Serum procalcitonin levels are associated with rhabdomyolysis following exertional heatstroke: an over 10-year intensive care survey / 世界急诊医学杂志（英文）

@#BACKGROUND: Heatstroke has become a common emergency event in hospitals. Procalcitonin (PCT) is used as a biomarker of infection in the emergency department (ED), but its role in rhabdomyolysis (RM) following exertional heatstroke (EHS) remains unclear. METHODS: A retrospective cohort study enrolled patients with EHS from the intensive care unit (ICU). We collected RM biomarkers, inflammation markers, critical disease scores at admission, 24 h, 48 h, and discharge, and 90-day mortality. Correlation analysis, linear regression and curve fitting were used to identify the relationship between PCT and RM. RESULTS: A total of 162 patients were recruited and divided into RM (n=56) and non-RM (n=106) groups. PCT was positively correlated with myoglobin (Mb), acute hepatic injury, disseminated intravascular coagulation (DIC), Sequential Organ Failure Assessment (SOFA) score, and Acute Physiology and Chronic Health Evaluation II (APACHE II) score, with correlation coefficients of 0.214, 0.237, 0.285, 0.454, and 0.368, respectively (all P<0.05). Interestingly, the results of curve fitting revealed a nonlinear relationship between PCT and RM, and a two-piecewise linear regression model showed that PCT was related to RM with an odds ratio of 1.3 and a cut-off of <4.6 ng/mL. Survival analysis revealed that RM was associated with higher mortality compared to non-RM cases (P=0.0093). CONCLUSION: High serum PCT concentrations are associated with RM after EHS in critically ill patients. Elevated PCT concentrations should be interpreted cautiously in patients with EHS in the ED.

Investigating preoperative myoglobin level as predictive factor for acute kidney injury following cardiac surgery with cardiopulmonary bypass: a retrospective observational study

Abstract Background: Early identification of patients at risk of AKI after cardiac surgery is of critical importance for optimizing perioperative management and improving outcomes. This study aimed to identify the association between preoperative myoglobin levels and postoperative acute kidney injury (AKI) in patients undergoing valve surgery or coronary artery bypass graft surgery (CABG) with cardiopulmonary bypass. Methods: This retrospective study included 293 patients aged over 17 years who underwent valve surgery or CABG with cardiopulmonary bypass. We excluded 87 patients as they met the exclusion criteria. Therefore, 206 patients were included in the final analysis. The patients' demographics as well as intraoperative and postoperative data were collected from electronic medical records. AKI was defined according to the Acute Kidney Injury Network classification system. Results: Of the 206 patients included in this study, 77 developed AKI. The patients who developed AKI were older, had a history of hypertension, underwent valve surgery with concomitant CABG, had lower preoperative hemoglobin levels, and experienced prolonged extracorporeal circulation (ECC) times. Multivariate logistic regression analysis revealed that preoperative myoglobin levels and ECC time were correlated with the development of AKI. A higher preoperative myoglobin level was an independent risk factor for the development of cardiac surgery-associated AKI. Conclusions: Higher preoperative myoglobin levels may enable physicians to identify patients at risk of developing AKI and optimize management accordingly.

Acute kidney injury caused by rhabdomyolysis which is induced by intestinal infection: a case report and literature review / 中国基层医药

Objective:To report a case of acute kidney injury caused by rhabdomyolysis and summarize its etiology, pathogenesis, and treatment strategy.Methods:The clinical data of a case of rhabdomyolysis complicated by acute kidney injury admitted to Affiliated Huadu Hospital of Southern Medical University on August 30, 2020, were collected, including clinical manifestation, auxiliary examination, and disease outcome. Referring to the previous literature reports of rhabdomyolysis complicated by acute kidney injury, this paper discusses its etiology, monitors and analyzes some indicators such as serum creatinine, blood urea nitrogen, creatine kinase, myoglobin, and 24-hour urine volume during the treatment, and summarizes the clinical diagnosis and treatment ideas of the disease.Results:This case developed an intestinal infection after an unclean diet, which induced rhabdomyolysis and acute kidney injury. Renal pathology after renal biopsy showed that renal biopsy result was consistent with an acute tubulointerstitial injury caused by myoglobin tubular nephropathy. The biochemical indexes such as creatine kinase and myoglobin decreased rapidly after ordinary hemodialysis, but the levels of serum creatinine and blood urea nitrogen did not decrease markedly, and there was continuous oliguria. After switching to hemodialysis filtration and continuous intensive dialysis treatment, the levels of serum creatinine and blood urea nitrogen decreased rapidly, the amount of urine increased gradually, and finally, the renal function recovered.Conclusion:For acute kidney injury caused by rhabdomyolysis, early sufficient blood purification can accelerate the clearance of myoglobin, promote the recovery of the injured kidney, and improve the prognosis of the disease.

Clinical value of myoglobin in predicting multiple organ dysfunction in wasp sting patients / 中华急诊医学杂志

