Serum Levels Of Creatinine Kinase Research Articles

Mitochondrial myopathy without extraocular muscle involvement: a unique clinicopathologic profile.

Mitochondrial myopathy without extraocular muscles involvement (MiMy) represents a distinct form of mitochondrial disorder predominantly affecting proximal/distal or axial muscles, with its phenotypic, genotypic features, and long-term prognosis poorly understood. A cross-sectional study conducted at a national diagnostic center for mitochondrial disease involved 47 MiMy patients, from a cohort of 643 mitochondrial disease cases followed up at Qilu Hospital from January 1, 2000, to January 1, 2021. We compared the clinical, pathological, and genetic features of MiMy to progressive external ophthalmoplegia (PEO) and mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS) patients. MiMy patients demonstrated a more pronounced muscle involvement syndrome, with lower 6MWT scores, higher FSS, and lower BMI compared to PEO and MELAS patients. Serum levels of creatinine kinase (CK), lactate, and growth and differentiation factor 15 (GDF15) were substantially elevated in MiMy patients. Nearly a third (31.9%) displayed signs of subclinical peripheral neuropathy, mostly axonal neuropathy. Muscle biopsies revealed that cytochrome c oxidase strong (COX-s) ragged-red fibers (RRFs) were a typical pathological feature in MiMy patients. Genetic analysis predominantly revealed mtDNA point pathogenic variants (59.6%) and less frequently single (12.8%) or multiple (4.2%) mtDNA deletions. During the follow-up, a majority (76.1%) of MiMy patients experienced stabilization or improvement after therapeutic intervention. This study provides a comprehensive profile of MiMy through a large patient cohort, elucidating its unique clinical, genetic, and pathological features. These findings offer significant insights into the diagnostic and therapeutic management of MiMy, ultimately aiming to ameliorate patient outcomes and enhance the quality of life.

Characterization of antihypertensive and cardioprotective effects of extra virgin olive oil against doxorubicin induced cardiomyopathy in rats

Context: The medicinal uses of olive fruit oil (Olea europaea) are clearly documented as an anti-inflammatory, anti-diabetic (type-2 DM), and to protect against heart diseases. Aims: To evaluate the therapeutic influence of extra virgin olive oil (EVOO) as an antihypertensive and cardioprotective against doxorubicin (DXR) induced cardiomyopathy in rats. Methods: Wistar rats were divided into five groups as group 1 (normal control), group 2 (disease control i.e., DXR-treated) and groups 3, 4 and 5 as therapeutic groups (i.e., DXR- treated rats plus 2.5%, 5%, and 10% EVOO in diet respectively). Cardiac injury was induced by the administration of DXR. Cardioprotective, anti-hypertensive and antioxidant potential of EVOO were studied by measuring different blood, serum, and tissue biomarkers, enzymes and hemodynamic parameters in disease control and experimental rat groups. Results: Hemodynamic parameters were significantly reduced in rats administered with 2.5%, 5%, and 10% EVOO as compared to group 2 rats at p<0.05, p<0.01, and p<0.001 respectively. Serum levels of creatinine kinase, troponin T, CK-MB and LDH were found markedly reduced in rats fed with 10% dietary EVOO as compared to disease control rats (p<0.01). Serum levels of antioxidant enzymes like GSH and SOD were found significantly higher in group 5 rats as compared to group 2 at p<0.01, and p<0.001, respectively. Conclusions: Dietary administration of EVOO has the potential to reduce drug-induced cardiomyopathies and sustained use of EVOO in diet could be cardioprotective and useful against high blood pressure.

