Myoglobin Levels Research Articles

A case of Legionella pneumophila pneumonia complicated by acute hemorrhagic leukoaraiosis and rhabdomyolysis

Legionella pneumophila pneumonia complicated by acute hemorrhagic leukoencephalopathy (AHLE) and rhabdomyolysis is an extremely rare clinical entity. This report presents the case of a female patient diagnosed with Legionella pneumophila pneumonia who subsequently developed AHLE and rhabdomyolysis. Laboratory investigations demonstrated markedly elevated creatine kinase and myoglobin levels, and a head CT scan revealed multiple cerebral hemorrhagic lesions. The patient received a multidisciplinary treatment regimen, including anti-infective therapy, respiratory support, fluid resuscitation, blood purification, neuroprotective measures, corticosteroids, immunoglobulin therapy, and symptomatic supportive care. The patient's condition gradually improved, and she was successfully discharged. This case highlights the need for clinicians to remain vigilant for rare but severe complications associated with Legionella infections and emphasizes the importance of timely, comprehensive management in achieving favorable outcomes.

Lazertinib-Induced Rhabdomyolysis in a Patient With Non-Small Cell Lung Cancer: A Case Report.

Lazertinib is a third-generation epidermal growth factor receptor tyrosine kinase inhibitor effective in patients with non-small cell lung cancer. Although generally well tolerated, this case report presents a rare occurrence of common terminology criteria for adverse events grade 3 rhabdomyolysis in a 69-year-old Korean woman after taking lazertinib. The patient exhibited general weakness and tea-coloured urine with elevated levels of creatine phosphokinase (CPK), lactate dehydrogenase (LDH), aspartate aminotransferase (AST), serum myoglobin and hyperkalemia. Lazertinib was temporarily discontinued, and urine alkalization was initiated. After the patient's condition improved, lazertinib was restarted at a reduced dose (80 mg) without any adverse effects. This case highlights the importance of assessing CPK and LDH levels in patients undergoing treatment with lazertinib, particularly in those with myalgia and elevated AST levels. Further studies are required to clarify the mechanisms underlying lazertinib-induced rhabdomyolysis.

Correlations between trans-thoracic echocardiographic parameters and serum biomarkers levels in 25 professional football players before and after cardiopulmonary exercise testing

Abstract Background Sudden cardiac death (SCD) is a rare but tragic event which can involve young and apparently healthy individuals. Several heart conditions, such as hypertrophic cardiomyopathy (HCM), the most frequent cause of SCD in young adults, may not be diagnosed as early as needed. Therefore, proper screening methods and protocols are required for athletes and individuals who engage in chronic intense physical activity. Purpose Current guidelines recommend a screening for athletes and healthy individuals who engage in high-intensity physical activities based on patient history and symptoms, clinical examination and resting 12-lead electrocardiography (ECG). While trans-thoracic echocardiography (TTE) is an useful tool in showing and differentiating pathological patterns from physiological adaptive changes, there is not enough evidence to include it as a standard screening method. Therefore we conducted a study in which we evaluated the use of a complex screening protocol involving the afore-mentioned screening tools, together with TTE, with the aim of better highlighting potential life-threatening cardiac anomalies which may cause adverse events during physical activity. Materials and Methods In the years 2021–2023, we evaluated 25 male professional football players, all between the ages of 18 and 21. They underwent physical examination, resting 12-lead ECG, (TTE) examination, using the M-mode, Continuous wave Doppler (CWD) and the pulse wave Doppler (PWD), as well as serum biomarkers determinations (D-Dimers, Myoglobin, CK-MB, Troponin I and NT-proBNP), before and after cardiopulmonary exercise testing (CPET). Results All of the athletes' echocardiographies showed the "athlete's heart" pattern, with a slightly enlarged left ventricular cavity and mild concentric left ventricular hypertrophy (LVH). Additionally, the myocardium's contractility was within normal bounds and the ejection fraction was on upper limit of the normal values. Two of the examinations showed a mild tricuspid regurgitation, while other four displayed a mitral valve prolapse, regarded to be minor physiological variations in a well-trained individual. No aspects suggestive of dilated cardiomyopathy, hypertrophic cardiomyopathy or isolated left ventricular non-compaction were observed. Most correlations were between the myoglobin levels and the TTE parameters, showing how the overall changes comprising of left ventricular hypertrophy, enlarged cavities and increased cardiac performance may be translated also through the increased serum myoglobin levels in athletes, both at rest and after CPET. Conclusion TTE remains the most precise way to differentiate between physiological LVH and HCM among other pathological patterns. The "athlete's heart" pattern and the morpho-functional changes it encompasses in young individuals were correlated to increased levels of serum biomarkers such as myoglobin, both at rest and after CPET.

