Serum Myoglobin Levels Research Articles

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.

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.

Quantitative diagnosis of early acute compartment syndrome using two-dimensional shear wave elastography in a rabbit model.

This study explored the association of the elasticity modulus and shear wave velocity (SWV) of the tibialis anterior muscle, as measured by two-dimensional shear wave elastography (2D-SWE), with the intracompartmental pressure (ICP) determined using the Whitesides method in a New Zealand rabbit model of acute compartment syndrome (ACS). Additionally, it evaluated the viability of 2D-SWE as a noninvasive, quantitative tool for the early detection of ACS. An ACS model was established through direct external compression by applying pressure bandaging to the lower legs of 15 New Zealand rabbits using neonatal blood pressure cuffs. Another five animals represented a non-modeled control group. To measure the elasticity modulus and SWV of the tibialis anterior muscles, 2D-SWE was employed. Blood oxygen saturation, serum creatine kinase (CK), and myoglobin levels were monitored. Subsequently, the anterior tibial compartment was dissected, and the tibialis anterior was removed for hematoxylin and eosin staining to assess muscle injury. The elasticity modulus and SWV of the tibialis anterior muscle increased with compression duration, as did serum CK and myoglobin levels. ICP was strongly positively correlated with these parameters, particularly mean velocity (r=0.942, P&lt;0.001) and CK (r=0.942, P&lt;0.001). Blood oxygen saturation was negatively correlated with ICP (r=-0.887, P&lt;0.001). Histological analysis indicated progressive muscle cell swelling over time, with damage transitioning from reversible to irreversible and culminating in necrosis. In a rabbit ACS model, ICP was strongly positively correlated with muscle elasticity modulus/SWV. Consequently, 2D-SWE may represent a novel tool for assessing early-phase ACS.

The Implication of Elevated Serum Myoglobin Level in Acute Diabetic Complications of Ketoacidosis and Hyperglycemic Hyperosmolar State: A Real-World Study.

To investigate the implications of elevated myoglobin (MYO) in acute diabetic conditions of diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS). This study integrates in-patient data from Shanghai Pudong Hospital from 2019 to 2023. Laboratory data were compared between stable T2D patients (without acute diabetic complications), DKA, and HHS patients. The multilinear regression explored variables relevant to the elevated MYO in DKA and HHS. The dynamics of MYO, the survival rate, and associated risk factors in HHS were determined. Except for triglyceride, procalcitonin, low-density lipoprotein, islet cell autoimmune antibodies, N-terminal Pro-brain natriuretic peptide (NT-ProBNP), and brain natriuretic peptide (BNP), there were significant differences in age, gender distribution, duration of diabetes, type of diabetes, and other referred laboratory data (p<0.05). The age, gender, creatine kinase (CK), estimated glomerular filtration rate (eGFR), and free triiodothyronine (FT3) in DKA, whereas osmolar, uric acid (UA), and cardiac troponin I (cTNI) in the HHS, were significant determinants of elevated MYO, respectively (p<0.05). The dynamic of MYO in HHS was in line with the survival trend, where the percentage of death was 29.73%, and aging with higher procalcitonin levels was a key risk factor. Besides, the cumulative survival rates between patients with or without bone fracture or muscle injury were substantially different. This real-world study demonstrated DKA and HHS potentially have unique causes for increased MYO. By utilizing the appropriate regression parameters, we could forecast the progression of increased MYO in groups of DKA and HHS, while based on risk factors of aging, severity of infection, and different MYO sources, we could predict the prognosis of HHS.

Protein Kinase C Beta II Inhibitor Conjugated with Myristic Acid and Trans-Activator of Transcription improves intracellular delivery and cardiovascular protection in porcine myocardial ischemia/reperfusion injury

