Myoglobin Values Research Articles

Biomarkers and prediction of anthracyclic cardiotoxicity in breast cancer.

Chemotherapy with doxorubicin may lead to left ventricular dysfunction. There is a controversial recommendation that biomarkers can predict ventricular dysfunction, which is one of the most feared manifestations of anthracycline cardiotoxicity. The aim of this study was to evaluate the behavior of biomarkers such as Troponin I, type B natriuretic peptide, creatine phosphokinase fraction MB, and myoglobin in predicting cardiotoxicity in a cohort of women with breast cancer undergoing chemotherapy with anthracycline. This is an observational, prospective, longitudinal, unicentric study, which included 40 women with breast cancer, whose therapeutic proposal included treatment with doxorubicin. The protocol had a clinical follow-up of 12 months. Biomarkers such as Troponin I, type B natriuretic peptide, creatine phosphokinase fraction MB, and myoglobin were measured pre-chemotherapy and after the first, third, fourth, and sixth cycles of chemotherapy. There was a progressive increase in type B natriuretic peptide and myoglobin values in all chemotherapy cycles. Although creatine phosphokinase fraction MB showed a sustained increase, this increase was not statistically significant. Troponin, type B natriuretic peptide, myoglobin, and creatine phosphokinase fraction MB were the cardiotoxicity markers with the earliest changes, with a significant increase after the first chemotherapy session. However, they were not able to predict cardiotoxicity. Troponin I, type B natriuretic peptide, myoglobin, and creatine phosphokinase fraction MB are elevated during chemotherapy with doxorubicin, but they were not able to predict cardiotoxicity according to established clinical and echocardiographic criteria. The incidence of subclinical cardiotoxicity resulting from the administration of doxorubicin was 12.5%.

Handling tuna steak with co-gas and liquid smoke production waste gas

In this study, liquid smoke production waste gas (LSPW) was used as a substitute for carbon monoxide (CO) and filter smoke in handling frozen tuna steaks. Tuna steaks were packed in plastic bags, then inside the bag, tuna steak were sprayed with CO and LSPW, and stored at 4°C for two days. After that, each package was vacuumed and stored at -25°C for four weeks. Observation of quality deterioration of tuna steak started from the beginning of storage until the fourth week. The results showed a significant difference in the average TPC value of tuna steak sprayed with CO and LSPW during frozen storage. While the values of pH, TVB, myoglobin, and color were not significantly different. Until the end of the observation, the quality of tuna steak was still relatively good with myoglobin content values of CO and LSPW treatments, respectively: 36.65±4.78 and 42.04±4.47 mg%, color 34.67±9.07 and 35.67±8.50 °Hue, pH 6.47±0.15 and 6.60±0.10, TVB-N 18.04±0.93 and 17.86±0.98 mg N/100g, histamine 1.92±0.05 and 1.85±0.13 ppm, and TPC 7.41x102 and 8.70x102cfu/g.

Effect of Using Parsley (Petroselinum crispum) As Feed Additive on Some Meat Traits of Broiler Chicks

The present study was conducted to determine the effect of dietary additive with parsley on some meat traits of the breast and thigh meat of broiler chicks, at eight-day old, chicks will be divided equally on floor pens into 5 groups, each group contained 3 replicates (8 chicks/ each). Treatments are dividing as (T1), using basal diet free from parsley as control (T2), using basal diet plus 3 gm. parsley/Kg of diet (T3), using basal diet plus 6 gm. parsley/Kg of diet (T4), using basal diet plus 9 gm. parsley/Kg of diet (T5), using basal diet plus 12 gm. parsley/Kg of diet. In the end of this experiment all after the slaughtering the broiler, the sample will be taken from breast and thigh. Adding parsley to feed of chicks effect significantly (p<0.01) on chemical composition in breast and thigh meat, and high percentages recorded in meat from broiler chicks fed on parsley, adding of parsley as feed additive promote significantly (p<0.01) physical traits, TBA, TVN.B values, Met- myoglobin and Myoglobin value of breast and thigh meat of broiler chicks, using parsley effect significantly on some amino acids percentages in breast and thigh meat of broiler chicks, adding parsley effect significantly in Chromium, Copper, Nickel and Zinc concentrations in thigh meat, also effect on Iron concentrations in breast meat.

Diquat Poisoning: Care Management and Medico-Legal Implications.