Co-occurrence of exercise-induced acute kidney injury and rhabdomyolysis in a holding cell at a police station: a case report.

We present a rare case of a patient with co-occurring exercise-induced acute kidney injury(AKI) and rhabdomyolysis. A 67-year-old man was referred to our department with AKI. Five days before referral, the patient had sudden-onset loin pain while banging and kicking on a door in a holding cell at a police station. Diffusion-weighted magnetic resonance imaging showed wedge-shaped areas of signal hyperintensity in both kidneys. Serum and urinary myoglobin levels were mildly elevated. Kidney biopsy showed cellular injury of the tubular epithelial cells and myoglobin casts in the tubules. The patient was diagnosed with exercise-inducedAKI and mild rhabdomyolysis and was treated conservatively. His kidney function improved gradually withno need for hemodialysis. This case report exhibits a unique presentation of the co-occurrence of exercise-induced AKIand rhabdomyolysis after intense anaerobic and aerobic exercise. To the best of our knowledge, this is the first report to pathologically demonstrate co-occurring exercise-induced AKI and rhabdomyolysis.

Increased postictal creatine kinase in epilepsy patients

Excessive muscle activity during generalized convulsive seizures in epilepsy patients in some cases can cause significant changes in blood plasma biochemical parameters, increased level of a set of metabolites, particularly, serum creatine kinase, accompanied by azotemia, which leads to prominent diagnostic and therapeutic difficulties. It is necessary to monitor the creatine kinase concentration after seizures, especially in case of electrolyte disturbances. To correct elevated creatine kinase or myoglobin levels, infusion therapy, urine alkalinization along with diuretics administration should be performed.

Quantification of Myocardial Biomarkers in Sudden Cardiac Deaths Using a Rapid Immunofluorescence Method for Simultaneous Biomarker Analysis.

Differential diagnosis of sudden cardiac death (SCD) remains challenging, particularly in cases lacking evident structural abnormalities. Cardiac markers have been proposed as useful tools for this differentiation in forensic contexts. However, key issues include the influence of postmortem interval (PMI) on marker stability and the limitations of traditional approaches that focus on pericardial fluid, which requires invasive sampling compared to peripheral blood. This study aimed to evaluate the potential of cardiac markers in peripheral blood for diagnosing SCD, addressing methodological concerns related to PMI, hemolysis, and sample handling. This study analyzed 5 cardiac markers (creatine kinase-MB [CK-MB], myoglobin, troponin I [TnI], BNP, and D-dimer) in peripheral blood samples from 42 autopsied cadavers, divided into an SCD group and a control group. Marker levels were quantified using immunofluorescence, with cases meticulously selected to exclude confounding factors such as chronic diseases, pulmonary thromboembolism, and drowning. The study also accounted for potential degradation due to PMI, and evaluated the accuracy of point-of-care testing (POCT) in forensic samples. The study identified statistically significant differences in myoglobin and TnI levels between the SCD group and the control group, though myoglobin's diagnostic reliability remains limited due to its lack of specificity for myocardial injury. TnI emerged as a more robust marker for SCD. Contrary to prior concerns, PMI showed no significant correlation with marker levels in samples handled without freeze-thaw cycles. Issues related to hemolysis were addressed, and no significant effects were observed from resuscitation maneuvers. This study supports the potential use of cardiac markers, particularly TnI, in peripheral blood for postmortem SCD diagnosis, emphasizing the importance of rapid and systematic analysis to minimize hemolysis-related variability. While further validation is needed to confirm these findings, this approach offers a less invasive, economical, and practical method for forensic investigations.