Introduction: While timely reperfusion of oxygenated blood is critical during resuscitation of ischemic myocardium, oxidative stress during reperfusion still leads to ischemia/reperfusion (I/R) injury and ultimately, cardiomyocyte death. The major sources of oxidative stress targeted in this study are NADPH oxidase (NOX-2) and mitochondria, which are both activated by protein kinase C beta II (PKCβII). In previous studies with an ex-vivo rat heart I/R model, Myristic Acid (Myr) and Trans-Activator Transcription (Tat; YGRKKRRQRRR) conjugated PKCβII inhibitor (Myr-Tat-PKCβII-; N-Myr-Tat-CC-SLNPEWNET) showed cardioprotective effects and decreased infarct size. In this study, we hypothesized that Myr-Tat-PKCβII- will offer cardioprotective effects in comparison with a scrambled peptide control (Myr-Tat-PKCβII-scram; N-Myr-Tat-CC-WNPESLNTE) in an in-vivo porcine myocardial I/R model. Methods: Regional I(1 hour)/R(3 hours) was induced in Male Yorkshire pigs (38-50kg) by inflating a balloon to occlude the Left Anterior Descending Artery (LAD) at the level of the second diagonal branch (supplies 40% of anterior left ventricle) and then deflating it to allow for reperfusion. Then, a bolus of either Myr-Tat-PKCβII- or Myr-Tat-PKCβII-scram (20ng/kg; ~100pmol in blood) was immediately administered into the LAD. Cardiac function and injury were measured by monitoring changes in ejection fraction (EF) and through routine measurements of serum creatine phosphokinase (CPK), troponin I, and myoglobin, respectively. After I/R, the hearts were stained with 1% Evans Blue dye to identify the area at risk (AR) and 1% triphenyltetrazolium chloride to determine the area of necrosis (AN). Infarct size was then quantified (AN/AR) and all data was analyzed via Student’s t-test. Results: Analysis showed that Myr-Tat-PKCβII- significantly restored EF to within 1.40.7% of baseline compared to controls which only restored EF to within 6.42.1% (p&lt;0.05) of baseline EF. Myr-Tat-PKCβII- showed a significant increase in serum myoglobin levels at 1 hr of reperfusion (1362.1 83.4 μg/mL, n=4) compared to scrambled control (202.1197.3 μg/mL, n=3 p&lt;0.05). Myr-Tat-PKCβII- reduced infarct size to 10.0±2.8%; n=4; compared to scrambled control hearts (28.5±8.3%; n=6; p&lt;0.05). CPK and Troponin I levels were comparable in both groups. These results suggest that Myr-Tat-PKCβII- can help prevent cardiac injury when given immediately after an ischemic event. Conclusions: Data from ex-vivo rat heart I/R model, coupled with data from this in-vivo porcine myocardial I/R model indicate the effcacy of Myr-Tat-PKCβII- in preventing oxidative stress-induced myocardial I/R injury when given at the beginning of reperfusion. These findings suggest that Myr-Tat-PKCβII- could be useful in the clinical setting when administered immediately after cardiac resuscitation. Future studies include the treatment of rat cardiomyocyte cells with Myr-Tat-PKCβII- prior to 24 hr hypoxia/24 hr reoxygenation, followed by cell viability assays compared to untreated control. This additional data can help determine the optimal dose to use in a 12 week survival study using the same porcine myocardial I/R protocol. Funding: This study was funded by the Philadelphia College of Osteopathic Medicine, Department of Biomedical Sciences, Division of Research, and the Center for Chronic Diseases of Aging, the National Heart, Lung &amp; Blood Institute at NIH (grant # 1R43HL160338-01) and Young Therapeutics, LLC. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Risk factor and correlation between postoperative serum myoglobin and acute kidney injury after pulmonary endarterectomy.

Acute kidney injury (AKI) is a common and life-threatening complication following pulmonary endarterectomy (PEA). Our study aimed to investigate the risk factors associated with AKI and evaluate the correlation between serum myoglobin (sMb) levels and postoperative AKI. We conducted a retrospective study involving 134 patients who underwent PEA at China-Japan Friendship Hospital. AKI was defined and staged according to the Kidney Disease Improving Global Outcomes (KDIGO) criteria. During the study period, the incidence of postoperative AKI was 57.5%, and the associated mortality rate was 6.0%. Severe AKI was found to be significantly associated with worse short-term outcomes (P<0.05). Logarithmically transformed postoperative day (POD) 0 sMb levels were significantly associated with AKI [odds ratio (OR) =5.174; 95% confidence interval (CI), 2.307-11.603; P<0.001] and severe AKI (OR =4.605; 95% CI, 1.510-14.048; P=0.007), also had independent predictive value [area under the curve (AUC) =0.776 in AKI and AUC =0.737 in severe AKI]. The optimal cut-off values were 370.544 ng/mL for AKI and 419.473 ng/mL for severe AKI. Furthermore, albumin concentration was found to play a protective role in the development of severe AKI (OR =0.838; 95% CI, 0.716-0.980; P=0.027) when higher than 40.350 g/L. Our findings suggest that a high concentration of POD0 sMb may increase the risk of developing AKI following PEA surgery. Increasing albumin concentration could serve as an effective preventive measure against AKI.