Evaluation of changes in body composition and proinflammatory marker levels in ovariectomized rats with induced hyperthyroidism

We examined the effect of TSH-suppressive dose of LT4 on changes in body composition and proinflammatory markers in ovariectomized rats. Bilateral ovariectomy (OVX) and sham operations (Sham) were performed in female Sprague–Dawley rats at 7 weeks of age. Rats were divided as Sham (n = 6), Sham + LT4 (n = 6), OVX (n = 8), and OVX + LT4 (n = 8). Eight weeks after surgery, the body composition was analyzed using Dual energy X-ray Absorptiometry. The percentage of gain of fat mass and lean mass of whole body, body trunk and extremities were evaluated. Serum TSH, cholesterol, creatinine kinase (CK), C-reactive peptide, interleukin (IL)-1β, IL-4, IL-6, IL-10, monocyte chemoattractant protein-1 and tumor necrosis factor-α were compared among the four experimental groups. The middle third of soleus muscle was analyzed with cross-sectional area (CSA), Feret’s diameter (FD) and an area of interstitial space. A Kruskal–Wallis test was used and post-hoc analysis was performed using the GRAPHPAD PRISM (ver 8.0, GraphPad Software, Inc.) The fat mass, but not lean mass, was significantly increased in the OVX groups compared with Sham groups, regardless of LT4 treatment. CSA, FD and the area of interstitium were elevated in OVX groups and increased with LT4 treatment. OVX + LT4 group showed the most deteriorated muscle with the lowest serum level of CK and highest level of IL-6.

Assessment of serum cardiac troponin-I over serum CPK-MB in early diagnosis of acute myocardial infarction (AMI)

Background: The early mortality rate from AMI is 30% with about half of them occurring within 1hour of disability. Although the mortality rate after admission for AMI has declined by 30% over the past decades, approximately 1 of every 25 patients who survive the initial hospitalization die in the first year after AMI. The gold standard for diagnosis of MI has been an elevated serum level of creatinine kinase – myocardial band (CK- MB), the cardiac-specific isoenzyme of CK. However, elevated CK-MB may not detect all myocardial necrosis. In patients who die suddenly after severe or silent episodes of ischemia, autopsies frequently reveal micronecrosis that was not reflected in routine CK-MB measurements. The present study was undertaken to know that serum Cardiac Troponin-I is more sensitive marker than serum CPK-MB in early diagnosis of acute myocardial infarction (AMI).Methods: The study was carried out in tertiary care hospital in Gulbarga. The study was undertaken with an aim to study that serum cardiac troponin-I (cTnl) is more sensitive than serum CK-MB in early diagnosis of acute myocardial infarction (AMI). The study was conducted on patients admitted with history of chest pain suggestive of AMI as diagnosed by WHO criteria to medicine ward of Basaveshwar Teaching and General Hospital, Gulbarga. The period of study was from June 2012 to June 2014. The sample size included 100 patients with history of chest pain suggestive of AMI, selected by simple random method.Results: Our results revealed that cardiac troponin I was more sensitive (62%) than CK-MB in overall cases admitted in between 6-24 hrs from the onset of chest pain. Maximum number (41%) of AMI patients were affected on the anterior wall followed by Inferior wall of AMI. 11 percent were affected with Antero lateral wall wereas 5 to 6 percent were affected with anteroseptal and global acute and right ventricular AMI was seen among 2 percent of patients. Anterior wall AMI was the significantly affected site with AMI (ʎ2:12.5, P:0.0004). The maximum number of acute myocardial infarctions were ST elevation myocardial infarctions. 28% of cases where CKMB is normal, the cTnI detects the AMI cases indicating its sensitivity.Conclusions: Cardiac troponin-I (cTnI) was more sensitive serum marker than CKMB in the early diagnosis of acute myocardial infarction (AMI). Anterior wall was the most significantly affected site of AMI. In the future, further improvements in analytical performance may open additional diagnostic windows.

