Serum Myoglobin Research Articles

Nimbolide prevents myocardial damage by regulating cardiac biomarkers, antioxidantlevel, and apoptosis signaling against doxorubicin-induced cardiotoxicity in rats.

The current work planned to assess the protecting properties of nimbolide against doxorubicin (DOX)-treated myocardial damage. Myocardial damage was produced with2.5 mg/kg of DOX given onalternative days (14 days). Thiobarbituric acid reactive substances (TBARS) levels of alipid peroxidative marker were elevated, whereas reduced body weight, heart weight, blood pressure indices and reduced levels of antioxidants like glutathione-S-transferase, superoxide dismutase, catalase, glutathione peroxidase, glutathione, and glutathione reductase were observed in the heart tissue of DOX-treated animals. DOX-treated animalsshowedaugmented levels of cardiac markers likes monocyte chemotactic protein-1, interferon-gamma, aspartate transferase, creatine kinase, lactate dehydrogenase, creatine kinase-muscle/brain, heart-type fatty acid-binding protein, glycogen phosphorylase isoenzyme BB, transforming growth factor-β, brain natriuretic peptide, myoglobin, and cTnI in serum. Histopathological assessment confirmed the DOX-induced cardiotoxicity. Furthermore, DOX-induced rats showed augmented inflammatory mediators (nuclear factor-κB [NF-kB], tumor necrosis factor-α [TNF-α], and interleukin-1β [IL-1β]) and increased PI3K/Akt signaling proteins (PI3K, p-Bad/Bad, caspase-3, and p-Akt), whereas decreased oxidative markers (HO-1 and NQO-1) and p-PTEN were observed. Nimbolide-supplemented rats showed reduced activity/levels of cardiac markers and TBARS levels in serum and heart tissue. Levels of enzymatic and nonenzymatic antioxidants were augmented in the heart tissue of nimbolide-supplemented rats. Nimbolide influence decreased apoptosis, inflammation, and enhanced antioxidant markers through the modulation of p-Bad/Bad, caspase-3, PI3K, p-Akt, TNF-α, NF-kB, IL-1β, HO-1, NQO-1, and p-PTEN markers. The histopathological explanations were observed to be in line with biochemical analysis. Therefore, the findingof current work wasthat nimbolide has a defensiveeffect onthe myocardium against DOX-induced cardiac tissue damage.

Sinapic acid safeguards cardiac mitochondria from damage in isoproterenol-induced myocardial infarcted rats.

Myocardial infarction (MI) is a life-threatening disease. In this study, we examined the anti-mitochondrial damaging effects of sinapic acid (SA) in isoproterenol (ISO)-induced myocardial infarcted rats. Myocardial infarcted rats were prepared by injecting ISO (100 mg/kg body weight) on the 9th and 10th day. Rats were pretreated and cotreated with SA (12 mg/kg body weight) orally, daily for 10 days. A considerable increase in serum lactate dehydrogenase, creatine kinase, myoglobin, and cardiac troponin-T was noticed in the ISO-induced rats. ISO also significantly amplified lipid peroxidation and calcium ions, and depleted the antioxidant system and mitochondrial enzymes in rat's heart mitochondria. SA treatment improved the distorted above- mentionedbiochemical parameters in ISO-treated rats withits anti-mitochondrial damaging effects. Thisultrastructural study on heart mitochondria and in vitro studies also confirmed the effects of SA. The current findings are suggestive of SA's cardioprotective effects.

Evaluation Of Muscle Swelling After Concentric Muscle Contraction Using Bioelectrical Impedance Analysis