Factors Associated with Acute Kidney Injury Occurrence and Prognosis in Rhabdomyolysis at the Emergency Department.

Background and Objectives: This study aimed to analyze patients with rhabdomyolysis who presented to emergency departments and identify their distribution of related disease and prognostic factors. Materials and Methods: A retrospective cohort study was conducted on patients with rhabdomyolysis who presented to emergency departments over a 10-year period. Patient data, including patients' demographic variables (sex and age), mode of arrival, final diagnosis, statin use, rhabdomyolysis trigger factors, and levels of serum creatine phosphokinase (CPK), myoglobin, creatinine, sodium, potassium, phosphate, calcium, and lactate, were analyzed. Univariate and multivariate logistic regression analyses were conducted to identify the predictive factors of acute kidney injury (AKI). Results: Among the patients, 268 (65.6%) were found to have trigger factors without underlying diseases. Furthermore, 115 (28.2%) patients developed AKI. This comprehensive study sheds light on the diverse factors influencing the occurrence of AKI in rhabdomyolysis and provides insights into AKI predictive markers. Furthermore, we analyzed the cases by dividing them into six groups: occurrence of AKI, occurrence of infection, and simple or complex rhabdomyolysis. CPK time course was found to be important in clinical prognosis, such as AKI occurrence, dialysis or not, and mortality. Conclusions: Age, statin use, elevated creatinine and lactate levels, and initial serum CPK level emerged as significant predictors of AKI. CPK time course was also found to be an important factor in predicting the clinical outcomes of patients with rhabdomyolysis.

Correlation Between Early Serum Myoglobin Levels and the Incidence and Prognosis of Intensive Care Unit-Acquired Weakness (ICU-AW) in Septic Shock Patients: A Comparative Study.

Intensive Care Unit-acquired weakness (ICU-AW) is a common complication that significantly impedes patient recovery. In the study, we investigated the correlation between early serum myoglobin levels in patients with septic shock due to pneumonia, and the incidence of ICU-AW, duration of mechanical ventilation, and prognosis. Patients were classified based on the development of ICU-AW within the first 10 days of ICU admission. We measured serum myoglobin levels upon ICU entry, and analyzed demographic data, APACHE II scores, use of mechanical ventilation, and clinical outcomes, including mortality and duration of mechanical ventilation. The results indicated significantly elevated serum myoglobin levels in the ICU-AW group, correlated with prolonged mechanical ventilation and increased mortality. ROC analysis revealed myoglobin as a promising biomarker for predicting ICU-AW, with an area under the curve of 0.843 (95% CI: 0.819~0.867), demonstrating a sensitivity of 76.00% and specificity of 82.30%. These findings underscored serum myoglobin as a predictive biomarker for early ICU-AW in septic shock patients, highlighting its potential to guide clinical decision-making.

Serum myoglobin modulates kidney injury via inducing ferroptosis after exertional heatstroke.

Myoglobin released by rhabdomyolysis (RM) is considered to be involved in pathogenesis of kidney disease caused by crush injury, but whether high level of serum myoglobin predisposes patients to acute kidney injury (AKI) and its molecular mechanisms are still unclear in exertional heatstroke (EHS). We aimed to determine the association and potential mechanism of myoglobin and AKI, and further investigate the targeted therapeutic agents for myoglobinemia. Serum myoglobin concentrations in patients with EHS were measured at admission, 24 h and 48 h after admission and discharge. The risk of AKI at 48 h was the primary outcome; the secondary outcome was composite outcome events with myoglobin levels and AKI at discharge and death at 90 days. In experimental studies, we further investigated the mechanisms of human kidney proximal tubular (HK-2) cells that were exposed to human myoglobin under heat stress conditions and the effect of baicalein. Our measurements showed that the highest myoglobin quartile (vs. the lowest) had an adjusted odds ratio (OR) of 18.95 (95% confidence interval [CI], 6.00-59.83) for AKI and that the OR (vs. quartile 2) was 7.92 (95% CI, 1.62-38.89) for the secondary outcome. The survival rate of HK-2 cells treated with myoglobin under heat stress was significantly decreased, and the production of Fe2+ and reactive oxygen species (ROS) was markedly increased, accompanied by changes in ferroptosis proteins, including increased p53, decreased SLC7A11 and GPX4, and alterations in endoplasmic reticulum stress (ERS) marker proteins. Treatment with baicalein attenuated HK-2 cell ferroptosis induced by myoglobin under heat stress through inhibition of ERS. High myoglobin was associated with AKI in the EHS, and its mechanisms involved ERS-associated ferroptosis. Baicalein may be a potential therapeutic drug for the treatment of AKI in patients with high myoglobin induced by rhabdomyolysis following EHS.