Objective:To investigate the clinical features and risk factors of multiple organ dysfunction syndrome (MODS) caused by wasp sting.Methods:A retrospective cohort study was conducted to collect the general data of wasp sting patients who had a clear history of wasp sting disease and clinical manifestations from June 2016 to December 2020 and were first diagnosed as wasp sting in hospital. Patients with hematological diseases, malignant tumors, severe liver and kidney dysfunction, cardiac insufficiency, and patients who had received hormone therapy before admission were excluded. Patients who were unable to obtain effective laboratory results due to hemolysis or other reasons within 48 h of admission were also excluded. The white blood cell count (WBC), neutrophil count (NEU), lymphocyte count (LYM), hemoglobin count (HB), myoglobin (Mb/MYO), activated partial thromboplastin time (APTT), albumin (ALB), K, Na, and Cl of the blood samples collected within 48 h after admission were recorded. Patients were divided into the MODS group and non-MODS group according to whether MODS occurred during hospitalization. Uni- and multivariate analysis were used to analyze the factors affecting the occurrence of MODS in wasp sting patients during hospitalization, and the receiver operating characteristic (ROC) curve was plotted to evaluate the predictive effect of myoglobin level on the occurrence of MODS in wasp sting patients during hospitalization.Results:Mb, WBC, NEU, APTT and serum potassium in the MODS group [3890.00 (1416.90-4057.00) ng/mL, (21.99 ± 8.18) × 10 9/L, (19.61 ± 7.33)× 10 9/L, (93.75 ± 45.77) s, and (4.99 ± 0.95) mmol/L] were significantly higher than those in the non-MODS group [73.50 (34.30-264.20) ng/mL, (13.40 ± 4.14)× 10 9/L, (11.18±4.73)× 10 9/L, (37.00 ± 17.16) s, and (4.05 ± 0.56) mmol/L] (all P < 0.05); blood chlorine and ALB [(101.50 (98.25-105.00) mmol/L and (35.36 ± 6.44) g/L)] were significantly lower than those in the non-MODS group [(105.00 (103.00-107.00) mmol/L and (40.71 ± 5.48) g/L)] (all P < 0.05). Multivariate logistic regression analysis showed that NEU ( OR = 0.729, 95% CI: 0.542~0.981), Mb ( OR = 0.999, 95% CI: 0.998~1.000), and APTT ( OR = 0.951, 95% CI: 0.921~0.982) were independent risk factors for MODS in wasp sting patients. ROC curve analysis showed that NEU, Mb and APTT could be used to evaluate the occurrence of MODS in wasp sting patients. Among them, Mb had the highest predictive value (AUC = 0.950, 95 % CI: 0.891~0.982). The optimal cutoff value of Mb for predicting the occurrence of MODS in wasp sting patients was 515.30 ng/mL, and the corresponding sensitivity and specificity were 90.62% and 87.23%, respectively. Conclusion:Mb is an independent risk factor for MODS in wasp sting patients, which can be used as a good predictor of MODS in wasp sting patients.

Qualidade da carne de frangos da linhagem Label Rouge suplementados com minerais biocomplexados e criados em sistema alternativo / [Meat quality of Label Rouge lineage chicken supplemented with biocomplexed minerals and reared in an alternative system]

Objetivou-se avaliar a influência da suplementação com minerais biocomplexados sobre a qualidade da carne de frangos da linhagem Label Rouge, de ambos os sexos, criados em sistema alternativo. O delineamento experimental foi inteiramente ao acaso (DIC), disposto em esquema fatorial (3x2), sendo três dietas (controle; 0,50ppm de selênio; 0,40ppm de cromo) e dois sexos. Para a estabilidade lipídica, foi utilizado o DIC, disposto em esquema fatorial (3x2x2), sendo três dietas, dois sexos e dois tempos de armazenamento (zero e 12 meses). Os parâmetros avaliados no peito e na coxa foram: pH final, cor (L* - luminosidade, a* - índice de vermelho, b* - índice de amarelo, C* - índice de saturação e h* - ângulo de tonalidade), perda de peso por cozimento (PPC), força de cisalhamento (FC) e estabilidade lipídica. Além disso, foram avaliadas a proporção das formas químicas da mioglobina da coxa e a quantificação do conteúdo de selênio no peito. Não houve efeito isolado da dieta sobre os parâmetros físicos e químicos do peito e da coxa e sobre a concentração de selênio no peito. As fêmeas apresentaram médias superiores de L* (57,57), b* (10,55) e C* (10,60) do peito; e os machos de L* (55,09) da coxa. Entre os machos, as aves alimentadas com a dieta controle e com cromo expressaram valores superiores de FC da coxa em relação às suplementadas com selênio; para o tratamento com cromo, os machos apresentaram média superior de FC da coxa e, em contrapartida, para o tratamento com selênio, as fêmeas manifestaram a maior média. As amostras submetidas ao período de 12 meses de armazenamento mostraram maiores valores de substâncias reativas ao ácido tiobarbitúrico (TBARS) em ambos os cortes. A suplementação com cromo e selênio biocomplexados não provocou alterações na qualidade da carne; as fêmeas demonstraram melhores atributos de qualidade da carne.(AU)

The objective of the present study was to evaluate the influence of the supplementation with biocomplexed minerals on the quality of the meat of label Rouge lineage chicken, of both genders, reared in an alternative system. The experimental design was completely randomized (CRD) in a factorial scheme (3x2), with three diets (control; 0.50ppm of selenium; 0.40ppm of chromium) and two genders. For lipid stability, the CRD arranged in a factorial scheme (3x2x2) was used, being three diets, two genders and two storage times (0 and 12 months). The parameters evaluated in the breast and in the thigh were: final pH, color (L* - luminosity, a* - red index, b* - yellow index, C* - saturation index and h* - tonality angle), weight loss per cooking (WLC), shear force (SF) and lipid stability. In addition, we evaluated the proportion of chemical forms of myoglobin of the thigh and the quantification of selenium content in the breast. There was no isolated effect of diet on the physical and chemical parameters of the breast and thigh and selenium concentration in the breast. Females had higher mean values of L* (57.57), b* (10.55) and C* (10.60) of the breast; and males of L* (55.09) of the thigh. Among males, poultry fed with the control diet and chromium showed higher SF values of the thigh than those supplemented with selenium; for the treatment with chromium, the males presented superior average of SF of the thigh and, in contrast, for the treatment with selenium, the females had the highest average. Samples submitted to the period of 12-month of storage showed higher values of substances reactive to thiobarbituric acid (TBARS) in both cuts. Supplementation with biocomplexed chromium and selenium did not cause changes in meat quality; females presented better attributes of meat quality.(AU)