Anti-aging effect and gene expression profiling of dung beetle glycosaminoglycan in aged rats

BackgroundThis study aimed to evaluate the anti-aging effect of a newly prepared insect-derived compound, dung beetle glycosaminoglycan (GAG), given intraperitoneally to old SD rats as part of their diet for 1 month. Insect GAG administration was found to be related to a reduction in oxidative damage, hepato-cellular biomarker levels, protein carbonyl content, and malondialdehyde concentration. The anti-aging-related molecular genetic mechanisms of dung beetle GAG are not yet fully elucidated.ResultsCatharsius molossus (a type of dung beetle) GAG (CaG) possessed anti-aging activities; it reduced the serum level of creatinine kinase, had aortic vasorelaxant activities and cardioprotective actions, and maintained a normal glucose level in treated rats. Microarray analysis was performed with a rat 30 K cDNA clone set array to identify the gene-expression profiles of 14-month-old SD rats treated with dung beetle glycosaminoglycan 5 mg/kg (CaG5) over a 1-month period, which was done to investigate its anti-aging effect as compared to that of either Bombus ignitus (a type of bumblebee) queen GAG 5 mg/kg (IQG5) or chondroitin sulfate 10 mg/kg. CaG5 and IQG5 had marked anti-inflammatory effects, bringing about inhibition of free fatty acid, uric acid, sGPT, IL-1 beta, and CK values. In addition, anticoagulant and antithrombotic effects were seen: the concentration of factor 1 (fibrinogen) was increased in CaG- treated rat plasma. The CaG5-treated rat group, compared to the control, displayed upregulation of 131 genes, including lipocalin 2 (Lbp) and a serine peptidase inhibitor, Kaszal type3 (Spink3), and 64 downregulated genes, including lysyl oxidase (Lox), serine dehydratase (sds), and retinol saturase (Retsat).ConclusionOur data suggest that dung beetle glycosaminoglycan may be a helpful treatment for aged rats, which indicates its potential as a therapeutic biomaterial for aging.

Clinical value of one-level oblique lateral interbody fusion in the treatment of degenerative lumbar disc diseases

Objective To evaluate the clinical outcomes of one-level oblique lateral interbody fusion (OLIF) for the treatment of degenerative lumbar diseases. Methods A total of 36 patients, 11 males and 25 females with ages from 32 to 75 (average 55.2 ± 13.6 years), underwent one-level OLIF with or without posterior pedicle screw-rod instrumentations from October 2014 to May 2016. The index diagnosis was discogenic back pain in 15 cases, and spondylolisthesis with or without segmental instability in 21 cases. The distribution of operative level was 30 cases at L4/5 and 6 cases at L3/4. The changes of serum level of creatinine kinase was measured 1 and 3 days post-operatively, and compared to that of the pre-operative one. Clinical outcomes were evaluated using visual analogue scale (VAS) and Oswestry disability questionnaire (ODI) scores. Lumbar X-ray was taken and the clinical outcomes were re-assessed. Results 25 in the 36 patients underwent supplementary posterior pedicle screw-rod instrumentation with OLIF procedures. The operation lasted for 46-175 min, with a mean duration of (112±43) min. Blood loss during the operation was 30-180 ml, with a mean of (63 ± 35) ml. Average length of stay was (4.5±2.1) d, ranging from 3-7 d. Serum level of creatinine kinase was (63.5±16.8) IU/L before operation, (416.8±152.1) IU/L 1 day after operation, (112.4±37.5) IU/L 3 days after operation. The VAS and ODI score decreased from (8.3±2.3) pre-operatively to (1.6±0.4) 6 months post-operatively, and from (69.2±17.5) to (10.7±2.7), respectively. The total incidence of complications was 25%, including 8.3% of intra-operative complications (3 cases of cage subsidence) and 16.7% of post-operative ones. The latter consisted of ipsilateral hip flexor weakness in 1, ipsilateral anterior thigh pain in 1, contralateral pain in flexion of hip in 1, ipsilateral sympathetic chain injury in 1, and pain in area of iliac bone donor site in 2. All symptoms were released or disappeared during follow-up. Conclusion OLIF as a novel technique for spinal surgical management showed excellent short-term outcomes. Clinical results with long-term follow-up are required. Key words: Lumbar vertebrae; Spinal fusion; Clinical protocols