P108: Analysis Of Postoperative Cytokine Adsorber Therapy (Cytosorbentstm Inc Cytosorb®) In Patients With Condition After Implantation Of A Mechanical Left Ventricular Assist Device (Medtronic Heartwaretm HVADTM System)

Background: The CytoSorb® is used to adsorb low and medium molecular weight hydrophobic substances to counteract increasing organ dysfunction by reducing inflammatory mediators, metabolites and proteins, thus potentially positively influencing the recovery process. The aim of this study is to evaluate the effects of the CytoSorb® on the selected organ functions heart, kidneys and liver in patients undergoing implantation of a Medtronic HeartwareTM-HVADTM-LVAD. Methods: A monocentric retrospective observational study was performed. After evaluation of the in-clinic database, 19 patients underwent LVAD implantation at the Department of Cardiac Surgery, Erlangen University Hospital, from Nov 1, 2019 to Jan 1, 2021. Of these, 6 patients received postoperative therapy with CytoSorb® (CytoSorbentsTM Inc) and formed group “A” of this study. A control group “non-A” without CytoSorb® was matched to group “A” regarding: age, sex, BMI, EuroSCORE II, duration of surgery, defined pre- and postoperative laboratory parameters and outcome. The use of cytokine adsorber in group “A” was analyzed. Its effects on heart, kidneys and liver were assessed by defined laboratory parameters (myoglobin, CK, creatinine, urea, BUN, total bilirubin and AST) and at defined time points. The outcome of patients in group “A” was assessed by 30-day mortality. Results: The group comparison showed: group “A” had a higher arithmetic mean risk profile in the EuroSCORE II (m(A) 10.3% vs. m(non-A) 7.2%), a higher BMI (m(A) 32.26 kg/m2 vs. m(non-A) 26.75 kg/m2), and a longer duration of surgery (m(A) 176 min. vs. m(non-A) 145 min.). Preoperative laboratory parameters: higher values in group “A” for creatinine, urea, BUN, total bilirubin, and AST; lower values in group “A” for myoglobin and CK. 24 hours postoperatively: a statistically significant difference for total bilirubin (95% CI: 0.48 to 7.42; p = 0.03), at a fixed significance level of α < 0.05, no significant differences for myoglobin, CK, creatinine, urea and AST for both groups. Analysis of group “A” in the first 24 h after starting therapy: the serum levels of myoglobin, creatinine, urea, total bilirubin and AST did not increase further on arithmetic average or began to decrease moderately. For CK, this effect was seen with a 24 h time lag. A statistically significant decrease for urea was observed over the entire 72 h period (95% CI: - 35.097 to - 7.073; p = 0.006), and the use of the adsorber correlated with a decrease in the value by an average of 21.08 points. Outcome group “A” : 3 patients in group “A” with late mortality > 30 days. Conclusion: The CytoSorb® therapy in group “A” did not lead to any further increase in the arithmetic mean values of the laboratory values examined over the entire time course of the analysis. A rebound in serum levels was observed for myoglobin and total bilirubin after termination of adsorber therapy. Persistent or further increasing organ dysfunction of heart and liver could be considered as causal.

