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Christison KS, Sol JA, Gurney SC, Dumke CL. Twenty-Four Percent of Wildland Firefighters Reach Critical Levels of Serum Creatine Kinase During 80-Hour Critical Training. Wilderness Environ Med 2023; 34:334-340. [PMID: 37258394 DOI: 10.1016/j.wem.2023.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 03/03/2023] [Accepted: 04/10/2023] [Indexed: 06/02/2023]
Abstract
INTRODUCTION Wildland firefighters (WLFFs) must undergo a 2-wk critical training (CT) period prior to deployment to the field. This stress may result in clinical risks, including severe muscle damage and rhabdomyolysis. We aimed to document the effects of WLFFs' CT on physiologic markers of muscle damage and soreness. METHODS Two interagency hotshot crews (n=25) were followed during spring 2022 for 80 h of training. Activity counts as well as records of upper-body (US) and lower-body (LS) muscle soreness were collected daily. Body weight (BW) and skinfold measurements were recorded on Day 1 (D1) and D11 to estimate body fat (BF) and lean body weight (LBW). Blood was collected on D1 and D11 to measure muscle and liver damage markers. RESULTS Critical training resulted in significant elevations in creatine kinase (CK) (216.9±57.4 U/L vs 5166.4±1927.8 U/L, P=0.017) and lactate dehydrogenase (LDH) (175.5±4.0 IU/L vs 340.0±42.6 IU/L, P=0.001) despite no significant changes in BW, BF, LBW, cortisol, or testosterone. Main effects of time were seen in US and LS, peaking on D11 (US: 5.2±0.4 cm, P<0.001; LS: 5.5±0.4 cm, P<0.001). Those who spent the most minutes with activity counts of >1500 counts/min showed the greatest increase in CK and LDH. CONCLUSIONS These data suggest that WLFFs undergo significant physiologic stressors, resulting in muscle soreness and damage during CT, with 6 of the 25 subjects reaching critical levels of serum CK. It appears that much of the muscle damage and soreness occurred because of unaccustomed WLFF job-specific tasks.
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Affiliation(s)
- Katherine S Christison
- School of Integrative Physiology and Athletic Training, University of Montana, Missoula, MT
| | - Joseph A Sol
- School of Integrative Physiology and Athletic Training, University of Montana, Missoula, MT; United States Department of Agriculture, Forest Service, National Technology and Development Program, Missoula, MT
| | - Shae C Gurney
- School of Integrative Physiology and Athletic Training, University of Montana, Missoula, MT
| | - Charles L Dumke
- School of Integrative Physiology and Athletic Training, University of Montana, Missoula, MT.
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Komine S, Miura I, Miyashita N, Oh S, Tokinoya K, Shoda J, Ohmori H. Effect of a sulforaphane supplement on muscle soreness and damage induced by eccentric exercise in young adults: A pilot study. Physiol Rep 2021; 9:e15130. [PMID: 34927380 PMCID: PMC8685487 DOI: 10.14814/phy2.15130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 11/08/2021] [Accepted: 11/10/2021] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE Excessive exercise increases the production of reactive oxygen species in skeletal muscles. Sulforaphane activates nuclear factor erythroid 2-related factor 2 (Nrf2) and induces a protective effect against oxidative stress. In a recent report, sulforaphane intake suppressed exercise-induced oxidative stress and muscle damage in mice. However, the effect of sulforaphane intake on delayed onset muscle soreness after eccentric exercise in humans is unknown. We evaluated the effect of sulforaphane supplement intake in humans regarding the delayed onset muscle soreness (DOMS) after eccentric exercise. RESEARCH METHODS & PROCEDURES To determine the duration of sulforaphane supplementation, continuous blood sampling was performed and NQO1 mRNA expression levels were analyzed. Sixteen young men were randomly divided into sulforaphane and control groups. The sulforaphane group received sulforaphane supplements. Each group performed six set of five eccentric exercise with the nondominant arm in elbow flexion with 70% maximum voluntary contraction. We assessed muscle soreness in the biceps using the visual analog scale, range of motion (ROM), muscle damage markers, and oxidative stress marker (malondialdehyde; MDA). RESULTS Sulforaphane supplement intake for 2 weeks increased NQO1 mRNA expression in peripheral blood mononuclear cells (PBMCs). Muscle soreness on palpation and ROM were significantly lower 2 days after exercise in the sulforaphane group compared with the control group. Serum MDA showed significantly lower levels 2 days after exercise in the sulforaphane group compared with the control group. CONCLUSION Our findings suggest that sulforaphane intake from 2 weeks before to 4 days after the exercise increased NQO1, a target gene of Nrf2, and suppressed DOMS after 2 days of eccentric exercise.
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Affiliation(s)
- Shoichi Komine
- Faculty of Human CareTeikyo Heisei UniversityToshima‐kuJapan
- Faculty of MedicineUniversity of TsukubaTsukubaJapan
| | - Ikuru Miura
- Doctoral program in Sports MedicineGraduate School of Comprehensive Human SciencesUniversity of TsukubaTsukubaJapan
| | - Nao Miyashita
- Master's program in Physical Education, Health and Sport SciencesGraduate School of Comprehensive Human SciencesUniversity of TsukubaTsukubaJapan
| | - Sechang Oh
- Faculty of MedicineUniversity of TsukubaTsukubaJapan
| | - Katsuyuki Tokinoya
- Department of Health Promotion SciencesGraduate School of Human Health SciencesTokyo Metropolitan UniversityHachioji‐shiJapan
- Japan Society for the Promotion of ScienceChiyoda‐kuJapan
| | - Junichi Shoda
- Faculty of MedicineUniversity of TsukubaTsukubaJapan
| | - Hajime Ohmori
- Faculty of Health and Sport SciencesUniversity of TsukubaTsukubaJapan
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Affiliation(s)
- Eun Ji Kim
- Department of Metabolic Medicine/Chemical Pathology, Guy's & St Thomas' Hospitals, London, UK
| | - Anthony S Wierzbicki
- Department of Metabolic Medicine/Chemical Pathology, Guy's & St Thomas' Hospitals, London, UK
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Kurita N, Kamitani T, Wada O, Shintani A, Mizuno K. Disentangling Associations Between Serum Muscle Biomarkers and Sarcopenia in the Presence of Pain and Inflammation Among Patients With Osteoarthritis: The SPSS-OK Study. J Clin Rheumatol 2021; 27:56-63. [PMID: 31397765 DOI: 10.1097/rhu.0000000000001156] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND/OBJECTIVE Reduction of muscle markers, such as creatine phosphokinase (CK), in rheumatic diseases and its association with reduced muscle mass may be of clinical importance in osteoarthritis (OA). Considering the complexity of secondary sarcopenia, clarifying the association between muscle markers and sarcopenia and disentangling the involvement of OA-related conditions are of clinical importance. We investigated the association between serum muscle biomarkers and sarcopenia among patients with OA, considering the presence of pain and inflammation. METHODS Overall, 1425 patients with knee and hip OA scheduled for joint replacement surgery were included in a single-center cross-sectional study from Screening for People Suffering Sarcopenia in Orthopedic cohort of Kobe study. Primary outcome was sarcopenia defined by 2 criteria (the Asian Working Group for Sarcopenia and the European Working Group on Sarcopenia in Older People). Pain and inflammation were measured using the numeric rating scale and serum C-reactive protein (CRP) levels, respectively. Associations between the biomarkers (serum CK, aspartate aminotransferase, alanine aminotransferase) and sarcopenia were examined using logistic regression models. RESULTS Sarcopenia by the Asian Working Group for Sarcopenia criteria was present in 4.0% of patients. In adjusted analyses, sarcopenia was negatively associated with higher serum CK levels, but not with serum aspartate aminotransferase or alanine aminotransferase levels independent of pain score and serum CRP. Neither pain score nor serum CRP level was associated with sarcopenia. Similar results were found when the European Working Group on Sarcopenia in Older People criteria were used. CONCLUSIONS Serum CK was associated with sarcopenia, suggesting the potential usefulness for sarcopenia detection regardless of pain or inflammation in OA.
