Individual-based Creatine Kinase Reference Values in Response to Soccer Match-play

The aim of the present study was to determine the creatine kinase reference limits for professional soccer players based on their own normal post-match response. The creatine kinase concentration was analyzed in response to official matches in 25 players throughout a 3-year period. Samples were obtained between 36–43 hours following 70 professional soccer matches and corresponded to 19.1±12.1 [range: 6–49] samples per player. Absolute reference limits were calculated as 2.5th and 97.5th percentile of the samples collected. Creatine kinase values were also represented as a percentage change from the individual’s season mean and represented by 90th, 95th and 97.5th percentiles. The absolute reference limits for creatine kinase concentration calculated as 97.5th and 2.5th percentiles were 1480 U.L−1 and 115.8 U.L−1, respectively. The percentage change from the individual’s season mean was 97.45±35.92% and players were in the 90th, 95th and 97.5th percentiles when the percentages of these differences were 50.01, 66.7, and 71.34% higher than player’s season mean response, respectively. The data allowed us to determine whether the creatine kinase response is typical or if it is indicative of a higher than normal creatine kinase elevation and could be used as a practical guide for detection of muscle overload, following professional soccer match-play.

Radiographic outcome of root canal treatment in dogs: 281 teeth in 204 dogs (2001–2018)

OBJECTIVE To evaluate the radiographic outcome of root canal treatment (RCT) in dogs and compare outcomes with those reported for a previous study performed at the same institution in 2002. ANIMALS 204 dogs representing 281 teeth that underwent RCT. PROCEDURES The medical record database of a veterinary teaching hospital was searched to identify dogs that underwent RCT between 2001 and 2018. Only dogs that had undergone at least 1 radiographic recheck appointment a minimum of 50 days after RCT were included in the study. Dental radiographs were reviewed. Treatment was considered successful if the periapical periodontal ligament space was within reference limits and preexisting external inflammatory root resorption (EIRR), if present, had stabilized. Treatment was considered to show no evidence of failure (NEF) if preoperative EIRR had stabilized and any preoperative periapical lucency (PAL) remained the same or had decreased in size but had not completely resolved. Treatment was considered to have failed if EIRR or a PAL developed after RCT, if a preoperative PAL increased in size, or if preexisting EIRR progressed. RESULTS Follow-up time ranged from 52 to 3,245 days (mean, 437 days). RCT was classified as successful for 199 (71%) teeth, NEF for 71 (25%) teeth, and failed for 11 (4%) teeth. CONCLUSIONS AND CLINICAL RELEVANCE Results showed that almost 2 decades after RCT outcome in dogs was first evaluated, during which time numerous advances in dental materials and techniques had been made, the success rate of RCT was virtually unchanged.

HAND-ARM VIBRATION IN DIFFERENT OPERATING CONDITIONS WITH A CHAINSAW

The mechanization of forest harvesting is a trend in Brazil. However, small and medium-sized companies in the forestry sector, even today, opt for semi-mechanized harvesting, using chainsaws for the harvesting and sectioning of trees. Despite technological advances, when operated continuously, chainsaws may cause damage to the operator’s body, acting as a stressor, and vibration excess is responsible for numerous health disorders, among them the Raynaud syndrome. In this sense, this study aimed to determine the vibration levels to which a chainsaw operator is subjected, during the transversal cut (tracing) of the wood, in different forest species and cutting sets. The treatments consisted of three forest species (Eucalyptus grandis, Eucalyptus dunnii and Acacia mearnsii De Wild) and two cutting sets, consisting of square tooth chains of the semi-chisel and chisel types. The vibration assessment was based on the criteria established by the Regulatory Standards NR15, NHO10 and ISO 2631-4. The results of vibration levels were higher than the reference limits established by ISO 2631-4, and, for both cutting sets, the highest vibration levels occurred on the “x” axis. After the data processing, the acceleration values resulting from the normalized exposure to hand-arm vibrations showed significant differences for the “y” and “z” axes. Therefore, it can be inferred that the chainsaw operation is a stressor, potentially capable of causing damage to workers' health.

Serum Creatinine Reference Limits in Pediatric Population—A Single Center Electronic Health Record-Based Database in Taiwan

Objective: To assess age- and sex-specific serum creatinine levels in a pediatric population using a hospital-based database in Taiwan.Study Design: Data on serum creatinine levels were obtained from the National Taiwan University Hospital-integrated Medical Database (NTUH-iMD). Due to the possibility of having acute kidney injury or chronic kidney disease, individuals with multiple serum creatinine measurements were excluded, and outliers in each age- and sex-specific group were also subsequently removed. The remaining creatinine measurements in each group were analyzed, and 95% reference limits were established.Results: Serum creatinine data of individuals aged between 1 month and 18 years from May 2011 to January 2018 were retrieved. After applying the exclusion criteria, 27,911 individuals with a single corresponding serum creatinine measurement were enrolled. Creatinine level reference limits for each age- and sex-specific group were generated. The upper reference limits (URLs), which are particularly useful in clinical practice, followed the natural trend of increasing serum creatinine with age.Conclusion: We generated serum creatinine reference limits from a single hospital-integrated medical database in Taiwan for different age- and sex-specific groups of children. Our results will aid physicians in clinical practice regarding renal function evaluation, especially for patients without a recent baseline serum creatinine level.