The Effect of Short-term Administration of High-dose Vitamins E and C on Serum Creatine Kinase and Myoglobin in the Resting Phase of Elite Sanda Athletes: A Randomized Trial

Background: Muscle damage during continuous and intensive sports activities is common; therefore, experts in the field of sports medicine pay special attention to this issue. Objectives: We investigated the short-term effect of high-dose vitamin C and E supplements on serum levels of creatine kinase (CK) and myoglobin in elite athletes of the Sanda field. Methods: This research was a parallel single-blind randomized study design in which elite Sanda athletes were matched based on weight and randomly assigned to the vitamin C + E supplement (n = 10) and placebo groups (n = 10). Subjects took vitamin C (1400 U per day) and vitamin E (2000 U per day) supplements for 4 days (3 days before the competition and on the competition day). Blood sampling was done on the morning of the competition and 24 hours later (the following day) to measure serum levels of CK and myoglobin. Results: The serum CK level had a significant decrease in the supplement group (P = 0.001; mean ± SD: 237.2 ± 19.28), and myoglobin significantly increased (P = 0.001; mean ± SD, 41.1 ± 1.97) compared with the placebo group. Also, a paired sample t test showed that serum CK and myoglobin levels significantly decreased (P = 0.001; pretest, 307.7 ± 5.56; posttest, 237.2 ± 19.28) and increased (P = 0.005; pretest, 24.2 ± 2.7; posttest, 41.1 ± 1.97) in the supplement group, respectively, compared to the pretest values. However, no significant difference was observed in the placebo group. Conclusions: Short-term intake of high-dose vitamins C and E can facilitate recovery during competitive events such as Sanda. This claim can be defended based on the changes in CK and myoglobin in the blood serum of athletes.

Myositis Autoantibodies in Patients with Suspected Post-Treatment Lyme Disease Syndrome.

Most patients suffering from Lyme disease are effectively treated with antibiotics. In some patients, however, problems persist for a long time despite appropriate therapy. The term post-treatment Lyme disease syndrome (PTLDS) is currently used for this condition in scientific literature. The pathogenesis is still not precisely known, but the involvement of immunopathological mechanisms is assumed. In our study, we analyzed the presence of autoantibodies including myositis-specific (MSA) and myositis-associated autoantibodies (MAA) in patients with laboratory proven history of Lyme disease and with clinical symptoms of PTLDS. A total of 59 patients meeting the criteria for PTLDS were enrolled in this study. The control group consisted of 40 patients undergoing differential diagnosis of neurological disorders without clinical and/or laboratory-proven history of Lyme disease. The presence of autoantibodies was determined by immunoblot methods and positive samples were further tested for serum creatine kinase (CK) and myoglobin levels. The presence of myositis autoantibodies was detected in 18 subjects with suspected PTLDS (30.5%), but only in 5% of control subjects exhibiting no evidence of Lyme disease history. The difference was statistically significant (p = 0.002). The subsequent biochemical analysis of muscle-damage markers in positive subjects found a mild elevation in six MSA/MAA-positive PTLDS patients. The study detected raised MSA/MAA autoantibodies formation in the group of PTLDS patients raising the question about their involvement in the pathogenesis of this syndrome.

Myoglobinemia, Peripheral Arterial Disease, and Patient Mortality.

Peripheral arterial disease (PAD) causes leg muscle damage due to inadequate perfusion and increases cardiovascular events and mortality 2- to 3-fold. It is unclear if PAD is a biomarker for high-risk cardiovascular disease or if skeletal muscle injury harms arterial health. The objective of this work is to test if serum myoglobin levels (myoglobinemia) are a marker of PAD, and if so, whether myoglobin impairs vascular health. Patient blood samples were collected from PAD and control (no PAD) patients and interrogated for myoglobin concentrations and nitric oxide bioavailability. Patient mortality over time was captured from the medical record. Myoglobin activity was tested on endothelial cells and arterial function. Myoglobin is a biomarker for symptomatic PAD and was inversely related to nitric oxide bioavailability; 200 ng/mL myoglobin in vitro increased endothelial cell permeability in vitro and decreased nitrate bioavailability. Ex vivo, 100 ng/mL myoglobin increased vascular tone in naive murine aortas approximately 1.5 times, impairing absolute vessel relaxation. In vivo, we demonstrated that myoglobinemia caused impaired flow-mediated dilation in a porcine model. Patients presenting with myoglobin levels of 100 ng/mL or greater had significantly more deaths than those with myoglobin levels of less than 100 ng/mL. Using a combination of patient data, in vitro, ex vivo, and in vivo testing, we found that myoglobin is a biomarker for symptomatic PAD and a potent regulator of arterial health that can increase vascular tone, increase vascular permeability, and cause endothelial dysfunction, all of which may contribute to the vulnerability of PAD patients to cardiovascular events and death.