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Affiliation(s)
| | - Tsukasa Kamitani
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto
| | | | - Ayumi Shintani
- Department of Medical Statistics, Osaka City University, Osaka, Japan
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Bertaux A, Alameda B, Tataw J, Kenfak A. [Cognitive bias in the context of epidemic]. Rev Med Suisse 2020; 16:2392-2396. [PMID: 33300700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
In connection with the scope and duration of the COVID-19 pandemic, the clinical judgement of clinicians and medical practitioners could be influenced such that diagnostic errors (delays and inaccuracies) may ensue. We hereby recall through two clinical scenarios the constant need for practitioners to take a step back in reflecting of the diagnostic process to avoid the « tunnel effect » which may result in delaying common and frequent infectious diseases. The flu-like symptoms presented by these patients (fever, myalgia and asthenia…) quickly prompted our emergency room colleagues to suspect SARS-CoV-2 infection. However, further investigations including imagery and blood cultures revealed completely different but common infectious disease conditions, which are potentially fatal.
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Affiliation(s)
- Adrien Bertaux
- Service de médecine interne, Hôpital du Jura bernois, 2740 Moutier
| | - Beatriz Alameda
- Service de médecine interne, Hôpital du Jura bernois, 2610 Saint-Imier
| | - James Tataw
- Service de médecine interne, Hôpital du Jura bernois, 2740 Moutier
| | - Alain Kenfak
- Service de médecine interne, Hôpital du Jura bernois, 2740 Moutier
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Martin-Rincon M, Gelabert-Rebato M, Galvan-Alvarez V, Gallego-Selles A, Martinez-Canton M, Lopez-Rios L, Wiebe JC, Martin-Rodriguez S, Arteaga-Ortiz R, Dorado C, Perez-Regalado S, Santana A, Morales-Alamo D, Calbet JAL. Supplementation with a Mango Leaf Extract (Zynamite®) in Combination with Quercetin Attenuates Muscle Damage and Pain and Accelerates Recovery after Strenuous Damaging Exercise. Nutrients 2020; 12:E614. [PMID: 32110986 PMCID: PMC7146389 DOI: 10.3390/nu12030614] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 02/20/2020] [Accepted: 02/21/2020] [Indexed: 02/06/2023] Open
Abstract
Prolonged or unusual exercise may cause exercise-induced muscle damage (EIMD). To test whether Zynamite®, a mango leaf extract rich in the natural polyphenol mangiferin, administered in combination with quercetin facilitates recovery after EIMD, 24 women and 33 men were randomly assigned to two treatment groups matched by sex and 5 km running performance, and ran a 10 km race followed by 100 drop jumps to elicit EIMD. One hour before the competition, and every 8 hours thereafter for 24 hours, they ingested placebo (728 mg of maltodextrin) or 140 mg of Zynamite® combined with 140 mg of quercetin (double-blind). Although competition times were similar, polyphenol supplementation attenuated the muscle pain felt after the competition (6.8 ± 1.5 and 5.7 ± 2.2 a.u., p = 0.035) and the loss of jumping performance (9.4 ± 11.5 and 3.9 ± 5.2%, p = 0.036; p = 0.034) and mechanical impulse (p = 0.038) 24 hours later. The polyphenols attenuated the increase of serum myoglobin and alanine aminotransferase in men, but not in women (interaction p < 0.05). In conclusion, a single dose of 140 mg Zynamite® combined with 140 mg of quercetin, administered one hour before competition, followed by three additional doses every eight hours, attenuates muscle pain and damage, and accelerates the recovery of muscle performance.
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Affiliation(s)
- Marcos Martin-Rincon
- Department of Physical Education and Research Institute of Biomedical and Health Sciences (IUIBS), University of Las Palmas de Gran Canaria, Campus Universitario de Tafira s/n, 35017 Las Palmas de Gran Canaria, Spain; (M.M.-R.); (M.G.-R.); (V.G.-A.); (A.G.-S.); (M.M.-C.); (S.M.-R.); (R.A.-O.); (C.D.); (S.P.-R.); (A.S.); (D.M.-A.)
| | - Miriam Gelabert-Rebato
- Department of Physical Education and Research Institute of Biomedical and Health Sciences (IUIBS), University of Las Palmas de Gran Canaria, Campus Universitario de Tafira s/n, 35017 Las Palmas de Gran Canaria, Spain; (M.M.-R.); (M.G.-R.); (V.G.-A.); (A.G.-S.); (M.M.-C.); (S.M.-R.); (R.A.-O.); (C.D.); (S.P.-R.); (A.S.); (D.M.-A.)
- Nektium Pharma, Agüimes, 35118 Las Palmas de Gran Canaria, Spain; (L.L.-R.); (J.C.W.)
| | - Victor Galvan-Alvarez
- Department of Physical Education and Research Institute of Biomedical and Health Sciences (IUIBS), University of Las Palmas de Gran Canaria, Campus Universitario de Tafira s/n, 35017 Las Palmas de Gran Canaria, Spain; (M.M.-R.); (M.G.-R.); (V.G.-A.); (A.G.-S.); (M.M.-C.); (S.M.-R.); (R.A.-O.); (C.D.); (S.P.-R.); (A.S.); (D.M.-A.)
| | - Angel Gallego-Selles
- Department of Physical Education and Research Institute of Biomedical and Health Sciences (IUIBS), University of Las Palmas de Gran Canaria, Campus Universitario de Tafira s/n, 35017 Las Palmas de Gran Canaria, Spain; (M.M.-R.); (M.G.-R.); (V.G.-A.); (A.G.-S.); (M.M.-C.); (S.M.-R.); (R.A.-O.); (C.D.); (S.P.-R.); (A.S.); (D.M.-A.)
| | - Miriam Martinez-Canton
- Department of Physical Education and Research Institute of Biomedical and Health Sciences (IUIBS), University of Las Palmas de Gran Canaria, Campus Universitario de Tafira s/n, 35017 Las Palmas de Gran Canaria, Spain; (M.M.-R.); (M.G.-R.); (V.G.-A.); (A.G.-S.); (M.M.-C.); (S.M.-R.); (R.A.-O.); (C.D.); (S.P.-R.); (A.S.); (D.M.-A.)
| | - Laura Lopez-Rios
- Nektium Pharma, Agüimes, 35118 Las Palmas de Gran Canaria, Spain; (L.L.-R.); (J.C.W.)
| | - Julia C. Wiebe
- Nektium Pharma, Agüimes, 35118 Las Palmas de Gran Canaria, Spain; (L.L.-R.); (J.C.W.)
| | - Saul Martin-Rodriguez
- Department of Physical Education and Research Institute of Biomedical and Health Sciences (IUIBS), University of Las Palmas de Gran Canaria, Campus Universitario de Tafira s/n, 35017 Las Palmas de Gran Canaria, Spain; (M.M.-R.); (M.G.-R.); (V.G.-A.); (A.G.-S.); (M.M.-C.); (S.M.-R.); (R.A.-O.); (C.D.); (S.P.-R.); (A.S.); (D.M.-A.)
| | - Rafael Arteaga-Ortiz
- Department of Physical Education and Research Institute of Biomedical and Health Sciences (IUIBS), University of Las Palmas de Gran Canaria, Campus Universitario de Tafira s/n, 35017 Las Palmas de Gran Canaria, Spain; (M.M.-R.); (M.G.-R.); (V.G.-A.); (A.G.-S.); (M.M.-C.); (S.M.-R.); (R.A.-O.); (C.D.); (S.P.-R.); (A.S.); (D.M.-A.)
