Del Nido vs. Cold Blood Cardioplegia for High-Risk Isolated Coronary Artery Bypass Grafting in Patients with Reduced Ventricular Function

ABSTRACT Introduction: The evidence for using del Nido cardioplegia protocol in high-risk patients with reduced ejection fraction undergoing isolated coronary surgery is insufficient. Methods: The institutional database was searched for isolated coronary bypass procedures. Patients with ejection fraction < 40% were selected. Propensity matching (age, sex, infarction, number of grafts) was used to pair del Nido (Group 1) and cold blood (Group 2) cardioplegia patients. Investigation of biomarker release, changes in ejection fraction, mortality, stroke, perioperative myocardial infarction, composite endpoint (major adverse cardiac and cerebrovascular events), and other perioperative parameters was performed. Results: Matching allowed the selection of 45 patient pairs. No differences were noted at baseline. After cross-clamp release, spontaneous sinus rhythm return was observed more frequently in Group 1 (80% vs. 48.9%; P=0.003). Troponin values were similar in both groups 12 and 36 hours after surgery, as well as creatine kinase at 12 hours. A trend favored Group 1 in creatine kinase release at 36 hours (median 4.9; interquartile range 3.8-9.6 ng/mL vs. 7.3; 4.5-17.5 ng/mL; P=0.085). Perioperative mortality, rates of myocardial infarction, stroke, or major adverse cardiac and cerebrovascular events were similar. No difference in postoperative ejection fraction was noted (median 35.0%; interquartile range 32.0-38.0% vs. 35.0%; 32.0-40.0%; P=0.381). There was a trend for lower atrial fibrillation rate in Group 1 (6.7% vs. 17.8%; P=0.051). Conclusion: The findings indicate that del Nido cardioplegia provides satisfactory protection in patients with reduced ejection fraction undergoing coronary bypass surgery. Further prospective trials are required.

Miositis aguda asociada a infección por virus influenza. Serie de casos en un hospital pediátrico

La miositis aguda benigna asociada a influenza es una complicación esporádica. En Argentina, en el año 2022, hubo un aumento temprano de la circulación de influenza y del número total de las notificaciones, con la aparición de miositis secundarias. Serie clínica retrospectiva de nueve pacientes pediátricos que consultaron por dolor e impotencia funcional de extremidades inferiores, y enzimas musculares elevadas, en el hospital Pedro de Elizalde de la Ciudad Autónoma de Buenos Aires, entre agosto y octubre del 2022. En todos se detectó infección por virus influenza y se recuperaron sin secuelas. La miositis aguda benigna es una entidad infrecuente en la infancia, cuyo diagnóstico es predominantemente clínico y de recuperación ad integrum. Debe ser sospechada en pacientes con clínica compatible en contexto de alta circulación viral. La vigilancia epidemiológica aporta herramientas para identificar los virus circulantes y sus posibles complicaciones.

Benign acute myositis associated with influenza is a sporadic complication. In Argentina, in 2022, there was an early increase in influenza circulation and the total number of notifications, with the appearance of secondary myositis. Retrospective clinical series of nine pediatric patients who consulted for pain and functional impotence of the lower extremities, and elevated muscle enzymes, at the Pedro de Elizalde hospital in the Autonomous City of Buenos Aires, between August and October 2022. In all of them, infection by influenza virus and recovered without sequelae. Benign acute myositis is a rare entity in childhood, whose diagnosis is predominantly clinical and recovery ad integrum. It should be suspected in patients with compatible symptoms in a context of high viral circulation. Epidemiological surveillance provides tools to identify circulating viruses and their possible complications.

Inborn Errors of Metabolism Associated With Autism Among Children: A Multicenter Study from Iran

Objective: This study aimed to find the common inborn errors of metabolism in Iranian patients with autism spectrum disorder. Methods: In this cross-sectional multicenter study, 105 children and adolescents with autism spectrum disorder from six centers in different cities of Iran were enrolled between August, 2019 and October, 2020. Metabolic screening, including measuring plasma levels of amino acids, acylcarnitines, creatine, and guanidinoacetate, and urinary levels of organic acids, purines, and pyrimidines was performed. Other data, including age, parental consanguinity, history of seizure, developmental mile-stones, and physical examination, were also recorded. Results: An inborn error of metabolism was found in 13 (12.4%) patients. Five patients (4.8%) had cerebral creatine deficiency syndrome, 4 (3.8%) had arginine succinate aciduria, 2- methylbutyryl glycinuria, short-chain acyl-CoA dehydrogenase deficiency, and combined methylmalonic aciduria/malonic aciduria. There was a strong association between positive metabolic evaluation and parental consanguinity, history of seizures, microcephaly, and delayed development. Conclusions: Our results suggest that metabolic screening should be performed in the cases of autism associated with parental consanguinity, developmental delay, and a history of seizures. The assays to be considered as a screening panel include plasma or blood amino acids, acylcarnitines, creatine and guanidinoacetate, and urinary levels of organic acids.

Impacts of quercetin supplementation post-exercise / Impactos da suplementação de quercetina pós-exercício / Impactos de la suplementación de quercetina después del ejercicio

ABSTRACT Introduction: Quercetin (Q) is a flavonoid that has been shown to be an antioxidant in vitro. A current review is necessary to evaluate whether Q can improve biochemical damage markers following exercise-induced muscle damage (EIMD) and delayed onset muscle soreness (DOMS). Objective: Specify the impact of Q supplementation on EIMD, DOMS, and inflammatory cytokines (IL-6, IL-10, and TNF-α) after exercise. Methods: Participants (n=28) were randomly assigned to Q (1000 mg/day) and placebo (PLA). Intake was done 48 hours before EMID to 96 hours after EMID (one week). Before EIMD (PRE) and 24, 48, 72, and 96 hours after EIMD, blood samples were collected for CK and measurement of inflammatory cytokines. ANOVA test was used for data analysis with a significance P > 0.05. Results: Peak DOMS was seen 48 hours after EIMD, regardless of the DOMS combination. Q had a significant reducing effect on CK response at 24 hours (-43%), 48 hours (-48%), 72 hours (-56%), and 96 hours (-67%) after EIMD compared to placebo. IL-10 and IL-6 did not change statistically for the applied sample size. TNF-α was lower by Q intake significantly at 24 hours (-24%), 48 hours (-22%), and 96 hours (-22%) compared to PLA. Furthermore, the TNF-α trend was lower with Q intake at 72 hours (-19%). Conclusion: Q supplementation decreased biological inflammation during post-IMD recovery but not quadriceps DOMS. Level of Evidence: Therapeutic Studies - Investigating Treatment Outcomes.