Rise CKMB and Myoglobin Levels in Non-Cardiac Patients of Ischemic Stroke Presenting to Emergency Department of a Tertiary Care Hospital

Objective: To assess the rise in CKMB and Myoglobin levels and associated factors in non-cardiac patients of ischemic stroke presenting to the Emergency Department of a Tertiary Care Hospital.&#x0D; Study Design: Cross-sectional study.&#x0D; Place and Duration of Study: Department of Emergency Medicine, Pak Emirates Military Hospital (PEMH), Rawalpindi Pakistan, from Dec 2020 to May 2021.&#x0D; Methodology: A total of 150 patients with ischemic stroke diagnosed by the consultant Emergency physician or medical specialist based on clinical and neuro-radiological findings were included in this study. Serum CKMB and myoglobin levels were assessed along with other baseline investigations among the study participants. In addition, the relationship of age, gender, the severity of the stroke and the presence of non-cardiac comorbidities was assessed with the rise in CKMB and myoglobin levels among the target population.&#x0D; Results: Out of 200 patients with ischemic stroke included in the study, 114(67.0%) were males, while 86(43.0%) were females. 75(37.5%) patients had either raised CKMB or Myoglobin levels, while 125(62.5%) patients had both biomarkers within range. On the National Institutes of Health Stroke Scale, 110(55.0%) patients had mild, 55(22.5%) had mild to moderately severe, 25(12.5%) had severe, and 10(5.0%) had very severe symptoms. Statistical analysis revealed that increased stroke severity had a statistically significant relationship (p-value&lt;0.001) with raised CKMB/Myoglobin levels in the target population.&#x0D; Conclusion: Raised CKMB or myoglobin levels were found in many patients with acute ischemic stroke. The stroke severity was associated with raised levels of these biomarkers.

Megalin blockade with cilastatin ameliorates multiple wasp sting-induced acute kidney injury in rats

Cilastatin has been shown to prevent various drug-induced nephrotoxicities and confer renoprotection in a mouse model of glycerol-mediated rhabdomyolysis-induced acute kidney injury (AKI). The present study aimed to investigate whether cilastatin attenuates wasp sting-induced AKI in rats. Male Wistar rats were divided into the control, cilastatin, AKI, and AKI + cilastatin groups. Nephrotoxicity was assessed using renal function, rhabdomyolysis (creatine kinase, CK) and intravascular hemolysis (lactate dehydrogenase, LDH) markers, and histological changes. In addition, tubular injury biomarkers, apoptosis, oxidative stress markers, complement C3 expression, and urine and blood myoglobin levels were examined. Compared with the control or cilastatin group, the AKI group showed significant histological damage, increased levels of CK, LDH, and creatinine, and increased mRNA expression of tubular injury biomarkers. Cilastatin ameliorated wasp venom-induced kidney injury by attenuating oxidative stress and apoptosis. Cilastatin also reduced C3 expression in the renal tubular cells. In addition, cilastatin reduced serum myoglobin levels and increased urine myoglobin concentrations. Therefore, megalin blockade with cilastatin attenuates wasp venom-induced AKI owing to its antioxidative and antiapoptotic properties.

Propofol-Related Infusion Syndrome: A Clinical Review

Propofol-related infusion syndrome (PRIS) is a lethal condition characterized by multiple organ system failures. It can occur due to prolonged administration of propofol (an anesthetic) in mechanically intubated patients. The main presenting features of this condition include cardiovascular dysfunction with particular emphasis on impairment of cardiovascular contractility, metabolic acidosis, lactic acidosis, rhabdomyolysis, hyperkalaemia, lipidaemia, hepatomegaly, acute renal failure, and eventually mortality in most cases. The significant risk factors that predispose one to PRIS are: critical illnesses, increased serum catecholamines, steroid therapy, obesity, young age (significantly below three years), depleted carbohydrate stores in the body, increased serum lipids, and most importantly, heavy or extended dosage of propofol. The primary pathophysiology behind PRIS is the disruption of the mitochondrial respiratory chain that causes inhibition of adenosine triphosphate (ATP)synthesis and cellular hypoxia. Further, excess lipolysis of adipose tissue occurs, especially in critically ill patients where the energy source is lipid breakdown instead of carbohydrates. This process generates excess free fatty acids (FFAs) that cannot undergo adequate beta-oxidation. These FFAs contribute to the clinical pathology of PRIS. It requires prompt management as it is a fatal condition. The clinicians must observe the patient's electrocardiogram (ECG), serum creatine kinase, lipase, amylase, lactate, liver enzymes, and myoglobin levels in urine, under propofol sedation. Doctors should immediately stop propofol infusion upon noticing any abnormality in these parameters. The other essentials of management of various manifestations of PRIS will be discussed in this article, along with a detailed explanation of the condition, its risk factors, diagnosis, pathophysiology, and presenting features. This article aims to make clinicians more aware of the occurrence of this syndrome so that better ways to manage and treat this condition can be formulated in the future.