| | - Cecilia Dorado
- Department of Physical Education and Research Institute of Biomedical and Health Sciences (IUIBS), University of Las Palmas de Gran Canaria, Campus Universitario de Tafira s/n, 35017 Las Palmas de Gran Canaria, Spain; (M.M.-R.); (M.G.-R.); (V.G.-A.); (A.G.-S.); (M.M.-C.); (S.M.-R.); (R.A.-O.); (C.D.); (S.P.-R.); (A.S.); (D.M.-A.)
| | - Sergio Perez-Regalado
- Department of Physical Education and Research Institute of Biomedical and Health Sciences (IUIBS), University of Las Palmas de Gran Canaria, Campus Universitario de Tafira s/n, 35017 Las Palmas de Gran Canaria, Spain; (M.M.-R.); (M.G.-R.); (V.G.-A.); (A.G.-S.); (M.M.-C.); (S.M.-R.); (R.A.-O.); (C.D.); (S.P.-R.); (A.S.); (D.M.-A.)
| | - Alfredo Santana
- Department of Physical Education and Research Institute of Biomedical and Health Sciences (IUIBS), University of Las Palmas de Gran Canaria, Campus Universitario de Tafira s/n, 35017 Las Palmas de Gran Canaria, Spain; (M.M.-R.); (M.G.-R.); (V.G.-A.); (A.G.-S.); (M.M.-C.); (S.M.-R.); (R.A.-O.); (C.D.); (S.P.-R.); (A.S.); (D.M.-A.)
- Complejo Hospitalario Universitario Insular-Materno Infantil de Las Palmas de Gran Canaria, Clinical Genetics Unit, 35016 Las Palmas de Gran Canaria, Spain
| | - David Morales-Alamo
- Department of Physical Education and Research Institute of Biomedical and Health Sciences (IUIBS), University of Las Palmas de Gran Canaria, Campus Universitario de Tafira s/n, 35017 Las Palmas de Gran Canaria, Spain; (M.M.-R.); (M.G.-R.); (V.G.-A.); (A.G.-S.); (M.M.-C.); (S.M.-R.); (R.A.-O.); (C.D.); (S.P.-R.); (A.S.); (D.M.-A.)
| | - Jose A L Calbet
- Department of Physical Education and Research Institute of Biomedical and Health Sciences (IUIBS), University of Las Palmas de Gran Canaria, Campus Universitario de Tafira s/n, 35017 Las Palmas de Gran Canaria, Spain; (M.M.-R.); (M.G.-R.); (V.G.-A.); (A.G.-S.); (M.M.-C.); (S.M.-R.); (R.A.-O.); (C.D.); (S.P.-R.); (A.S.); (D.M.-A.)
- Department of Physical Performance, Norwegian School of Sport Sciences, 0806 Oslo, Norway
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Dohlmann TL, Morville T, Kuhlman AB, Chrøis KM, Helge JW, Dela F, Larsen S. Statin Treatment Decreases Mitochondrial Respiration But Muscle Coenzyme Q10 Levels Are Unaltered: The LIFESTAT Study. J Clin Endocrinol Metab 2019; 104:2501-2508. [PMID: 30299473 DOI: 10.1210/jc.2018-01185] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 10/03/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Myalgia is a common adverse effect of statin therapy, but the underlying mechanism is unknown. Statins may reduce levels of coenzyme Q10 (CoQ10), which is an essential electron carrier in the mitochondrial electron transport system, thereby impairing mitochondrial respiratory function, potentially leading to myalgia. OBJECTIVES To investigate whether statin-induced myalgia is coupled to reduced intramuscular CoQ10 concentration and impaired mitochondrial respiratory function. METHODS Patients receiving simvastatin (i.e., statin) therapy (n = 64) were recruited, of whom 25 experienced myalgia (myalgic group) and 39 had no symptoms of myalgia (NS group). Another 20 had untreated high blood cholesterol levels (control group). Blood and muscle samples were obtained. Intramuscular CoQ10 concentration was measured, and mitochondrial respiratory function and reactive oxygen species (ROS) production were measured. Citrate synthase (CS) activity was used as a biomarker of mitochondrial content in skeletal muscle. RESULTS Intramuscular CoQ10 concentration was comparable among groups. Mitochondrial complex II-linked respiration was reduced in the statin-myalgic and -NS groups compared with the control group. When mitochondrial respiration was normalized to CS activity, respiration rate was higher in the myalgic group compared with the NS and control groups. Maximal ROS production was similar among groups. CONCLUSION Statin therapy appeared to impair mitochondrial complex-II-linked respiration, but the mitochondrial capacity for complex I+II-linked respiration remained intact. Myalgia was not coupled to reduced intramuscular CoQ10 levels. Intrinsic mitochondrial respiratory capacity was increased with statin-induced myalgia but not accompanied by increased ROS production.
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Affiliation(s)
- Tine Lovsø Dohlmann
- Xlab, Center for Healthy Aging, Department of Biomedical Sciences, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Morville
- Xlab, Center for Healthy Aging, Department of Biomedical Sciences, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Anja Birk Kuhlman
- Xlab, Center for Healthy Aging, Department of Biomedical Sciences, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Karoline Maise Chrøis
- Xlab, Center for Healthy Aging, Department of Biomedical Sciences, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jørn Wulff Helge
- Xlab, Center for Healthy Aging, Department of Biomedical Sciences, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Flemming Dela
- Xlab, Center for Healthy Aging, Department of Biomedical Sciences, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Geriatrics, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Steen Larsen
- Xlab, Center for Healthy Aging, Department of Biomedical Sciences, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
- Clinical Research Centre, Medical University of Bialystok, Bialystok, Poland
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Larish AM, Dickson RR, Kudgus RA, McGovern RM, Reid JM, Hooten WM, Nicholson WT, Vaughan LE, Burnett TL, Laughlin-Tommaso SK, Faubion SS, Green IC. Vaginal Diazepam for Nonrelaxing Pelvic Floor Dysfunction: The Pharmacokinetic Profile. J Sex Med 2019; 16:763-766. [PMID: 31010782 DOI: 10.1016/j.jsxm.2019.03.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 02/13/2019] [Accepted: 03/02/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Vaginal diazepam is frequently used to treat pelvic floor tension myalgia and pelvic pain despite limited knowledge of systemic absorption. AIM To determine the pharmacokinetic and adverse event profile of diazepam vaginal suppositories. METHODS We used a prospective pharmacokinetic design with repeated assessments of diazepam levels. Eight healthy volunteers were administered a 10-mg compounded vaginal diazepam suppository in the outpatient gynecologic clinic. Serum samples were collected at 0, 45, 90, 120, and 180 minutes; 8, 24, and 72 hours; and 1 week following administration of a 10-mg vaginal suppository. The occurrence of adverse events was assessed using the alternate step and tandem walk tests, the Brief Confusion Assessment Method, and numerical ratings. Plasma concentrations of diazepam and active long-acting metabolites were measured. Pharmacokinetic parameters were calculated by standard noncompartmental methods. RESULTS The mean peak diazepam concentration (Cmax) of 31.0 ng/mL was detected at a mean time (Tmax) of 3.1 hours after suppository placement. The bioavailability was found to be 70.5%, and the mean terminal elimination half-life was 82 hours. The plasma levels of temazepam and nordiazepam peaked at 0.8 ng/mL at 29 hours and 6.4 ng/mL at 132 hours, respectively. Fatigue was reported by 3 of 8 participants. CLINICAL IMPLICATIONS Serum plasma concentrations of vaginally administered diazepam are low; however the half-life is prolonged. STRENGTHS & LIMITATIONS Strengths include use of inclusion and exclusion criteria aimed at mitigating clinical factors that could adversely impact diazepam absorption and metabolism, and the use of an ultrasensitive LC-MS/MS assay. Limitations included the lack of addressing the efficacy of vaginal diazepam in lieu of performing a pure pharmacokinetic study with healthy participants. CONCLUSION Vaginal administration of diazepam results in lower peak serum plasma concentration, longer time to peak concentration, and lower bioavailability than standard oral use. Providers should be aware that with diazepam's long half-life, accumulating levels would occur with chronic daily doses, and steady-state levels would not be reached for up to 1 week. This profile would favor intermittent use to allow participation in physical therapy and intimacy. Larish AM, Dickson RR, Kudgus RA, et al. Vaginal Diazepam for Nonrelaxing Pelvic Floor Dysfunction: The Pharmacokinetic Profile. J Sex Med 2019;16;763-766.