RESUMO Introdução: A quercetina (Q) é um flavonóide que provou ser um antioxidante in vitro. Fez-se necessária uma revisão atual projetada para avaliar se a Q pode melhorar os marcadores bioquímicos de dano após o dano muscular induzido pelo exercício (EIMD) e a dor muscular de início retardado (DOMS). Objetivo: O objetivo da revisão atual foi especificar o impacto da suplementação Q sobre EIMD, DOMS e citocinas inflamatórias (IL-6, IL-10 e TNF-α) após o exercício. Métodos: Os participantes (n=28) foram alocados em Q (1000 mg/dia) e placebo (PLA) aleatoriamente. Fez-se ingestão 48 horas antes da EMID a 96 horas após a EMID (uma semana). Antes da EIMD (PRE) e 24, 48, 72 e 96 horas após a EIMD, amostras de sangue coletadas para CK e medição de citocinas inflamatórias. O teste ANOVA foi usado para análise de dados com significância P > 0,05. Resultados: O pico DOMS foi visto em 48 horas após EIMD, independentemente da combinação de DOMS. Q teve um efeito de redução significativo na resposta CK em 24 horas (-43%), 48 horas (-48%), 72 horas (-56%) e 96 horas (-67%) após a EIMD em comparação com placebo. IL-10 e IL-6 não mudaram estatisticamente para o tamanho da amostra aplicada. TNF-α foi menor pela ingestão de Q significativamente às 24 horas (-24%), 48 horas (-22%), e 96 horas (-22%) em comparação com o PLA. Ademais, a tendência TNF-α foi menor com a ingestão de Q às 72 horas (-19%). Conclusão: A suplementação de Q diminuiu a inflamação biológica durante a recuperação pós EIMD, porém não os DOMS do quadríceps. Nível de evidência: Estudos Terapêuticos - Investigando os Resultados de tratamento.

RESUMEN Introducción: La quercetina (Q) es un flavonoide que ha demostrado ser un antioxidante in vitro. Por ello, es necesaria una revisión actual diseñada para evaluar si la Q puede mejorar los marcadores bioquímicos de daño tras el daño muscular inducido por el ejercicio (EIMD) y el dolor muscular de aparición retardada (DOMS). Objetivo: El objetivo de la presente revisión fue especificar el impacto de la suplementación con Q en el EIMD, el DOMS y las citoquinas inflamatorias (IL-6, IL-10 y TNF-α) después del ejercicio. Métodos: Los participantes (n=28) fueron asignados aleatoriamente a Q (1000 mg/día) y a placebo (PLA). La ingesta se realizó desde 48 horas antes de la EMID hasta 96 horas después de la misma (una semana). Antes de la EMID (PRE) y 24, 48, 72 y 96 horas después de la EMID, se tomaron muestras de sangre para la CK y la medición de citoquinas inflamatorias. Se utilizó la prueba ANOVA para el análisis de los datos con una significancia P > 0,05. Resultados: El pico de DOMS se observó en las 48 horas posteriores a la EIMD, independientemente de la combinación de DOMS. Q tuvo un efecto significativamente reductor en la respuesta de la CK a las 24 horas (-43%), 48 horas (-48%), 72 horas (-56%) y 96 horas (-67%) después de la EIMD en comparación con el placebo. La IL-10 y la IL-6 no cambiaron estadísticamente para el tamaño de muestra aplicado. El TNF-α se redujo significativamente con la ingesta de Q a las 24 horas (-24%), a las 48 horas (-22%) y a las 96 horas (-22%) en comparación con el PLA. Además, la tendencia del TNF-α fue menor con la ingesta de Q a las 72 horas (-19%). Conclusión: La suplementación con Q disminuyó la inflamación biológica durante la recuperación después de un IMD, pero no el DOMS del cuádriceps. Nivel de evidencia: Estudios terapéuticos -Investigación de los resultados del tratamiento.

Cherry extract on post-exercise muscle damage / Extrato de cereja em danos musculares pós-exercício / El extracto de cereza daños musculares post ejercicio

ABSTRACT Introduction: Cherry extract has a high amount of anthocyanins and flavonoids containing antioxidant effects. Its high antioxidant characteristics have been shown to reduce markers of delayed muscle soreness (DOMS) and exercise-induced muscle damage (EIMD) to improve recovery after exercise. Objective: Verify the effects of the cherry extract on post-exercise muscle damage. Methods: Google scholar, Medline, and Scopus were systematically searched until February 2022. The Cochrane Collaboration tool was applied to determine the risks of bias. Results: The results showed that cherry extract administration did not have a decreasing impact on creatine kinase levels overall: (WMD = 12.85 IU. L-1, 95% CI: −35.94, 61.64; P = 0.606). Considerable heterogeneity was observed among the articles (Cochran's Q-test = 990.80, P = 0.000, I2 = 96.7 %). However, there is a significant reducing effect on pain sensation by the consumption of cherry extract (WMD = −6.105 mm; 95% CI: −11.193 −1.017; p = 0.019). Conclusion: Cherry extract consumption effectively reduced late-onset muscle pain among participants in the overall and subgroup analysis. Thus, the cherry extract may be a complementary alternative in recovery after exercise. Level of evidence II; Therapeutic studies - Manuscript review.

RESUMO Introdução: O extrato de cereja tem uma alta quantidade de antocianinas e flavonóides contendo efeitos antioxidantes. Suas altas características antioxidantes demonstraram reduzir os marcadores de dor muscular retardada (DOMS) e dano muscular induzido pelo exercício (EIMD) para melhorar a recuperação após o exercício. Objetivo: Verificar os efeitos do extrato de cereja nos danos musculares pós-exercício. Métodos: Google scholar, Medline e Scopus foram sistematicamente pesquisados até fevereiro de 2022. A ferramenta de colaboração da Cochrane foi aplicada para determinar os riscos de viés. Resultados: Os resultados mostraram que a administração do extrato de cereja não teve um impacto decrescente nos níveis de creatina quinase em geral: (WMD = 12,85 IU. L-1, 95% CI: −35,94, 61,64; P = 0,606). Uma heterogeneidade considerável foi observada entre os artigos (teste Q da Cochran = 990,80, P = 0,000, I2 = 96,7 %). Porém, há um efeito redutor significativo na sensação de dor pelo consumo de extrato de cereja (WMD = −6,105 mm; 95% CI: −11,193 −1,017; p = 0,019). Conclusão: O consumo de extrato de cereja foi efetivo na redução de dores musculares de início tardio entre os participantes, na análise geral e nos subgrupos. Assim, o extrato de cereja pode ser uma alternativa complementar na recuperação após os exercícios. Nível de evidência II; Estudos terapêuticos - Revisão de manuscritos.

RESUMEN Introducción: El extracto de cereza tiene una gran cantidad de antocianinas y flavonoides con efectos antioxidantes. Se ha demostrado que sus altas características antioxidantes reducen los marcadores de dolor muscular retardado (DOMS) y el daño muscular inducido por el ejercicio (EIMD) para mejorar la recuperación después del ejercicio. Objetivo: Verificar los efectos del extracto de cereza en el daño muscular posterior al ejercicio. Métodos: Se realizaron búsquedas sistemáticas en Google scholar, Medline y Scopus hasta febrero de 2022. Se aplicó la herramienta de colaboración Cochrane para determinar los riesgos de sesgo. Resultados: Los resultados mostraron que la administración de extracto de cereza no tuvo un impacto decreciente en los niveles de creatina quinasa en general: (WMD = 12,85 UI. L-1, IC del 95%: −35,94, 61,64; P = 0,606). Se observó una considerable heterogeneidad entre los artículos (prueba Q de Cochran = 990,80, P = 0,000, I2 = 96,7 %). Sin embargo, el consumo de extracto de cereza tiene un efecto significativo de reducción del dolor (WMD = −6,105 mm; IC del 95%: −11,193 −1,017; p = 0,019). Conclusión: El consumo de extracto de cereza fue eficaz para reducir el dolor muscular de aparición tardía entre los participantes en el análisis global y de subgrupos. Así, el extracto de cereza puede ser una alternativa complementaria en la recuperación después de los ejercicios. Nivel de evidencia II; Estudios terapéuticos - Revisión de manuscritos.