Evaluation of cardiac parameters between survivors and nonsurvivors of COVID-19 patients

SUMMARY OBJECTIVE: The present study compares the cardiac parameters of the survivor and nonsurvivor patients with COVID-19 infection. METHODS: This study was conducted in 379 patients diagnosed with COVID-19 disease. Information of 21 nonsurvivor and 358 survivor patients with COVID-19 was obtained from the hospital information management system and analyzed retrospectively. Relationship between cardiac parameters in patients categorized into the mortal and immortal groups was investigated. RESULTS: Of the total 379 patients involved in this study, 155 (40.9%) were females and 224 (59.1%) were males. No statistically significant difference in mortality was found between females and males (p=0.249). The total median age was 70, the median age in the nonsurvivor group was 74 (35-89), and it was 69.5 (18-96) in the survivor group (p=0.249). The median values of high-sensitivity troponin (hs-Tn), creatine kinase MB form, and especially myoglobin in the survivor and nonsurvivor groups were 25/64.9 (p=0.028), 18/23 (p=0.02), and 105.5/322.4 (p<0.001), and the difference was statistically significant. Comparing mortality, while there was 1 (0.7%) nonsurvivor out of 134 patients in the service unit, there were 20 (8.2%) nonsurvivors out of 245 patients in the intensive care unit. This difference was statistically significant (p=0.003). The cutoff value of myoglobin, which may pose a risk of mortality, was found to be 191.4 µg/L, while it was 45.7 ng/l for hs-Tn and 60.1 U/L for creatine kinase MB. CONCLUSIONS: Advanced age and increased levels of high-sensitivity troponin, creatine kinase MB, and myoglobin were found to be associated with mortality.

Value of HEART score combined with three bedside tests of myocardial infarction in the diagnosis and prognosis of emergency chest pain / 中国医师杂志

Objective:To explore the value of HEART score combined with three bedside tests of myocardial infarction in the diagnosis of emergency chest pain patients.Methods:310 patients with emergency chest pain treated in Langfang People's Hospital from January 2018 to December 2018 were retrospectively selected. The HEART score was evaluated at admission, and the levels of serum creatine kinase isoenzyme (CK-MB), myoglobin (Myo) and troponin I (cTnI) were detected.Results:Among 310 patients, 232 cases were diagnosed as cardiogenic chest pain, 78 cases were non cardiogenic chest pain; In cardiogenic chest pain, 151 cases were acute coronary syndrome and 81 cases were stable angina pectoris; The HEART score, CK-MB, Myo and cTnI in patients with cardiogenic chest pain were (5.00±1.01)points, (14.45±3.11)ng/ml, (60.20±11.34)ng/ml and (2.30±0.89)ng/ml, respectively, which were significantly higher than those in patients with non cardiogenic chest pain ( P<0.05); The HEART score, CK-MB, myo and cTnI in patients with acute coronary syndrome were (5.83±1.12), (16.02±2.88)ng/ml, (64.49±12.01)ng/ml and (2.54±0.91)ng/ml, which were significantly higher than those in patients with stable angina pectoris ( P<0.05); The area under receiver operating characteristic (ROC) curve of HEART score combined with myocardial infarction in the diagnosis of cardiogenic chest pain was 0.811 ( P<0.05), which was higher than single diagnosis of other indexes; the sensitivity and specificity were 85.28% and 82.50% respectively; The area under ROC curve of HEART score combined with myocardial infarction in the diagnosis of acute coronary syndrome was 0.901 ( P<0.05), which was higher than single diagnosis of other indexes; the sensitivity and specificity were 90.00% and 85.00% respectively; The HEART score of patients with acute coronary death was (6.88±1.02), which was significantly higher than that of patients with survival ( P<0.05); The area under ROC curve predicted by HEART score was 0.674 ( P<0.05). When the cut-off value was 6, the sensitivity and specificity were 78.00% and 70.00%, respectively; the CK-MB, Myo and cTnI increased with the risk of cardiogenic chest pain ( P<0.05). Conclusions:HEART score combined with three bedside tests of myocardial infarction has a good application value in the emergency chest pain, which is worthy of clinical use.

Instrumental color and oxidative stability of light and dark muscles of Nile tilapia / Cor instrumental e estabilidade oxidativa de músculos claros e escuros de tilápia do Nilo

ABSTRACT: The aim of the present study was to compare the color and oxidative stability of light (LM) and dark (DM) muscles of Nile tilapia (Oreochromis niloticus) stored at 4 °C for eight days. Five different trials of LM and DM samples were analyzed for instrumental color attributes (lightness, redness and yellowness), including the surface color stability through ratio of reflectance at 630/580 nm (R630/580), myoglobin concentration, total lipid content, fatty acid profile, metmyoglobin reducing activity (MRA), pH, lipid oxidation and protein oxidation. Results of the present study indicated that DM of Nile tilapia (Oreochromis niloticus) present lower oxidative and color stability during refrigerated storage than LM.

RESUMO: O objetivo do presente estudo foi comparar a estabilidade de cor e oxidativa de músculos claros (LM) e escuros (DM) de tilápia do Nilo (Oreochromis niloticus) armazenados a 4° C por oito dias. Cinco repetições diferentes de amostras de LM e DM foram analisadas quanto aos atributos instrumentais de cor (luminosidade, teor de vermelho e teor de amarelo), incluindo a estabilidade de cor na superfície através da razão de refletâncias nos comprimentos de onda 630 e 580 nm (R630/580), concentração de mioglobina, lipídios totais, perfil de ácidos graxos, atividade de redução da metamioglobina (MRA), pH, oxidação lipídica e oxidação proteica. Os resultados do presente estudo indicam que músculos escuros (DM) de tilápia do Nilo (Oreochromis niloticus) apresentam menor estabilidade oxidativa e de cor durante o armazenamento refrigerado, quando comparados aos músculos claros (LM).

