MDMA and cocaine can result in acute onset rhabdomyolysis. However, delayed onset rhabdomyolysis and its pathophysiology is of concern Early therapeutic intervention improves prognosis. Such cases should be promptly referred and managed in centers equipped with critical care and renal replacement therapy.

BACKGROUND: Skin conditions are common in patients on maintenance hemodialysis and those with pancreatitis. However, there is a lack of research on dermatological issues in patients who have both hemodialysis and pancreatitis concurrently.
METHODS: A 62-year-old male patient with a 4-year history of maintenance hemodialysis (MHD) presented with pain and was diagnosed with acute pancreatitis and gallbladder stones. Markedly elevated blood amylase, creatine kinase, and myoglobin were noted, alongside a purplish-red skin discoloration. Treatment included inhibition of digestive fluid secretion, anti-infection measures, blood purification, fasting, rehydration, and symptomatic care. Notably, continuous renal replacement therapy (CRRT) combined with hemoperfusion (HP) was employed. The patient\'s dialysis effluent initially appeared red. Upon examination of the patient\'s peripheral blood smear, red blood cell debris was not observed. The dialysis effluent (on Day 0) was analyzed, revealing no hemoglobin (0 g/L) but an elevated myoglobin concentration of 80.4 U/L. After the therapeutic intervention, the indicators, including the blood amylase, C-reactive protein, total bilirubin, creatine kinase, and myoglobin were improved. The patient experienced resolution of sternal and upper abdominal pain within two days. After four consecutive days of CRRT and HP treatment, the skin color returned to normal, alongside improved clarity of the dialysis effluent. Subsequently, the patient\'s method of blood purification was reverted to conventional hemodialysis. On the eighth day of hospitalization, the patient resumed normal diet and was discharged.
CONCLUSIONS: In the case of the current patient with acute pancreatitis undergoing MHD, it is noteworthy to report the observation of a unique purplish-red skin discoloration. This phenomenon may be attributable to inflammation resulting from acute pancreatitis, and the retention of myoglobin within the body.

UNASSIGNED: This study aimed to describe the successful identification and treatment of severe hyperkalemia, cardiac arrhythmia, rhabdomyolysis, and acute kidney injury (AKI) in a domestic cat that underwent general anesthesia for abdominal exploratory surgery. The definitive underlying cause remains unknown; however, a reaction to propofol is suspected.
UNASSIGNED: A 6-month-old intact male domestic short-hair cat underwent general anesthesia and developed severe intraoperative rhabdomyolysis, hyperkalemia, ventricular fibrillation, and AKI during surgery despite a documented mild hypokalemia and normal creatinine before inducing anesthesia. Propofol was administered as part of the anesthetic protocol. The patient was resuscitated successfully and responded well to advanced medical intervention. The hyperkalemia and AKI were resolved within less than 24 h from surgery and rhabdomyolysis was resolved at the time of recheck 5 days later.
UNASSIGNED: While previously suspected in dogs, to the authors\' knowledge, propofol-related infusion syndrome (PRIS) has not been reported in domestic cats. Veterinary professionals should be aware that drug-induced intraoperative rhabdomyolysis and hyperkalemia can develop unexpectedly and should remain a differential for acute cardiac arrhythmias or cardiac arrest and AKI.

We report a woman in her 30s with dysferlinopathy whose diagnosis was masked by superimposed hypothyroidism. Laboratory studies revealed Hashimoto\'s thyroiditis and markedly raised serum creatine kinase (CK of 6255 U/L; reference range 0-170 U/L). Electromyography, nerve conduction studies and MRI of the hip and thigh were consistent with a diagnosis of hypothyroid myopathy, but thyroxine failed to resolve her clinical presentation or normalise the CK level. Immunohistochemical (IHC) staining of right vastus lateralis muscle biopsy revealed the selective absence of dysferlin leading to a diagnosis of limb-girdle muscular dystrophy type IIB. Dysferlinopathy is a challenging diagnosis due to a varied clinical picture and low incidence. Misdiagnosis is common even in uncomplicated presentations, and this case outlines the need for routine inclusion of IHC and a low threshold for genetic testing, in the workup of complex myopathy.