Resistance exercise using concentric and eccentric muscle contraction (i.e., dumbbell curl exercise) decreased significantly bioelectrical impedance analysis (BIA) (Atsuta et al. 2019). However, the influence of muscle contraction type on exercise-induced BIA change remains unclear. PURPOSE: The purpose of the present study was to examine time course changes in muscle swelling evaluated by BIA following concentric-muscle contraction. METHODS: Nine male subjects (20.0 ± 0.8 yrs, 175.4 ± 2.4 cm, 65.2 ± 6.3 kg) performed isokinetic (60 deg/s) concentric knee extension (6 repetitions × 10sets, 60 s rest period between sets). Before and during 24 h of post-exercise, time course changes in BIA (locally evaluated BIA for vastus lateralis muscle), maximal voluntary contraction (MVC) of knee extension exercise, muscle thickness (evaluated by ultrasound) for vastus lateralis muscle and thigh circumference were evaluated. Blood samples were also drawn to investigate blood lactate, serum creatine kinase (CK) and myoglobin levels. RESULTS: Blood lactate and CK levels were significantly increased after exercise (P<0.05). Moreover, the MVC was significantly decreased immediately after exercise (before exercise: 269.2 ± 30.4 Nm, immediately after exercise: 233.6 ± 28.7 Nm, P<0.05). However, BIA value, muscle thickness and circumference did not change significantly after the exercise (p>0.05 for all variables). CONCLUSIONS: Resistance exercise consisting of concentric muscle contraction did not affect local BIA. The finding was not consistent with that in our previous study using the resistance exercise consisting of both concentric and eccentric muscle contraction.

Characterization Of Normal Biomarkers Of Muscle Damage In Collegiate Athletes

Exertional rhabdomyolysis is a serious clinical condition in which skeletal muscle is rapidly broken down, potentially leading to life-threatening systemic complications. Clinicians often diagnose rhabdomyolysis based on elevations in circulating creatine phosphokinase (CPK) and symptomology. Normal CPK and other biomarker concentrations following intense exercise are unknown. PURPOSE: This study aimed to determine reference concentrations for selected biomarkers that suggest muscle damage in athletes and examine the time-course of muscle damage biomarker responses after strenuous exertion. METHODS: 20 collegiate NCAA I football players were enrolled in the study. Serum and urine samples were collected immediately and 24 hours post strenuous practice (0h and 24h, resp). Serum samples were analyzed for biomarkers of muscle damage including a Chem26 metabolic and chemistry panel and myoglobin. Urine samples were analyzed for creatinine and myoglobin concentrations. Participants were also given Physical Symptoms Questionnaires to obtain subjective measures of symptoms that may be related to severe muscle damage, or rhabdomyolysis. RESULTS: A total of 28 samples were collected with 9 repeats. CPK levels were elevated at 0h (958.2 ± 544.1 IU/L), but trended down 24h post practice (751.0 ± 410.5IU/L, p=0.059). LDH was acutely elevated at 0h (217.9 ± 30.6 IU/L) compared to the 24h timepoint (170.3 ± 35.5 IU/L, p<0.0001). Average serum myoglobin was higher post-practice (1.31 ± 1.57 ng/mL), but decreased 24 h post-exercise (0.36 ± 0.71 ng/mL, p<0.001). Similarly, urine creatinine concentrations were higher 0h post practice (390.1 ± 164.2 mg/mL), and decreased 24h post (214.2 ± 99.4 mg/dL, p<0.0001). Urine myoglobin was also elevated at 0h post practice (18.18 ± 36.7 ng/mL), but decreased 24h post (0.66 ± 1.43 ng/mL, p=0.001). The Physical Symptoms Questionnaires did not reveal any symptoms related to severe muscle damage. CONCLUSION: Biomarkers of muscle damage were elevated immediately post strenuous exercise, but dropped 24 hours post-practice. Serum and urine biomarkers of muscle damage collected immediately post strenuous exercise are unlikely to be specific markers of rhabdomyolysis, but rather of transient exercise-induced muscle damage in a highly trained athletic population.

A dual role of cumin-seed extract towards the silver nanoparticle synthesis and stabilisation and its potential for antibacterial and anticancer activities through oxidative damage

The usual procedures for synthesising metal nanoparticles need sophisticated and expensive instruments or high-priced chemicals which are environmentally unsafe. Therefore, we used our assay green method for synthesising silver nanoparticles (AgNPs). The method is simple, convenient and eco-friendly. Silver nanoparticle was synthesised using cumin seeds (Cuminum cyminum) as both reducing and capping agents. Synthesised nanoparticle was characterised using UV–vis spectroscopy, XRD, DLS, TEM, SEM and FTIR analyses and the formation of 9–17 nm round shaped nanoparticles was established. Biochemical activities have been studied by affinity towards proteins (bovine serum albumin, human serum albumin and myoglobin), antimicrobial and cytotoxic activities. The result showed that the synthesised nanoparticles have affinity towards protein molecules and show positively unsympathetic antibacterial activity to Gram-positive (Staphylococcus aureus) and Gram-negative (Escherichia coli) bacteria. Cytotoxic activity against Hep–2 cell line by the formation of reactive oxygen was also confirmed.