Creatine supplementation for post-exercise muscle damage / Suplementação com creatina para danos musculares pós-exercício / Suplementación con creatina para daños musculares después del ejercicio

ABSTRACT Introduction: Exercise-induced muscle damage (EIMD) can occur from recent or unusual physical activity, leading to a temporary reduction in muscle function. And increased pain. Several articles indicate the positive impacts of creatine on EIMD. Objective: Evaluate the impact of creatine on EIMD. Methods: Online searches were performed in Scopus, Embase, Medline and Google scholar until March 2022. Results: Thirteen studies met the inclusion criteria. To assess the quality of the studies, the Cochrane collaboration system was used for risk and bias analysis. Due to the high heterogeneity of interventions and studies designed, a meta-analysis was not performed. The current paper reveals that creatine intake is preferable to inactive recovery and only a rest period between several harmful and exhausting physical activities. Conclusion: Benefits were attenuated in EIMD markers that reduce muscle operation and muscle strength loss after exercise. Level of evidence II; Therapeutic studies - Manuscript review.

RESUMO Introdução: O dano muscular induzido pelo exercício (EIMD) pode acontecer por atividade física recente ou não habitual e leva a uma redução temporária da função muscular. e aumento da dor. Vários artigos indicam impactos positivos da creatina sobre a EIMD. Objetivo: Avaliar o impacto da creatina sobre a EIMD. Métodos: Foram feitas pesquisas eletrônicas em Scopus, Embase, Medline e Google scholar até março de 2022. Resultados: Treze estudos preencheram os critérios de inclusão. Para avaliar a qualidade dos estudos, o sistema de colaboração Cochrane foi utilizado na análise de risco e viés. Devido à alta heterogeneidade de intervenções e estudos desenhados, a meta-análise não foi realizada. As informações do documento atual revelam que a ingestão de creatina é preferível a uma recuperação inativa e apenas um período de repouso entre diversas atividades físicas prejudiciais e exaustivas. Conclusão: Os benefícios evidenciaram-se atenuados nos marcadores EIMD que reduzem a operação muscular e a perda de força muscular após os exercícios. Nível de evidência II; Estudos terapêuticos - Revisão de manuscritos.

RESUMEN Introducción: el daño muscular inducido por el ejercicio (EIMD) puede producirse por una actividad física reciente o inusual y provoca una reducción temporal de la función muscular y un aumento del dolor. Varios artículos indican impactos positivos de la creatina en la EIMD. Objetivo: Evaluar el impacto de la creatina en la EIMD. Métodos: Se realizaron búsquedas electrónicas en Scopus, Embase, Medline y Google scholar hasta marzo de 2022. Resultados: Trece estudios cumplieron los criterios de inclusión. Para evaluar la calidad de los estudios, se utilizó el sistema de colaboración Cochrane para el análisis de riesgos y sesgos. Debido a la gran heterogeneidad de las intervenciones y de los estudios diseñados, no se realizó un metanálisis. La información del presente documento revela que la ingesta de creatina es preferible a una recuperación inactiva y sólo un período de descanso entre varias actividades físicas perjudiciales y agotadoras. Conclusión: Los beneficios se mostraron atenuados en los marcadores EIMD que reducen el funcionamiento muscular y la pérdida de fuerza muscular después del ejercicio. Nivel de evidencia II; Estudios terapéuticos - Revisión de manuscritos.

Role of whey protein in post-workout recovery / Função da proteína de soro de leite na recuperação pós-treino / El papel de la proteína de suero de leche en la recuperación post-entrenamiento

ABSTRACT Introduction: Evidence indicates that whey protein supplementation may accelerate tissue repair and be useful for exercise-induced muscle injury (EIMD) by accelerating recovery and elevating protein synthesis and blood amino acids. However, the potential role of whey protein after EIMD in humans is inconsistent. Objective: Find the effective role of whey protein in post-exercise recovery from EIMD. Methods: Scopus, Medline, and Google scholar, were systematically searched until March 2022. To assess the risk of bias, the Cochrane collaboration tool was applied. Weighted mean differences (WMD), 95% confidence intervals (CI), and random effect models to calculate the total effect. Results: The result of the review indicated that the decreasing impact of whey protein intake is significant on creatine kinase (CK) [WMD = −19.11 IU.L-1, CI: −36.200, −2.036; P = 0.028]. The effect of whey protein supplementation on lactate dehydrogenase (LDH) concentration indicated that the impact of whey protein on changing LDH levels is significant. In addition, subgroup analysis showed significant decreases in CK and LDH based on post-exercise follow-up times, whey protein dosage, test duration, supplementation time, exercise types, and training status. Conclusion: The results showed the efficacy of whey protein in decreasing CK and LDH levels among adults in general and in subgroup analysis. Therefore, whey protein could have an effective role in the post-exercise recovery of EIMD. Level of evidence II; Therapeutic studies - review of results.

RESUMO Introdução: As evidências indicam que a suplementação de proteína de soro de leite pode acelerar a reparação tecidual e, portanto, ser útil para as lesões musculares induzidas pelo exercício (EIMD), acelerando a recuperação, além de elevar a síntese proteica e os aminoácidos sanguíneos. Entretanto, o papel potencial da proteína de soro de leite após a EIMD em humanos, é inconsistente. Objetivos: Encontrar a função efetiva da proteína de soro de leite na recuperação pós exercício de EIMD. Métodos: Scopus, Medline e Google scholar foram sistematicamente pesquisados até março de 2022. Para avaliar o risco de viés, foi aplicada a ferramenta de colaboração Cochrane. Diferenças médias ponderadas (WMD), intervalos de confiança de 95% (CI) e modelos de efeito aleatório foram utilizados para o cálculo do efeito total. Resultados: O resultado da revisão indicou que o impacto decrescente do consumo de proteína de soro de leite é significativo na creatina quinase (CK) [WMD = −19,11 IU.L-1, CI: −36,200, −2,036; P = 0,028]. O efeito da suplementação proteica do soro de leite na concentração de desidrogenase láctica (LDH) indicou que o impacto da proteína do soro de leite na mudança dos níveis de LDH é significativo. Além disso, a análise dos subgrupos mostrou diminuição significativa na CK e LDH, com base nos tempos de acompanhamento após o exercício, dosagem da proteína do soro de leite, duração dos testes, tempo de suplementação, tipos de exercício e status de treinamento. Conclusão: Os resultados mostraram a eficácia da proteína de soro de leite na diminuição dos níveis de CK e LDH entre adultos, em geral e na análise dos subgrupos. Portanto, a proteína do soro de leite poderia ter uma função eficaz na recuperação pós exercício de EIMD. Nível de evidência II; Estudos terapêuticos - revisão dos resultados.