Acute chemical intoxication represents one of the major causes of Emergency Room admittance, and possible errors in diagnosis are extremely frequent, especially when patients present generic and non-specific symptoms. Diquat, a bipyridyl class of herbicides, exerts high intrinsic toxicity as a consequence of free oxygen radicals, leading to cellular death and organ dysfunctions. Following ingestion, with the major source of absorption for suicidal purposes, the chemical induces local irritating effects; systemic symptoms appear later, while specific symptoms can occur in the following 48 h. A smoker and hypertensive 50-year-old man arrives at the E.R., reporting that an episode of herbicide inhalation occurred few hours earlier. Physical examination evidenced alkalosis with hypoxemia, leucocytosis, mild hyperglycaemia and moderate increase in creatine kinase and myoglobin. Despite blood creatine kinase and myoglobin values that were higher than normal, he was prescribed with hydration and anti-pain therapy. During the night, the man left the hospital; he returned the next morning at 8:45 a.m., with cardiorespiratory arrest, medium fixed non-reactive mydriasis, diffused cyanosis of the skin and of the mucous membranes, as well as imperceptible pulse and peripheral pressure. Despite resuscitation attempts, the patient died at 9:30 a.m.; the body was immediately transferred to the morgue. Autopsy and toxicological analyses were carried out nine days later, evidencing paraquat ingestion for suicidal purposes. GC/MS analyses to verify the presence of diquat were performed on body fluids and gastric and colon contents; all specimens resulted positive, thus confirming the cause of death as herbicide ingestion (blood diquat concentration of 1.2 mg/L; more than twice the minimum to observe a systemic poisoning). The procedure followed for patient management resulted to be not in line with the provisions of both guidelines and good clinical practices. Staff did not perform clinical-diagnostical monitoring of the patient’s condition or ask for more specific analyses (i.e., serum creatine phosphokinase monitoring). This misconduct led to a decrease in the patient’s chances to survive.

Myoglobin and troponin as prognostic factors in patients with COVID-19 pneumonia

BackgroundThe outbreak of novel coronavirus pneumonia 2019 (COVID-19) has caused millions of deaths worldwide. It is well documented that troponin predicts the prognosis of patients. Myoglobin is not only an important marker of myocardial injury, but it indicates systemic muscle damage. However, its relationship with COVID-19 was rarely reported. The present study compared the predictive value of troponin and myoglobin on the final prognosis of COVID-19 patients by analyzing the clinical characteristics and serum levels of myoglobin and troponin in severe/critical COVID-19 patients. MethodsWe enrolled 499 consecutive eligible hospitalized patients with severe/critical COVID-19 from February 14 to March 24, 2020 at Leishenshan Hospital, Wuhan, China. Clinical characteristics and laboratory data were collected and compared between the patients who died and survived. We analyzed the receiver operating characteristic curves of myoglobin and troponin. Then, the patients were divided into myo+ group, myo− group, tro+ group, and tro− group, and survival curves were analyzed. The prognostic predictable values of myoglobin and troponin were further analyzed using Cox multifactorial analysis. ResultsMyoglobin and troponin were significantly elevated in the death group (134.4 [interquartile range (IQR) 24.80, 605] vs 38.02 [IQR 3.87, 11.73]ng/ml, p<0.001), and troponin was also significantly elevated in the death group (0.01 [IQR 0.01, 0.01] vs 0.04 [IQR 0.02, 0.15]ng/ml, p<0.001). The ROC curves demonstrated that the area under the curve when using myoglobin to predict patient death was 0.911, with a threshold of 1.17, which was equivalent to troponin. Kaplan–Meier survival analysis revealed a significantly lower survival curve in the myo+ group than the myo− group. Multifactor Cox survival analysis showed that troponin was no longer significant (HR=0.98, 95% CI 0.92–1.03, p=0.507), but elevated myoglobin was an independent predictor of death in COVID-19 patients (HR=1.001, 95% CI 1.001–1.002, p<0.001). The analysis of the Cox model for predicting patient death and plotting decision curves suggested that the single factor myoglobin model was superior to troponin, and the predictive value of the multifactor model was superior to the single-factor analyses. ConclusionsIn severe/critical COVID-19 patients, myoglobin and troponin were predictors of mortality and the probability of conversion to critical illness, and myoglobin may be superior to troponin for predictive value.