Current Treatment on Compartment Syndrome of the Hand

Compartment syndrome is a critical condition characterized by elevated pressures within constricted myofascial compartments, leading to vascular compromise, hypoxia, and potential irreversible injury. While commonly affecting the forearm and lower leg, compartment syndrome of the hand is rare and poses unique diagnostic and therapeutic challenges. The pathophysiology involves increased intracompartmental pressure from various etiologies, such as trauma, edema, or external compression, culminating in a cycle of ischemia and worsening edema. Rhabdomyolysis, defined by rapid muscle tissue degradation and release of intracellular components into the bloodstream, is intricately linked to compartment syndrome, with each condition potentially exacerbating the other. Elevated serum creatine kinase and myoglobin levels are hallmark diagnostic markers of rhabdomyolysis. Hand compartment syndrome, despite its rarity, necessitates prompt identification and surgical intervention. The hand's complex anatomical structure comprises ten compartments, each at risk for ischemic injury under increased pressure. Clinically, hand compartment syndrome manifests as severe pain disproportionate to injury, edema, and abnormal posturing. Diagnosis relies on clinical suspicion, supported by intracompartmental pressure monitoring. Emergent fasciotomy remains the definitive treatment, requiring multiple incisions to decompress affected compartments. Magnetic resonance imaging (MRI) is valuable for assessing tissue damage and guiding management strategies. This review underscores the importance of early recognition and timely intervention in compartment syndrome and highlights the interdependent relationship between compartment syndrome and rhabdomyolysis.

Indexes of systemic inflammation in hemorrhagic stroke with effective blood flow: a dynamic observation

Increasing evidence suggests that stroke is a systemic disease affecting multiple organs. Systemic inflammatory response and immune dysregulation associated with hemorrhagic stroke, may play an important role in brain injury, its recovery, and stroke outcomes. However, it is worth of note that, from our point of view, the classical concepts about inflammation in pathophysiology and general pathology do not entirely meet the needs of modern medical practice. The existence of this problem is also typical for assessing pathogenesis, as well as for optimizing pathogenetic therapy of severe strokes. Therefore, within the framework of this work, a dynamic observation and assessment of pathogenesis in severe intracerebral hemorrhage was carried out using the criteria of a systemic inflammation scale. The study included patients with intracerebral hemorrhage and effective cerebral blood flow. Blood sampling was carried out on days 1-3 and 5-7 after clinical manifestation of intracerebral hemorrhage. To determine markers of systemic inflammation in the blood plasma of patients, the levels of IL-6, IL-8, IL-10, TNFá, procalcitonin, cortisol, myoglobin, troponin I and D-dimers were examined using an enzyme-linked immunosorbent assay. The Kolmogorov–Smirnov test was used to confirm the normal data distribution. Further comparison of quantitative data was carried out using the nonparametric Wilcoxon test for paired comparisons. All results were considered statistically significant at p 0.05. In patients on days 1-3 and 5-7, statistically significant differences were not observed in almost all studied markers of systemic inflammation, except for IL-8 and tumor necrosis factor-á. Such increased contents of pro-inflammatory cytokines may indicate increased systemic inflammation over time in the patients with intracerebral hemorrhage and effective cerebral blood flow. Hence, the condition of such patients may worsen on days 5-7 after manifestations of intracerebral hemorrhage, thus requiring more careful monitoring of patients’ blood counts and therapy aimed at suppression of increasing inflammation.

The Effect of Ingesting Alginate-Encapsulated Carbohydrates and Branched-Chain Amino Acids During Exercise on Performance, Gastrointestinal Symptoms, and Dental Health in Athletes.

This study aimed to compare the effects of a carbohydrate (CHO) hydrogel with (ALG-CP) or without (ALG-C) branched-chain amino acids, and a CHO-only non-hydrogel (CON), on cycling performance. The hydrogels, encapsulated in an alginate matrix, are designed to control CHO release, potentially optimising absorption, increasing substrate utilisation, and reducing gastrointestinal distress as well as carious lesions. In a randomised, double-blinded, crossover trial, 10 trained male cyclists/triathletes completed three experimental days separated by ~6 days. During the experimental days, participants completed a standardised 2 h cycling bout (EX1), followed by a time-to-exhaustion (TTE) performance test at W75%. Supplements were ingested during EX1. Participants cycled ~8.8 (29.6%) and ~5.4 (29.1%) minutes longer during TTE with ALG-CP compared to ALG-C and CON, respectively. TTE was 65.28 ± 2.8 min with ALG-CP, 56.46 ± 10.92 min with ALG-C, and 59.89 ± 11.89 min with CON. Heart rate (HR) was lower during EX1 with ALG-CP (p = 0.03), and insulin levels increased more significantly during the first 45 min with ALG-CP. Plasma glucose and glucagon levels remained consistent across supplements, although glucagon was higher with ALG-CP before TTE. Post-exercise myoglobin levels were lower with ALG-CP compared to ALG-C (p = 0.02), indicating reduced muscle damage. While ALG-CP improved performance duration compared to ALG-C and CON, the difference did not reach statistical significance. Additionally, there was a lower HR during the cycling session, alongside a significantly lower level of myoglobin with ALG-CP. These findings suggest that ALG-CP may offer advantages in cycling performance and recovery.