Annular Erythema Associated with Sjögren’s Syndrome Preceding Overlap Syndrome of Rheumatoid Arthritis and Polymyositis with Anti-PL-12 Autoantibodies

A 44-year-old woman exhibited swelling with erythema on the bilateral upper eyelids. She was treated with prednisolone 20 mg/day at a different hospital. However, after the prednisolone was discontinued, the lesions relapsed. Four months after onset, the patient came to our clinic. A lip biopsy to investigate possible Sjogren’s syndrome (SS) confirmed lym phocytic infiltration of the minor salivary glands. Circulating autoantibodies to SS-A (anti-SS-A) were positive, but anti-SS-B antibodies were negative. She had no muscle weakness at any site of the body. Serum levels of creatinine kinase were not elevated. She was diagnosed with SS according to the Japanese Ministry of Health revised criteria for the diagnosis of SS (4). The lesions resolved with oral prednisolone 30 mg/day. When the prednisolone dose was reduced to 22.5 mg/day, several lesions of annular erythema (AE) appeared on the lower back (Fig. 1A). A biopsy of the AE lesion showed sleeve-like perivascular and periappendigeal lymphocytic infiltration, which was consistent with AE with SS (AESS) (Fig. 1B, C). The lesions resolved with oral prednisolone 30 mg/day and azathioprine 50 mg/day. Sixteen months after the onset of SS, arthralgia on the bilateral hip, knee, and ankle joints occurred. Oral prednisolone had been tapered to 10 mg/day, and oral azathioprine 50 mg/ day had been maintained. Physical examinations found swelling of the bilateral knee and ankle joints. Circulating anti-CCP antibodies were 453 U/ml (normal value < 15 U/ml). Serum levels of c-reactive protein and matrix metalloproteinase-3 Annular Erythema Associated with Sjogren’s Syndrome Preceding Overlap Syndrome of Rheumatoid Arthritis and Polymyositis with Anti-PL-12 Autoantibodies

Direct anterior approach to THR: what it is and what it is not.

Direct anterior approach to THR: what it is and what it is not.

SAT0200 Abnormal Cardiac SPECT/CT in Newly Diagnosed, Untreated Patients with Idiopathic Inflammatory Myopathies

BackgroundKnowledge of cardiac involvement in idiopathic inflammatory myopathies (IIM) is limited and a matter of debate with reported frequencies between 6% and 75%. Although clinically overt disease is rare, cardiac...

A single-bout of one-hour spinning exercise increases troponin T in healthy subjects

Objectives. While long-term endurance exercise is known to increase cardiac biomarkers, only a few studies on short-term exercise and these markers have been reported. The aim of this study was to investigate the acute effects of a one-hour bicycle spinning on cardiac biomarkers in healthy individuals. Design. Serum levels of high-sensitive troponin T (TnT), creatinine kinase MB fraction (CK-MB), N-terminal pro-brain natriuretic peptide (NT-proBNP), creatinine kinase (CK) and myoglobin were measured at baseline, 1 and 24 hour after one hour of spinning exercise in ten healthy and fit (age 31.0 ± 6.6 years) individuals. Results. TnT doubled one hour post-exercise (All values ≤ 5 – 9.7 ± 6.0 ng/L, p < 0.001). Two individuals had TnT levels above upper reference limit, URL (20.7 and 20.2 ng/L, URL = 12 ng/L). Myoglobin levels increased 72% one hour post-exercise (38 ± 20 – 66 ± 41 mg/L, p < 0.02). TnT and myoglobin levels returned to baseline 24 hour post-exercise. Serum levels of CK-MB, NT-proBNP and CK were not significantly changed. Conclusions. A single-bout of one-hour bicycle spinning transiently increases TnT and myoglobin in healthy subjects. Some subjects even have TnT release above URL. Thus, recently performed exercise also of short duration should be taken into consideration in the evaluation of acute chest pain with release of cardiac TnT.

