we observed 17 events, all related to heart failure (HF) (median event-free survival: 83.5 months). Eight patients (23%) underwent transplantation, and 9 (26%) died of HF while waiting for transplantation. Eight patients received an implantable cardioverter-defibrillator, although none had device intervention during a median follow-up of 14 months (interquartile range: 5 to 25 months). No patient died suddenly, suffered syncope, or developed life-threatening ventricular arrhythmias. DYS-related DCM should be suspected in male patients with increased serum creatine phosphokinase (82%) and X-linked inheritance. The disease shows a high risk of end-stage HF but a lower risk of life-threatening arrhythmias.

Cerebromalacia with Epilepsy and Cortical Blindness in a Laboratory Japanese Macaque (Macaca fuscata)

The authors performed a pathological examination of a 5-year-old female laboratory Japanese monkey who developed cortical blindness and epileptic seizures. Generalized, tonic-clonic seizures started to occur during behavioral training to get the animal to enter a carrying cage for future psychological experiments. Blindness was suspected because of a lack of approaching behavior toward foods such as fruits. Although the monkey was extensively treated with anticonvulsants, the clinical signs did not improve. An increased serum creatine phosphokinase (CPK) level and bilateral occipital brain atrophy were detected. Histopathologically, a severe degree of cerebromalacia was detected bilaterally in the occipital lobe, and necrosis and gliosis were seen mainly in the temporal lobe. Focal inflammation was found in the meninges. No other changes were observed in other nervous tissues or organs, and no signs of a parasitic or viral infection were found in the systemic organs. Spontaneously occurring lesions in the central nervous system have been rarely reported in laboratory monkeys. In the present case, the cause of cerebromalacia could not be confirmed, but the relationship between symptoms such as abnormal vision and the presence of brain lesions was distinct. The authors believe that this case is a valuable historical control case for the laboratory Japanese macaque.