The influence of intermittent venovenous hemodiafiltration on the course of acute kidney injury in multiple trauma victims

Background. Acute kidney injury (AKI) is a common complication of polytrauma that requires renal replacement therapy (RRT) in 10 to 28 % of cases. RRT methods can be divided into discrete, or intermittent, and continuous. There are currently no clear recommendations regarding the choice of the RRT method. The purpose was to study the effect of intermittent venovenous hemodiafiltration (HDF) on indicators of renal function, hemodynamics, homeostasis and inflammation in multiple trauma victims with rhabdomyolysis and AKI. Materials and methods. Fifty victims with multiple trauma complicated by rhabdomyolysis and AKI were examined. We investigated the levels of total creatine kinase and myoglobin, indicators of kidney function, frequency of vasopressor support, indicators of general blood analysis, liver complex, coagulogram, acid-base and gas composition of blood. The study was conducted upon admission, before the start and after the end of each HDF session and on the last day of treatment. Results. Multiple trauma with massive rhabdomyolysis led to AKI, manifested by oliguria and hyperazotemia (and from the 3rd day, by hyperkalemia), as well as cardiovascular failure, anemia, liver dysfunction, and inflammatory response. AKI progression to renal failure despite conservative therapy led to the beginning of HDF on 3.6 ± 0.8 days of hospital stay. HDF allowed to effectively reduce indicators of the renal complex and normalize the potassium level, and at the same time did not have a negative effect on hemostasis or other indicators of homeostasis. 72.9 % of victims needed two HDF sessions, 47.9 % — three, 31.3 % — four or more. The most pronounced reduction of hyperazotemia was observed after the second session. Among the survivors, restoration of adequate diuresis by the day 14 was observed in 39.3 % of cases. The mortality rate was 34.0 %. Laboratory markers of renal function were not significantly different between survivors and deceased; the difference was in markers of liver function, coagulogram and acid-base balance, as well as the need for vasopressor support. That is, the mortality was due to the progression not so much of kidney failure, but of the failure of other organs and systems. It should also be noted that the injury severity score among survivors was 23.5 ± 4.0 points, and among non-survivors — 40.5 ± 6.8 points (p < 0.001). Conclusions. Multiple trauma with massive rhabdomyolysis leads to the development of multiple organ failure. Intermittent HDF allows to quickly and effectively reduce azotemia and normalize potassium levels without adversely affecting coagulation or other indicators of homeostasis. Most multiple trauma victims need 2 or more sessions of HDF. Mortality remains high and primarily depends on the severity of anatomical injuries and the addition of other organs and systems failure.

Case Report: Urinary Proteomic Analysis of Exercise-Induced Rhabdomyolysis with Acute Kidney Injury

Exertional rhabdomyolysis (ER) is a frequently observed consequence following sustained strenuous exercise. The incidence of exercise-induced rhabdomyolysis has risen in the healthy population in recent decades, posing potential systemic, life-threatening complications like acute kidney injury (AKI). Early diagnosis requires prompt identification and management to prevent morbidity. This case report details the presentation of a 24-year-old male military member from the amphibious command specialization course, who attended the hospital emergency room with symptoms of nausea and dark brown urine 24 hours after strenuous military physical training. Laboratory results revealed a significant elevation in serum creatine kinase (CK) and creatinine (Cre) levels, reaching 9300 IU/L and 5.7 mg/dL, respectively. Concurrently, liver enzymes and urea levels were elevated, leading to the diagnosis of both ER and AKI. The individual exhibited a polygenic risk profile for ER, increasing susceptibility to inflammation and muscle damage. Further investigation through urine proteomic analysis unveiled the presence of various proteins associated with muscle damage, including creatine kinase M (CKM), myoglobin (MB), carbonic anhydrase (CA1), titin (TTN), as well as proteins linked to AKI, such as alpha-2-macroglobulin (A2MG), beta-2-microglobulin (B2MG), insulin-like growth factor-binding protein 7 (IBP7), metalloproteinase inhibitor 1 (TIMP1), and uromodulin (UROM), among others. Following a 12-day intensive care unit (ICU) treatment, a notable reduction in CK and MB levels was observed, accompanied by the restoration of renal function to normal levels. Subsequent laboratory tests during outpatient follow-up, two weeks after discharge, confirmed the normalization of relevant markers. The utilization of urinary proteomics emerged as a non-invasive method for monitoring pathophysiological changes, offering valuable insights into the mechanisms underlying ER and associated AKI.