Capacidad predictiva de mioglobina vs creatincinasa total de lesión renal aguda en pacientes traumatizados / Predictive capacity of myoglobin vs total creatine kinase of acute renal failure in traumatized patients

Resumen OBJETIVO: Comparar la capacidad predictiva de mioglobina, creatincinasa total y hemoglobina en orina de lesión renal aguda en pacientes con traumatismo. MATERIAL Y MÉTODO: Estudio transversal, analítico, comparativo, observacional, en el que se identificaron todos los pacientes mayores de 18 años con diagnóstico de traumatismo o politraumatismo, provenientes del servicio de urgencias, de agosto de 2017 a enero de 2018 en el Hospital General Xoco de la Secretaría de Salud de la Ciudad de México, se midieron: mioglobina, creatincinasa total, concentraciones de creatinina y hemoglobina en orina a su ingreso. RESULTADOS: Se incluyeron 24 pacientes de 20 a 79 años de edad, con predominio del género masculino. Al comparar las áreas bajo la curva de las pruebas se determinó que no hubo significación estadística (p = 0.266) para la creatincinasa de ingreso porque mostró un área bajo la curva de 0.636, el intervalo de confianza al 95% se encontró por debajo de 0.500. Asimismo, la mioglobina de ingreso se observó en un área bajo la curva de 0.657 (p = 0.198; IC 95% 0.423-0.891). CONCLUSIONES: Las concentraciones de creatincinasa total y mioglobina no demostraron ser predictores adecuados de lesión renal al no haber diferencia significativa; sin embargo, se encontró que las concentraciones de creatinina al ingreso tienen mayor capacidad predictiva de lesión renal aguda en pacientes con traumatismo e hiperCKemia.

Abstract OBJECTIVE: To compare the predictive capacity of myoglobin, total creatine kinase and urine hemoglobin for acute renal injury in patients with trauma. MATERIAL AND METHOD: A cross-sectional, analytical, comparative, observational study was made with all adults over 18 years of age with a diagnosis of trauma or polytraumatism from August 2017 to January 2018 in the General Hospital of Xoco, Mexico City. Myoglobin, total creatine kinase, creatinine and hemoglobin levels were measured in urine at their admission. RESULTS: There were studied 24 patients from 20 to 79 years old, with a predominance of the male gender. When comparing the areas under the test curve it was determined that there was no statistical significance (p = 0.266) for the creatine kinase at the patient's admission, as it showed an area under the curve of 0.636, the 95% confidence interval was below 0.500. Likewise, the myoglobin at the patient's admission was observed under the curve area of 0.657 (p = 0.198; IC 95% 0.423-0.891). CONCLUSIONS: Levels of total creatine kinase and myoglobin did not prove to be adequate predictors of kidney injury because there was no significant difference. However, creatinine levels at admission have greater predictive capacity of acute renal injury in patients with trauma and hyperCKemia.

Screening and Verification of RNA-seq-based PBCRS for Treating Key Genes of Breast Cancer / 中国实验方剂学杂志

Objective: To study the inhibitory effect of the medicine group of promoting blood circulation and removing stasis (PBCRS) on breast cancer induced by 7, 12-dimethylbenz(a)anthracene (DMBA) in rats, and screen out and verify key genes based on RNA Sequencing (RNA-seq) technology and Ingenuity Pathway Analysis (IPA). Method: Totally 96 Sprague-Dawley (SD) rats were randomly divided into blank group, DMBA model control group, tamoxifen (TAM) group (1.9 mg·kg-1·d-1), high-dose, middle-dose and low-dose PBCRS groups (12.96, 6.48, 3.24 g·kg-1·d-1). One week after drug intervention, except for the blank group, the DMBA was used to induce the rat model of breast cancer (with an interval of a week, irrigation for two times at the dose of 100 mg·kg-1). After 10 weeks, the changes in tumor weight and tumor volume were observed. The total RNA was extracted by total RNA extraction kit, and three RNA samples were collected from the DMBA model control group and the middle-dose PBCRS group for genetic testing. Based on RNA-seq, key differential genes were screened out and verified by Real-time PCR. Result: Comparing with the DMBA model control group, the tumor volume and tumor weight in middle-dose PBCRS group were decreased significantly (PPConclusion: PBCRS may inhibit the occurrence of breast cancer by interfering with the expression of FBP1 in breast cancer tissue.

Retrospective analysis of diabetic hyperosmolar hyperglycemia complicated with rhabdomyolysis / 中国基层医药