Possible role of higher serum level of myoglobin as predictor of worse prognosis in Sars Cov 2 hospitalized patients. A monocentric retrospective study

Background Limited data on myoglobin and infectious diseases are available. In this study we evaluate the potential role of myoglobin in predicting poor outcome in patients with Sars-Cov2 pneumonia. Method One hundred and twenty-one Sars-Cov 2 patients with average age of 69.9±13.2 years, and symptoms duration of 8.8±7.9 days were enrolled in the study. At the admission, the serum levels of myoglobin, erythrocyte sedimentation rate, C reactive protein (CRP), procalcitonin, ferritin, creatine phosphokinase, creatinine, fibrinogen, d-dimers, lactic dehydrogenase, troponin (Tn-I), creatine kinase myocardial band (CK-MB), complement fractions C3 and C4, immunoglobulins, interleukin 6 were evaluated. We also assessed the patients’ complete clinical history and performed a thorough physical examination including age, disease history and medications. Results Twenty-four (20%) patients died, and 18 (15%) patients required intensive care. The mean time between symptoms onset and death was 12.4 days ± 9.1. Univariate analysis of the patients’ data highlighted some independent risk factors for mortality in COVID-19, including higher neutrophils rate (HR: 1.171), lower lymphocytes rate (HR: 0.798), high CK-MB serum levels (HR: 1.6), high Tn-I serum levels (HR: 1.03), high myoglobin serum levels (HR: 1.014), Alzheimer (HR 5.8), and higher CRP values (HR: 1.011). Cox regression analysis model revealed that higher serum values of myoglobin (HR 1.003; 95%CI: 1.001-1.006; p=0.01), and CRP (HR 1.012; 95% CI: 1.001 – 1.023; p=0.035) could be predictors of mortality in COVID-19 patients. The value of myoglobin level for predicting 28 days-mortality using ROC curve was 121.8 ng/dL. Lower survival rate was observed in patients with serum levels of myoglobin>121.8 ng/dL (84% vs 20% respectively, p=0.0001). Conclusion Our results suggest that higher serum levels of myoglobin could be considerable an effective predictor of poor outcomes in COVID-19 patients; a careful follow-up in these patients is strongly suggested. The possibility of enhancing these findings in other cohorts of COVID-19 patients could validate the clinical value of myoglobin as a biomarker for worse prognosis in COVID-19.

Effect of Glutamine Supplementation on Muscular Damage Biomarkers in Professional Basketball Players.

Scientific evidence supports the role of L-glutamine in improving immune function. This could suggest a possible role of L-glutamine in recovery after intense exercise. To this end, the present report aimed to study if oral L-glutamine supplementation could attenuate muscle damage in a group of players of a mainly eccentric sport discipline such as basketball. Participants (n = 12) were supplemented with 6 g/day of glutamine (G group) or placebo (P group) for 40 days in a crossover study design (20 days with glutamine + 20 days with placebo and vice versa). Blood samples were obtained at the beginning and at the end of each period and markers from exercise-induced muscle damage were determined. The glutamine supplemented group displayed significantly low values of aspartate transaminase, creatine kinase and myoglobin in blood, suggesting less muscle damage compared to the placebo. In addition, adrenocorticotropic hormone levels were lower in the glutamine supplemented group than in the placebo. As a result, the circulating cortisol levels did not increase at the end of the study in the glutamine supplemented group. Altogether, the results indicate that glutamine could help attenuate exercise-induced muscle damage in sport disciplines with predominantly eccentric actions.

Exercise-Induced Muscle Damage in Postmenopausal Well-Trained Women.

Sex hormone deprivation derived from menopause may affect exercise-induced muscle damage (EIMD). No studies have previously evaluated this response between postmpenopausal and premenopausal eumenorrheic women over the menstrual cycle. Postmenopausal women will present higher EIMD markers than premenopausal women, especially in comparison with the menstrual cycle phases where sex hormone concentrations are higher. Cross-sectional study. Level 3. Thirteen postmenopausal and 19 eumenorrheic women, all of them resistance-trained, performed an eccentric squat-based exercise. The postmenopausal group performed 1 bout of exercise, while the eumenorrheic group performed 3 bouts coinciding with the early follicular, late follicular, and mid-luteal phases ot their menstrual cycle. Muscle soreness, countermovement jump, creatine kinase (CK), myoglobin, lactate dehydrogenase, interleukin-6, tumor necrosis factor-α, and C-reactive protein were evaluated before and postexercise. The expected differences in sex hormones were observed between groups (P < 0.001) according to their reproductive status. Postexercise increases in CK, myoglobin, and muscle soreness (168.2 ± 45.5 U/L, 123.1 ± 41.5 µg/L, and 20.7 ± 21.3 mm, respectively) were observed in comparison with baseline (136.2 ± 45.5 U/L, 76.9 ± 13.8 µg/L, and 2.7 ± 4.2 mm, respectively). Myoglobin values at baseline in postmenopausal women were higher compared with premenopausal women in the aforementioned menstrual cycle phases, respectively (62.8 ± 8.2, 60.4 ± 7.2, and 60.1 ± 10.6 µg/L; P < 0.001 for all comparisons), which was supported by large effect sizes (0.72-1.08 standardized d units). No postexercise differences were observed between groups in any markers (P > 0.05). Despite higher resting levels of myoglobin and lower strength values in postmenopausal than in premenopausal women, EIMD was similar between both reproductive profiles. This suggests a potential benefit of being physically active despite aging and sex hormone deprivation. Sex hormone deprivation derived from menopause seems not to influence muscle damage reponse to eccentric exercise in resistance-trained postmenopausal women.