Polygenic Profile and Exercise-Induced Muscle Damage by a Competitive Half-Ironman.

Del Coso, J, Salinero, JJ, Lara, B, Gallo-Salazar, C, Areces, F, Herrero, D, and Puente, C. Polygenic profile and exercise-induced muscle damage by a competitive half-ironman. J Strength Cond Res 34(5): 1400-1408, 2020-To date, it is still unknown why some individuals develop higher levels of muscle damage than other individuals, despite participating in exercise with comparable levels of physical intensity. The aim of this investigation was to analyze 7 single-nucleotide polymorphisms (SNPs) that are candidates to explain individual variations in the level of muscle damage attained during a half-ironman competition. Using the model of Williams and Folland (2, 1, and 0 points for optimal, intermediate, and suboptimal genotype), we determined the total genotype score from the accumulated combination of 7 SNPs (ACE = 287bp Ins/Del; ACTN3 = p.R577X; creatine kinase, muscle type = NcoI; insulin-like growth factor 2 = C13790G; interleukin-6 = 174G>C; myosin light chain kinase = C37885A; and tumor necrosis factor-α = 308G>A) in 22 experienced triathletes. Before and after the race, a sample of venous blood was obtained to measure serum markers of muscle damage. Two groups of triathletes were established according to their postcompetition serum CK concentration: low CK responders (n = 10; 377 ± 86 U·L) vs. high CK responders (n = 12; 709 ± 136 U·L). At the end of the race, low CK responders had lower serum myoglobin concentrations (384 ± 243 vs. 597 ± 293 ng·ml, p = 0.04). Although the groups were similar in age, anthropometric characteristics, and training habits, total genotype score was higher in low CK responders than in high CK responders (7.7 ± 1.1 vs. 5.5 ± 1.1 point, p < 0.01). A favorable polygenic profile can contribute to reducing the level of muscle damage developed during endurance exercise.

Bimetallic MnCo oxide nanohybrids prepared from Prussian blue analogue for application as impedimetric aptasensor carrier to detect myoglobin

The accurate detection of myoglobin (Myo) in human serum plays a crucial role in early diagnosis of acute myocardial infarction. This work presents a novel impedimetric aptasensor for sensitive and selective detection of Myo, in which bimetallic MnCo oxide nanohybrids (represented by MnOxCoOy) were used as platforms for anchoring Myo aptamer strands. A series of MnOxCoOy nanohybrids were prepared from bimetallic MnCo-based Prussian blue analogue (PBA) nanocubes via calcination at different temperatures under N2 atmosphere. Basic characterizations revealed that homogeneously-distributed MnOx and CoOy nanoparticles were achieved at 500 °C (MnOxCoOy,500) calcination, which immensely enhanced the electrochemical conductivity in addition to boosting the aptamer immobilization. Compared with the pristine MnCo-PBA-based aptasensor, the MnOxCoOy,500-based aptasensor exhibited higher sensitivity and selectivity for Myo detection, with lower detection limit of 0.56 fg·mL−1 (0.034 fM) in a wide dynamic range of 0.01~2000 pg·mL−1, which is the most sensitive among similar previously reported Myo sensors. Moreover, the constructed MnOxCoOy,500-based aptasensor displayed good stability, excellent reproducibility and acceptable applicability in human serum. The proposed strategy establishes a remarkable platform for the construction of aptasensor that is feasible for the Myo detection in a real human serum sample.