Objective@#To investigate the clinical characteristics and treatment strategies of diabetic hyperosmolar hyperglycemia (HHS) with rhabdomyolysis (RM).@*Methods@#The clinical data of 40 patients with HHS treated in the General Hospital of Shenyang Military Command from November 2013 to November 2017 were retrospectively analyzed.According to the serum levels of creatine phosphokinase and myoglobin, they were divided into RM group (12 cases) and non-RM group (28 cases). The clinical characteristics and treatment results of the two groups were compared.@*Results@#There were 12 cases in the RM group, 6 cases were diagnosed RM at the time of consultation, and 6 cases developed RM during the course of treatment.Compared with the non-RM group, RM group had lower systolic pressure[(98.3±17.8)mmHg vs.(128.0±18.1)mmHg, t=4.823, P=0.000], higher blood glucose level[(44.4±14.0)mmol/L vs.(32.6±8.1)mmol/L, t=2.717, P=0.016], and more acidosis, mainly manifested by lower pH[(7.16±0.15)vs.(7.32±0.13), t=3.355, P=0.002], lower bicarbonate[(12.92±5.23)mmol/L vs.(19.07±6.80)mmol/L, t=2.792, P=0.008], higher blood D-3 hydroxybutyric acid [(5.84±2.98)mmol/L vs.(2.55±2.13)mmol/L, t=4.012, P=0.000], and renal function was worse[creatinine (257.1±149.8)μmol/L vs.(148.1±85.3)μmol/L, t=2.925, P=0.006]. Individualized rehydration and low dose insulin were given to control blood sugar, and increasing blood pressure, kidney protection, correction of electrolyte disturbance, anti-infection and inhibition of gland secretion were given to the complications.Hydration and alkalization were given to 7 cases of RM, and continuous renal replacement therapy (CRRT) was given to 5 cases.In 10 cases of HHS with RM, creatine kinase decreased, renal function recovered, and 2 patients died.@*Conclusion@#It is very important to improve the understanding of RM in HHS patients, routinely monitor the dynamic changes of muscle enzymes, make a good early diagnosis and prevention of RM.Urine hydration and alkalization should be given in time after RM occurs, and CRRT treatment as early as possible can improve the survival rate of diabetic patients.

Clinical investigation on the risk factors for prognosis in patients with septic shock / 中华危重病急救医学

Objective@#To study the risk factors of prognosis in patients with septic shock, and to provide a reliable evidence to evaluate severity.@*Methods@#A retrospective analysis was conducted. The data of 185 patients with septic shock admitted to the intensive care unit (ICU) of Anhui Provincial Hospital Affiliated to Anhui Medical University from March 2016 to December 2018 were enrolled. Routine blood test, blood biochemistry, blood gas analysis, myoglobin (Myo), cardiac troponin I (cTnI), blood lactic acid (Lac), procalcitonin (PCT) and ratio of C-reactive protein and albumin (CRP/ALB) of patients on the day of septic shock diagnosis were collected. Glasgow coma scale (GCS), quick sequential organ failure assessment (qSOFA), acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) and multiple organ dysfunction score (MODS) as well as the time from hospitalization to septic shock and duration of mechanical ventilation were recorded. The patients were divided into death group and survival group according to whether they survived or not on 28 days. According to Myo level, the patients were divided into two groups: Myo elevation group (Myo > 98 μg/L) and Myo normal group (Myo≤98 μg/L). Patients with Myo elevation were divided into survival subgroup and death subgroup according to the prognosis of 28 days. The clinical data were compared among the groups, and the influencing factors of prognosis in septic shock patients were screened by multivariate Logistic regression analysis.@*Results@#185 patients were all enrolled in the final analysis, there were 106 deaths and 79 survivors on 28 days, 154 patients with elevated Myo and 31 patients with normal Myo. ① Compared with the patients with septic shock in the survival group, the death group had older patients, increased qSOFA, APACHEⅡ, MODS scores and blood Myo, Lac, PCT levels, faster heart rate, decreased GCS score, and shorter time from hospitalization to septic shock and duration of mechanical ventilation. However, there was no significant difference in cTnI or CRP/Alb between the two groups. Multivariate Logistic regression analysis showed that age [odds ratio (OR) = 1.037, 95% confidence interval (95%CI) was 1.010-1.065, P = 0.007], heart rate (OR = 1.020, 95%CI was 1.003-1.037, P = 0.023), qSOFA score (OR = 2.839, 95%CI was 1.321-6.102, P = 0.008), Myo (OR = 1.492, 95%CI was 1.088-2.045, P = 0.013), time from hospitalization to septic shock (OR = 0.938, 95%CI was 0.898-0.980, P = 0.004) and duration of mechanical ventilation (OR = 0.936, 95%CI was 0.899-0.975, P = 0.001) were independent risk factors for prognosis in patients with septic shock. ② Compared with Myo normal group, the Myo elevation group had higher 28-day mortality [61.0% (94/154) vs. 38.7% (12/31), χ2 = 5.259, P = 0.022]. Compared with the survival patients with elevated Myo, the death patients were older, and had higher PCT and qSOFA score, faster heart rate, lower GCS score, and shorter time from hospitalization to septic shock and duration of mechanical ventilation. But there was no significant difference in CRP/Alb between the two groups. Multivariate Logistic regression analysis showed that qSOFA score (OR = 2.796, 95%CI was 1.270-6.153, P = 0.011), time from hospitalization to septic shock (OR = 0.925, 95%CI was 0.884-0.967, P = 0.001) and duration of mechanical ventilation (OR = 0.931, 95%CI was 0.884-0.980, P = 0.006) were independent risk factors for the prognosis in the septic shock patients with elevated blood Myo.@*Conclusions@#Age, heart rate, qSOFA score, Myo, time from hospitalization to septic shock, duration of mechanical ventilation were independent risk factors for the prognosis of patients with septic shock. The 28-day mortality in patients with elevated blood Myo was significantly higher than that in those with normal blood Myo. The qSOFA score, time from hospitalization to septic shock and duration of mechanical ventilation were independent risk factors for the prognosis of septic shock patients with elevated blood Myo.

