Exercise-Induced Troponin Elevation in High-Performance Cross-Country Skiers.

Background: Troponin I and T are biomarkers to diagnose myocardial infarction and damage. Studies indicate that strenuous physical activity can cause transient increases in these troponin levels, typically considered physiological. However, current data show differences in the exercise-induced increase in troponin I and T in elite athletes. Method: This prospective clinical study aimed to determine troponin I and T levels in 36 top cross-country skiers of the German national team (18 male, 18 female) after a standardized competition load over two days. All study participants underwent a comprehensive sports medical and cardiological evaluation, including ECG and echocardiography. A multivariable regression analysis was utilized to identify possible predictors of increased troponin I levels. Results: Only three male athletes (8.1%) showed an isolated increase in Troponin I (Ø 112.49 ng/L, cut off < 45.2 ng/L), while no increase in troponin T in the study population was detected. Conclusions: The analysis suggested several potential predictors for increased troponin I levels, such as height, weight, weekly training hours, and indications of an enlarged sports heart, though none achieved statistical significance. Knowing the different exercise-induced detectability of the various troponins in the clinical setting is essential.

Differences in Troponin I and Troponin T Release in High-Performance Athletes Outside of Competition.

Troponin I and troponin T are critical biomarkers for myocardial infarction and damage and are pivotal in cardiological and laboratory diagnostics, including emergency settings. Rapid testing protocols have been developed for urgent care, particularly in emergency outpatient clinics. Studies indicate that strenuous physical activity can cause transient increases in these troponin levels, which are typically considered benign. This research focused on 219 elite athletes from national teams, evaluating their troponin I and T levels as part of routine sports medical exams, independent of competition-related physical stress. The results showed that 9.2% (18 athletes) had elevated troponin I levels above the reporting threshold, while their troponin T levels remained within the normal range. Conversely, only 0.9% (two athletes) had normal troponin I but raised troponin T levels, and 2.3% (five athletes) exhibited increases in both markers. No significant cardiovascular differences were noted between those with elevated troponin levels and those without. This study concludes that elevated troponin I is a common response to the intense physical training endured by high-performance endurance athletes, whereas troponin T elevation does not seem to be directly linked to physical exertion in this group. For cardiac assessments, particularly when ruling out cardiac damage in these athletes, troponin T might be a more reliable indicator than troponin I.

Warning criteria for MEP monitoring during carotid endarterectomy: a retrospective study of 571 patients.

Monitoring of transcranial electrical motor evoked potentials (tcMEP) during carotid endarterectomy (CEA) has been shown to effectively detect intraoperative cerebral ischemia. The unique purpose of this study was to evaluate changes of MEP amplitude (AMP), area under the curve (AUC) and signal morphology (MOR) as additional MEP warning criteria for clamping-associated ischemia during CEA. Therefore, the primary outcome was the number of MEP alerts (AMP, AUC and MOR) in the patients without postoperative motor deficit (false positives). We retrospectively reviewed data from 571 patients who received CEA under general anesthesia. Monitoring of somatosensory evoked potentials (SSEP) and tcMEP was performed in all cases (all-or-none MEP warning criteria). The percentages of false positives (primary parameter) of AMP, AUC and MOR were evaluated according to the postoperative motor outcome. In the cohort of 562 patients, we found significant SSEP/MEP changes in 56 patients (9.96%). In 44 cases (7.83%) a shunt was inserted. Nine patients (1.57%) were excluded due to MEP recording failure. False positives were registered for AMP, AUC and MOR changes in 121 (24.01%), 148 (29.36%) and 165 (32.74%) patients, respectively. In combination of AMP/AUC and AMP/AUC/MOR false positives were found in 9.52% and 9.33% of the patients. This study is the first to evaluate the correctness of the MEP warning criteria AMP, AUC and MOR with regard to false positive monitoring results in the context of CEA. All additional MEP warning criteria investigated produced an unacceptably high number of false positives and therefore may not be useful in carotid surgery for adequate detection of clamping-associated ischemia.

Glucocorticoid sensitivity in fibromyalgia patients: decreased expression of corticosteroid receptors and glucocorticoid-induced leucine zipper.

In fibromyalgia (FM) patients, differences in glucocorticoid receptor (GR) affinity and disturbances associated with loss of hypothalamic-pituitary-adrenal (HPA) axis resiliency have been observed. Based on these studies, we investigated whether FM would be associated with abnormalities in glucocorticoid (GC) sensitivity. Salivary and blood samples were collected from 27 FM patients and 29 healthy controls. Total plasma cortisol and salivary free cortisol were quantified by ELISA and time-resolved fluorescence immunoassay, respectively. GR sensitivity to dexamethasone was evaluated through IL-6 inhibition in stimulated whole blood. The corticosteroid receptors, GR alpha and mineralocorticoid receptor, as well as the glucocorticoid-induced leucine zipper (GILZ) and the FK506 binding protein 5 mRNA expression were assessed in peripheral blood mononuclear cells (PBMCs) by real-time RT-PCR. Furthermore, the corticosteroid receptors were analysed for polymorphism. We observed lower basal plasma cortisol levels (borderline statistical significance) and a lower expression of corticosteroid receptors and GILZ in FM patients when compared to healthy controls. The MR rs5522 (I180V) minor allele was found more often in FM patients than in controls and this variant was recently associated with a mild loss of receptor function. The lower GR and MR expression and possibly the reduced MR function may be associated with an impaired function of the HPA axis in these patients which, compounded by lower anti-inflammatory mediators, may sustain some of symptoms that contribute to the clinical picture of the syndrome.

Adhesion molecules and cytokine expression in fibromyalgia patients: increased L-selectin on monocytes and neutrophils.

Several lines of evidence implicate the immune system in the pathophysiology of fibromyalgia (FM). We investigated the role of cytokines and adhesion molecules involved in immune cell trafficking and the influence of 1.5 mg of dexamethasone (DEX) per os on their expression. L-selectin was elevated on monocytes and neutrophils of FM patients. Differences in group response to DEX were observed for CD11b on NK cells, sICAM-1 and IL-2. This study shows a slight disturbance in the innate immune system of FM patients, and suggests an enhanced adhesion and recruitment of leukocytes to inflammatory sites.

A new view on hypocortisolism.

Low cortisol levels have been observed in patients with different stress-related disorders such as chronic fatigue syndrome, fibromyalgia, and post-traumatic stress disorder. Data suggest that these disorders are characterized by a symptom triad of enhanced stress sensitivity, pain, and fatigue. This overview will present data on the development, mechanisms and consequences of hypocortisolism on different bodily systems. We propose that the phenomenon of hypocortisolism may occur after a prolonged period of hyperactivity of the hypothalamic-pituitary-adrenal axis due to chronic stress as illustrated in an animal model. Further evidence suggests that despite symptoms such as pain, fatigue and high stress sensitivity, hypocortisolism may also have beneficial effects on the organism. This assumption will be underlined by some studies suggesting protective effects of hypocortisolism for the individual.