Elevated serum myoglobin levels at hospital admission and the risk of early death among patients with hemophagocytic lymphohistiocytosis: evidence from 155 pediatric patients

Patients with hemophagocytic lymphohistiocytosis (HLH) have high risk of early mortality. The purpose of this study was to test the hypothesis that the elevated level of serum myoglobin among patients with HLH is associated with disease severity and increased risk of mortality. We retrospectively investigated the serum myoglobin levels from 155 pediatric patients diagnosed with HLH in the Hunan Children's Hospital, China. The levels of myoglobin and creatine kinase at hospital admission among non-survivors and survivors were compared. The myoglobin level was dichotomized for the estimation of hazard ratio (HR) for mortality. Patients who died within 7 and 30days of hospitalization had significantly higher myoglobin levels than did survivors (p < 0.05). The myoglobin level was negatively associated with the days of survival among non-survivors (Spearman correlation coefficient = - 0.29, p = 0.04). An elevated myoglobin level (> 90ng/mL) was significantly associated with increased mortality (unadjusted HR = 2.66, 95%CI: 1.41, 5.00, p = 0.0024) and persisted after adjusting for age, Epstein-Barr virus infection, admission department, acute kidney injury, myocardial damage, and shock. In conclusion, an elevated serum myoglobin level was associated with increased risk of early death among pediatric patients with HLH, suggesting the potential of myoglobin to be used as a reference indicator for monitoring and managing of HLH.

Clinical analysis of risk factors for severe patients with novel coronavirus pneumonia

Objective To analyze the clinical features of patients with coronavirus disease 2019 (COVID-19) in Shanghai and to investigate the risk factors for disease progression to severe cases. Methods The clinical data of 292 adult patients with COVID-19 hospitalized in Shanghai Public Health Clinical Center from January 20, 2020 to February 10, 2020 were retrospectively analyzed, including 21 severe patients and 271 mild patients. The demographic characteristics, epidemiological history, history of underlying diseases and laboratory examinations were compared between the two groups. Measurement data were compared using t test or Mann-Whitney U test. The count data were compared using hi-square test. The binary logistic regression equation was used to analyze the risk factors for the progression of patients to severe cases. Results Among the 292 patients, 21 were severe cases with the rate of 7.2% (21/292). One patient died, and the mortality rate was 4.8% in severe patients. The severe patients aged (65.0±15.7) years old, 19 (90.5%) were male, 11 (52.4%) had underlying diseases, 7 (33.3%) had close relatives diagnosed with COVID-19. The mild patients aged (48.7±15.7) years old, 135 (49.8%) were male, 74 (27.3%) had underlying diseases, 36 (13.3%) had close relatives diagnosed with COVID-19. The differences between two groups were all significant statistically (t=-4.730, χ2=12.930, 5.938 and 4.744, respectively, all P<0.05). Compared with the mild patients, the levels of absolute numbers of neutrophils, alanine aminotransferase, aspartate aminotransferase, lactate dehydrogenase, creatinine, serum cystatin C, C reactive protein (CRP), procalcitonin , D-dimer, pro-B-type natriuretic peptide (proBNP), serum myoglobin, creatine kinase (CK), creatine kinase isoenzyme (CK-MB), serum troponin I (cTnI) in severe patients were all significantly higher (U=2 091.5, 1 928.0, 1 215.5, 729.0, 1 580.5, 1 375.5, 917.5, 789.5, 1 209.0, 1 434.0, 638.0, 964.5, 1 258.0 and 1 747.5, respectively, all P<0.05), while the levels of lymphocyte count, albumin, transferrin, CD3+ T lymphocyte count, CD8+ T lymphocyte count and CD4+ T lymphocyte count in severe patients were all significantly lower (U=1 263.5, t=4.716, U=1 214.0, 962.0, 1 167.5 and 988.0, respectively, all P<0.05). Further logistic regression analysis showed that the albumin (odds ratio (OR)=0.806, 95%CI 0.675-0.961), CRP (OR=1.016, 95%CI 1.000-1.032), serum myoglobin (OR=1.010, 95%CI 1.004-1.016), CD3+ T lymphocyte count (OR=0.996, 95%CI 0.991-1.000) and CD8+ T lymphocyte count (OR=1.006, 95%CI 1.001-1.010) at admission were independent risk factors for the progression of COVID-19 patients to severe illness (all P<0.05). Conclusions Severe cases of patients with COVID-19 in Shanghai are predominantly elderly men with underlying diseases. Albumin, CRP, serum myoglobin, CD3+ T lymphocyte count and CD8+ T lymphocyte count could be used as early warning indicators for severe cases, which deserve more clinical attention. Key words: Coronavirus infection; Pneumonia; 2019 novel coronavirus; Severe case; Risk factor