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Affiliation(s)
- Alyssa M Larish
- Department of Obstetrics and Gynecology. Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Rozalin R Dickson
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Rachel A Kudgus
- Department of Pharmacology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Renee M McGovern
- Department of Pharmacology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Joel M Reid
- Department of Pharmacology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - W Michael Hooten
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Wayne T Nicholson
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA; Department of Pharmacology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Lisa E Vaughan
- Department of Obstetrics and Gynecology. Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Tatnai L Burnett
- Department of Obstetrics and Gynecology. Mayo Clinic College of Medicine, Rochester, MN, USA
| | | | - Stephanie S Faubion
- Women's Health, Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Isabel C Green
- Department of Obstetrics and Gynecology. Mayo Clinic College of Medicine, Rochester, MN, USA.
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Pennisi M, Di Bartolo G, Malaguarnera G, Bella R, Lanza G, Malaguarnera M. Vitamin D Serum Levels in Patients with Statin-Induced Musculoskeletal Pain. Dis Markers 2019; 2019:3549402. [PMID: 31019583 PMCID: PMC6452565 DOI: 10.1155/2019/3549402] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 01/27/2019] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Statin-associated muscle symptoms are common side effects of statin therapy. These symptoms include myopathy, myalgia, and rhabdomyolysis. Vitamin D has been associated with musculoskeletal health; thus, its deficiency may produce detrimental effects in this tissue. Indeed, one symptom of vitamin D deficiency is myalgia, and the normalization of low vitamin D levels can relieve it. PATIENTS AND METHODS This cross-sectional study examined 1210 statin-treated patients to assess vitamin D status. These patients were divided into two groups: 287 with statin-associated muscle symptoms (SAMS) and 923 control patients without SAMS. RESULTS We have found a significant association between deficient and insufficient vitamin D status and statin-associated muscle symptoms (SAMS). Vitamin D deficiency (<30 nmol/L) presents 77% (95% C.I. 71.6% to 81.7%) sensitivity and 63.4% (95% C.I. 60.2% to 66.5%) specificity in diagnosing SAMS. Odds ratio analysis showed that this association is moderate-strong both for deficient and for insufficient status. CONCLUSION We found a correlation between vitamin D deficiency and SAMS. Therefore, vitamin D levels may be useful for the diagnosis and management of SAMS.
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Affiliation(s)
| | - Giuseppe Di Bartolo
- 2Research Center “The Great Senescence”, University of Catania, 95100 Catania, Italy
| | - Giulia Malaguarnera
- 2Research Center “The Great Senescence”, University of Catania, 95100 Catania, Italy
| | - Rita Bella
- 3Department of Medical and Surgical Sciences and Advanced Technologies, University of Catania, Catania, Italy
| | - Giuseppe Lanza
- 4Department of Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
- 5Oasi Research Institute-IRCCS, Via Conte Ruggero, 73-94018 Troina, Italy
| | - Michele Malaguarnera
- 2Research Center “The Great Senescence”, University of Catania, 95100 Catania, Italy
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Abstract
An Endurance Athlete with Calf Pain - Probably Musculoskeletal? Abstract. Deep vein thromboses are frequent and account for one third of all cardiovascular diseases. But undoubtedly patients often present risk factors. To assume a deep vein thrombosis in an endurance athlete with pain in the calf, therefore seems unreasonable. The positive D-dimer and the side differences of the calf diameter was the key for the correct diagnosis. The treatment with Heparin improved clinical symptoms within 5 days and the patient became free of pain. The additionally conducted ultrasound showed no more hints for a thromboembolic process.
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Kotsis Y, Mikellidi A, Aresti C, Persia E, Sotiropoulos A, Panagiotakos DB, Antonopoulou S, Nomikos T. A low-dose, 6-week bovine colostrum supplementation maintains performance and attenuates inflammatory indices following a Loughborough Intermittent Shuttle Test in soccer players. Eur J Nutr 2018; 57:1181-1195. [PMID: 28285432 PMCID: PMC5861165 DOI: 10.1007/s00394-017-1401-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Accepted: 02/10/2017] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of the study was to investigate the effect of a 6-week, low-dose bovine colostrum (BC) supplementation on exercise-induced muscle damage (EIMD) and performance decline in soccer players following the Loughborough Intermittent Shuttle Test (LIST) during a competitive season period. METHODS In a double-blind, randomized, placebo-controlled design, two groups of soccer players were allocated to a 3.2 g/day of whey protein (WP, N = 8) or BC (N = 10) and performed a pre- and a post-supplementation LIST. Maximum isometric voluntary contraction, squat jump (SQJ), countermovement jump, muscle soreness, blood cell counts, creatine kinase (CK), C-reactive protein (CRP) and interleukin-6 (IL-6) were monitored for 2, 24, 48, 72 h post-LIST. RESULTS LIST induced transient increases in leukocytes, granulocytes, CK, muscle soreness, CRP, IL-6 and declines in lymphocytes and performance indices. Supplementation resulted in a faster recovery of SQJ, CK and CRP compared to pre-supplementation kinetics (trial × time: p = 0.001, 0.056, 0.014, respectively) and lower incremental area under the curve (iAUC) for IL-6, only in the BC group [pre-: 31.1 (6.78-46.9), post-: 14.0 (-0.16 to 23.5) pg h/ml, p = 0.034]. Direct comparison of the two groups after supplementation demonstrated higher iAUC of SQJ [WP: -195.2 (-229.0 to (-52.5)), BC: -15.8 (-93.2 to 16.8) cm h, p = 0.034], a trend for lower iAUC of CK in the BC group [WP: 18,785 (4651-41,357), BC: 8842 (4807-14,802) U h/L, p = 0.081] and a significant intervention × time interaction for CRP (p = 0.038) in favor of BC. CONCLUSIONS Post-exercise EIMD may be reduced and performance better maintained by a low dose of BC administration following LIST in soccer players.
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Affiliation(s)
- Yiannis Kotsis
- Department of Nutrition and Dietetics, Faculty of Health Sciences and Education, Harokopio University, Eleftheriou Venizelou 70, 17671, Athens, Greece
| | - Anastasia Mikellidi
- Department of Nutrition and Dietetics, Faculty of Health Sciences and Education, Harokopio University, Eleftheriou Venizelou 70, 17671, Athens, Greece
| | - Cleopatra Aresti
- Department of Nutrition and Dietetics, Faculty of Health Sciences and Education, Harokopio University, Eleftheriou Venizelou 70, 17671, Athens, Greece
| | - Eleni Persia
- Department of Nutrition and Dietetics, Faculty of Health Sciences and Education, Harokopio University, Eleftheriou Venizelou 70, 17671, Athens, Greece
| | - Aristomenis Sotiropoulos
- Faculty of Physical Education and Sport Sciences, National and Kapodistrian University of Athens, Athens, Greece
| | - Demosthenes B Panagiotakos
- Department of Nutrition and Dietetics, Faculty of Health Sciences and Education, Harokopio University, Eleftheriou Venizelou 70, 17671, Athens, Greece
| | - Smaragdi Antonopoulou
- Department of Nutrition and Dietetics, Faculty of Health Sciences and Education, Harokopio University, Eleftheriou Venizelou 70, 17671, Athens, Greece
| | - Tzortzis Nomikos
- Department of Nutrition and Dietetics, Faculty of Health Sciences and Education, Harokopio University, Eleftheriou Venizelou 70, 17671, Athens, Greece.