Myoglobin and troponin as prognostic factors in patients with COVID-19 pneumonia

BackgroundThe outbreak of novel coronavirus pneumonia 2019 (COVID-19) has caused millions of deaths worldwide. It is well documented that troponin predicts the prognosis of patients. Myoglobin is not only an important marker of myocardial injury, but it indicates systemic muscle damage. However, its relationship with COVID-19 was rarely reported. The present study compared the predictive value of troponin and myoglobin on the final prognosis of COVID-19 patients by analyzing the clinical characteristics and serum levels of myoglobin and troponin in severe/critical COVID-19 patients. MethodsWe enrolled 499 consecutive eligible hospitalized patients with severe/critical COVID-19 from February 14 to March 24, 2020 at Leishenshan Hospital, Wuhan, China. Clinical characteristics and laboratory data were collected and compared between the patients who died and survived. We analyzed the receiver operating characteristic curves of myoglobin and troponin. Then, the patients were divided into myo+ group, myo− group, tro+ group, and tro− group, and survival curves were analyzed. The prognostic predictable values of myoglobin and troponin were further analyzed using Cox multifactorial analysis. ResultsMyoglobin and troponin were significantly elevated in the death group (134.4 [interquartile range (IQR) 24.80, 605] vs 38.02 [IQR 3.87, 11.73]ng/ml, p<0.001), and troponin was also significantly elevated in the death group (0.01 [IQR 0.01, 0.01] vs 0.04 [IQR 0.02, 0.15]ng/ml, p<0.001). The ROC curves demonstrated that the area under the curve when using myoglobin to predict patient death was 0.911, with a threshold of 1.17, which was equivalent to troponin. Kaplan–Meier survival analysis revealed a significantly lower survival curve in the myo+ group than the myo− group. Multifactor Cox survival analysis showed that troponin was no longer significant (HR=0.98, 95% CI 0.92–1.03, p=0.507), but elevated myoglobin was an independent predictor of death in COVID-19 patients (HR=1.001, 95% CI 1.001–1.002, p<0.001). The analysis of the Cox model for predicting patient death and plotting decision curves suggested that the single factor myoglobin model was superior to troponin, and the predictive value of the multifactor model was superior to the single-factor analyses. ConclusionsIn severe/critical COVID-19 patients, myoglobin and troponin were predictors of mortality and the probability of conversion to critical illness, and myoglobin may be superior to troponin for predictive value.

Effect of Dietary Supplementing Cumin (Cuminum cyminum L.) on Meat Traits of the Broiler Chicks

This study was conducted to evaluate the dietary using of cumin as feed supplement on meat quality traits of the broiler chicken. Eight-day old broiler divided into 4 groups, 3 replicates (8 chicks/replicate) each for 45 days. Treatments included; (T1), basal diet without cumin or control, (T2), basal diet with 3 g. cumin. kg-1 of diet, (T3), basal diet with 6 g. cumin. kg-1 of diet, (T4), basal diet with 9 g. cumin. kg-1 of diet. At the end of this experiment after slaughtering all the chicks, samples were taken from breast and thigh meat. Results revealed that cumin supplementation did not significantly (p&lt;0.01) affect moisture percentages of breast meat and protein percentages of thigh meat. Results also showed that use basal diet with 3 and 6 g.cumin. kg-1 of diet significantly (p&lt;0.01) impact on meat water holding capacity and cooking loss percentages, while different cumin level impact on fat, ash percentages, pH value, TBA, TVB.N values, metmyoglobin, myoglobin value, copper, nickel, zinc, iron, magnesium, phosphorus and calcium concentrations of thigh meat, as well as iron, magnesium, phosphorus, sodium and calcium concentrations of breast meat. Results conclude that using cumin as feed supplement in 3, 6 and 9 g.kg-1 level, improve most chemical and physical traits of meat.