Short- and long-term renal outcomes following severe rhabdomyolysis: a French multicenter retrospective study of 387 patients

BackgroundRhabdomyolysis is a life-threatening disease that can lead to severe hyperkalemia, acute kidney injury (AKI) and hypovolemic shock. The predictive factors of AKI and acute to chronic kidney disease (CKD) transition remain poorly described.MethodsThis multicenter retrospective study enrolled 387 patients with severe rhabdomyolysis (CPK > 5000 U/L). Primary end-point was the development of severe AKI, defined as stage 2 or 3 of KDIGO classification. Secondary end-points included the incidence of AKI to CKD transition.ResultsAmong the 387 patients, 315 (81.4%) developed AKI, including 171 (44.1%) with stage 3 AKI and 103 (26.6%) requiring RRT. Stage 2–3 AKI was strongly correlated with serum phosphate, potassium and bicarbonate at admission, as well as myoglobin over 8000 U/L and the need for mechanical ventilation. 42 patients (10.8%) died before day 28. In the 80 patients with available eGFR values both before and 3 months after the rhabdomyolysis, the decrease in eGFR (greater than 20 mL/min/1.73 m2 in 23 patients; 28.8%) was correlated to the severity of the AKI and serum myoglobin levels > 8000 U/L at admission.ConclusionsSevere rhabdomyolysis leads to AKI in most patients admitted to an ICU. Mechanical ventilation and severity of the rhabdomyolysis, including myoglobin level, are associated with the risk of stage 2–3 AKI. The long-term renal decline is correlated to serum myoglobin at admission.

Multiple trauma including pelvic fracture with multiple arterial embolization: an autopsy case report

BackgroundPelvic fracture with high energy trauma has a high mortality rate, especially in men. In addition, severe multiple trauma, major hemorrhage, and administration of red blood cells predict mortality in elderly patients with pelvic fracture. We herein report a rare case in which multiple arterial embolization occurred after pelvic fracture.Case presentationAn 83-year-old male cyclist was transported to our hospital after being struck by a car. On arrival, he was diagnosed with multiple trauma, including rib fractures with hemothorax, lumbar fractures of the transverse process, and injuries in the right acetabulum, left adrenal gland, and liver. He underwent massive transfusion and transcatheter arterial embolization due to extravasation from the right superior gluteal artery and left adrenal gland. On the second day, owing to right lower leg ischemia, serum creatinine kinase and myoglobin levels were markedly elevated from the reference value; hence, a right above-knee amputation was performed 12 h after the accident. However, both protein levels remained high after amputation, resulting in acute renal injury, which was treated via hemodiafiltration on hospital day 3. In addition, sustained low efficiency hemodialysis and plasma exchange were performed on hospital day 4. Despite these treatments, the patient’s hemodynamics did not improve, and he died on hospital day 8. The autopsy revealed necropsy of the iliopsoas muscles and the digestive tract.ConclusionsThe causes of the patient’s death were considered to be persistent rhabdomyolysis and severe hypotension due to iliopsoas necrosis and peritonitis due to digestive tract necrosis. Multiple arterial embolization caused by consumption coagulopathy associated with multiple trauma may account for severe outcomes in this case.

Resistance exercise causes greater serum hepcidin elevation than endurance (cycling) exercise.