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12
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Sadeeqa S, Maqsood M, Ahmad M. Prevalence of statin induced myopathy in Lahore, Pakistan. Pak J Pharm Sci 2018; 31:617-622. [PMID: 29625933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Cardiovascular diseases are considered to be the leading cause of disability and deaths in the whole world. The major cause behind this disease is the formation of lipid plagues in the form of thrombus. The statins (HMG-CoA reductase inhibitors) are used for the treatment and prevention of hyperlipidemia. Myopathy is the major side effect caused by statins. The purpose of this study was to determine the prevalence of statin induced myopathy. A cross-sectional study design was adopted using convenient random sampling technique at Punjab Institute of Cardiology, Lahore Pakistan from November 2016 to February 2017. A total of 300 male and female patients were included having age range of 40-80 years. Data was collected directly from the patients and prevalence of myalgia was determined by the symptoms of the patients. Creatine Phospho Kinase levels were obtained of those patients showing symptoms. Data was analyzed by using SPSS version 21. The results showed that 51% patients were myalgic with mean±SEM, 1.49±0.29. Myalgia was more prevalent in age range 40-50, with females 57% and males 47%. Significant relation was found between myalgia and type of statin (p=0.05), duration of use of statin (p=0.036) and dose of statin (p=0.031). The study concludes that the prevalence of myalgia was not significant but females were more prone to myalgic symptoms as compared to males. It was further concluded that myalgic symptoms were directly related to dose and duration & type of statin use.
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Affiliation(s)
- Saleha Sadeeqa
- Institute of Pharmacy, Lahore College for Women University, Lahore, Pakistan
| | - Mariam Maqsood
- Institute of Pharmacy, Lahore College for Women University, Lahore, Pakistan
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Nieman DC, Meaney MP, John CS, Knagge KJ, Chen H. 9- and 13-Hydroxy-octadecadienoic acids (9+13 HODE) are inversely related to granulocyte colony stimulating factor and IL-6 in runners after 2h running. Brain Behav Immun 2016; 56:246-52. [PMID: 27018002 DOI: 10.1016/j.bbi.2016.03.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Revised: 03/21/2016] [Accepted: 03/23/2016] [Indexed: 11/19/2022] Open
Abstract
This study utilized a pro-inflammatory exercise mode to explore potential linkages between increases in 9- and 13-hydroxy-octadecadienoic acid (9+13 HODE) and biomarkers for inflammation, oxidative stress, and muscle damage. Male (N=10) and female (N=10) runners ran at ∼70% VO2max for 1.5h followed by 30min of downhill running (-10%). Blood samples were taken pre-run and immediately-, 1-h-, and 24-h post-run, and analyzed for 9+13 HODE, F2-isoprostanes, six cytokines, C-reactive protein (CRP), creatine kinase (CK), and myoglobin (MYO). Gender groups performed at comparable relative heart rate and oxygen consumption levels during the 2-h run. All outcome measures increased post-run (time effects, P⩽0.001), with levels near pre-run levels by 24h except for CRP, CK, MYO, and delayed onset of muscle soreness (DOMS). Plasma 9+13 HODE increased 314±38.4% post-run (P<0.001), 77.3±15.8% 1-h post-run (P<0.001), and 40.6±16.4% 24-h post-exercise (P=0.024), and F2-isoprostanes increased 50.8±8.9% post-run (P<0.001) and 19.0±5.3% 1-h post-run (P=0.006). Post-run increases were comparable between genders for all outcomes except for 9+13 HODE (interaction effect, P=0.024, post-run tending higher in females), IL-10 (P=0.006, females lower), and DOMS (P=0.029, females lower). The pre-to-post-run increase in 9+13 HODEs was not related to other outcomes except for plasma granulocyte colony stimulating factor (GCSF) (r=-0.710, P<0.001) and IL-6 (r=-0.457, P=0.043). Within the context of this study, exercise-induced increases in 9+13 HODEs tended higher in females, and were not related to increases in F2-isoprostanes, muscle damage, or soreness. The negative relationships to GCSF and IL-6 suggest a linkage between 9+13 HODES and exercise-induced neutrophil chemotaxis, degranulation, and inflammation.
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Affiliation(s)
- David C Nieman
- Appalachian State University, North Carolina Research Campus, Kannapolis, NC, United States.
| | - Mary Pat Meaney
- Appalachian State University, North Carolina Research Campus, Kannapolis, NC, United States
| | - Casey S John
- Appalachian State University, North Carolina Research Campus, Kannapolis, NC, United States
| | - Kevin J Knagge
- Analytical Sciences, David H. Murdock Research Institute, Kannapolis, NC, United States
| | - Huiyuan Chen
- Analytical Sciences, David H. Murdock Research Institute, Kannapolis, NC, United States
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Nissen SE, Stroes E, Dent-Acosta RE, Rosenson RS, Lehman SJ, Sattar N, Preiss D, Bruckert E, Ceška R, Lepor N, Ballantyne CM, Gouni-Berthold I, Elliott M, Brennan DM, Wasserman SM, Somaratne R, Scott R, Stein EA. Efficacy and Tolerability of Evolocumab vs Ezetimibe in Patients With Muscle-Related Statin Intolerance: The GAUSS-3 Randomized Clinical Trial. JAMA 2016; 315:1580-90. [PMID: 27039291 DOI: 10.1001/jama.2016.3608] [Citation(s) in RCA: 352] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
IMPORTANCE Muscle-related statin intolerance is reported by 5% to 20% of patients. OBJECTIVE To identify patients with muscle symptoms confirmed by statin rechallenge and compare lipid-lowering efficacy for 2 nonstatin therapies, ezetimibe and evolocumab. DESIGN, SETTING, AND PARTICIPANTS Two-stage randomized clinical trial including 511 adult patients with uncontrolled low-density lipoprotein cholesterol (LDL-C) levels and history of intolerance to 2 or more statins enrolled in 2013 and 2014 globally. Phase A used a 24-week crossover procedure with atorvastatin or placebo to identify patients having symptoms only with atorvastatin but not placebo. In phase B, after a 2-week washout, patients were randomized to ezetimibe or evolocumab for 24 weeks. INTERVENTIONS Phase A: atorvastatin (20 mg) vs placebo. Phase B: randomization 2:1 to subcutaneous evolocumab (420 mg monthly) or oral ezetimibe (10 mg daily). MAIN OUTCOME AND MEASURES Coprimary end points were the mean percent change in LDL-C level from baseline to the mean of weeks 22 and 24 levels and from baseline to week 24 levels. RESULTS Of the 491 patients who entered phase A (mean age, 60.7 [SD, 10.2] years; 246 women [50.1%]; 170 with coronary heart disease [34.6%]; entry mean LDL-C level, 212.3 [SD, 67.9] mg/dL), muscle symptoms occurred in 209 of 491 (42.6%) while taking atorvastatin but not while taking placebo. Of these, 199 entered phase B, along with 19 who proceeded directly to phase B for elevated creatine kinase (N = 218, with 73 randomized to ezetimibe and 145 to evolocumab; entry mean LDL-C level, 219.9 [SD, 72] mg/dL). For the mean of weeks 22 and 24, LDL-C level with ezetimibe was 183.0 mg/dL; mean percent LDL-C change, -16.7% (95% CI, -20.5% to -12.9%), absolute change, -31.0 mg/dL and with evolocumab was 103.6 mg/dL; mean percent change, -54.5% (95% CI, -57.2% to -51.8%); absolute change, -106.8 mg/dL (P < .001). LDL-C level at week 24 with ezetimibe was 181.5 mg/dL; mean percent change, -16.7% (95% CI, -20.8% to -12.5%); absolute change, -31.2 mg/dL and with evolocumab was 104.1 mg/dL; mean percent change, -52.8% (95% CI, -55.8% to -49.8%); absolute change, -102.9 mg/dL (P < .001). For the mean of weeks 22 and 24, between-group difference in LDL-C was -37.8%; absolute difference, -75.8 mg/dL. For week 24, between-group difference in LDL-C was -36.1%; absolute difference, -71.7 mg/dL. Muscle symptoms were reported in 28.8% of ezetimibe-treated patients and 20.7% of evolocumab-treated patients (log-rank P = .17). Active study drug was stopped for muscle symptoms in 5 of 73 ezetimibe-treated patients (6.8%) and 1 of 145 evolocumab-treated patients (0.7%). CONCLUSIONS AND RELEVANCE Among patients with statin intolerance related to muscle-related adverse effects, the use of evolocumab compared with ezetimibe resulted in a significantly greater reduction in LDL-C levels after 24 weeks. Further studies are needed to assess long-term efficacy and safety. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01984424.