Comparison study between Wiltse paraspinal approach and conventional approach for thoracolumbar vertebral fracture.

Objective To determine the difference of paraspinal muscle injury between Wiltse paraspinal approach and conventional approach for the thoracolumbar vertebral fracture with open reduction and internal fixation. Methods A total of 47 patients with thoracolumbar vertebral fracture(ASIA E) under-went posterior open reduction and internal fixation from June 2004 to December 2006. Randomly, 22 pa-tients adopted Wiltse paraspinal approach, including 16 males and 6 females with the mean age of 37.6 years; 25 patients adopted traditional approach, 18 males and 7 females with the mean age of 40.1 years. The operative duration, blood loss and changes of postoperative serum level of Creatinine Kinase were com-pared. Total 47 patients were followed up with VAS scores 1 day preoperatively, 1 and 6 months postopera-tively. And EMG were adopted for long-term evaluation. Results There was no obvious difference in surgi-cal time, but less blood loss, lower index of serum level of Creatinine Kinase in Wihse paraspinal approach group. The VAS score in Wihse paraspinal approach was significantlt less than that in conventional approach group 1 and 6 months postoperatively. And in conventional approach group EMGs demonstrated fibrillation potentials, but they were normal in Wihse approach group. Conclusion The Wihse paraspinal approach is an easy way for treating of thoracolumbar vertebral fracture, minimize the soft tissue injury in operation and creates less complications after operation. Key words: Thoracic vertebrae; Lumbar vertebrae; Spinal fractures; Fracture fixation, internal

Cardiac Injury Markers in Non-elite Marathon Runners

An elevation of cardiac injury markers including creatinine kinase (CK), myoglobin (Myo) and cardiac troponin T (cTnT) has been observed in elite athletes following strenuous exercise. The mechanism and significance of this observation however have not been fully elucidated. The goals of this study were: 1) to determine whether these changes in biomarkers also occur in a large, heterogeneous group of non-elite athletes; and 2) to identify possible clinical or biochemical associations. We recruited 129 non-elite runners in 2006, 61 individuals who were taking part in the half (13.1 miles) marathon and 68 individuals participating in the full (26.2 miles) marathon. Demographic data and blood samples were collected for analysis of CK, Myo, cTnT, and Creatinine (Cr) levels within two hours of race start, at race completion, and 1-h post-race for both patient cohorts. In the 61 individuals (40 males, 40+/-12 yrs) completing the half marathon in a mean time of 150+/-20 min, 90.3%, 65.2%, and 30.6% of the subjects exhibited significant elevations in Myo, CK, and cTnT, respectively immediately post race and 100%, 74.9% and 45.9% in the same biomarkers one hour-post race. In the 68 individuals (44 males, 42+/-14 yrs) completing the full marathon in a mean time of 310+/-30 min, 95.3%, 70.2% and 35.7% exhibited significant elevations in Myo, CK and cTnT respectively immediately post race and 100%, 78.5% and 52.8% in the same biomarkers one hour-post race. The elevation in cTnT levels post-race were modestly associated with the time required to complete the race for the entire cohort of marathon runners. The serum levels of Cr, CK, and Myo post-race did not correlate however with age, sex, BMI, level of training, or prior marathon experience. Elevations of cardiac injury markers in non-elite athletes are extremely common following the completion of endurance events and correlate to the increased endurance time. Whether the increase in the levels of these enzymes represents true myocardial injury or a result of the release of cTnT from the myocytes requires further investigation.