RESUMEN Introducción: Las pruebas indican que la suplementación con proteína de suero de leche puede acelerar la reparación de los tejidos y, por lo tanto, ser útil para las lesiones musculares inducidas por el ejercicio (EIMD) al acelerar la recuperación, así como elevar la síntesis de proteínas y los aminoácidos en sangre. Sin embargo, el papel potencial de la proteína de suero después de la EIMD en los seres humanos, es inconsistente. Objetivos: Encontrar el papel efectivo de la proteína de suero de leche en la recuperación posterior al ejercicio de EIMD. Métodos: Se realizaron búsquedas sistemáticas en Scopus, Medline y Google scholar hasta marzo de 2022. Para evaluar el riesgo de sesgo, se aplicó la herramienta de colaboración Cochrane. Para calcular el efecto total se utilizaron diferencias medias ponderadas (WMD), intervalos de confianza (CI) del 95% y modelos de efectos aleatorios. Resultados: El resultado de la revisión indicó que el impacto decreciente de la ingesta de proteína de suero es significativo en la creatina quinasa (CK) [WMD = −19,11 UI.L-1, IC: −36,200, −2,036; P = 0,028]. El efecto de la suplementación con proteína de suero en la concentración de lactato deshidrogenasa (LDH) indicó que el impacto de la proteína de suero en el cambio de los niveles de LDH es significativo. Además, el análisis de subgrupos mostró disminuciones significativas de la CK y la LDH en función de los tiempos de seguimiento tras el ejercicio, la dosis de proteína de suero, la duración de la prueba, el tiempo de suplementación, los tipos de ejercicio y el estado de entrenamiento. Conclusión: Los resultados mostraron la eficacia de la proteína de suero en la disminución de los niveles de CK y LDH entre los adultos en general y en el análisis de subgrupos. Por lo tanto, la proteína de suero podría tener un papel eficaz en la recuperación posterior al ejercicio de EIMD. Nivel de evidencia II; Estudios terapéuticos - revisión de resultados.

Training for physical conditioning of young bodybuilding athletes / Treinamento para o condicionamento físico de jovens atletas de musculação / Entrenamiento para el acondicionamiento físico de jóvenes atletas de culturismo

ABSTRACT Introduction Biochemical indicators such as blood urea nitrogen and creatine kinase in young athletes are ways to test their fitness. These data provide the basis for assessing young athletes' physical and functional fitness during training. Objective Investigate serum urea nitrogen levels and creatine kinase levels in weightlifters. Methods 12 biomarkers of athletes were tracked and observed in this article. After this study, it was found that changes were observed in their physiological parameters. These changes are usually found every three weeks. The method of mathematical statistics was used to analyze the data obtained. Results The average creatine kinase levels were significantly elevated in the first cycle. These data differ from the basal level (P<0.01). The increased serum urea nitrogen and creatine kinase levels indicate that the athlete has entered a state of fatigue. Conclusion Blood urea nitrogen and creatine kinase levels are essential in determining the degree of fatigue and sports injuries in athletes. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.

RESUMO Introdução Indicadores bioquímicos como nitrogênio ureico no sangue e creatina quinase em atletas jovens são formas de testar a aptidão física. Esses dados fornecem a base para avaliar o condicionamento físico e funcional que os jovens atletas precisam durante o treinamento. Objetivo Investigar os níveis de nitrogênio sérico ureico e creatina quinase em halterofilistas. Métodos 12 biomarcadores de atletas foram rastreados e observados neste artigo. Após este estudo, constatou-se que foram observadas mudanças em seus parâmetros fisiológicos. Estas mudanças são geralmente encontradas a cada três semanas. Utilizou-se o método de estatística matemática para analisar os dados obtidos. Resultados Os níveis médios de creatina quinase foram significativamente elevados no primeiro ciclo. Estes dados são bastante diferentes do nível basal (P<0,01). O aumento do nível sérico de nitrogênio ureico e creatina quinase indica que o atleta entrou em um estado de fadiga. Conclusão Os níveis de nitrogênio ureico no sangue e creatina quinase têm um papel essencial na determinação do grau de fadiga e lesões esportivas dos atletas. Nível de evidência II; Estudos terapêuticos - investigação dos resultados do tratamento.

RESUMEN Introducción Los indicadores bioquímicos como el nitrógeno ureico en sangre y la creatina quinasa en jóvenes atletas son formas de comprobar su estado físico. Estos datos proporcionan la base para evaluar la aptitud física y funcional que necesitan los jóvenes atletas durante el entrenamiento. Objetivo Investigar los niveles de nitrógeno ureico sérico y creatina quinasa en levantadores de pesas. Métodos En este artículo se examinaron y observaron 12 biomarcadores de atletas. Tras este estudio, se observaron cambios en sus parámetros fisiológicos. Estos cambios suelen producirse cada tres semanas. Para analizar los datos obtenidos se utilizó el método de la estadística matemática. Resultados Los niveles medios de creatina-cinasa fueron significativamente elevados en el primer ciclo. Estos datos son muy diferentes del nivel basal (P<0,01). El aumento de los niveles de nitrógeno ureico sérico y de creatina-cinasa indica que el atleta ha entrado en un estado de fatiga. Conclusión Los niveles de nitrógeno ureico en sangre y de creatina quinasa tienen un papel esencial en la determinación del grado de fatiga y de las lesiones deportivas en los atletas. Nivel de evidencia II; Estudios terapéuticos - investigación de los resultados del tratamiento.

Cambios enzimáticos durante el entrenamiento anaeróbico láctico y su influencia en la capacidad aeróbica

Introducción: El entrenamiento deportivo es un proceso que requiere una planificación orientada a la adaptación del cuerpo a las cargas internas versus cargas externas; de allí, surge la necesidad de conocer el comportamiento de algunas enzimas musculoesqueléticas a través del control bioquímico y fisiológico del entrenamiento en el atletismo de medio fondo. Objetivo: Analizar los cambios enzimáticos de la creatinfosfoquinasa y la lactodeshidrogenasa durante el entrenamiento anaeróbico láctico y su influencia en la capacidad aeróbica en atletas de medio fondo. Método: Se utilizó el método descriptivo comparativo con una muestra de 20 sujetos aleatorizados en dos grupos: experimental y control; el análisis se realizó bajo el modelo estadístico Anova descriptiva, pruebas T y diseño de medidas repetidas con un intervalo del 95 % de confianza (p<0,05). Resultados: En las variables creatinfosfoquinasa y lactodeshidrogenasa inicial y final no hubo variaciones significativas intergrupos; se observaron diferencias en la creatinfosfoquinasa en varianza (p=0,022) del orden del 97,8 %; que en promedio (p=0,088) representó los niveles alcanzados del 91,2 %. En las medidas repetidas no se presentaron cambios estadísticamente significativos intergrupos. Para la variable del VO2máx se aplicó la prueba T para comparar los estados inicial y final en cada grupo y hubo diferencias en ambos grupos (control p=0,002; experimental p=0,000). Conclusiones: No hubo cambios enzimáticos importantes durante los entrenamientos anaeróbico láctico y aeróbico, a su vez, el entrenamiento anaeróbico láctico si tuvo influencia en la capacidad aeróbica.