The effects of rapid weight loss on skeletal muscle in judo athletes

ObjectiveTo observe the effect of rapid weight loss (RWL) methods over 3 days on muscle damage in judokas.MethodsEighteen judokas participated in this crossover study, meaning that judo athletes were subjected to exercise-only phase (4 days) and RWL phase (3 days). Subjects were tested for myoglobin, creatine kinase, aldolase, hemoglobin, and hematocrit values on seven consecutive days. These biomarkers served as indicators of acute muscle damage.ResultsDuring the exercise-only phase, no significant changes were observed. Myoglobin (Mb) (p < 0.001), creatine kinase (CK) (p < 0.001) and aldolase (ALD) (p < 0.001) significantly increased only during the RWL phase, as well as hemoglobin (Hb) (p < 0.001) and hematocrit (Hct) (p < 0.005) values. It was detected that peak values for muscle damage biomarkers were reached on the sixth day, while Hct and Hb values were the highest on the seventh day of the study.ConclusionOur study showed significant muscle damage induced by RWL. The prevalence of RWL use by judokas is high but firm scientific evidence is lacking in the evaluation of the current practice of it. Therefore, further knowledge must be gained to evaluate the effectiveness of RWL on performance and its impact on judokas’ wellbeing.

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

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

Spectrum-activity relationship of trichosanthis fructus and trichosanthis fructus strip pieces for rat myocardial ischemia-reperfusion injury

To investigate the spectrum-activity relationship of Trichosanthis Fructus and Trichosanthis Fructus strip pieces for rat myocardial ischemia-reperfusion injury. HPLC fingerprints of Trichosanthis Fructus and Trichosanthis Fructus strip pieces were established, and the values of creatinekinase-MB (CK-MB), myoglobin (MYO) and cardiac troponin-T (cTNT) in 3 dose groups (2.25, 13.5, 27.0 g·kg⁻¹, equivalent to the crude herb g·kg⁻¹) of Trichosanthis Fructus and Trichosanthis Fructus strip pieces with myocardial ischemia-reperfusion injury in rats were measured, and the grey relational analysis was used to study the spectrum-activity relationship of Trichosanthis Fructus and Trichosanthis Fructus strip pieces for rat myocardial ischemia-reperfusion injury. With the dosage increase from 2.25 g·kg⁻¹ to 27.0 g·kg⁻¹, the correlation degree of spectrum-activity relationship of Trichosanthis Fructus and Trichosanthis Fructus strip pieces was also enhanced, but the change trend was different between these two groups. According to the frequency of the top 10 peaks in the correlation degree, peak 17, 14, 16, 19, 32, 12, 26, 30, 4, 6 and 2 were the basic effective substances group of Trichosanthis Fructus, peak 6,14,12,32,30,4 and 6 were the basic effective substances group of Trichosanthis Fructus strip pieces. Peak 6, 14, 12, 32, 30, 4 and 26 in fingerprints of Trichosanthis Fructus and Trichosanthis Fructus strip pieces were the main common pharmacodynamic substance base, among them, peak 6 was 5-hydroxymethyl furfural, peak 14 was vanillic acid and the peak 28 was rutin, but the correlation degree with the efficacy was different. The effect of Trichosanthis Fructus and Trichosanthis Fructus strip pieces on rat myocardial ischemia-reperfusion injury was due to the synergistic effect of the effective substance groups related to the dosage. The essential pharmacodynamic substance groups of Trichosanthis Fructus and Trichosanthis Fructus strip pieces were different, but they shared a common active ingredient group.

The effects of a soccer match on muscle damage indicators

During a soccer match players perform a substantial number of explosive activities such as jumps, duels, shots and dribblings, accelerations, decelerations, changes of direction and sprints. Precisely such repetitive eccentric contractions are related to muscle damage (exercise-induced muscle damage) that is, two or three days after the match, clinically presented as muscle soreness. The aim of this research was to identify the changes in muscle damage indicators in young players after playing a soccer game. The sample of examinees was composed of 43 soccer players (16.8±1.06 years) who were divided into two groups according to their age (22 cadets aged 15.86±0.35 years and 21 U19 players aged 17.76±0.54 years). Each group played one soccer game lasting 90 minutes each. Right before and immediately after the soccer match, examinees venous blood samples were taken in order to determine the markers of muscle damage. All statistical analyses were conducted by the SPSS software. The examinees demonstrated significantly higher values of myoglobin, creatine kinase, lactate dehydrogenase, aminotransferase, alkaline phosphatase and gamma-glutamyl-transferase after the game, as well as total number of leukocytes and concentration of C-reactive protein as indicators of inflammation. The results of this research showed that, as the muscle protein concentration was increased and an inflammatory reaction also occurred, soccer matches caused muscle damage in young players.