BackgroundHepcidin is an iron regulating hormone, and exercise-induced hepcidin elevation is suggested to increase the risk of iron deficiency among athletes.ObjectiveWe compared serum hepcidin responses to resistance exercise and endurance (cycling) exercise.MethodsTen males [mean ± standard error: 172 ± 2 cm, body weight: 70 ± 2 kg] performed three trials: a resistance exercise trial (RE), an endurance exercise trial (END), and a rest trial (REST). The RE consisted of 60 min of resistance exercise (3−5 sets × 12 repetitions, 8 exercises) at 65% of one repetition maximum, while 60 min of cycling exercise at 65% of was performed in the END. Blood samples were collected before exercise and during a 6-h post-exercise (0h, 1h, 2h, 3h, 6h after exercise).ResultsBoth RE and END significantly increased blood lactate levels, with significantly higher in the RE (P < 0.001). Serum iron levels were significantly elevated immediately after exercise (P < 0.001), with no significant difference between RE and END. Both the RE and END significantly increased serum growth hormone (GH), cortisol, and myoglobin levels (P < 0.01). However, exercise-induced elevations of GH and cortisol were significantly greater in the RE (trial × time: P < 0.001). Plasma interleukin-6 (IL-6) levels were significantly elevated after exercise (P = 0.003), with no significant difference between the trials. Plasma hepcidin levels were elevated after exercise (P < 0.001), with significantly greater in the RE (463 ± 125%) than in the END (137 ± 27%, P = 0.03). During the REST, serum hepcidin and plasma IL-6 levels did not change significantly.ConclusionResistance exercise caused a greater exercise-induced elevation in hepcidin than did endurance (cycling) exercise. The present findings indicate that caution will be required to avoid iron deficiency even among athletes in strength (power) types of events who are regularly involved in resistance exercise.

Supplementation with a Mango Leaf Extract (Zynamite®) in Combination with Quercetin Attenuates Muscle Damage and Pain and Accelerates Recovery after Strenuous Damaging Exercise.

Prolonged or unusual exercise may cause exercise-induced muscle damage (EIMD). To test whether Zynamite®, a mango leaf extract rich in the natural polyphenol mangiferin, administered in combination with quercetin facilitates recovery after EIMD, 24 women and 33 men were randomly assigned to two treatment groups matched by sex and 5 km running performance, and ran a 10 km race followed by 100 drop jumps to elicit EIMD. One hour before the competition, and every 8 h thereafter for 24 h, they ingested placebo (728 mg of maltodextrin) or 140 mg of Zynamite® combined with 140 mg of quercetin (double-blind). Although competition times were similar, polyphenol supplementation attenuated the muscle pain felt after the competition (6.8 ± 1.5 and 5.7 ± 2.2 a.u., p = 0.035) and the loss of jumping performance (9.4 ± 11.5 and 3.9 ± 5.2%, p = 0.036; p = 0.034) and mechanical impulse (p = 0.038) 24 h later. The polyphenols attenuated the increase of serum myoglobin and alanine aminotransferase in men, but not in women (interaction p < 0.05). In conclusion, a single dose of 140 mg Zynamite® combined with 140 mg of quercetin, administered one hour before competition, followed by three additional doses every eight hours, attenuates muscle pain and damage, and accelerates the recovery of muscle performance.

Exercise-Induced Muscle Damage and Cardiac Stress During a Marathon Could be Associated with Dietary Intake During the Week Before the Race