Systemic inflammatory response in rats with explosive wound

Aim. To evaluate the temporal changes in circulating cytokines rallying systemic inflammatory response after a blast injury.Material and Methods. Experiments were performed on 60 male Wistar rats (50 rats with blast-related soft tissue injury of the thigh and 10 intact rats). Blast injury was modeled under general anaesthesia using grater firecrackers stuffed with a pyrotechnic mixture. After 3, 7, 14 and 28 days post injury, we carried out a gross examination of the wound and its drainage, measured wound area, assessed local oedema severity, and evaluated serum potassium, myoglobin TNF-α, IL-1β, IL-6, and IL-10.Results. Three to seven days post injury, therewas abundant serous and purulent exudate and pronounced local edema without considerable changes in the wound area. Serum myoglobin and potassium were raised 2.2-2.6-fold and 1.3-fold, respectively (p &lt; 0.05); in addition, we documented the elevation of a major pro-inflammatory cytokine IL-1β. Fourteen days post injury, wound area reduced by 24%, (p &lt; 0.05) along with the decreased wound drainage and local edema of the injured area. Although the levels of serum myoglobin and pro-inflammatory cytokines (in particularIL-6) lowered, they were still significantly higher as compared with the intact rats. Twenty eight days post injury, fibrosis has been completed, epithelialization occurred and only a small scab remained on the wound surface. Yet, serum IL-1β still was 1.3-fold higher than in the intact animals (p &lt; 0.05), albeit IL-6 and TNF-α returned to the reference values. The concentration of anti-inflammatory cytokine IL-10 reached its maximum values relative to the control (3.9-fold, p &lt; 0.05) to the 14th day post injury that was followed by a considerable reduction (though not reaching the reference values) by the period of scar formation.Conclusion. Blast injury in rats is accompanied by a dysregulated balance between pro-inflammatory and anti-inflammatory cytokines throughout all regeneration phases.

Relaxin-3 Ameliorates Diabetic Cardiomyopathy by Inhibiting Endoplasmic Reticulum Stress

Background This study is aimed at investigating whether relaxin-3 exhibits protective effects against cardiomyopathy in diabetic rats by suppressing ERS. Methods Eighty male SD rats were randomly divided into two groups: controls (n = 20) and diabetes (n = 60). The streptozotocin-treated rats were randomly divided into three groups: diabetic group (DM), low-dose relaxin-3 group (0.2 μg/kg/d), and high-dose relaxin-3 group (2 μg/kg/d). The myocardial tissues and collagen fiber were observed by hematoxylin and eosin (H&E) and Masson staining. Serum brain natriuretic peptide (BNP), troponin (TNI), myoglobin, interleukin (IL-17), interleukin (IL)-1α, and tumor necrosis factor (TNF)-α were determined by ELISA. The protein expression of glucose regulatory protein 78 (GRP78) and C/EBP homologous protein (CHOP) in the heart tissue of each group was detected by Western blot analysis. Results (1) HE and Masson staining indicated that relaxin-3 could attenuate myocardial lesions and myocardial collagen volume fraction. (2) BNP, TnI, and myoglobin in the DM group at four and eight weeks were significantly higher than in the controls (P < 0.01). The relaxin-3-treated groups showed significantly reduced serum BNP, TnI, and myoglobin levels compared with the DM group (P < 0.05). (3) IL-17, IL-1α, and TNF-α levels in the DM rats at 4 weeks were higher than in the controls (P < 0.05). Low or high dose of relaxin-3-treated groups showed reduced serum IL-17 and TNF-α levels compared with the DM group at four and eight weeks (P < 0.05). (4) CHOP and GRP78 protein expression was increased in the DM group at four and eight weeks compared with the controls (P < 0.01), and small and large doses of relaxin-3 significantly reduced GRP78 and CHOP protein expression. Conclusions Exogenous relaxin-3 ameliorates diabetic cardiomyopathy by inhibiting ERS in diabetic rats.