DETECTION AND MONITORING OF TISSUE ISCHEMIA DUE TO ACUTE ARTERIAL OBSTRUCTION IN THE LIMBS OF PATIENTS WITH QUANTITATIVE VIOLATIONS IN CONSCIOUSNESS, PERIDURAL ANESTHESIA

Traced and interpreted is the dynamic and correlative relations between the values of certain biochemical parameters of the homeostasis connected with cell metabolism in skeletal muscles so a verification of tissue ischemia (TI) and ischemic tissue lesion (ITL) can be performed. The target group is patients with quantitative violations in consciousness and peridural catheters placed for anesthesia, with the suspicion that an acute arterial obstruction in the limbs (AAOL) has occurred, or one has already been verified. Test of the serum levels of CK; CK (MB); ASAT; ALAT and Myoglobin were initially performed and were monitored in dynamic. A valuation of the ASAT/ALAT index in close correlation with the other parameters and clinical course of the disease was also performed. A particular dynamic and correlation, before the operation, after the timely revascularization, during the development of ischemic gangrene and after the amputation on an optimal level, was observed. We found an acute elevation of the enzyme activity of CK; CK (MB) and ASAT in the case of AAOL which generated TI. ALAT and Myoglobin remained in the reference ranges. In cases with unsuccessful, late or impossible revascularization and transition to TI and ITL (ischemic rhabdomyolysis) we found progressive elevation in the levels of the parameters being monitored, including ALAT and Myoglobin. The registered values, in the patients who were not operated, before death, were 900 times above for CK, and CK (MB) did not exceed 5% of CK. Over 100 times the standard value for ASAT and ALAT without and hepatic pathology and acute coronary incident. The ASAT/ALAT index is extremely positive in the group with ITL. The registered values of serum Myoglobin reached up to 70 times above the reference range. Upon, revascularization, amputation on an optimal level or an experienced gangrene, a rapid decrease in the values to the reference range for a period 24-48 hours, was observed, except for ALAT, it normalized after 2-3 days. In cases with ischemic gangrene the ASAT/ALAT index from extremely positive in the beginning (>3.0-5.0) progressively decreased due to the rapid elevation of the values of ALAT with permanently high ASAT. The significant changes and correlative relations of the monitored parameters have distinct differences in cases with reversible TI and irreversible ITL, forming typical laboratory constellations in all of the controlled cases. This gives sufficient reason to believe that the implemented approach can form the basis of an objective method for early detection and monitoring of TI and ischemic tissue damage in AAOL in the target patient population for good clinical practice.

Predictive value of serum myoglobin and creatine phosphokinase for development of acute kidney injury in traumatic rhabdomyolysis

Introduction:Rhabdomyolysis (RM) is a condition where there is injury to striated muscle fibers causing release of myoglobin, creatine phosphokinase (CPK), and other intracellular contents into the circulation. High myoglobin levels cause acute kidney injury (AKI). Trauma is the most common cause of RM and development of complications related to the degree of myoglobin released. Currently, the degree of RM is assessed and treatment is instituted based on serum CPK. As myoglobin is the direct cause of AKI, we set out to determine if serum myoglobin is a more reliable predictor than CPK for the development of AKI in traumatic RM.Methodology:A prospective observational study of 90 patients was admitted to the surgical Intensive Care Unit/high dependency unit of a tertiary hospital with traumatic RM whose serum CPK >5000 U/L. Along with standard treatment including intravascular volume optimization and hemodynamic stabilization, they were treated with “crush protocol.” Daily/twice a day, serum CPK and myoglobin were estimated. Categorical data are expressed as frequency and percentage, and the continuous variables are presented as mean (standard deviation) or median (interquartile range) based on normality. Other statistical analyses were done using the Chi-square test, independent t-test, and rank sum test based on normality.Results:Fourteen out of 90 patients developed AKI and one patient required renal replacement therapy. CPK value of >12,000 U/l was identified to have 64% sensitivity and 56% specificity for developing AKI whereas serum myoglobin value of >5000 ng/ml was identified to have 78% sensitivity and 77% specificity for developing AKI.Conclusion:Following traumatic RM, in patients on “crush protocol,” serum myoglobin is a more sensitive and specific test than serum CPK, for predicting AKI.