Introduction: Sports training is a process that requires a planning oriented to the adaptation of the body to internal loads versus external loads; from there, arises the need to know the behavior of some musculoskeletal enzymes through the biochemical and physiological control of training in middle-distance athletics. Objective: To analyze the enzymatic changes of creatine phosphokinase and lactodehydrogenase during lactic anaerobic training and their influence on aerobic capacity in middle-distance athletes. Methods: The descriptive comparative method was used with a sample of 20 subjects randomized in two groups: experimental and control; the analysis was performed under the descriptive Anova statistical model, T-tests and repeated measures design with a 95% confidence interval (p<0.05). Results: In the initial and final creatine phosphokinase and lactodehydrogenase variables, there were no significant intergroup variations; differences were observed in creatine phosphokinase regarding variance or standard deviation (p=0.022) in the order of 97.8 %; which in average (p=0.088) represented the levels reached of 91.2 %. In the repeated measures, there were no statistically significant intergroup changes. For the VO2max variable, the T-test was applied to compare the initial and final states in each group and there were differences in both groups (control p=0.002; experimental p=0.000). Conclusions: There were no important enzymatic changes during lactic anaerobic and aerobic training, and lactic anaerobic training had an influence on aerobic capacity.

Clinical efficacy of ateplase combined with heparin in the treatment of acute moderate- and high-risk pulmonary thromboembolism and its effects on arterial blood gas analysis and myocardial enzyme level / 中国基层医药

Objective:To investigate the clinical efficacy of alteplase combined with heparin in the treatment of acute moderate- and high-risk pulmonary thromboembolism and its effects on arterial blood gas analysis and myocardial enzyme level.Methods:Seventy-eight patients with acute moderate- and high-risk pulmonary thromboembolism who received treatment in Dongyang People's Hospital from January 2015 to January 2022 were retrospectively included in this study. They were divided into observation ( n = 39) and control ( n = 39) groups according to different treatment methods. The control group was treated with heparin, while the observation group was treated with alteplase based on heparin. All patients were treated for 7 days. Clinical efficacy as well as arterial blood gas analysis, myocardial enzymes, pulmonary artery pressure, and tricuspid annular plane systolic excursion pre- and post-treatment were compared between the two groups. Results:The total response rate in the observation group was significantly higher than that in the control group (94.87% vs. 76.92%, χ2 = 5.18, P < 0.05). After treatment, the partial pressure of carbon dioxide in the observation group was significantly lower than that in the control group [(36.24 ± 5.12) mmHg vs. (44.25 ± 3.78) mmHg, 1 mmHg = 0.133 kPa, t = 7.86, P < 0.05]. After treatment, the partial pressure of oxygen in the observation group was significantly higher than that in the control group [(78.82 ± 5.1) mmHg vs. (71.23 ± 4.89) mmHg, t = 6.66, P < 0.05]. After treatment, lactate dehydrogenase, creatine kinase, and creatine kinase isoenzyme in the observation group were (107.42 ± 15.45) U/L, (37.21 ± 10.84) U/L, and (12.28 ± 3.54) U/L, respectively, which were significantly lower than (189.94 ± 21.20) U/L, (65.42 ± 6.57) U/L, and (19.29 ± 3.08) U/L in the control group ( t = 19.64, 13.89, 9.33, all P < 0.001). After treatment, the pulmonary arterial pressure in the observation group was significantly lower than that in the control group [(32.24 ± 3.86) mmHg vs. (37.79 ± 5.17) mmHg, t = 5.37, P < 0.001]. Tricuspid annular plane systolic excursion in the observation group was significantly higher than that in the control group [(14.07 ± 1.27) mm vs. (12.63 ± 1.16) mm, t = 5.22, P < 0.001]. Conclusion:Ateplase combined with heparin has an obvious effect on acute moderate- and high-risk pulmonary thromboembolism. It can improve arterial blood gas analysis and reduce myocardial enzyme levels.

Caracterización del perfil biomédico y deportivo en futbolistas profesionales

Introducción: caracterizar los deportistas es fundamental. En fútbol profesional se efectúa, aunque no de forma estandarizada. Esta investigación es la primera fase de un modelo de evaluación y seguimiento. Objetivo: describir el perfil de las variables del control biomédico y deportivo en un equipo de futbolistas profesionales. Métodos: estudio descriptivo en 32 futbolistas. Variables agrupadas en: 1) identificación; 2) antecedentes deportivos; 3) antropométricas; 4) monitoreo del entrenamiento; 5) fuerza; 6) GPS. Las mediciones se efectuaron según protocolo estandarizado. Se presentan las medias y desviaciones estándar (DE), medianas y rango intercuartíl (RIQ), y frecuencias relativas. En componentes claves se efectúan análisis por posición de juego. Resultados: la edad media fue 24,0 ± 4,6. El tiempo como profesional fue de 5,5 años. Las lesiones ligamentarias y musculares fueron los antecedentes más comunes con 31,5 % y 22,9 %, respectivamente; el 71,0 % ocurrieron en competencia. Los arqueros y delanteros tuvieron mayores porcentajes de masa adiposa. Defensas y volantes presentaron las mayores distancias recorridas con 64.560 y 64.386 metros, respectivamente. Los defensas y delanteros alcanzaron las mayores frecuencias de sprint (>27km/h). Los mayores desequilibrios de fuerza lo registraron los arqueros (50 % rodilla izquierda), seguidos de un 33,0 % en los volantes. Se evidenció alta heterogeneidad en los valores de creatina quinasa (CPK). Conclusión: un modelo estandarizado e interdisciplinario permite determinar el estado nutricional y antecedentes, monitorizar la carga y perfil de juego, evaluar los desequilibrios y marcadores de sobrecarga muscular; con miras a reducir el riesgo de lesiones y aumentar el rendimiento.

Summary Introduction: Characterizing athletes is essential. In professional soccer it is done, although not in a standardized way. This research is the first phase of an evaluation and monitoring model. Objective: To describe the profile of the variables of biomedical and sports control in a team of professional soccer players. Methods: Descriptive study in 32 soccer players. Variables were grouped in: 1) identification; 2) sports background; 3) anthropometry; 4) training monitoring; 5) strength; 6) GPS. Measurements were made according to standardized protocol. The means and standard deviations (SD), medians and interquartile range (IQR) and relative frequencies are presented. Analysis by playing position is carried out on key components. Results: The mean age was 24.0 ± 4.6. The time as a professional was 5.5 years. Ligament and muscle injuries were the most common antecedents with 31.5% and 22.9%, respectively; 71.0% occurred in competition. Goalkeepers and forwards had higher percentages of fat mass. Defenders and midfielders had the longest distances covered with 64.560 and 64.386 meters, respectively. Defenders and forwards reached the highest sprint frequencies (>27km /h). The greatest strength imbalances were recorded by goalkeepers (50% left knee), followed by 33.0% in midfielders. High heterogeneity was evidenced in creatine kinase (CPK) values. Conclusion: A standardized and interdisciplinary model allows determining nutritional status and antecedents, monitoring load and playing profile, evaluating imbalances and muscle overload markers; with the aim of reducing the risk of injury and increasing performance.

HyperCKemia-MB due to macroCK type 1: Case report

HyperCKemia is a rare condition characterized by a persistent increase in serum creatine kinase (CK) levels or some isoenzymes. Usually, there are no clinical, electromyography or histological manifestations, which involves a challenge at the time of diagnosis. The patient in question showed no characteristic signs or symptoms, apart from fatigue and post-exercise myalgia. Assessment was performed by rheumatology and endocrinology, determination of total CK and MB fraction in blood, and electromyography and protein electrophoresis were requested as part of the approach. This case report is considered as novel, interesting, and useful for clinical practice as few similar ones were found in the scientific literature. The difficult etiological diagnosis of this entity, and the algorithm used to arrive at it, are all presented. It is concluded that in those patients with hyperCKemia of unknown etiology, this diagnosis should be kept in mind, and be confirmed by performing a CK electrophoresis.