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Affiliation(s)
| | - Erik Stroes
- University of Amsterdam Faculty of Medicine, Amsterdam, the Netherlands
| | | | | | - Sam J Lehman
- Flinders University, Bedford Park, SA, Australia
| | | | - David Preiss
- Clinical Trial Service Unit, University of Oxford, Oxford, United Kingdom8Epidemiological Services Unit, University of Oxford, Oxford, United Kingdom
| | | | - Richard Ceška
- Charles University in Prague, Prague, Czech Republic11General University Hospital in Prague, Prague, Czech Republic
| | - Norman Lepor
- David Geffen School of Medicine at the University of California, Los Angeles
| | | | - Ioanna Gouni-Berthold
- Center for Endocrinology, Diabetes and Preventive Medicine, University of Cologne, Cologne, Germany
| | | | | | | | | | - Rob Scott
- Amgen Inc, Thousand Oaks, California
| | - Evan A Stein
- Metabolic and Atherosclerosis Research Center, Cincinnati, Ohio
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15
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Hicks KM, Onambélé GL, Winwood K, Morse CI. Muscle Damage following Maximal Eccentric Knee Extensions in Males and Females. PLoS One 2016; 11:e0150848. [PMID: 26986066 PMCID: PMC4795791 DOI: 10.1371/journal.pone.0150848] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 02/19/2016] [Indexed: 11/19/2022] Open
Abstract
Aim To investigate whether there is a sex difference in exercise induced muscle damage. Materials and Method Vastus Lateralis and patella tendon properties were measured in males and females using ultrasonography. During maximal voluntary eccentric knee extensions (12 reps x 6 sets), Vastus Lateralis fascicle lengthening and maximal voluntary eccentric knee extensions torque were recorded every 10° of knee joint angle (20–90°). Isometric torque, Creatine Kinase and muscle soreness were measured pre, post, 48, 96 and 168 hours post damage as markers of exercise induced muscle damage. Results Patella tendon stiffness and Vastus Lateralis fascicle lengthening were significantly higher in males compared to females (p<0.05). There was no sex difference in isometric torque loss and muscle soreness post exercise induced muscle damage (p>0.05). Creatine Kinase levels post exercise induced muscle damage were higher in males compared to females (p<0.05), and remained higher when maximal voluntary eccentric knee extension torque, relative to estimated quadriceps anatomical cross sectional area, was taken as a covariate (p<0.05). Conclusion Based on isometric torque loss, there is no sex difference in exercise induced muscle damage. The higher Creatine Kinase in males could not be explained by differences in maximal voluntary eccentric knee extension torque, Vastus Lateralis fascicle lengthening and patella tendon stiffness. Further research is required to understand the significant sex differences in Creatine Kinase levels following exercise induced muscle damage.
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Affiliation(s)
- K. M. Hicks
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle-Upon-Tyne, United Kingdom
- Institute for Performance Research, Department of Exercise and Sport Science, Manchester Metropolitan University Cheshire, Manchester, United Kingdom
- * E-mail:
| | - G. L. Onambélé
- Institute for Performance Research, Department of Exercise and Sport Science, Manchester Metropolitan University Cheshire, Manchester, United Kingdom
| | - K. Winwood
- Institute for Performance Research, Department of Exercise and Sport Science, Manchester Metropolitan University Cheshire, Manchester, United Kingdom
| | - C. I. Morse
- Institute for Performance Research, Department of Exercise and Sport Science, Manchester Metropolitan University Cheshire, Manchester, United Kingdom
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16
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Magni P, Macchi C, Morlotti B, Sirtori CR, Ruscica M. Risk identification and possible countermeasures for muscle adverse effects during statin therapy. Eur J Intern Med 2015; 26:82-8. [PMID: 25640999 DOI: 10.1016/j.ejim.2015.01.002] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 12/28/2014] [Accepted: 01/05/2015] [Indexed: 11/22/2022]
Abstract
The use of statins for cardiovascular disease prevention is clearly supported by clinical evidence. However, in January 2014 the U.S. Food and Drug Administration released an advice on statin risk reporting that "statin benefit is indisputable, but they need to be taken with care and knowledge of their side effects". Among them the by far most common complication is myopathy, ranging from common but clinically benign myalgia to rare but life-threatening rhabdomyolysis. This class side effect appears to be dose dependent, with more lipophilic statin (i.e., simvastatin) carrying a higher overall risk. Hence, to minimize statin-associated myopathy, clinicians should take into consideration a series of factors that potentially increase this risk (i.e., drug-drug interactions, female gender, advanced age, diabetes mellitus, hypothyroidism and vitamin D deficiency). Whenever it is appropriate to stop statin treatment, the recommendations are to stay off statin until resolution of symptoms or normalization of creatine kinase values. Afterwards, clinicians have several options to treat dyslipidemia, including the use of a lower dose of the same statin, intermittent non-daily dosing of statin, initiation of a different statin, alone or in combination with nonstatin lipid-lowering agents, and substitution with red yeast rice.