Abstract: Ex Vivo Normothermic Limb Perfusion and Limb Specific Monitoring Evaluation of Perfusion Quality

PURPOSE: Ischemia time represents a significant limitation for successful extremity replantation and transplantation because of the rapid deterioration of ischemic muscle. Static cold storage (SCS) of the limb is the standard clinical practice. Normothermic ex vivo perfusion system has the potential to prolong viability providing oxygen and metabolites after limb amputation. The aim of our study was to establish a perfusion protocol with limb specific diagnostic tools to evaluate the quality and uniformity of perfusion in an ex vivo model. METHODS: A total of 18 swine limbs were perfused, five of them followed the final, optimized protocol. Limbs were perfused at 39OC for twelve hours using an oxygenated colloid solution with packed red blood cells. Glucose and electrolytes were kept within physiologic range by the addition of hypertonic solution or by partial hypotonic perfusate exchanges. Limb specific perfusion quality was assessed by muscle contractility upon electrical nerve stimulation, compartment pressure, creatine kinase(CK) and myoglobin concentrations, tissue oxygen saturation (near infrared spectroscopy), indocyanine green (ICG) angiography, and infrared radiation emission by thermographic imaging. RESULTS: All five limbs reached the 12 hour perfusion target maintaining normal compartment pressure (16.23 ± 7.94 mmHg), minimal weight increase (0.54%±0.07), mean muscle temperature of 33.54 ± 1.5oC, and tissue oximetry readings of 59.67%±10.21. Average values of final myoglobin and CK were 875 ± 291.4 ng/mL, and 53344 ± 14850.34 U/L, respectively. Muscle movement was present in all limbs until cessation of perfusion. Differences in uniformity and quality of distal perfusion were demonstrated using thermography and angiography imaging after 12 hours of perfusion. Colder areas on Thermographic imaging correlated to mal perfused areas on ICG angiography. CONCLUSIONS: Ex-vivo normothermic limb perfusion preserves limb physiology and function for at least 12 hours. Thermography and ICG angiography are valuable tools in the assessment of limb perfusion quality with the advantage of providing an immediate evaluation which allows for the visual identification of perfusion gradients and regions of mal-perfusion. Muscle contraction upon nerve stimulation, a uniform physiologic temperature and tissue oxygenation, and the distal dye distribution on angiography identify a successful perfusion. These methods may have important future implications on the decision to transplant or replant a perfused limb. Myoglobin and CK concentration increased in all limbs during ex vivo perfusion, but the functional significance of this is still to be determined.

Possible Influences on the Interpretation of Functional Domain (FD) Near-Infrared Spectroscopy (NIRS): An Explorative Study.

The influence of subcutaneous adipose tissue (ATT) and oxygen (O2) delivery has been poorly defined in frequency domain (FD) near-infrared spectroscopy (NIRS). Therefore, the aim of this study was to investigate the possible influence of these variables on all FD NIRS responses using a reliable protocol. Moreover, these influences were also investigated when using relative oxy- and deoxyhemoglobin and -myoglobin (oxy[Hb + Mb] and deoxy[Hb + Mb]) values (in %). A regression analysis was carried out for ATT and maximal-minimum oxy[Hb + Mb], deoxy[Hb + Mb], oxygen saturation (SmO2), and total hemoglobin (totHb) amplitudes during an incremental cyclic contraction protocol (ICCP) in a group of 45 participants. Moreover, the same analysis was carried out between subcutaneous ATT and the relative oxy- and deoxy[Hb + Mb] values (in %). In the second part of this study, a regression analysis was performed for peak forearm blood flow (FBF) during ICCP and the absolute and relative NIRS values in a group of 37 participants. Significant exponential correlation coefficients were found between ATT and deoxy[Hb + Mb] (r = 0.53; P < 0.001), oxy[Hb + Mb] (r = 0.57; P < 0.001), and SmO2 amplitudes (r = 0.57; P < 0.001). No significant relations were found between ATT and relative oxy[Hb + Mb] (r = 0.37; P = 0.07) and deoxy[Hb + Mb] (r = 0.09; P = 0.82). Significant positive correlation coefficients were found between force at exhaustion and maximal FBF (r = 0.66; P < 0.001), maximal differences in deoxy[Hb + Mb] (r = 0.353; P = 0.032) and totHb (r = 0.512; P = 0.002) while no significant correlation coefficients were found between these maximal force values and maximal differences in oxy[Hb + Mb] (r = -0.267; P = 0.111) and SmO2 (r = -0.267; P = 0.111). Significant linear correlation coefficients were found between FBF and deoxy[Hb + Mb] (r = 0.51; P = 0.001), oxy[Hb + Mb] (r = -0.50; P = 0.001), SmO2 (r = -0.54; P = 0.001), and totHb amplitude (r = 0.61; P < 0.001). No significant correlations were found when using relative oxy[Hb + Mb] (r = -0.01; P = 0.957) and deoxy[Hb + Mb] (r = -0.02; P = 0.895). Based on these findings, caution is advised when using NIRS values, as subcutaneous ATT and O2 delivery significantly influence NIRS measurements. To eliminate these influences, use of relative deoxy[Hb + Mb] is advised, especially in clinical settings or in people with a higher subcutaneous ATT layer.