It is still debatable which is the least invasive approach to the hip joint in arthroplasty for a femoral neck fracture (FNF). We compared the traditional direct lateral approach (DLA) with the direct anterior approach (DAA) regarding creatine kinase (CK), C-reactive protein (CRP), and hemoglobin (Hb).
In a randomized controlled trial, 130 elderly patients with dislocated FNFs treated with total hip arthroplasty (THA) were included. CK, CRP, and Hb were measured preoperatively and on postoperative days 1 to 4 and were compared between the DAA and DLA groups using repeated measures mixed-effect models.
The CK level was significantly higher on the 1st postoperative day in the DLA group, 597 U/L (95% confidence interval [CI] 529-666) vs 461 U/L (CI 389-532), estimated mean difference (MD) 136 U/L (CI 38-235). The CRP levels were significantly higher on postoperative days 3 and 4 in the DLA group, 207 mg/L (CI 189-226) vs 161 mg/L (CI 143-180), estimated MD 46 mg/L (CI 19-72) and 162 mg/L (CI 144-181) vs 121 (CI 102-140), estimated MD 41 mg/L (CI 15-68). Blood loss, expressed as difference in Hb, did not differ between the groups.
In an elderly population with FNFs, we found that the DAA, compared with the DLA, results in less CK and CRP increase, but no change in Hb.