Eccentric exercise-induced muscle damage and inflammation in conjunction with high-altitude decompression in adults.

This study aimed to investigate the effect of eccentric exercise on exercise-induced muscle damage (EIMD) and inflammation on high-altitude-induced venous gas emboli (VGE). Subjects were exposed to an altitude of 24,000 ft. for 90 min, with either prior eccentric exercise (ECC) or no exercise (Control) 24 h before. Blood samples were collected at baseline (T0), before (T1), and after (T2) altitude exposures. VGE load was evaluated using the Eftedal-Brubakk (ΕΒ) scale. Creatine kinase (CK) and myoglobin were used to assess muscle damage, while interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-α), C-reactive protein (CRP), and fibrinogen were used to evaluate inflammation. ECC showed higher EB-scores during altitude exposures [median(range), 3(0-5)] than Control [1(0-4), p = 0.019]. Increases in myoglobin (+35%, p = 0.012), CK (+130%, p < 0.001), IL-6 (+72%, p = 0.02), and CRP (+63%, p = 0.004) were observed from T0 to T1 in ECC, but not Control. Significantly higher levels of myoglobin (p = 0.033), CK (p < 0.001), IL-6 (p = 0.016), and CRP (p = 0.002) were noted in the ECC compared to Control at T1. IL-6 increased from T1 to T2 in ECC (p = 0.005), with higher levels than Control at T2 (p = 0.046). A correlation was found between EB-scores and T1 myoglobin levels (rs = 0.450; p = 0.004), and to T1-T2 IL-6 changes (rs = 0.396; p = 0.037). Eccentric EIMD followed by inflammation is associated with a higher decompression strain, with VGE load aggravating systemic inflammation.

Estimation of Postmorterm Interval by Using Myoglobin Concentration in Blood, Liver And Parotid Glands of Albino Rats

Objective: To determine the postmortem interval (PMI) by estimating myoglobin concentration in blood, liver and parotid gland of albino rats and to compare the postmortem level of myoglobin among blood, liver and parotid gland. Study Design: Quasi-Experimental study. Place and Duration of Study: Department of Forensic Medicine and Toxicology King Edward Medical University, Lahore in collaboration with the University of Veterinary and Animal Sciences, Lahore from 20 June 2021 to 19 June 2022. Methodology: A total of 72 rats were killed by cervical dislocation and postmortem myoglobin levels were checked in blood, liver and parotid gland at 8 different postmortem intervals (9 rats in each interval) to check its significance in relation to postmortem time. Results: There was a significant correlation between myoglobin concentration in blood, liver and parotid gland with Postmortem Interval with p value of &lt; 0.001. The analysis indicated that the combination of blood, liver, and parotid myoglobin concentrations yielded the highest predictive accuracy (r = 0.982). The next best model included liver and parotid myoglobin concentrations (r = 0.980), while the model based solely on liver myoglobin concentration had the lowest predictive accuracy (r = 0.946). Conclusion: The myoglobin concentration in glandular tissues is a helpful parameter to determine PMI. As the postmortem interval increases the myoglobin concentration in the blood, liver and parotid gland also increases.