Neurogranin as a Reliable Biomarker for Synaptic Dysfunction in Alzheimer’s Disease

(1) Background: Neurogranin is a post-synaptic protein expressed in the neurons of the hippocampus and cerebral cortex. It has been recently proposed as a promising biomarker of synaptic dysfunction, especially in Alzheimer’s disease (AD). However, more efforts are needed before introducing it in clinical practice, including the definition of its reference interval (RI). The aim of the study was to establish the RI of cerebrospinal fluid (CSF) neurogranin levels in controls and individuals with non-neurodegenerative neurological diseases; (2) We included a total of 136 individuals that were sub-grouped as follows: AD patients (n = 33), patients with non-neurodegenerative neurological diseases (n = 70) and controls (33). We measured CSF neurogranin levels by a commercial ELISA kit. CSF RI of neurogranin was calculated by a robust method; (3) Results: AD patients showed increased levels of neurogranin. We also found that neurogranin was significantly correlated with T-tau, P-tau and mini mental state examination in AD patients. The lower and upper reference limits of the RI were 2.9 (90%CI 0.1–10.8) and 679 (90%CI 595–779), respectively; (4) Conclusion: This is the first study establishing the RI of CSF neurogranin.

Billroth II procedure for the treatment of spontaneous gastrointestinal perforation in two cats

CASE DESCRIPTION A 9-year-old castrated male domestic shorthair cat (cat 1) and a 10-year-old castrated male Maine Coon cat (cat 2) were presented for recurrent feline lower urinary tract disease after receiving outpatient care from their primary veterinarians. CLINICAL FINDINGS Physical examination findings for both cats were initially within reference limits. After a short period of hospitalization, both cats developed peritoneal effusion; results of cytologic analysis of a sample of the fluid were consistent with septic peritonitis. During exploratory laparotomy, perforation of the pylorus or proximal portion of the duodenum secondary to ulceration was identified. TREATMENT AND OUTCOME Both cats underwent partial duodenectomy, partial gastrectomy (pylorectomy), and gastrojejunostomy (Billroth II procedure). The cats recovered from surgery and returned to a normal quality of life; however, each had mild episodes of anorexia but maintained a stable body weight. Cat 2 required additional surgery for trichobezoar removal 7 weeks later but recovered quickly. At 7 months after trichobezoar removal, cat 2 developed intermittent vomiting, but clinicopathologic, abdominal ultrasonographic, and upper gastrointestinal tract endoscopic findings were within reference limits. At 9 (cat 2) and 13 (cat 1) months after the Billroth II procedure, both cats were reported to be in good general health and without gastrointestinal signs. CLINICAL RELEVANCE In both cats, the Billroth II procedure was technically straightforward and associated with a full recovery and good medium- to long-term quality of life. A Billroth II procedure could be considered for treatment of cats with large mural lesions in the pyloroduodenal region.

Revisited Upper Reference Limits for Highly Sensitive Cardiac Troponin T in Relation to Age, Sex, and Renal Function

(1) Background: Highly sensitive cardiac troponin T (hs-cTnT) plays an essential role in the diagnosis of myocardial injury. The upper reference limit of the respective assay is generally applied, irrespective of age, renal function, or sex. We aimed to identify age-adjusted and sex-adjusted upper reference limits in relation to renal function in a large population-based cohort without cardiac diseases. (2) Methods: We included 5428 subjects of the population-based LIFE-Adult cohort, free of diagnosed cardiac diseases. Sex-adjusted and age-adjusted 99th percentiles for hs-cTnT in subjects with preserved renal function were obtained. (3) Results: The hs-cTnT values were higher in men of all age groups. In both sexes, an increasing age positively correlated with higher hs-cTnT values. Hs-cTnT weakly correlated with serum creatinine. The three-dimensional analysis of age, creatinine, and hs-cTnT showed no relevant additional effect of creatinine on hs-cTnT. In men aged above 60 and women above 70, the calculated 99th percentiles clearly exceeded the commonly applied thresholds. (4) Conclusion: Age and sex have a major impact on the serum concentration of hs-cTnT, while renal function does not. We propose to consider age-adjusted and sex-adjusted reference values.

Right atrium size in the general population

Echocardiography is the most common routine cardiac imaging method. Nevertheless, only few data about sex-specific reference limits for right atrium (RA) dimensions are available. Transthoracic echocardiographic RA measurements were studied in 9511 participants of the Gutenberg-Health-Study. A reference sample of 1942 cardiovascular healthy subjects without chronic obstructive pulmonary disease was defined. We assessed RA dimensions and sex-specific reference limits were defined using the 95th percentile of the reference sample. Results showed sex-specific differences with larger RA dimensions in men that were attenuated by standardization for body-height. RA-volume was 20.2 ml/m in women (5th–95th: 12.7–30.4 ml/m) and 26.1 ml/m in men (5th–95th: 16.0–40.5 ml/m). Multivariable regressions identified body-mass-index (BMI), coronary artery disease (CAD), chronic heart failure (CHF) and atrial fibrillation (AF) as independent key correlates of RA-volume in both sexes. All-cause mortality after median follow-up-period of 10.7 (9.81/11.6) years was higher in individuals who had RA volume/height outside the 95% reference limit (HR 1.70 [95%CI 1.29–2.23], P = 0.00014)). Based on a large community-based sample, we present sex-specific reference-values for RA dimensions normalized for height. RA-volume varies with BMI, CHF, CAD and AF in both sexes. Individuals with RA-volume outside the reference limit had a 1.7-fold higher mortality than those within reference limits.