Adequate food intake is important prior to endurance running competitions to facilitate adequate exercise intensity. However, no investigations have examined whether dietary intake could prevent exercise-induced muscle damage (EIMD) and cardiac stress (EICS). Thus, this study’s objective was to determine the associations between EIMD, EICS and endurance athlete diets one week before a marathon race. Sixty-nine male runners participated in this study. Food intake during the week prior to the race was collected through a seven-day weighed food record. Dietary intake on race day was also recorded. At the end of the marathon, blood samples were drawn to determine serum creatine kinase (CK) and myoglobin, and muscle–brain isoform creatine kinase (CK-MB), prohormone of brain natriuretic peptide (NT-proBNP), cardiac troponin I (TNI), and cardiac troponin T (TNT) concentration as markers of EIMD and EICS, respectively. To determine the association between these variables, a stepwise regression analysis was carried out. The dependent variable was defined as EIMD or EICS and the independent variables were defined as the number of servings within each different food group. Results showed that the intake of meat during the previous week was positively associated with post-race CK (Standardized Coefficients (β) = 0.643; p < 0.01) and myoglobin (β = 0.698; p < 0.001). Vegetables were negatively associated the concentration of post-race CK (β = −0.482; p = 0.002). Butter and fatty meat were positively associated with NT-proBNP (β = 0.796; p < 0.001) and TNI (β = 0.396; p < 0.001) post-marathon values. However, fish intake was negatively associated with CK (β = −0.272; p = 0.042), TNI (β = −0.593; p < 0.001) and TNT (β = −0.640; p = 0.002) post-marathon concentration. Olive oil was negatively associated with TNI (β = −0.536; p < 0.001) and TNT (β = −0.415; p = 0.021) values. In conclusion, the consumption of meat, butter, and fatty meat might be associated with higher levels of EIMD and EICS. On the other hand, fish, vegetables, and olive oil might have a protective role against EIMD and EICS. The selection of an adequate diet before a marathon might help to reduce some of the acute burdens associated with marathon races.

Impact of raising serum myoglobin on resuscitation of trauma patients with high injury severity score (ISS)

IntroductionRecent studies recommend limiting the amount of crystalloid perfused during resuscitation for trauma patients. Severely injured patients sustain extensive muscle damage with subsequent high serum myoglobin levels precipitating acute renal injury if not treated immediately. To timely identify patients at risk of acute renal injury, we proposed determining the strength of the correlation between the American College of Surgeons–defined injury severity score with serum and urine myoglobin level in the early hours of arrival to the emergency department to determine the patient at higher risk of raising serum myoglobin level and subsequent renal injury. MethodA retrospective analysis was conducted at a 400-bed community teaching hospital with a level 2 trauma section and annual admission of 750–800 patients using the data in the trauma registry (2010–2017). Patients with an injury severity score of 15 or above were selected, and Student t test and Pearson correlation 2-tailed analysis were used to identify the relationship with serum myoglobin. ResultThere were 306 patients total, with 200 men (70.3%) and 106 women (29.7%) and a mean age of 60.64 (SD = 23.6) (range 18–96) years. The mean injury severity score was 22.3 (SD = 8.5) (range 16–75). The median level of serum myoglobin in the first 24 hours of admission was 848.56 ng/mL (range 22–11,197). There was a strong and significant correlation between the 2 variables (r = 0.397, P < .0001). ConclusionThe appearance of urine myoglobin with serum level of 39 ng/mL suggests that with higher injury severity score, the potential for acute kidney injury is likely and should be addressed early in the patient management.

Effects of Extended Lower Extremity Cooling Following Zone 3 REBOA in a Porcine Hemorrhage Model.

External cooling of ischemic limbs has been shown to have a significant protective benefit for durations up to 4 hours. It was hypothesized that this benefit could be extended to 8hours. Six swine were anesthetized and instrumented, then underwent a 25% total blood volume hemorrhage. Animals were randomized to hypothermia or normothermia followed by 8hours of Zone 3 resuscitative endovascular balloon occlusion of the aorta, then resuscitation with shed blood, warming, and 3hours of critical care. Physiologic parameters were continuously recorded, and laboratory specimens were obtained at regular intervals. There were no significant differences between groups at baseline. There were no significant differences between creatine kinase in the hypothermia group when compared to the normothermia group (median [IQR]=15,206U/mL [12,476-19,987] vs 23,027U/mL [18,745-26,843]); P=0.13) at the end of the study. Similarly, serum myoglobin was also not significantly different in the hypothermia group after 8hours (7,345ng/mL [5,082-10,732] vs 5,126ng/mL [4,720-5,298]; P=0.28). No histologic differences were observed in hind limb skeletal muscle. While external cooling during prolonged Zone 3 resuscitative endovascular balloon occlusion of the aorta appears to decrease ischemic muscle injury, this benefit appears to be time dependent. As the ischemic time approaches 8hours, the benefit from hypothermia decreases.

Retrospective Comparison of Renal Ultrasonographic and Clinical Findings in Patients with Rhabdomyolysis.