To analyze the changes in lactate dehydrogenase, creatine kinase, creatine kinase isoenzyme, high-sensitivity troponin T, N-terminal B-type natriuretic peptide precursor, homocysteine, and novel inflammatory indices (neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, systemic immune-inflammation index) before and after competitions in amateur marathon runners, and to assess the effects of myocardial injury due to acute exercise and the value of novel inflammatory indices in marathon exercise monitoring. This paper is an analytical study. Amateur athletes recruited by Beijing Hospital to participate in the 2022 Beijing Marathon and the 2023 Tianjin Marathon, and those who underwent health checkups at the Beijing Hospital Medical Checkup Center from January to June 2023 were selected as the study subjects, and 65 amateur marathon runners (41 males and 24 females) and 130 healthy controls (82 males and 48 females) were enrolled in the study according to the inclusion criteria. Peripheral blood was collected one week before, immediately after, and one week after running, and routine blood tests, cardiac enzymes, infarction markers, N-terminal B-type natriuretic peptide precursor, and homocysteine were performed to calculate the values of novel inflammatory indexes. Wilcoxon signed-rank test and Spearman\'s rank correlation analysis were used to compare the differences in the levels of each index between the amateur marathon population and the health checkup population, and to compare the changes and correlations of each index at the three time points in the amateur marathoners.The results showed that the neutrophil-lymphocyte ratios of the healthy physical examination population and 65 amateur marathoners 1 week before running were 1.73 (1.33, 2.16) and 1.67 (1.21, 2.16), the platelet-lymphocyte ratios were 122.75 (96.69, 155.89) and 120.86 (100.74, 154.63), and the systemic immune inflammation index was 398.62 (274.50, 538.69) and 338.41 (258.62, 485.38), etc.; on 1 week before running, immediately after running and 1 week after running, lactate dehydrogenase of 65 amateur marathon runners was 173.00(159.00, 196.50)U/L,284.00(237.50, 310.50)U/L, 183.00(165.50, 206.50)U/L, creatine kinase was 131.00(94.30, 188.20)U/L,318.00(212.00, 573.15)U/L,139.00(90.55, 202.40)U/L, creatine kinase isoenzyme was 2.50(1.76, 3.43)μg/L,6.24(4.87, 10.30)μg/L,2.73(1.57, 4.40)μg/L.In 65 amateur marathon runners, lactate dehydrogenase, creatine kinase, creatine kinase isoenzyme, high sensitivity troponin T, N-terminal B-type natriuretic peptide precursor, homocysteine, and novel inflammation markers were significantly elevated in the immediate post-run period compared with 1 week before the run, and the differences were statistically significant (Z=-7.009, Z=-6.813, Z=-6.885, Z=-7.009, Z=-7.009, Z=-6.656; P<0.05 for the above indicators).Neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, and systemic immune-inflammatory index all showed significant positive correlation with the pre-and post-run rates of change of high-sensitivity troponin T (ρ=0.28, P=0.03;ρ=0.31, P=0.01;ρ=0.27, P=0.03); these 3 markers were also significantly and positively correlated with the pre-and post-run rates of change in a collection of myocardial-related markers such as lactate dehydrogenase, creatine kinase, creatine kinase isozymes, high-sensitivity troponin T, N-terminal B-type natriuretic peptide precursor, and homocysteine, respectively(r=0.446, P=0.039; r=0.452, P=0.033; r=0.449, P=0.036).In addition, the platelet-lymphocyte ratio was positively correlated with the pre-and post-run rates of change in creatine kinase and creatine kinase isoenzymes(ρ=0.27, P=0.03;ρ=0.28, P=0.02).In conclusion, acute myocardial injury may be triggered during marathon exercise. Changes in novel inflammatory markers were significantly associated with changes in myocardial enzymes, infarction markers, N-terminal B-type natriuretic peptide precursors, and homocysteine, which may be of value for the prediction of myocardial injury during exercise.
分析业余马拉松运动员竞赛前后乳酸脱氢酶、肌酸激酶、肌酸激酶同工酶、高敏肌钙蛋白T、N末端B型钠尿肽前体、同型半胱氨酸及新型炎症指标（中性粒细胞-淋巴细胞比值、血小板-淋巴细胞比值、全身免疫炎症指数）的变化，评估急性运动导致的心肌损伤及新型炎症指标在马拉松运动监测中的应用价值。本文为分析性研究。选择北京医院招募的分别参加2022年北京马拉松和2023年天津马拉松的业余运动员和2023年1—6月于北京医院体检中心健康体检人群作为研究对象，依照纳入标准入选业余马拉松运动员65名（男性41名，女性24名），健康对照人群130名（男性82名，女性48名）。业余马拉松运动员分别在跑前1周、跑后即刻及跑后1周采集外周血，检测或计算上述指标。采用Wilcoxon符号秩检验及Spearman等级相关分析，比较业余马拉松人群与健康体检人群之间各指标水平的差异，同时比较业余马拉松运动员3个时间点各指标的变化及相关关系。结果显示健康体检人群和业余马拉松运动员跑前1周的中性粒细胞-淋巴细胞比值为1.73（1.33，2.16）、1.67（1.21，2.16），血小板-淋巴细胞比值为122.75（96.69，155.89）、120.86（100.74，154.63），全身免疫炎症指数为398.62（274.50，538.69）、338.41（258.62，485.38）等；业余马拉松运动员在跑前1周、跑后即刻及跑后1周的乳酸脱氢酶为173.00（159.00，196.50）U/L、284.00（237.50，310.50）U/L、183.00（165.50，206.50）U/L，肌酸激酶为131.00（94.30，188.20）U/L、318.00（212.00，573.15）U/L、139.00（90.55，202.40）U/L，肌酸激酶同工酶为2.50（1.76，3.43）μg/L、6.24（4.87，10.30）μg/L、2.73（1.57，4.40）μg/L等。65名业余马拉松运动员中，跑后即刻与跑前1周相比，乳酸脱氢酶、肌酸激酶、肌酸激酶同工酶、高敏肌钙蛋白T、N末端B型钠尿肽前体、同型半胱氨酸及新型炎症指标均显著升高，差异有统计学意义（Z=-7.009，Z=-6.813，Z=-6.885，Z=-7.009，Z=-7.009，Z=-6.656；以上指标P<0.05）。中性粒细胞-淋巴细胞比值、血小板-淋巴细胞比值、全身免疫炎症指数均与高敏肌钙蛋白T的跑步前后变化率存在显著的正相关（ρ=0.28，P=0.03；ρ=0.31，P=0.01；ρ=0.27，P=0.03）；这3个指标也分别与以乳酸脱氢酶、肌酸激酶、肌酸激酶同工酶、高敏肌钙蛋白T、N末端B型钠尿肽前体、同型半胱氨酸等心肌相关指标集合的跑步前后变化率具有显著的正相关（r=0.446，P=0.039；r=0.452，P=0.033；r=0.449，P=0.036）。另外，血小板-淋巴细胞比值与肌酸激酶及肌酸激酶同工酶的跑步前后变化率也呈正相关（ρ=0.27，P=0.03；ρ=0.28，P=0.02）。综上，马拉松运动过程中可能引发急性心肌损伤。新型炎症指标变化与心肌酶、心梗标志物、N末端B型钠尿肽前体、同型半胱氨酸变化相关显著，对于运动中心肌损伤预测可能具有一定价值。.

