Increased Creatine Kinase May Predict A Worse COVID-19 Outcome.

Early reports from Asia suggested that increased serum levels of the muscular enzyme creatine-(phospho)-kinase (CK/CPK) could be associated with a more severe prognosis in COVID-19. The aim of this single-center retrospective cohort study of 331 consecutive COVID-19 patients who were hospitalized during Italy's "first wave" was to verify this relationship, and to evaluate the role of possible confounding factors (age, body mass index, gender, and comorbidities). We subdivided our cohort in two groups, based on "severe" (n = 99) or "mild" (n = 232) outcomes. "Severe" disease is defined here as death and/or mechanical invasive ventilation, in contrast to "mild" patients, who were discharged alive with no need for invasive ventilation; this latter group could also include those patients who were treated with non-invasive ventilation. The CK levels at admission were higher in those subjects who later experienced more severe outcomes (median, 126; range, 10-1672 U/L, versus median, 82; range, 12-1499 U/L, p = 0.01), and hyperCKemia >200 U/L was associated with a worse prognosis. Regression analysis confirmed that increased CK acted as an independent predictor for a "severe" outcome. HyperCKemia was generally transient, returning to normal during hospitalization in the majority of both "severe" and "mild" patients. Although the direct infection of voluntary muscle is unproven, transient muscular dysfunction is common during the course of COVID-19. The influence of this novel coronavirus on voluntary muscle really needs to be clarified.

Sport in Town: The Smart Healthy ENV Project, a Pilot Study of Physical Activity with Multiparametric Monitoring.

BACKGROUND: Increasing evidence links meteorological characteristics and air pollution to physiological responses during sports activities in urban areas with different traffic levels. OBJECTIVE: The main objective of the Smart Healthy ENV (SHE, "Smart Monitoring Integrated System For A Healthy Urban Environment In Smart Cities") project was to identify the specific responses of a group of volunteers during physical activity, by monitoring their heart rates and collecting breath samples, combined with data on meteorological determinants and pollution substances obtained through fixed sensor nodes placed along city routes and remotely connected to a dedicated data acquisition server. METHODS: Monitoring stations were placed along two urban routes in Pisa, each two km long, with one located within the park beside the Arno river (green route) and the other in a crowded traffic zone (red route). Our sample participants were engaged in sports activities (N = 15, with different levels of ability) and were monitored through wearable sensors. They were first asked to walk back and forth (4 km) and then to run the same route. The experimental sessions were conducted over one day per route. A breath sample was also collected before each test. A questionnaire concerning temperature and fatigue perception was administered for all of the steps of the study over the two days. RESULTS: The heart rates of the participants were monitored in the baseline condition, during walking, and while running, and were correlated with meteorological and pollutant data and with breath composition. Changes in the heart rates and breath composition were detected during the experimental sessions. These variations were related to the physical activity and to the meteorological conditions and air pollution levels. CONCLUSIONS: The SHE project can be considered a proof-of-concept study aimed at monitoring physiological and environmental variables during physical activity in urban areas, and can be used in future studies to provide useful information to those involved in sports and the broader community.

Robot-assisted laparoscopic single-site hysterectomy: our experience and multicentric comparison with single-port laparoscopy.

BACKGROUND: Analysis of perioperative outcomes of robotic single-site technique and to compare surgical outcomes with a new laparo-endoscopic single-port surgery (LESS) technique for total hysterectomy. METHODS: Perioperative data from 12 women undergone robotic single-site hysterectomy (RSSH) for benign or oncologic disease were compared with data from 15 patients who underwent total laparo-endoscopic single-site hysterectomy (LESSH) for benign disease using the new X-Cone (Karl Storz, Tuttlingen, Germany). The CUSUM technique for quantitative assessment of the learning curve was then performed. RESULTS: The mean operative time (OT) was 85±33 minutes for RSSH group and 100±20 minutes for LESSH group. Mean blood loss was 80±18 mL and 92±21 mL for RSSH and LESSH, respectively. For each group, the CUSUM learning curves identified two phases with a highly significant decrease of mean OT between phase 1 and phase 2 in both groups. The OT of both groups during phase 2 was significantly lower than during phase 1. CONCLUSIONS: This study confirms the safety and reproducibility of the RSS. The comparison between RSS and LESS techniques has shown that RSS has important advantages over the LESS, like deeper learning curve, lower OT not correlated with age and uterus size.