Nomogram and Machine Learning Models Predict 1-Year Mortality Risk in Patients With Sepsis-Induced Cardiorenal Syndrome

ObjectiveEarly prediction of long-term outcomes in patients with sepsis-induced cardiorenal syndrome (CRS) remains a great challenge in clinical practice. Herein, we aimed to construct a nomogram and machine learning model for predicting the 1-year mortality risk in patients with sepsis-induced CRS.MethodsThis retrospective study enrolled 340 patients diagnosed with sepsis-induced CRS in Shanghai Tongji Hospital between January 2015 and May 2019, as a discovery cohort. Two predictive models, the nomogram and machine learning model, were used to predict 1-year mortality. The prognostic variables used to develop the nomogram were identified based on a forward stepwise binary logistic regression, and the predictive ability of the nomogram was evaluated by the areas under the receiver operating characteristic curve (AUC) and the calibration curve. Meanwhile, machine learning (ML) techniques, such as support vector machine, random forest (RF), and gradient boosted decision tree, were assessed mainly by accuracy and AUC. Feature ranking analysis was performed using the ML algorithm. Both nomogram and ML models were externally validated by an independent cohort of 103 patients diagnosed with sepsis-induced CRS between June 2019 and December 2020.ResultsAge, sequential sepsis-related organ failure score (SOFA), serum myoglobin (MYO), vasopressor use, and mechanical ventilation were identified as independent risk factors for 1-year mortality in the nomogram predictive model. In the discovery cohort, the nomogram yielded higher AUC for predicting mortality than did the SOFA score (0.855 [95% CI: 0.815–0.895] vs. 0.756 [95% CI: 0.705–0.808]). For ML, the model developed by RF showed the highest accuracy (0.765) and AUC (0.854). In feature ranking analysis, factors such as age, MYO, SOFA score, vasopressor use, and baseline serum creatinine were identified as important features affecting 1-year prognosis. Moreover, the nomogram and RF model both performed well in external validation, with an AUC of 0.877 and 0.863, respectively.ConclusionOur nomogram and ML models showed that age, SOFA score, serum MYO levels, and the use of vasopressors during hospitalization were the main factors influencing the risk of long-term mortality. Our models may serve as useful tools for assessing long-term prognosis in patients with sepsis-induced CRS.

The Effects of Ticagrelor Combined with Tirofiban on Coagulation Function, Serum Myocardial Injury Markers, and Inflammatory Factor Levels in Patients with Acute Myocardial Infarction after Percutaneous Coronary Intervention.

Background Acute myocardial infarction (AMI) refers to the acute necrosis of part of the myocardium caused by persistent and severe myocardial ischemia. This study is aimed at investigating the efficacy of tirofiban combined with ticagrelor in AMI patients after percutaneous coronary intervention (PCI) and its effects on plasma activated partial thromboplastin time (APTT), fibrinogen (FIB), D-dimer (D-D) levels, myocardial injury markers, and inflammatory factors. Methods 68 AMI patients with AMI who received PCI were divided into control group and observation group (n =34) according to postoperative treatment methods. Both groups received ticagrelor tablets (90 mg). The observation group was additionally given tirofiban (10 μg/kg). APTT, FIB, D-D, serum myoglobin (MB), cardiac troponin I (cTnI), serum C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), and IL-6, myeloperoxidase (MPO) levels and the peak time in both groups were detected. The incidence of cardiovascular events and drug safety were compared. Results After treatment, APTT was increased, and FIB and D-D levels were decreased in both groups. After treatment, the APTT in the observation group was longer, and FIB and D-D levels were lower than those in the control group. The peak time of serum MB and cTnI in the observation group was earlier than that in the control group. The levels of serum MB and cTnI in the observation group were lower than those in the control group. After treatment, serum CRP, TNF-α, IL-6, and MPO levels were decreased. And the incidence of cardiovascular events was reduced. Conclusion Tirofiban combined with ticagrelor can improve coagulation function, protect myocardium, relieve inflammation, and reduce the risk of cardiovascular events in patients with AMI after PCI.