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Affiliation(s)
- Paolo Magni
- Dipartimento di Scienze Farmacologiche e Biomolecolari, Università degli Studi di Milano, Italy; Centro Dislipidemie, Ospedale Niguarda Cà Granda, Milan, Italy.
| | - Chiara Macchi
- Dipartimento di Scienze Farmacologiche e Biomolecolari, Università degli Studi di Milano, Italy
| | | | - Cesare R Sirtori
- Dipartimento di Scienze Farmacologiche e Biomolecolari, Università degli Studi di Milano, Italy; Centro Dislipidemie, Ospedale Niguarda Cà Granda, Milan, Italy
| | - Massimiliano Ruscica
- Dipartimento di Scienze Farmacologiche e Biomolecolari, Università degli Studi di Milano, Italy; Centro Dislipidemie, Ospedale Niguarda Cà Granda, Milan, Italy
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Derosa G, Romano D, D'Angelo A, Maffioli P. Berberis aristata combined with Silybum marianum on lipid profile in patients not tolerating statins at high doses. Atherosclerosis 2015; 239:87-92. [PMID: 25577665 DOI: 10.1016/j.atherosclerosis.2014.12.043] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2014] [Revised: 12/13/2014] [Accepted: 12/19/2014] [Indexed: 11/19/2022]
Abstract
AIM To evaluate the effects of Berberis aristata combined with Silybum marianum in dyslipidemic patients intolerant to statins at high doses. METHODS 137 euglycemic, dyslipidemic subjects, with previous adverse events to statins at high doses, were enrolled. Statins were stopped for 1 month (run-in), then they were re-introduced at the half of the previously taken dose. At randomization, patients tolerating the half dose of statin, were assigned to add placebo or B. aristata/S. marianum 588/105 mg, 1 tablet during the lunch and 1 tablet during the dinner, for six months. We evaluated lipid profile and safety parameters variation at randomization, and after 3, and 6 months. RESULTS B. aristata/S. marianum reduced fasting plasma glucose (-9 mg/dl), insulin (-0.7 μU/ml), and HOMA-index (-0.35) levels compared to baseline and also to placebo. Lipid profile did not significantly change after 6 months since the reduction of statin dosage and the introduction of B. aristata/S. marianum, while it worsened in the placebo group both compared to placebo and with active treatment (+23.4 mg/dl for total cholesterol, +19.6 mg/dl for LDL-cholesterol, +23.1 mg/dl for triglycerides with placebo compared to B. aristata/S. marianum). We did not record any variations of safety parameters in nether of groups. CONCLUSIONS B. aristata/S. marianum can be considered as addition to statins in patients not tolerating high dose of these drugs.
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Affiliation(s)
- Giuseppe Derosa
- Department of Internal Medicine and Therapeutics, University of Pavia, Fondazione IRCCS, Policlinico S. Matteo, Pavia, Italy; Center for the Study of Endocrine-Metabolic Pathophysiology and Clinical Research, University of Pavia, Pavia, Italy.
| | - Davide Romano
- Department of Internal Medicine and Therapeutics, University of Pavia, Fondazione IRCCS, Policlinico S. Matteo, Pavia, Italy
| | - Angela D'Angelo
- Department of Internal Medicine and Therapeutics, University of Pavia, Fondazione IRCCS, Policlinico S. Matteo, Pavia, Italy
| | - Pamela Maffioli
- Department of Internal Medicine and Therapeutics, University of Pavia, Fondazione IRCCS, Policlinico S. Matteo, Pavia, Italy; PhD School in Experimental Medicine, University of Pavia, Pavia, Italy
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18
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Banach M, Serban C, Sahebkar A, Ursoniu S, Rysz J, Muntner P, Toth PP, Jones SR, Rizzo M, Glasser SP, Lip GYH, Dragan S, Mikhailidis DP. Effects of coenzyme Q10 on statin-induced myopathy: a meta-analysis of randomized controlled trials. Mayo Clin Proc 2015; 90:24-34. [PMID: 25440725 DOI: 10.1016/j.mayocp.2014.08.021] [Citation(s) in RCA: 131] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2014] [Revised: 08/21/2014] [Accepted: 08/22/2014] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To evaluate the efficacy of coenzyme Q10 (CoQ10) supplementation on statin-induced myopathy. PARTICIPANTS AND METHODS We searched the MEDLINE, Cochrane Library, Scopus, and EMBASE databases (November 1, 1987, to May 1, 2014) to identify randomized controlled trials investigating the impact of CoQ10 on muscle pain and plasma creatine kinase (CK) activity as 2 measures of statin-induced myalgia. Two independent reviewers extracted data on study characteristics, methods, and outcomes. RESULTS We included 6 studies with 302 patients receiving statin therapy: 5 studies with 226 participants evaluated the effect of CoQ10 supplementation on plasma CK activity, and 5 studies (4 used in the CK analysis and 1 other study) with 253 participants were included to assess the effect of CoQ10 supplementation on muscle pain. Compared with the control group, plasma CK activity was increased after CoQ10 supplementation, but this change was not significant (mean difference, 11.69 U/L [to convert to μkat/L, multiply by 0.0167]; 95% CI, -14.25 to 37.63 U/L; P=.38). Likewise, CoQ10 supplementation had no significant effect on muscle pain despite a trend toward a decrease (standardized mean difference, -0.53; 95% CI, -1.33 to 0.28; P=.20). No dose-effect association between changes in plasma CK activity (slope, -0.001; 95% CI, -0.004 to 0.001; P=.33) or in the indices of muscle pain (slope, 0.002; 95% CI, -0.005 to 0.010; P=.67) and administered doses of CoQ10 were observed. CONCLUSION The results of this meta-analysis of available randomized controlled trials do not suggest any significant benefit of CoQ10 supplementation in improving statin-induced myopathy. Larger, well-designed trials are necessary to confirm the findings from this meta-analysis.
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Affiliation(s)
- Maciej Banach
- Department of Hypertension, Medical University of Lodz, Lodz, Poland.
| | - Corina Serban
- Department of Functional Sciences, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania; Centre for Interdisciplinary Research, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Amirhossein Sahebkar
- Biotechnology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sorin Ursoniu
- Department of Functional Sciences, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Jacek Rysz
- Department of Nephrology, Hypertension, and Family Medicine, Medical University of Lodz, Lodz, Poland
| | - Paul Muntner
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL
| | - Peter P Toth
- Preventive Cardiology, CGH Medical Center, Sterling, IL
| | - Steven R Jones
- Preventive Cardiology, CGH Medical Center, Sterling, IL; The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD
| | - Manfredi Rizzo
- Biomedical Department of Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Stephen P Glasser
- Department of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Gregory Y H Lip
- University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, UK
| | - Simona Dragan
- Centre for Interdisciplinary Research, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania; Department of Cardiology, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Dimitri P Mikhailidis
- Department of Clinical Biochemistry, Royal Free Campus, University College London Medical School, University College London, London, UK
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19
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Lombao Iglesias D, Bagó Granell J, Vilor Rivero T. Validity of creatine kinase as an indicator of muscle injury in spine surgery and its relation with postoperative pain. Acta Orthop Belg 2014; 80:545-550. [PMID: 26280728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
PURPOSE To confirm the validity of postoperative creatine kinase (CK) values as an indicator of muscle lesion, assess the relationship of CK with variables indicating surgical invasiveness and investigate an association between CK values and excessive postoperative pain. MATERIAL AND METHODS The study included 96 patients (mean age 62.8 years) who underwent instrumented spine fusion for degenerative lumbosacral disease. Serum CK concentration was determined on the first postoperative day. All patients received intravenous paracetamol and metamizole, and in cases of intense pain, rescue analgesia with iv meperidine. Patients were categorized according to whether or not they required rescue analgesia. Data on the number of levels fused, the duration of surgery, and operative bleeding were recorded in each patient. RESULTS CK values were higher in men and in younger patients. Significant correlations were found between CK and the number of fused levels and duration of surgery. Only 17.7% of patients required rescue analgesia. CK levels did not significantly differ between patients who did not need rescue analgesia (1135 IU/L) and those who did (1421.5 IU/L). CONCLUSIONS Serum CK concentration is a valid marker of surgical muscle injury and is affected by the age and sex. Factors such as the magnitude and duration of surgery show a relationship with postoperative CK values. The incidence of severe postoperative pain is not significantly related to CK level.