Cardiopulmonary and inflammatory biomarkers in the assessment of the severity of canine dirofilariosis

The prognosis and success of adulticide treatment depends on the baseline severity of infection with Dirofilaria immitis in dogs and can influence the therapeutic protocol to choose. A study was conducted to assess the utility of the cardiopulmonary biomarkers N-terminal of the prohormone brain natriuretic peptide (NT-proBNP), cardiac troponin I (cTnI), myoglobin, and D-dimer, as well as the biomarker of inflammation C-reactive protein (CRP) to evaluate the severity of canine heartworm disease in different stages. Serum samples were collected from 20 heartworm-infected dogs for measurement of these biomarkers. Dogs were assigned to four groups (n=5/group) according to the severity of the disease: Class I and Class II dogs showed concentrations of biomarkers generally within normal ranges for healthy dogs, except CRP in dogs classified as Class II, which showed values slightly above laboratory reference values (19.46±5.69mg/l). Dogs of Class III showed elevated levels of NT-proBNP (1220.12±465.18pmol/l) (p<0.05), cTnI (0.99±0.39ng/ml), CRP (33.98±7.99mg/l) (p<0.05), and 40% of these dogs (2/5) presented pathological values of D-dimer and myoglobin (p<0.05). Dogs of Class IV (caval syndrome) presented elevated levels of NT-proBNP (>2530.8pmol/l), cTnI (1.99±0.32ng/ml), and CRP (80.24±47.69mg/l); all Class IV dogs showed pathological elevations of D-dimer (0.81±0.46ng/ml), and 60% (3/5) of these dogs showed pathological elevations of myoglobin (significant elevations [p<0.05] for all biomarkers with respect to reference values and values for dogs in Classes I, II, and III). In canine heartworm disease, chronic presence of D. immitis causes a proliferative endoarteritis, thromboembolisms, pulmonary hypertension, and right-sided congestive heart failure. As the severity of the disease worsens, serum values of cTnI, myoglobin, and NT-proBNP increase, indicating significant cardiac damage. The finding of pathological concentrations of D-dimer suggests the presence of thromboembolism and/or disseminated intravascular coagulation. CRP increases according to the severity of the disease, indicating inflammatory processes that could contribute to the progression of the disease. These preliminary results demonstrate the utility of cardiopulmonary and inflammation biomarkers to assist in the establishment of the severity of canine heartworm disease.

Evaluation of cardiopulmonary biomarkers during classic adulticide treatment versus the American Heartworm Society recommended treatment protocol in dogs infected by Dirofilaria immitis

Adulticide treatment of dogs with canine heartworm disease causes the death of the adult Dirofilaria immitis lodged in the vascular system of the host. During the death of the worms, pulmonary thromboembolisms (PTE), pulmonary inflammation, congestive heart failure, or renal disease are possible consequences. The aim of this study was to evaluate cardiopulmonary biomarkers and renal parameters during adulticide treatment of canine heartworm to compare the classic two-injection treatment protocol versus the American Heartworm Society (AHS) recommended protocol. Fourteen heartworm-infected dogs with high parasite burdens were divided in three groups and allocated to adulticide protocols as follows: Group A (n=5) was treated with the classic two-injection protocol; group B (n=5) was treated using the AHS recommended protocol, and group C (n=4) was treated as for group B but received diminishing anti-inflammatory doses of prednisone. To assess cardiorespiratory status, cardiac troponin I (cTnI), myoglobin, and D-dimer were measured. Renal function was evaluated by measuring urea, creatinine, and urine protein:creatinine (UP:C). Serum and urine samples were collected day 0 (day of diagnosis), 7 and 14 days after the first dose of adulticide, and 1 month after the last adulticide injection. Dogs that received classic treatment presented pathologic concentrations of D-dimer more frequently and showed higher average D-dimer levels, which may indicate the presence of more severe PTE. Group C showed the highest levels of D-dimer during treatment, which may be due to an exacerbation of PTE caused by the administration of prednisone. CTnI and myoglobin values remained above reference values in all groups during the study but reached the lowest values 1 month after the last injection. Levels of urea and creatinine were within normal ranges in all groups, and 28.5% of the dogs were proteinuric on day 0, progressing to better UP:C values at the end of the treatment, except in group A. The results of this study justify the treatment of canine heartworm disease using the AHS recommended adulticide guidelines and recommends re-evaluation of the role of glucocorticosteroids in the prevention and treatment of PTE.