La hiperCKemia es una condición poco frecuente caracterizada por un aumento persistente de los niveles de creatina quinasa (CK) sérica o de algunas isoenzimas, sin que suelan presentarse manifestaciones clínicas, electromiográficas o histológicas, lo cual implica un desafío a la hora del diagnóstico. El paciente cuyo caso se presenta aquí no mostró signos o síntomas característicos, únicamente fatiga y mialgias posteriores al ejercicio. Se llevó a cabo valoración por reumatología y endocrinología, determinación de CK total y fracción MB en sangre; además, se solicitó electromiografía y electroforesis de proteínas como parte del abordaje. Consideramos que este reporte de caso es novedoso, interesante y de utilidad para la práctica clínica pues se encuentran pocos similares en la literatura científica; adicionalmente, se pone en evidencia el difícil diagnóstico etiológico de esta entidad, así como el algoritmo utilizado para llegar a ella. Se concluye que este diagnóstico debe tenerse en mente en aquellos pacientes con hiperCKemia de etiología desconocida, y para confirmarlo es necesario hacer una electroforesis de CK.

Protective effect of creatine on amikacin-induced ototoxicity / Efeito protetor da creatina na ototoxicidade induzida por amicacina

Abstract Introduction Aminoglycosides are widely known for their ototoxic side effects. Nevertheless, they are potent antibiotics used in the treatment of life-threatening conditions because of the current concern for antibiotic resistance. We hypothesized that creatine supplements which are believed to improve mitochondrial antioxidant defense system and maintain optimal energy homeostasis may improve the ototoxic side effects. Objective This study aimed to investigate the protective effects of creatine monohydrate against ototoxicity induced by amikacin in rats in an experimental animal model, using distortion product otoacoustic emissions and auditory brainstem response. Methods Twenty healthy rats were assigned to four groups (5 rats in each): the control group, the creatine monohydrate group, the amikacin group and the amikacin + creatine monohydrate group. The creatine monohydrate group received creatine at a dose of 2 g/kg once daily via gastric gavage for 21 days. The amikacin group received amikacin at a dose of 600 mg/kg by intramuscular injections once daily for 21 days. The amikacin + creatine monohydrate group received intramuscular injections of amikacin (600 mg/kg) once daily for 21 days and creatine monohydrate (2 g/kg) once daily via gastric gavage for 21 days. The control group received nothing. The distortion product otoacoustic emissions and auditory brainstem response measurements were performed on all rats on days 0, 7, 21. Results Regarding auditory brainstem response values, a significant increase in the auditory threshold was observed in the amikacin group on day 21 (p < 0.001). The amikacin+creatine monohydrate group showed significantly lower levels of auditory brainstem response auditory thresholds on day 21 in comparison to the amikacin group (p < 0.001). Additionally, the control group and the amikacin+creatine monohydrate group did not differ significantly with respect to auditory brainstem response thresholds on treatment day 21 (p > 0.05). When we compare distortion product otoacoustic emissions values, there was no significant difference between the amikacin and amikacin+creatine monohydrate groups on day 7 (p > 0.05), However significantly greater distortion product otoacoustic emissions values were observed in the amikacin+creatine monohydrate group on day 21 compared to the amikacin group (p < 0.001). Conclusion Our findings demonstrate that creatine treatment protects against amikacin ototoxicity when given at a sufficient dose and for an adequate time period.

Resumo Introdução Os aminoglicosídeos são amplamente conhecidos por seus efeitos colaterais ototóxicos. No entanto, eles são antibióticos potentes usados no tratamento de doenças potencialmente fatais devido à atual preocupação com a resistência aos antimicrobianos. Nossa hipótese é que os suplementos de creatina, aos quais atribui-se um efeito benéfico sobre o sistema de defesa antioxidante mitocondrial e manutenção da homeostase energética ideal, possam melhorar os efeitos colaterais ototóxicos. Objetivo Investigar os efeitos protetores da creatina mono-hidratada contra a ototoxicidade induzida pela amicacina em ratos em um modelo experimental animal com o uso das emissões otoacústicas por produto de distorção e o potencial evocado auditivo de tronco encefálico. Método Vinte ratos saudáveis foram divididos em quatro grupos (5 ratos em cada): o grupo controle, o grupo creatina mono-hidratada, o grupo amicacina e o grupo amicacina + creatina mono-hidratada. O grupo creatina mono-hidratada recebeu creatina na dose de 2 g / kg uma vez ao dia por gavagem gástrica por 21 dias. O grupo amicacina recebeu amicacina na dose de 600 mg/kg por injeção intramuscular uma vez ao dia por 21 dias. O grupo amicacina + creatina mono-hidratada recebeu injeções intramusculares de amicacina (600 mg/kg) uma vez ao dia por 21 dias e creatina mono-hidratada (2 g/kg) uma vez ao dia por gavagem gástrica por 21 dias. O grupo controle nada recebeu. As medidas de emissões otoacústicas por produto de distorção e potencial evocado auditivo de tronco encefálico foram feitas em todos os ratos nos dias 0, 7, e 21. Resultados Em relação aos valores do potencial evocado auditivo de tronco encefálico, foi observado aumento significante dos limiares auditivos no grupo amicacina no 21° dia (p < 0,001). O grupo amicacina + creatina mono-hidratada apresentou níveis significantemente mais baixos de limiares auditivos de potencial evocado auditivo de tronco encefálico no dia 21 em comparação com o grupo amicacina (p < 0,001). Além disso, o grupo controle e o grupo amicacina + creatina mono-hidratada não diferiram significantemente em relação aos limiares de potencial evocado auditivo de tronco encefálico no 21° dia de tratamento (p > 0,05). Quando comparamos os valores de emissões otoacústicas por produto de distorção, não houve diferença significante entre os grupos amicacina e amicacina + creatina mono-hidratada no 7° dia (p > 0,05). No entanto, valores significantemente mais altos de emissões otoacústicas por produto de distorção foram observados no grupo amicacina + creatina mono-hidratada no 21° dia em comparação com o grupo amicacina p < 0,001). Conclusão O tratamento com creatina mono-hidratada protege contra a ototoxicidade da amicacina quando administrado em dose suficiente e por um período de tempo adequado.

The vitamin e consumption effect on muscle damage and oxidative stress: a systematic review and meta-analysis of randomized controlled trials / Efeito da ingestão de vitamina e sobre os danos musculares e o estresse oxidativo: uma revisão sistemática com meta-análise de ensaios controlados randomizados / Efecto del consumo de vitamina e sobre el daño muscular y el estrés oxidativo: una revisión sistemática con metaanálisis de ensayos controlados aleatorios

ABSTRACT Introduction: Vitamin E supplementation may protect against exercise-induced muscle damage (EIMD) through possible inhibition of free radical formation and cell membrane stabilization. However, there is no systematic review of this topic. This fact maintains academic stalemates that may have a resolution. Objective: This systematic review with meta-analysis aims to provide a comprehensive literature review on the hypothesis of the benefit of vitamin E supplementation on oxidative stress and muscle damage induced by aerobic exercise. Methods: A random-effects model was used, weighted mean difference (WMD) and 95% confidence interval (CI) were applied to estimate the overall effect. Results: The results revealed a significant effect of vitamin E supplementation on reducing creatine kinase (CK) and lactate dehydrogenase (LDH). In addition, a subgroup analysis resulted in a significant decrease in CK concentrations in trials with immediate and <24 hours post-exercise CK measurement; <1000 at daily vitamin E intake; ≤1 at weekly intake; 1 at six weeks and >6 weeks experimental duration, studies on aerobic exercise and training were part of the crossover study. Conclusion: Vitamin E can be seen as a priority agent for recovery from muscle damage. Evidence Level II; Therapeutic Studies - Investigating the results.