Background:This study evaluated the ultrasonographic and clinical findings of two groups with rhabdomyolysis, who showed abnormal or normal ultrasonographic findings of kidneys.Methods:Two groups (n = 78) of abnormal (A) and normal (B) renal ultrasonographic findings were included. Multiple laboratory findings were assessed within 2 days before or after ultrasonography. Student's t-test or Mann–Whitney U-test was used for statistical analysis.Results:The variable causes of rhabdomyolysis were intense exercise, burn, operation, shivering, and drug intoxication, etc. Group A (n = 26; M:F = 19:7) showed enlarged both kidneys, increased parenchymal thickness, and increased (n = 23, 88.5%) or decreased (n = 3, 11.5%) cortical echogenicity. Group A also showed elevated blood urea nitrogen (BUN), creatinine, potassium, and prolonged activated partial thromboplastin time (aPTT), compared with those in Group B (n = 52; M:F = 36:16), and these results were statistically significant (P < 0.01). The myoglobin in serum and urine, creatine kinase, prothrombin time, dark urine, and microscopic hematuria were not statistically different between the two groups.Conclusion:Patients with elevated BUN, creatinine, potassium, and prolonged aPTT showed the ultrasonographic findings of acute kidney injury, but other parameters were not statistically different between the two groups.

Clinical implications of serum myoglobin in trauma patients: A retrospective study from a level 1 trauma center.

Background:We aimed to study the clinical implication of high serum myoglobin levels in trauma patients.Methods:A retrospective analysis was conducted on data from trauma patients who were admitted to a level 1 trauma center between January 2012 and December 2015. A receiver operating characteristic (ROC) curve analysis was performed for the optimum myoglobin cutoff plotted against hospital length of stay of >1 week. Patients were divided into two groups (Group 1; low vs. Group 2; high myoglobin), and a comparative analysis was performed.Results:There were 898 patients who met the inclusion criteria with a mean age of 35.9 ± 14.6 years. Based on ROC, the myoglobin optimum cutoff was 1000 ng/ml (64% of patients were in Group 1 and 36% in Group 2). The mean myoglobin level was 328 ng/ml in patients with the Injury Severity Score (ISS) <15 versus 1202 ng/ml in patients with ISS ≥15 (P < 0.001). Patients in Group 2 had higher ISS (22.2 ± 10 vs. 18.8 ± 10), more musculoskeletal injuries (18.3% vs. 4.2%), more blood transfusion (74% vs. 39%), intubation (57% vs. 46.5%), and sepsis (12% vs. 7.3%). The length of hospital stays was significantly higher in Group 2, but mortality was comparable. High myoglobin levels had a crude odd ratio 2.41; 95% confidence interval (1.470–3.184) for a longer hospital stay with a positive predictive value of 89% and a specificity of 77%.Conclusions:One-third of the admitted trauma patients have elevated serum myoglobin level, which is associated with the prolonged hospital stay. The discriminatory power of myoglobin value of 1000 in trauma is fair, and further prospective assessments are needed.

Varicella-zoster virus-induced rhabdomyolysis: A case report and literature review

Infection is a possible cause of rhabdomyolysis. We describe the case of a 63-year-old male with malaise and erythematous papules on the right C5–C7 dermatomes, consistent with herpes zoster. Serum antibody and Tzanck tests of the skin lesion were positive. Increased serum creatine kinase (CK) and myoglobin levels and cola-colored urine indicated the development of rhabdomyolysis. Acute kidney injury was also observed. After excluding other possible predisposing factors, the patient was diagnosed with varicella-zoster virus (VZV)-induced rhabdomyolysis. Extracellular volume with alkalized fluids and topical acyclovir was administered. While CK levels declined to normal by day 13, the renal function was not restored. The skin lesion crusted by day 8 and scaled off gradually by day 13. Our case and literature review highlighted the necessity for systemic antiviral treatment and that poor VZV infection control could lead to irreversible kidney injury. In addition, systemic acyclovir should be administered carefully due to its complication of nephrotoxicity.

76-Year-Old Woman With Generalized Weakness

76-Year-Old Woman With Generalized Weakness