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Elcadi GH, Forsman M, Hallman DM, Aasa U, Fahlstrom M, Crenshaw AG. Oxygenation and hemodynamics do not underlie early muscle fatigue for patients with work-related muscle pain. PLoS One 2014; 9:e95582. [PMID: 24755957 PMCID: PMC3995774 DOI: 10.1371/journal.pone.0095582] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Accepted: 03/27/2014] [Indexed: 11/21/2022] Open
Abstract
Patients suffering from work-related muscle pain (WRMP) fatigue earlier during exercise than healthy controls. Inadequate oxygen consumption and/or inadequate blood supply can influence the ability of the muscles to withstand fatigue. However, it remains unknown if oxygenation and hemodynamics are associated with early fatigue in muscles of WRMP patients. In the present study we applied near-infrared spectroscopy (NIRS) on the extensor carpi radialis (ECR) and trapezius (TD) muscles of patients with WRMP (n = 18) and healthy controls (n = 17). Our objective was to determine if there were group differences in endurance times for a low-level contraction of 15% maximal voluntary contraction (MVC) – sustained for 12–13 min, and to see if these differences were associated with differences in muscle oxygenation and hemodynamics. At baseline, oxygen saturation (StO2%) was similar between groups for the ECR, but StO2% was significantly lower for TD for the WRMP patients (76%) compared to controls (85%) (P<0.01). Also, baseline ECR blood flow was similar in the two groups. For both muscles there were a larger number of patients, compared to controls, that did not maintain the 15% MVC for the allotted time. Consequently, the endurance times were significantly shorter for the WRMP patients than controls (medians, ECR: 347 s vs. 582 s; TD: 430 s vs. 723 s respectively). Responses in StO2% during the contractions were not significantly different between groups for either muscle, i.e. no apparent difference in oxygen consumption. Overall, we interpret our findings to indicate that the early fatigue for our WRMP patients was not associated with muscle oxygenation and hemodynamics.
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Affiliation(s)
- Guilherme H. Elcadi
- Centre for Musculoskeletal Research, University of Gävle, Gävle, Sweden
- Department of Community Medicine and Rehabilitation, Rehabilitation medicine, Umeå University, Umeå, Sweden
- * E-mail:
| | - Mikael Forsman
- Centre for Musculoskeletal Research, University of Gävle, Gävle, Sweden
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - David M. Hallman
- Centre for Musculoskeletal Research, University of Gävle, Gävle, Sweden
| | - Ulrika Aasa
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Martin Fahlstrom
- Department of Community Medicine and Rehabilitation, Rehabilitation medicine, Umeå University, Umeå, Sweden
- Department of Clinical Sciences, Professional Development, Umeå University, Umeå, Sweden
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Taylor T, West DJ, Howatson G, Jones C, Bracken RM, Love TD, Cook CJ, Swift E, Baker JS, Kilduff LP. The impact of neuromuscular electrical stimulation on recovery after intensive, muscle damaging, maximal speed training in professional team sports players. J Sci Med Sport 2014; 18:328-32. [PMID: 24785367 DOI: 10.1016/j.jsams.2014.04.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Revised: 02/06/2014] [Accepted: 04/04/2014] [Indexed: 11/18/2022]
Abstract
OBJECTIVES During congested fixture periods in team sports, limited recovery time and increased travel hinder the implementation of many recovery strategies; thus alternative methods are required. We examined the impact of a neuromuscular electrical stimulation device on 24-h recovery from an intensive training session in professional players. DESIGN Twenty-eight professional rugby and football academy players completed this randomised and counter-balanced study, on 2 occasions, separated by 7 days. METHODS After baseline perceived soreness, blood (lactate and creatine kinase) and saliva (testosterone and cortisol) samples were collected, players completed a standardised warm-up and baseline countermovement jumps (jump height). Players then completed 60 m × 50 m maximal sprints, with 5 min recovery between efforts. After completing the sprint session, players wore a neuromuscular electrical stimulation device or remained in normal attire (CON) for 8 h. All measures were repeated immediately, 2 and 24-h post-sprint. RESULTS Player jump height was reduced from baseline at all time points under both conditions; however, at 24-h neuromuscular electrical stimulation was significantly more recovered (mean±SD; neuromuscular electrical stimulation -3.2±3.2 vs. CON -7.2±3.7%; P<0.001). Creatine kinase concentrations increased at all time points under both conditions, but at 24-h was lower under neuromuscular electrical stimulation (P<0.001). At 24-h, perceived soreness was significantly lower under neuromuscular electrical stimulation, when compared to CON (P=0.02). There was no effect of condition on blood lactate, or saliva testosterone and cortisol responses (P>0.05). CONCLUSIONS Neuromuscular electrical stimulation improves recovery from intensive training in professional team sports players. This strategy offers an easily applied recovery strategy which may have particular application during sleep and travel.
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Affiliation(s)
- Tom Taylor
- Applied Science, College of Engineering, Swansea University, UK; The Head of Sports Science at West Ham United Football Club, UK
| | - Daniel J West
- Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Sciences, Northumbria University, UK
| | - Glyn Howatson
- Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Sciences, Northumbria University, UK
| | - Chris Jones
- Applied Science, College of Engineering, Swansea University, UK
| | | | - Thomas D Love
- Applied Science, College of Engineering, Swansea University, UK
| | | | - Eamon Swift
- The Head of Sports Science at West Ham United Football Club, UK
| | - Julien S Baker
- Institute of Clinical Exercise and Health Science, School of Science, Faculty of Science and Technology, University of the West of Scotland, UK
| | - Liam P Kilduff
- Applied Science, College of Engineering, Swansea University, UK.
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Palamaner Subash Shantha G, Ramos J, Thomas-Hemak L, Pancholy SB. Association of vitamin D and incident statin induced myalgia--a retrospective cohort study. PLoS One 2014; 9:e88877. [PMID: 24586424 PMCID: PMC3929495 DOI: 10.1371/journal.pone.0088877] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Accepted: 01/15/2014] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Evidence is conflicting with regards to the role of vitamin D in statin induced myalgia (SIM). Studies so far have assessed cross-sectional association and were limited by study sample selected predominantly from cardiology clinics. In this retrospective cohort study we assessed the association between vitamin D and SIM and attempted to establish a serum vitamin D cutoff to identify patients at risk for developing SIM. METHODS Medical charts of 5526 consecutive patients from a primary care practice in Scranton, Pennsylvania from 2005-2012 were reviewed. Vitamin D level (25-hydroxy cholecalciferol) at statin initiation was considered "Exposure level". Vitamin D levels were categorized into quartiles (≤ 10, 11-20, 21-30, >30 ng/ml). SIM was identified by patient report. RESULTS 1160 out of 5526 patients were treated with statins. The mean age was 55.9 years. 276 (24%) developed SIM. Unadjusted 7-yr cumulative incidences of SIM for quartiles 1-4 of vitamin D were 32.3, 21.5, 18.3 and 14.6% respectively. The lowest quartile of vitamin D was independently associated with 1.21 times the hazard of the fourth quartile for developing SIM (95% CI: 1.09, 1.33; P-trend = 0.001). Vitamin D cut-off ≤15 ng/ml, showed a positive predictive value, negative predictive value, likelihood ratio (LR) + and LR- of 81, 90, 5.1 and 0.1, respectively for predicting SIM. CONCLUSIONS Low vitamin D level at statin initiation is associated with SIM, levels ≤15 ng/ml have a high predictive accuracy for SIM. Randomized controlled trials are needed to validate our results.
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Affiliation(s)
| | - Julio Ramos
- Department of Internal Medicine, The Wright Center for Graduate Medical Education, Scranton, Pennsylvania, United States of America
| | - Linda Thomas-Hemak
- Department of Internal Medicine, The Wright Center for Graduate Medical Education, Scranton, Pennsylvania, United States of America
| | - Samir Bipin Pancholy
- Department of Cardiovascular Medicine, The Wright Center for Graduate Medical Education, Scranton, Pennsylvania, United States of America
- * E-mail:
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