RESUMO Introdução: A suplementação de vitamina E pode ter um efeito protetor contra danos musculares induzidos pelo exercício (EIMD) através da possível inibição da formação radical livre e estabilização da membrana celular. Todavia, não há uma revisão sistemática sobre esse tema. Tal fato mantém empasses acadêmicos que podem ter uma resolução. Objetivo: Esta revisão sistemática com meta-análise objetiva fornecer uma análise bibliográfica abrangente na hipótese do benefício na suplementação de vitaminas E sobre o estresse oxidativo e os danos musculares induzidos pelo pelo exercício aeróbico. Métodos: Foi utilizado um modelo com efeitos aleatórios, diferença média ponderada (ADM) e intervalo de confiança de 95% (IC) foram aplicados para estimar o efeito geral. Resultados: Os resultados revelaram um efeito significativo da suplementação de vitamina E na redução da creatina-quinase (CK) e lactato-desidrogenase (LDH). Além disso, uma análise do subgrupo resultou em uma diminuição significativa das concentrações de CK em ensaios com medição imediata e <24 horas de CK após o exercício; <1000 no consumo diário de vitamina E; ≤1 no consumo semanal; 1 em 6 semanas e >6 semanas de duração experimental, estudos sobre exercício aeróbico e treinamento fizeram parte do estudo cruzado. Conclusão: A vitamina E pode ser vista como um agente prioritário de recuperação de danos musculares. Nível de evidência II; Estudos Terapêuticos - Investigação de Resultados.

RESUMEN Introducción: La suplementación con vitamina E puede tener un efecto protector contra el daño muscular inducido por el ejercicio (EIMD) a través de la posible inhibición de la formación de radicales libres y la estabilización de la membrana celular. Sin embargo, no existe ninguna revisión sistemática sobre este tema. Este hecho mantiene un impasse académico que puede tener resolución. Objetivo: Esta revisión sistemática con meta-análisis tiene como objetivo proporcionar una amplia revisión de la literatura sobre la hipótesis del beneficio de la suplementación con vitamina E sobre el estrés oxidativo y el daño muscular inducido por el ejercicio aeróbico. Métodos: Se utilizó un modelo de efectos aleatorios, se aplicó la diferencia de medias ponderada (DMP) y el intervalo de confianza (IC) del 95% para estimar el efecto global. Resultados: Los resultados revelaron un efecto significativo de la suplementación con vitamina E en la reducción de la creatina quinasa (CK) y la lactato deshidrogenasa (LDH). Además, un análisis de subgrupos dio como resultado una disminución significativa de las concentraciones de CK en los ensayos con medición de CK inmediata y <24 horas después del ejercicio; <1000 en la ingesta diaria de vitamina E; ≤1 en la ingesta semanal; 1 en 6 semanas y >6 semanas de duración experimental, los estudios sobre el ejercicio aeróbico y el entrenamiento formaron parte del estudio cruzado. Conclusión: La vitamina E puede resultar un agente prioritario para la recuperación del daño muscular. Nivel de evidencia II; Estudios terapéuticos - Investigación de resultados.

Polimiositis: evolución de 4 años y agudización en 2019, caso masculino en Popayán, Cauca / Polymyositis: evolution of 4-years and agudizacion in 2019, male case in Popayán, Cauca

Resumen La polimiositis es una miopatía autoinmune que causa cada año a nivel mundial 4 casos por cada millón de habitantes, es de diagnóstico clínico y necesita tratamiento rápido y agresivo porque puede llevar a desenlaces fatales. Esta patología es infrecuente en hombres con una proporción mujer/hombre de 2.5:1, por lo que el objetivo del artículo fue describir y comparar con la literatura el caso de un paciente masculino con polimiositis quien debutó con debilidad muscular y dolor poliarticular de 20 días de evolución, con valores de creatina quinasa de 24000 UI/L, asociado a pérdida de peso y respondiendo adecuadamente al tratamiento médico brindado en el momento. Después de 3 años asintomático, sufrió una agudización que fue manejada con medicamentos de primera línea, pero sin mejoría, por lo que requirió metilprednisolona oral a altas dosis e inmunomoduladores. En ningún momento presentó compromiso de órganos vitales, actualmente es sintomático y se encuentra en manejo médico. MÉD.UIS.2022;35(1):49-56.

Abstract Polymyositis is an autoimmune myopathy and each year it causes 4 cases per million in the worldwide population, it is clinically diagnosed and needs rapid and aggressive treatment because it can lead to fatal outcomes. This pathology is infrequent in men, with a proportion women/men 2.5:1, the objective of the article was to describe and compare with the literature the case of a male patient with polymyositis, who presented with muscle weakness and polyarticular pain of 20 days of evolution, with Creatine kinase values of 24,000 IU/L, associated with weight loss, and responding adequately to the medical treatment provided at the time. After 3 years asymptomatic, he suffered an acute phase that was managed with first-line medications but without improvement, for which he required oral methylprednisolone at high doses and inmunomodulators. At no time did he present vital organ involvement, he is currently symptomatic and is under medical management. MÉD.UIS.2022;35(1):49-56.

Rapidly progressing treatment resistant anti-TIF1 gamma antibody positive dermatomyositis

Dermatomyositis is an idiopathic inflammatory myositis involving progressive muscle weakness with skin manifestations. Incidence of dermatomyositis is 1 per 100,000 in general population. Diagnosis is based on characteristic skin rashes, progressive muscleweakness and elevated muscle enzymes levels (creatine phosphokinase). The diagnosis is confirmed by clinical examination, abnormal electromyogram and autoimmune workup. In this case report, we report a case of difficult to treat dermatomyositis with proximal muscle weakness in an elderly male patient with classical skin lesions. The patient was resistant to steroid and immunoglobulin therapy.

Diagnosis and treatment of Takotsubo syndrome after liver transplantation and literature review / 器官移植

Objective To summarize the experience of diagnosis and treatment of Takotsubo syndrome (TTS) after liver transplantation. Methods Clinical data of one TTS patient after liver transplantation was retrospectively analyzed. Clinical features, diagnosis and treatment strategies were summarized, and literature review was conducted. Results A 43-year-old female patient successfully underwent split liver transplantation due to primary biliary cirrhosis for 8 years. At postoperative 3 d, the patient developed anxiety, irritation, dyspnea, disorientation, hypotension, N-terminal pro-brain natriuretic peptide (NT-proBNP) of > 35 000 pg/mL, creatine kinase isoenzyme (CK-MB) of 5.9 U/L and troponin I (TnI) of 1.78 μg/L. Electrocardiogram indicated the signs of sinus rhythm. Echocardiography indicated diffuse weakening of the left ventricular wall motion and spherical dilatation of the apex, accompanied with moderate and severe regurgitation of the mitral valve and tricuspid valve. The left ventricular ejection fraction (LVEF) declined to 23%, whereas no abnormal segmental motion of ventricular wall or corresponding electrocardiogram changes were observed. The possibility of acute coronary syndrome was excluded. The InterTAK diagnostic score was 73. The diagnosis of TTS after liver transplantation was considered. Metoprolol, coenzyme Q10, recombinant human brain natriuretic peptide, deacetyl lanatoside and lorazepam were given. Echocardiography at postoperative 10 d showed that the left ventricular function was significantly improved and the LVEF recovered to 50%. The patient was discharged 40 d after liver transplantation. The liver function was recovered well. During postoperative follow-up, she was given with metoprolol till the submission date, and no recurrence was reported. Conclusions TTS after liver transplantation is rare in clinical practice. It is difficult to make the diagnosis. The condition of TTS is severe and clinical prognosis is poor. Prompt diagnosis and interventions should be implemented.