Prospective screening and proposed treatment algorithm for immune checkpoint inhibitor induced myositis in neoadjuvant-treated rectal cancer patients: data from the phase II CHINOREC trial

Abstract Background Myositis is an infrequent (&amp;lt;1%) but potentially life-threatening (case fatality rate 40-50%) immune-related adverse event (irAEs) of immune checkpoint inhibitors (ICI), such as ipilimumab (IPI) and nivolumab (NIVO). The true incidence is likely to be underestimated and may not be representative for curative neoadjuvant treatment approaches in gastrointestinal (GI) cancers, especially in combination with chemoradiotherapy (CRT). Currently, the summary of product characteristics (SmPC) does not suggest any pre-emptive screening or surveillance. Methods The CHINOREC study is an ongoing prospective, randomized, open-label, multicenter, phase II investigator-initiated trial (IIT). Patients with intermediate to locally advanced rectal cancer (LARC) receive either neoadjuvant CRT alone or in combination with a single dose of IPI and 3 cycles of NIVO, following surgical resection. Patients are monitored at baseline and throughout the whole study period for myotoxicity biomarkers, including cardiac troponin T (cTnT) and cardiac troponin I (cTnI). Findings From 06/2020 to 11/2023, 80 patients have been enrolled of whom 50 patients were randomized to the CRT+IPI/NIVO arm. Six patients (12%) developed biopsy-verified myositis. Myositis treatment was promptly implemented using a pragmatic step-up approach. Patients received glucocorticoids (GC) with concomitant intravenous immunoglobulin (IVIG). If myotoxicity biomarkers did not improve, patients received infliximab (INFLIXI) and/or plasma exchange (PLEX). Although all patients had strikingly elevated cTnT (median peak 284 ng/L, 95% CI 39-3097), cTnI levels remained largely normal, correlating with a negative cardiac magnetic resonance (CMR). All patients underwent successful tumor surgery without any major surgical complication. As of today, all patients' creatine kinase (CK) and myoglobin (MB) levels have normalized and they are tumor free without any major sequela. Interpretation Longitudinal biomarker screening (cTnT/cTnI) for ICI-induced myotoxicities is pivotal in curative neoadjuvant-treated cancer patients to initiate an early counter treatment in a holistic step-up approach, without compromising oncological principles.

Kaempferol Reduces Cardiopulmonary Load and Muscular Damage in Repeated 400-m Sprints: A Double-Blind, Randomized, Placebo-Controlled Trial.

Plants exposed to hypoxic conditions have been suggested to produce more biologically active phytochemicals than those exposed to normal oxygen levels. Previously, we investigated 314 highland crop species and showed that the flavonoid kaempferol extracted from a highland quinoa grain markedly increased mitochondrial metabolism and ATP production in a hypoxic environment invitro. Thus, we hypothesized that kaempferol would be effective during exercise under harsh conditions, in which anaerobic metabolism occurs. This study adopted a double-blind, placebo-controlled, crossover design to investigate the effect of a single oral dose of kaempferol (10 mg) on the athletic performance-related indicators of 13 male university athletes (20.8 ± 0.7 years) who performed two consecutive 400-m runs with the shortest 90-min interval assuming qualifying and main races. Although no significant differences were observed in the 400-m race times between the placebo and kaempferol groups, kaempferol intake markedly reduced the respiratory and heart rates during the second run (p < 0.05). In addition, kaempferol intake reduced the levels of muscle damage markers, myoglobin, and aspartate transaminase (p < 0.05). A single oral dose of kaempferol reduced the cardiopulmonary burden and muscle damage in individuals participating in 400-m runs. Kaempferol may be a useful supplement for relieving the physical load, particularly in individuals performing strenuous exercises with high oxygen demand. Trial Registration: UMIN Clinical Trials Registry in Japan: UMIN000049588.

Application and clinical effects in lung bullae resection of CT 3-dimensional reconstruction.

To investigate the value and clinical effect of computed tomography (CT) 3-dimensional reconstruction technology in lung bullae resection. Ninety-eight patients who underwent thoracoscopic surgical resection of lung bullae in our hospital from February 2019 to February 2023 were selected and divided into 2 groups according to the principle of voluntary participation in the clinical trial, of which 43 cases underwent preoperative spiral CT for thin-layer enhancement or planar CT scanning of lung bullae (control group), and 43 cases were imaged with MimicsMedical 21 software for 3-dimensional reconstruction to develop a surgical plan (observation group). To compare the surgery-related indexes, postoperative complications, pain, and analgesic use between the 2 groups, we measured serum creatine phosphokinase and myoglobin levels. The amount of surgical bleeding, drainage volume, hospital stay, and postoperative visual analog scale score of the research group were lower than those of the control group (P < .05), and the duration of analgesic medication was shorter than that of the control group (P < .05), and the levels of serum creatine phosphokinase and myoglobin were lower than those of the control group at 1 and 3 days postoperatively, and the differences were statistically significant (P < .05). Preoperative CT 3-dimensional reconstruction technique can clearly show the anatomical structures around the lung bullae and has its application value for precise lung bullae.