BACKGROUND: Ginseng Radix et Rhizoma (GS) is frequently used as an adjuvant therapy for patients with heart failure (HF). Metoprolol is widely used in patients with HF. However, there is no report on the combined effects of GS and metoprolol in patients with HF.
OBJECTIVE: This study investigated the combined effects of GS and metoprolol in male C57BL/6J mice with HF and the underlying mechanisms.
METHODS: We utilized a mouse myocardial HF model to measure the serum levels of creatine kinase (CK) and creatine kinase-MB form (CK-MB) using an automated biochemical analyzer. Lactate dehydrogenase (LDH) and cardiac troponin (cTnT) levels were determined using enzyme-linked immunosorbent assays. Autophagy of myocardial cells was evaluated using transmission electron microscopy, and changes in signal pathway proteins related to autophagy were analyzed by Western blotting.
RESULTS: GS combined with metoprolol improved heart function, reduced heart damage, and decreased serum levels of CK, CK-MB, LDH, and cTnT. The combination of GS and metoprolol decreased autophagy in myocardial cells by reducing the levels of autophagy-related proteins (LC3, p62, Beclin1, and Atg5) and increasing the ratios of p-PI3K/PI3K, p-Akt/Akt, and p-mTOR/mTOR.
CONCLUSIONS: GS enhanced the anti-heart failure effect of metoprolol. Its mechanism of action might be related to the inhibition of autophagy mediated by the activation of the PI3K/Akt/mTOR pathway.

Legionella pneumophila is a bacterium that usually causes pulmonary disease but can rarely present with extrapulmonary manifestations, such as rhabdomyolysis. This is a case of Legionella infection with significant rhabdomyolysis but a lack of acute kidney injury. A 38-year-old male with a history of epilepsy presented to the emergency department after a seizure episode with confusion, fever, emesis and bruises. He also complained of a productive cough and scant haemoptysis for the past two months. Chest X-ray showed retrocardiac and left upper lobe opacities; urine was positive for Legionella antigen and myoglobinuria. Creatinine phosphokinase was 242,488 U/l and creatinine was 0.5 mg/dl. The patient was managed with oxygen therapy, aggressive IV hydration and IV azithromycin, and later IV levofloxacin until his symptoms resolved. Rhabdomyolysis may be a sign of Legionella infection. Rapid testing of Legionella antigen, especially in populations at risk, may be crucial for timely diagnosis and treatment. Kidney function may be preserved in the early stages of disease, but early treatment with antibiotics and aggressive hydration are an effective way to prevent deterioration in kidney function.
CONCLUSIONS: Legionella pneumonia is difficult to distinguish from bacterial pneumonia, therefore rapid Legionella testing, particularly in areas with high rates of incidence, is important for targeted therapy.Legionella pneumonia with rhabdomyolysis with extremely high CPK levels is usually associated with AKI but preserved kidney function is possible and early diagnosis and treatment can lead to decreased mortality and morbidity in severe cases.

BACKGROUND: A common tactic used by athletes to improve performance, lessen tiredness, and hasten recovery is dietary supplementation. We aimed to assess the role of a microalgae dietary liquid supplement additivated with Copper 22.5% NRV in water polo players\' performance.
METHODS: Twenty male water polo players were split into two groups: ten (spirulina group) took a twice-daily nutritional supplement containing 15 mL of spirulina liquid extract (titrated in Phycocyanin 1 mg/mL) and additivated with Copper 22.5% NRV for eight weeks, and ten (the placebo group) did not take the supplement. Subjective evaluations were finished using the Athlete\'s Subjective Performance Scale (ASPS). Levels of the biomarker creatine phosphokinase (CPK) were also assessed.
RESULTS: The spirulina group\'s mean total ASPS score increased significantly from baseline to follow-up and was significantly better than that of the placebo group (p < 0.001). Conversely, ASPS ratings in the placebo group slightly decreased. A positive correlation between spirulina supplementation and less severe ASPS was found using correlation matrix analysis. However, there was a slight difference in CPK levels from the baseline to the follow-up in the spirulina group.
CONCLUSIONS: A dietary supplement comprising spirulina and copper may help water polo players\' subjective performance measurements by lowering muscular tension. Larger, randomized controlled trials are yet required.

Intracellular molecules are transported by motor proteins or move by diffusion resulting from random molecular motion. Cardiomyocytes are packed with structures that are crucial for function, but also confine the diffusional spaces, providing cells with a means to control diffusion. They form compartments in which local concentrations are different from the overall, average concentrations. For example, calcium and cyclic AMP are highly compartmentalized, allowing these versatile second messengers to send different signals depending on their location. In energetic compartmentalization, the ratios of AMP and ADP to ATP are different from the average ratios. This is important for the performance of ATPases fuelling cardiac excitation-contraction coupling and mechanical work. A recent study suggested that compartmentalization modulates the activity of creatine kinase and adenylate kinase in situ. This could have implications for energetic signaling through, for example, AMP-activated kinase. It highlights the importance of taking compartmentalization into account in our interpretation of cellular physiology and developing methods to assess local concentrations of AMP and ADP to enhance our understanding of compartmentalization in different cell types.