Clinical investigation on the risk factors for prognosis in patients with septic shock / 中华危重病急救医学

Objective To study the risk factors of prognosis in patients with septic shock, and to provide a reliable evidence to evaluate severity. Methods A retrospective analysis was conducted. The data of 185 patients with septic shock admitted to the intensive care unit (ICU) of Anhui Provincial Hospital Affiliated to Anhui Medical University from March 2016 to December 2018 were enrolled. Routine blood test, blood biochemistry, blood gas analysis, myoglobin (Myo), cardiac troponin I (cTnI), blood lactic acid (Lac), procalcitonin (PCT) and ratio of C-reactive protein and albumin (CRP/ALB) of patients on the day of septic shock diagnosis were collected. Glasgow coma scale (GCS), quick sequential organ failure assessment (qSOFA), acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) and multiple organ dysfunction score (MODS) as well as the time from hospitalization to septic shock and duration of mechanical ventilation were recorded. The patients were divided into death group and survival group according to whether they survived or not on 28 days. According to Myo level, the patients were divided into two groups: Myo elevation group (Myo > 98 μg/L) and Myo normal group (Myo≤98 μg/L). Patients with Myo elevation were divided into survival subgroup and death subgroup according to the prognosis of 28 days. The clinical data were compared among the groups, and the influencing factors of prognosis in septic shock patients were screened by multivariate Logistic regression analysis. Results 185 patients were all enrolled in the final analysis, there were 106 deaths and 79 survivors on 28 days, 154 patients with elevated Myo and 31 patients with normal Myo. ① Compared with the patients with septic shock in the survival group, the death group had older patients, increased qSOFA, APACHEⅡ, MODS scores and blood Myo, Lac, PCT levels, faster heart rate, decreased GCS score, and shorter time from hospitalization to septic shock and duration of mechanical ventilation. However, there was no significant difference in cTnI or CRP/Alb between the two groups. Multivariate Logistic regression analysis showed that age [odds ratio (OR) = 1.037, 95% confidence interval (95%CI) was 1.010-1.065, P = 0.007], heart rate (OR = 1.020, 95%CI was 1.003-1.037, P = 0.023), qSOFA score (OR = 2.839, 95%CI was 1.321-6.102, P = 0.008), Myo (OR = 1.492, 95%CI was 1.088-2.045, P = 0.013), time from hospitalization to septic shock (OR = 0.938, 95%CI was 0.898-0.980, P = 0.004) and duration of mechanical ventilation (OR = 0.936, 95%CI was 0.899-0.975, P = 0.001) were independent risk factors for prognosis in patients with septic shock. ② Compared with Myo normal group, the Myo elevation group had higher 28-day mortality [61.0% (94/154) vs. 38.7% (12/31), χ2 = 5.259, P = 0.022]. Compared with the survival patients with elevated Myo, the death patients were older, and had higher PCT and qSOFA score, faster heart rate, lower GCS score, and shorter time from hospitalization to septic shock and duration of mechanical ventilation. But there was no significant difference in CRP/Alb between the two groups. Multivariate Logistic regression analysis showed that qSOFA score (OR = 2.796, 95%CI was 1.270-6.153, P = 0.011), time from hospitalization to septic shock (OR = 0.925, 95%CI was 0.884-0.967, P = 0.001) and duration of mechanical ventilation (OR = 0.931, 95%CI was 0.884-0.980, P = 0.006) were independent risk factors for the prognosis in the septic shock patients with elevated blood Myo. Conclusions Age, heart rate, qSOFA score, Myo, time from hospitalization to septic shock, duration of mechanical ventilation were independent risk factors for the prognosis of patients with septic shock. The 28-day mortality in patients with elevated blood Myo was significantly higher than that in those with normal blood Myo. The qSOFA score, time from hospitalization to septic shock and duration of mechanical ventilation were independent risk factors for the prognosis of septic shock patients with elevated blood Myo.

Predictive value of myoglobin and D-dimer on severe heat stroke: a clinical analysis of 38 patients with severe heat stroke / 中华危重病急救医学

Objective To explore the clinical characteristics and early sensitive indicators of severe heat stroke patients in order to predict the development of severe heat stroke in the early stage. Methods Thirty-eight patients with severe heat stroke admitted to emergency department of Beijing Daxing District People's Hospital from July 30th to August 5th in 2018 were enrolled. There were 18 patients suffered from exertional heat stroke (EHS), and 12 patients suffered from classical heat stroke (CHS), and 8 patients with heat spasm and heat exhaustion were selected as control group. The gender, age, onset time, body temperature, heart rate (HR), lactic acid (Lac), platelet (PLT), alanine aminotransferase (ALT), alanine aminotransferase (AST), blood urea nitrogen (BUN), serum creatinine (SCr), serum sodium at admission of hospital, as well as positive rate of myoglobin (MYO) and D-dimer (the positive threshold of MYO and D-dimer was 107 μg/L and 600 μg/L respectively) were recorded and compared among the groups. Receiver operating characteristic (ROC) curve was plotted to analyze the prognostic value of MYO and D-dimer on heat stroke. The outcome of all patients was followed up, and the 28-day mortality between EHS and CHS patients was compared. The patient's body temperature was measured again after 4 hours of active cooling treatment (T4 h), and the relationship between T4 h and 28-day mortality was discussed. Results The majority of severe heat stroke patients were male, especially in EHS patients. EHS patients were younger than CHS ones, and had shorter onset time, with significant differences among the groups. The body temperature and HR at admission in the EHS group and the CHS group were significantly higher than those in the control group [body temperature (℃): 41.34±0.67, 40.39±0.58 vs. 37.80±1.39; HR (bpm): 139.78±15.63, 113.08±17.70 vs. 92.00±15.89, all P < 0.05], PLT was significantly lowered (×109/L: 164.94±73.80, 165.78±53.49 vs. 249.50±84.22, both P < 0.05), and the positive rates of MYO and D-dimer were also significantly increased [MYO positive rate:100.0% (18/18), 100.0% (12/12) vs. 50.0% (4/8); D-dimer positive rate: 77.8% (14/18), 100.0% (12/12) vs. 12.5% (1/8), all P < 0.05]. ROC curve analysis showed that positive MYO and D-dimer at admission had certain diagnostic value for heat stroke, the area under ROC curve (AUC) was 0.750 and 0.871, the sensitivity was 50.0% and 87.5%, and the specificity was 100% and 86.7%, respectively. The 28-day mortality of the EHS group was significantly higher than that of the CHS group [44.4% (8/18) vs. 8.3% (1/12), P < 0.05]. Furthermore, the 28-day mortality of the patients with T4 h ≥ 38 ℃ in the EHS group was significantly higher than those with T4 h < 38 ℃ [70.0% (7/10) vs. 12.5% (1/8), P < 0.05]. Conclusions The decreased PLT and the increased D-dimer in the early stage of heat stroke indicate that the damage of coagulation mechanism is prominent in patients with heat stroke. EHS patients have the characteristics of acute onset, severe condition, rapid progression and poor prognosis, and the 28-day mortality is significantly higher than that of CHS patients. MYO and D-dimer are sensitive indicators in early stage of heat stroke patients, which can be used as reference for early diagnosis of heat stroke.