The combination of creatine kinase-myocardial band isoenzyme and point-of-care cardiac troponin/ contemporary cardiac troponin for the early diagnosis of acute myocardial infarction / 世界急诊医学杂志（英文）

@#BACKGROUND: The early diagnosis of acute myocardial infarction (AMI) remains challenging, especially for institutions without the high-sensitive cardiac troponin (hs-cTn) assay. Herein, we aim to assess the value of creatine kinase-myocardial band isoenzyme (CK-MB) combined with different cardiac troponin (cTn) assays in AMI diagnosis. METHODS: This multicenter, observational study included 3,706 patients with acute chest pain from September 1, 2015, to September 30, 2017. We classified the participants into three groups according to the cTn assays: the point-of-care cTn (POC-cTn) group, the contemporary cTn (c-cTn) group, and hs-cTn group. The diagnostic value was quantified using sensitivity and the area under the curve (AUC). RESULTS: Compared to the single POC-cTn/c-cTn assays, combining CK-MB and POC-cTn/c-cTn increased the diagnostic sensitivity of AMI (56.1% vs. 63.9%, P<0.001; 82.7% vs. 84.3%, P=0.025). In contrast, combining CK-MB and hs-cTn did not change the sensitivity compared with hs-cTn alone (95.0% vs. 95.0%, P>0.999). In the subgroup analysis, the sensitivity of combining CK-MB and c-cTn increased with time from symptom onset <6 h compared with c-cTn alone (72.8% vs. 75.0%, P=0.046), while the sensitivity did not increase with time from symptom onset >6 h (97.5% vs. 98.3%, P=0.317). The AUC of the combination of CK-MB and POC-cTn significantly increased compared to the single POC-cTn assay (0.776 vs. 0.750, P=0.002). The AUC of the combined CK-MB and c-cTn/hs-cTn assays did not significantly decrease compared with that of the single c-cTn/hs-cTn assays within 6 h. CONCLUSIONS: The combination of CK-MB and POC-cTn or c-cTn may be valuable for the early diagnosis of AMI, especially when hs-cTn is not available.

Effects of Tuina on serum creatine kinase and skeletal muscle mitochondria in delayed onset muscle soreness model rats / 针灸推拿医学（英文版）

Objective: To observe the effect of Tuina (Chinese therapeutic massage) on creatine kinase (CK), mitochondrial Ca2+ concentration, and ultrastructure of skeletal muscle in delayed onset muscle soreness (DOMS) model rats.Methods: A total of 130 healthy male Sprague-Dawley rats were randomly divided into a blank group, an exercise control group, a pre-exercise Tuina group, and a post-exercise Tuina group. According to the time points for sample collection, the exercise control group was divided into a 0 h exercise control group, a 24 h exercise control group, a 48 h exercise control group, and a 72 h exercise control group; the pre-exercise Tuina group was further divided into a 0 h pre-exercise Tuina group, a 24 h pre-exercise Tuina group, a 48 h pre-exercise Tuina group, and a 72 h pre-exercise Tuina group; and the post-exercise Tuina group was divided into a 0 h post-exercise Tuina group, a 24 h post-exercise Tuina group, a 48 h post-exercise Tuina group, and a 72 h post-exercise Tuina group. Rats in all groups except for the blank group received DOMS modeling. Professionals performed Nie-Pinching manipulation and finger Nian-Twisting manipulation on the lower limbs of the rats. The samples were collected at 0 h, 24 h, 48 h, or 72 h after exhaustive exercise for each pre-exercise Tuina group. The samples were collected at 0 h, 24 h, 48 h, or 72 h after Tuina for each post-exercise Tuina group. The changes in serum CK, skeletal muscle mitochondrial Ca2+ concentration, and Ca2+-adenosine triphosphatase (ATPase) were determined. The ultrastructure changes of skeletal muscles in each group were observed by a transmission electron microscope. Results: The electron microscope showed that compared with the exercise control group, the skeletal muscle structures of the pre-exercise Tuina group and the post-exercise Tuina group were significantly improved, and the overall performance of skeletal muscle in the pre-exercise Tuina group was more similar to that of the blank group. The level of serum CK in the pre-exercise Tuina group and the post-exercise Tuina group was significantly lower than that in the exercise control group (P<0.01). The Ca2+ concentration of skeletal muscle in the 24 h, 48 h, and 72 h pre-exercise Tuina groups was lower than that in the post-exercise Tuina group at the same time point (P<0.01). The Ca2+-ATPase concentration of skeletal muscle in the 24 h and 72 h pre-exercise Tuina groups was lower than that in the post-exercise Tuina group at the same time point (P<0.05).Conclusion: Tuina effectively prevents muscle damage caused by heavy exercise and long-term exercise, which may be related to the increase of skeletal muscle Ca2+-ATPase activity and mitochondrial Ca2+ transport.

Meta-analysis of acupuncture intervening exercise-induced fatigue / 针灸推拿医学（英文版）

Objective: To systematically evaluate the impact of acupuncture on exercise-induced fatigue (EIF). Methods: Scopus, Springer Link, Web of Science, PubMed, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang Academic Journal Full-text Database (Wanfang), Chongqing VIP Database (CQVIP), and China Biology Medicine Disc (CBM) were systematically searched to identify randomized controlled trials (RCTs) studying acupuncture treatment of EIF from the inception till August 2020. The risk of bias in the included studies was assessed using the Cochrane handbook. RevMan 5.3 was used to conduct statistical analysis on the extracted data. Results: A total of 11 RCTs were included for meta-analysis, involving 531 patients. It was revealed that acupuncture produced more significant effects in alleviating subjective fatigue [standardized mean difference (SMD)=-3.08, 95％ confidence interval (CI) (-4.35, -1.81), P<0.001], increasing the hemoglobin content [weighted mean difference (WMD)=3.89, 95％CI (1.37, 6.42), P=0.003], reducing the lactate dehydrogenase content [WMD=-10.63, 95％CI (-17.67, -3.59), P=0.003], reducing the blood lactic acid content [SMD=-2.65, 95％CI (-4.47, -0.83), P=0.004], and down-regulating the levels of serum creatine kinase [SMD=-0.79, 95％CI (-1.10, -0.48), P<0.001] and blood urea nitrogen [WMD=-1.47, 95％CI (-1.84, -1.11), P<0.001] than the control groups. Conclusion: Based on the existing evidence, acupuncture can be recognized as effective in improving EIF and is worthy of promotion in clinical settings.