Comparative analysis of meat quality of Laiwu black, Minxinan black and Hyla rabbits

Abstract. The meat rabbit industry in China relies on foreign breeds and synthetic lines; the development of superior domestic breeds has not yet been fully realised. We compared the meat quality of two Chinese local breeds of black rabbits (Laiwu black and Minxinan black) and Hyla commercial rabbits, to provide a reference for the utilisation of meat rabbit breeds. In the present study, 35 d old Laiwu black rabbits, Minxinan black rabbits, and Hyla rabbits (20 rabbits each) were selected and reared under identical feeding and management conditions for 7 weeks, after which 10 randomly selected rabbits from each group were slaughtered for the analysis of meat quality. The a∗ (redness) value of the two local breeds was significantly higher than that of Hyla rabbits (p&lt;0.01). The shearing force and drip loss of Laiwu black rabbits were significantly lower than those of the other groups (p&lt;0.05). The two local breeds exhibited significantly higher myoglobin levels than Hyla rabbits (p&lt;0.01), while melanin was highest in the meat of Minxinan black rabbits. The essential amino acids (valine, isoleucine, leucine and lysine) were significantly lower in Minxinan black rabbits than in the other groups (p&lt;0.05). Aldehyde (heptanal, octanal) contents in Minxinan black meat were significantly higher than those of the other groups (p&lt;0.01); however, nucleotide (guanine, adenine) contents were significantly lower (p&lt;0.01). Unsaturated fatty acids (oleic, linoleic, α-linolenic) were significantly higher in the meat of Laiwu black rabbits than in those of the other groups (p&lt;0.05). Both Laiwu black and Minxinan black rabbits have certain advantages in terms of nutritional indicators while also having good meat colour and flavour. The results of this study provide a theoretical reference for the research and development of meat rabbit breeds.

Effect of inflammatory factors on myocardial infarction

BackgroundCohort studies have increasingly shown associations between inflammatory markers and myocardial infarction (MI); however, the specific causal relationships between inflammatory markers and the development of MI remain unclear.Methods and resultsBy utilizing publicly accessible genome-wide association studies, we performed a two-sample Mendelian randomization (MR) analysis to explore the causal associations between inflammatory markers and myocardial infarction (MI). A random-effects inverse-variance weighted method was used to calculate effect estimates. The study included a total of 395,795 European participants for MI analysis and various sample sizes for inflammatory factors, ranging from 3,301 to 563,946 participants.Neutrophil count was found to increase the risk of MI (odds ratio [OR] = 1.08; 95% confidence interval [CI], 1.00–1.17; p = 0.04). C-reactive protein levels correlated positively with MI. No associations were observed with IL-1 beta, IL-6, IL-18, procalcitonin, TNF-α, total white cell count, or neutrophil percentage of white cells. Neutrophil count and C-reactive protein were inversely associated with lactate dehydrogenase: neutrophil cell count (OR 0.95; 95% CI, 0.93–0.98; p < 0.01) and C-reactive protein (OR 0.96; 95% CI, 0.92–1.00; p = 0.02). No associations of MI with myoglobin, troponin I, and creatine kinase-MB levels were found.ConclusionsThis two-sample MR analysis revealed a causal positive association of MI with neutrophil count, C-reactive protein level, and the myocardial injury marker lactate dehydrogenase. These results indicate that monitoring C-reactive protein and neutrophil counts may be useful in management of MI patients.