Acute renal failure with encephalopathy following Salmonellaenteritidis infection

Salmonellosis is one of the major causes of food poisoning in Japan. In general, consumption of food contaminated with non-typhi Salmonella causes acute gastroenterocolitis. However, salmonellosis has also been reported to be associated with development of severe extraintestinal multiorgan complications, including rhabdomyolysis (RM), acute renal failure (ARF), and rarely acute encephalopathy [1–5]. In this paper, we report on a patient with systemic lupus erythematosus (SLE) who developed ARF with suspected acute encephalopathy following Salmonella enteritidis infection. The patient was under treatment with immunosuppressive agents. Since patients with SLE are at an increased risk of severe infections [6], this case report may serve to emphasize the importance of prevention of food poisoning and of advocating appropriate hygienic practice in immunocompromised hosts. A 16-year-old Japanese girl with a 3-year history of SLE with WHO class IV disease was referred to our hospital because of drowsiness and disorientation. Although the SLE activity and serum complement levels were reasonably controlled under maintenance therapy with prednisolone (15 mg/day) and azathioprine (75 mg/day), the patient developed acute severe diarrhea, vomiting, and fever after eating a raw egg. She was admitted to a regional hospital with suspected food poisoning. On admission, her body weight was 36.5 kg, which represented a loss of about 1.5 kg over her previous weight recording. Her blood pressure was decreased to 70/36 mmHg. Laboratory studies revealed the following: peripheral white blood cell (WBC) count 11,200/μl, hemoglobin 13.8 g/dl, hematocrit 39.9%, platelet count 193,000/μl, blood urea nitrogen (BUN) 18.2 mg/dl, creatinine 0.9 mg/dl, and Creactive protein (CRP) 5.4 mg/dl. Despite adequate fluid replacement, the patient developed oliguria, drowsiness, and disorientation. Lumbar puncture revealed clear cerebrospinal fluid (CSF), and further examination of the CSF revealed the following: cell count 1 cell/mm, protein 22 mg/dl, glucose 71 mg/dl, and sterile culture. Emergency cranial computed tomographic and electroencephalographic findings were unremarkable. The BUN and serum creatinine increased to 41.5 mg/dl and 4.7 mg/dl, respectively. In addition, the serum level of creatinine kinase (CK) and urinary level of myoglobin also became markedly elevated to 21,307 IU/l (normal: 12–144 IU/l) and 1,073 ng/ml (normal: 0–70 ng/ml), respectively. A diagnosis of ARF caused by RM associated with some central nervous system (CNS) complication was made, and the patient was transferred to our hospital. Physical examination on admission to our hospital revealed that the patient was drowsy. Her blood pressure was 126/76 mmHg. Laboratory studies revealed the following: WBC count 10,590/μl, hemoglobin 13.9 g/100 ml, hematocrit 38.0%, platelet count 119,000/μl, serum total protein 6.6 g/dl, albumin 3.9 g/dl, BUN 63 mg/dl, creatinine 6.8 mg/dl, sodium 137 mmol/l, potassium 4.3 mmol/l, chloride 97 mmol/l, calcium 6.8 mg/dl, CRP 17.8 mg/dl, and CK 29,484 IU/l. Immunological studies revealed the following: IgG 502 mg/dl, IgA 185 mg/dl, IgM 43 mg/dl, C3 76 mg/dl (normal: 79–152 mg/dl), C4 20 mg/dl (normal: 16–38 mg/dl), and complement hemolytic activity 37.4 U/ml (normal: 23–46 U/ml). The serological test for antinuclear antibody was positive at a titer of 1:320, with a homogeneous pattern. Although the blood culture was negative, the stool culture was positive for Salmonella enteritidis. A search for endotoxin in the blood was negative. The levels of the proinflammatory cytokines, interleukin (IL)-6 and IL-8, were analyzed in the CSF specimen obtained at the onset of the salmonellosis. The CSF levels of both cytokines were significantly elevated: IL-6 328 pg/ml (measured by enzyme immunosorbent assay, normal: less than 4.0 pg/ml) and IL-8 327 pg/ml (measured by enzyme-linked immunosorbent assay, normal: less than 2.0 pg/ml). On the T. Nakahata . K. Tsugawa . H. Tanaka (*) Department of Pediatrics, Hirosaki University School of Medicine, 5 Zaifu-cho, Hirosaki, 036-8562, Japan e-mail: hirotana@cc.hirosaki-u.ac.jp