Acute responses of high-intensity circuit training in women: Low physical fitness levels show higher muscle damage / Respostas agudas de um circuito de treino de alta intensidade em mulheres: Níveis baixos de aptidão física apresentam maior dano muscular

High-intensity intermittent exercise (HIIE) elicits large improvements in health and cardiorespiratory fitness (CRF). HIIE can be applied with calisthenics exercises to improve strength and endurance. The acute effects of high-intensity circuit training (HICT) considering different CRF on myological variables are unknown. The aim was measure acute effects of HICT in young women considering different levels of CRF. Twelve women were allocated in two groups, who achieve 41mLO2•kg-1•min-1 or more= High Physical Fitness (HPF, n=5) and who achieve less than 41mLO2•kg-1•min-1= Low Physical Fitness (LPF,n=7). Protocol: 2x4 sets of 20 seconds at maximum intensity (all-out fashion) interspersed with 10 seconds of passive rest (jumping jacks, squat and thrust using 2kg dumbbells, mountain climber, and burpees). Blood samples were collected before, immediately after, 15minutes, 30minutes, one hour and 24 hours after. Heart rate, serum myoglobin, lactate, and creatine kinase (CK) concentration were analyzed. The HR achieved 94.1±3.7% of HRmax for LPF and 104.5±20.3% for HPF, p=0.03. The mean of delta lactate was similar between groups. The highest myoglobin has reached at 1h after the exercise protocol, with 50.0±30.2 ng/mL for LPF and 36.9±9.25 ng/mL for HPF. The delta of total CK before and after the exercise protocol shows that the serum CK level in LPF was significantly higher than HPF group (p=0.042). HICT composed by calisthenic protocol produced elevated and similar effects on HRmax, serum lactate and myoglobin in the woman with HPF and LPF. However, LPF group presented higher muscle damage inferred by serum CK concentrations.

O exercício intermitente de alta intensidade(HIIE) melhora a saúde e a aptidão cardiorrespiratória(CRF). HIIE pode ser aplicado com exercícios calistênicos para melhorar a força e resistência. Os efeitos agudos do treinamento de alta intensidade(HICT) considerando diferentes CRF em variáveis miológicas são desconhecidos. O objetivo foi medir os efeitos agudos do HICT em mulheres jovens, considerando diferentes níveis de CRF. Elas foram alocadas pelo nível de VO2máx. em dois grupos, as que atingiram 41mLO2•kg-1•min-1 ou mais= alta aptidão física(HPF,n=5) e menos de 41mLO2•kg-1•min-1= baixo aptidão física(LPF,n=7). Protocolo: 2x4 séries de 20s com intensidade máxima (all-out) intercalados com 10s de repouso passivo (jumping jacks, squat and thrust usando halteres 2kg, mountain climber e burpees). Sangue foi coletado antes, zero, 15, 30min, 1h e 24hs depois. Foram analisadas, freqüência cardíaca, mioglobina sérica, lactato e creatina quinase (CK). A FC alcançou 94,1±3,7% da FCmax para LPF e 104,5±20,3% para HPF, p=0,03. A média do delta lactato foi semelhante entre os grupos. O pico de mioglobina foi 1h após o protocolo de exercício, com 50.0±30.2ng/mL para LPF e 36.9±9.25ng/mL para HPF. O delta de CK total antes e depois do protocolo de exercício mostra que o nível sérico de CK no LPF foi significativamente maior do que o grupo HPF(p=0,042). O HICT com exercícios calistênicos produziu efeitos elevados e semelhantes sobre FCmax, lactato sérico e mioglobina nas mulheres com alta e baixa aptidão física. No entanto, o grupo LPF apresentou maior dano muscular inferido pelas concentrações séricas de CK.

Analysis of high risk factors of intensive care unit-acquired weakness in patients with sepsis / 中华危重病急救医学