6853 A Curious Case of MACS

Abstract Disclosure: M. Dillon: None. A. Syeda: None. V. Kantorovich: None. Introduction: Mild autonomous cortisol secretion (MACS) is characterized by biochemical evidence of mild hypercortisolemia inducing metabolic comorbidities without any obvious phenotypic stigmata of Cushing’s syndrome (CS). This case highlights the challenges faced in the diagnosis and management of MACS. Case: A 76-year-old female with past medical history of class II obesity (BMI 31.83 kg/m2), type 2 diabetes mellitus, hypertension, hyperlipidemia, osteoporosis and chronic kidney disease stage IIIb was diagnosed with MACS after an overnight 1 mg dexamethasone suppression test (DST) showed unsuppressed 8 AM cortisol of 2.4 mcg/dL (&amp;lt;1.8 mcg/dL). Dexamethasone level was appropriate at 355 ng/dL (180-550 ng/dL), ACTH was &amp;lt;5 pg/mL (6-50 pg/mL) and DHEA-S was normal. Late night salivary cortisol (LNSC) levels were elevated to 0.12 mcg/dL (&amp;lt; 0.09 mcg/dL). The 24-hour urine cortisol level was normal. Baseline 8 AM cortisol level was 17 mcg/dL and ACTH was 19 pg/mL. Abdominal CT scan showed a 1 cm left adrenal nodule of 25 HU density and a normal right adrenal with no atrophy. Phaeochromocytoma and primary hyperaldosteronism work up was negative. She started on Mifepristone 300 mg daily and titrated up to 600 mg daily. She presented to our institution one month later with 1 week of nausea, vomiting and muscle weakness. Laboratory studies revealed acute kidney injury with creatinine of 6.69 mg/dL (baseline Cr 1.5 mg/dL) and rhabdomyolysis with creatinine kinase level of 12,819 U/L (24-173 U/L) and urine myoglobin level of 888 ng/mL (0-13 ng/mL). It was evident that her catastrophic presentation was from development of adrenal insufficiency in the setting of Mifepristone glucocorticoid receptor blockade. The drug was discontinued immediately. She was treated with intravenous hydration and intermittent diuretics. Over 10 days, her clinical status gradually improved and creatinine decreased to baseline levels. Discussion: MACS is a challenging diagnosis as cortisol levels are affected by several variables including obesity, drugs, and poorly controlled diabetes. Hence, a meticulous evaluation is mandated before confirming the diagnosis. Our patient’s baseline cortisol and ACTH levels were normal, and her DST and LNSC levels were mildly elevated. Unilateral cortisol producing adenoma causes contralateral gland atrophy due to suppressed ACTH. This was not evident in our patient, thus making the diagnosis questionable. Adrenalectomy is the treatment of choice in MACS with adrenal adenoma. Off label medical management with Mifepristone, a glucocorticoid receptor antagonist, is being pursued in select cases and was trialed due to our patient's age and surgical risk. Mifepristone is approved for the treatment of hyperglycemia due to CS. The data supporting its use in MACS is sparse. Therefore, it is important to be aware of associated risks of Mifepristone when advising patients. Presentation: 6/3/2024

Interleukin 1β And Interleukin-6 and Some Oxidants in Patients With Stable Angina

ROS play an essential physiological roles in the cellular homoeostasis and cell signaling under normal circumstances. The overexpression of ROS was involved in the pathological events of several diseases, including cardiovascular, because they cause damage to many cell structures.This study aims to evaluate the levels of inflammatory biomarkers, [interleukin-6 (IL-6) and interleukin-1beta (IL-1β)] in stable angina patients and their relationship with oxidative stress. The current study is a case-control one performed on 88 patients with stable angina and 44 people as a control group attending the Nasiriyah Heart Center from August 2023 to March 2024. All cases were diagnosed by cardiologists and confirmed by laboratory investigations. Blood samples (10 ml) were collected from patients. Serum was isolated after centrifugation and stored at -20°C. Serum CK-MB, MYO and Trop I were determined by electro-chemiluminescence immunoassay. While, the ELISA was employed to assess the levels of human IL-6, human IL-1 β, SOD, (GSH-Px/ GPX), total cholesterol, triglycerides, LDL, VLDL and HDL, using the kits from Solarbio, China. The patients with stable angina didn’t show significant variation in the serum level of troponin I and CK-MB in comparison with control, while serum myoglobin level was significantly increased in patients with stable angina compared to control. Although the level of total cholesterol was insignificantly increased, but the levels of triglyceride (TG), VLDL-C and LDL-C were significantly increased, while the serum level of HDL-C was significantly declined in comparison with control. The serum levels IL-6 and IL-1β, in addition to activities of SOD and GPx were increased significantly in patients of angina compared to control. We could conclude that IL-1β, IL-6, SOD and GPx are increased in stable angina. Inflammatory events and oxidative stress could play an important roles in initiation of atherosclerosis and subsequent angina.