Objective To investigate high risk factors of intensive care unit-acquired weakness (ICUAW) in patients with sepsis. Methods A retrospective study was conducted. 164 patients with mechanical ventilation (MV) who were diagnosed sepsis and multiple organ dysfunction syndrome (MODS), admitted to intensive care unit (ICU) of the Second Affiliated Hospital of Kunming Medical University from January 1st, 2015 to September 30th, 2017 were enrolled. The general situation, the basic diseases (hypertension, diabetes), body mass index (BMI), protopathy diseases, the level of albumin before ICU admission, the MV time, whether to use glucocorticoid and continuous renal replacement therapy (CRRT) or not, nutrition supply (nutritional way, nutrition initiation time, amino acid/protein supply, nutritional status on ICU 3 days and 7 days), myoglobin, the length of ICU stay, the length of hospital stay, and acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ) score were collected. The high risk factors of ICUAW in patients with sepsis complicated with MODS were analyzed further using multi-factor Logistic regression analysis. Multiple linear regression analysis was used to analyze the myoglobin related factors in sepsis patients. Results The ICUAW incidence was 25.6% (42/164). The risk factors with differences in univariate analysis were included in the multivariate Logistic regression analysis, and it was shown that the level of albumin before ICU [odds ratio (OR) = 0.232, 95% confidence interval (95%CI) = 0.061-0.885, P = 0.032], the MV time (OR = 0.380,95%CI = 0.154-0.935, P = 0.035), nutrition initiation time (OR = 2.642, 95%CI = 1.100-6.346, P = 0.030), myoglobin (OR = 4.129, 95%CI = 1.681-10.142, P =0.002) were the independent risk factors for ICUAW in sepsis patients with MODS. The linear regression showed that the level of myoglobin was positively correlated with APACHE Ⅱ score (β= 38.297, P = 0.000), negatively correlated with the length of hospital stay (β= -7.071, P = 0.048), and it had nothing to do with the MV time and the length of ICU stay. Conclusions Evaluation of muscle function should be a routine part of ICU examination. The levels of albumin,MV time, hemoglobin and nutritional start-up time were independent risk factors for ICUAW in sepsis patients with MODS. Myoglobin levels can be used as an indicator of severity.

Epidemiological and clinical characteristics of 109 patients with crayfish-related rhabdomyolysis / 中华内科杂志

A total of 109 in patients with crayfish-related rhabdomyolysis were enrolled in our hospital from July to August 2016,including 31.2％(34/109)males and 68.8％ (75/109)females.The number of home-cooked crayfish accounted for 60.6％ (66/109).Main symptom was back pain 96.3％ (105/109).The misdiagnosis rate was 15.6％ (17/109).On day 1,2,3 after admission and the day before discharge,serum creatine kinase were 1 175(446,2 258)IU/L,3 710(2 137,8 875)IU/L,1 899(1 063,4595)IU/L and 317 (152,532)IU/L,respectively(P＜0.001).Serum myoglobin were (603±484)μg/L,(313±284)μg/L,(104±74)μg/L and (55 ± 20)μg/L,respectively(F=39.1,P＜0.001).Females were more susceptible to cra.crayfish-related rhabdomyolysis.Home-cooked crayfish is prone to induce rhabdomyolysis and easily to be misdiagnosed.Creatine kinase and myoglobin showed characteristic dynamic changes.

Clinical analysis of rhabdomyolysis syndrome caused by alcohol withdrawal syndrome / 中国医师进修杂志

Objective To analyze the characteristics of rhabdomyolysis (RM) caused by alcohol withdrawal syndrome (AWS). Methods The clinical data of 7 patients with RM induced by AWS were analyzed retrospectively. Results All 7 patients were male;the age was 38-63 (51.3 ± 9.8) years. All of the 7 patients showed obvious myalgia and fatigue, of whom 4 patients had limb swelling, and 3 patients had epigastric pain. Creatine kinase and myoglobin levels of 7 cases were significantly increased. One case had acute renal failure. Seven patients were improved after treatment with a large amount of fluid infusion. Conclusions For patients with AWS who have generalized withdrawal seizures and epileptic seizures, muscle cells can be damaged due to prolonged muscle contraction, which can cause RM. Changes of myoglobin, creatine kinase, renal function and liver function in patients with AWS should be monitored at clinical admissions. If RM occurs, the patients should be given early fluid therapy.

Research of serum myoglobin detection in patients with Kennedy's Disease / 临床神经病学杂志

Objective To explore the significance of serum myoglobin detection in the diagnosis and evaluation of Kennedy`s disease (KD).Methods The level of serum myoglobin (Myo) was detected in 60 KD patients and 30 amyotrophic lateral sclerosis (ALS) patients.Results The serum Myo level and abnormal rate in KD group were significantly higher than those in ALS group (all P0.05).There was no overlap of serum Myo level between the two groups.There was no significant difference of serum Myo level and CAG repeated number of ALS (r=-0.193,P>0.05).Conclusion Myo is likely as an easy and sensitive biomarker, used to identify the KD and special type of ALS, and used in the evaluation of the KD condition in the future.

Clinical Analyzation of Patients with Haff Disease in a Single Center / 现代生物医学进展

Objective:To explore the clinical characteristics of Haff disease in our hospital,be familiar with the disease and provide some experience in diagnosis and treatment.Methods:Inpatients with Haff disease in our Kidney disease center between July and August 2016 were retrospectively analyzed.The clinical data of patients was collected and statistically analyzed.Results:There were 66 patients (28 of male and 38 of female) in total with Haff disease between July and August 2016 in our ward.The average onset age was 35.5 years old (18-76 years old) and the average latency period was 5.6 hours (1-24 hours).All the patients had crayfish before the onset of the disease.The initial symptoms included muscle pain and concentrated brown urine (19 cases,28.8％).Laboratory tests suggested that transaminase and myotropin were increased significantly (alanine aminotransferase,aspartate aminotransferase,lactate dehydrogenase,creatine kinase,myoglobin and creatine kinase isoenzyme).A trace of blood (45％) and protein (16.7％) was present in some patients' urine test.After treatment,muscle pain was alleviated and urine color turned to clear in all patients.All the transaminase and muscle enzymes were significantly decreased (P＜0.05).No blood or protein was detected in the urine test.Conclusions:The epidemiology of Haffdisease in summer at Nanjing was related to the intake of crayfish.The latency period was short and the initial symptoms were mostly muscle soreness,with or without myoglobinuria.Laboratory tests showed serum creatine phosphokinase,myoglobin,creatine kinase isoenzymes were increased significantly.The treatment period was short with good prognosis.Generally no sequelae was observed.