Creatine Kinase Measurements Research Articles

Relationships between match activities and peak power output and Creatine Kinase responses to professional reserve team soccer match-play

The specific movement demands of soccer that are linked to post-match recovery and readiness to train are unclear. Therefore, we examined the relationship between Global Positioning System (GPS) variables and the change (Δ; from baseline) in Creatine Kinase (CK) concentrations and peak power output (PPO; during the countermovement jump) at 24h and 48h post-match. Fifteen English Premier League reserve team players were examined over 1–4 matches. Measurements of CK and PPO were taken before (24h prior to match-play) and after (+24h and +48h) each game during which movement demands were quantified using 10Hz GPS data. High intensity distance covered (r=0.386, p=0.029; r=−0.349; p=0.050), high intensity distance covered⋅min−1 (r=0.365, p=0.040; r=−0.364, p=0.040), high speed running distance (r=0.363, p=0.041; r=−0.360, p=0.043) and the number of sprints⋅min−1 (r=0.410, p=0.020; r=−0.368, p=0.038) were significantly related to ΔCK and ΔPPO at +24h post-match, respectively. No relationships were observed between any match variables and ΔCK and ΔPPO after +48h of recovery. These findings highlight that high intensity match activities are related to ΔCK and ΔPPO in the 24h, but not 48h, following soccer match-play. Such information is likely of interest to those responsible for the design of soccer player’s training schedules in the days following a match.

Corticosteroid Monotherapy Is Usually Insufficient Treatment for Idiopathic Inflammatory Myopathy

Idiopathic inflammatory myopathies (IIM) are a rare group of autoimmune diseases characterized by muscle inflammation. High-dose corticosteroids are conventionally used as the first-line therapy for IIM, but early introduction of noncorticosteroid immunosuppressive agents has become increasingly common in recent years despite a paucity of compelling evidence to support this. Here, we systematically analyze therapeutic practice patterns of IIM in a large municipal safety net medical center. We conducted a retrospective chart review of all adult patients attending rheumatology clinics at the Cook County Health and Hospital Systems from 2006 to 2011 with a diagnosis of IIM. Data collected included patient demographics, diagnosis, immunosuppressive therapies, serial serum creatine kinase (CK) measurements, and serial muscle strength testing. One hundred eight patients fulfilled eligibility criteria. The mean duration of follow-up was 62 months (range, 1-351 months). At presentation, the mean strength in the weakest muscle group was rated as 3.6 out of 5 (range, 1-5; SD 0.9), the mean initial CK was 4720 U/L (range, 23-38, 461; SD 6, 795), and initial mean prednisone dosage was 48 mg/d (range, 0-100, SD 22). At the end of the follow-up period, mean strength in the weakest muscle group was 4.6 out of 5 (range, 2-5; SD 0.7), mean peak CK was 412 (24-7533; SD 875), and the mean prednisone dosage was 12.7 mg (0-80; SD 17.5). Only 15 patients (14%) received exclusively corticosteroid monotherapy during the follow-up period. Ninety-three patients (86%) received additional immunosuppressive agents. Over the course of their illness, only a minority of patients in our cohort of IIM patients was treated with corticosteroids alone. It is unlikely we will determine optimal therapy in the absence of a large controlled study comparing corticosteroids versus a combination regimen, but it seems that rheumatologists favor addition of second-line immunosuppressive agents.

Determination of total creatine kinase activity in blood serum using an amperometric biosensor based on glucose oxidase and hexokinase

Creatine kinase (CK: adenosine-5-triphosphate–creatine phosphotransferase) is an important enzyme of muscle cells; the presence of a large amount of the enzyme in blood serum is a biomarker of muscular injuries, such as acute myocardial infarction. This work describes a bi-enzyme (glucose oxidase and hexokinase based) biosensor for rapid and convenient determination of CK activity by measuring the rate of ATP production by this enzyme. Simultaneously the biosensor determines glucose concentration in the sample. Platinum disk electrodes were used as amperometric transducers. Glucose oxidase and hexokinase were co-immobilized via cross-linking with BSA by glutaraldehyde and served as a biorecognition element of the biosensor. The biosensor work at different concentrations of CK substrates (ADP and creatine phosphate) was investigated; optimal concentration of ADP was 1mM, and creatine phosphate – 10mM. The reproducibility of the biosensor responses to glucose, ATP and CK during a day was tested (relative standard deviation of 15 responses to glucose was 2%, to ATP – 6%, to CK – 7–18% depending on concentration of the CK). Total time of CK analysis was 10min. The measurements of creatine kinase in blood serum samples were carried out (at 20-fold sample dilution). Twentyfold dilution of serum samples was chosen as optimal for CK determination. The biosensor could distinguish healthy and ill people and evaluate the level of CK increase. Thus, the biosensor can be used as a test-system for CK analysis in blood serum or serve as a component of multibiosensors for determination of important blood substances. Determination of activity of other kinases by the developed biosensor is also possible for research purposes.

Pulse Dose Methylprednisolone Therapy for Adult Idiopathic Inflammatory Myopathy.

Idiopathic inflammatory myopathies (IIM) are a rare group of autoimmune diseases characterized by muscle inflammation. Typically high-dose daily oral corticosteroids are used as the first-line therapy of IIM. Pulse dose intravenous methylprednisolone (IVMP) has been used for serious or refractory cases. Here, we systematically analyze the therapeutic effect of pulse dose IVMP in patients with IIM in a large municipal safety net medical center and review the literature on pulse IVMP in adult IIM. We conducted a retrospective chart review of patients who were diagnosed with IIM in the rheumatology clinics of the Cook County Health and Hospital Systems. Data collected included patient demographics, diagnosis, immunosuppressive therapies, serial serum creatine kinase (CK) measurements, and serial muscle strength testing. Seven patients received pulse dose IVMP for active myositis. At the time of pulse dose IVMP, the mean strength in the weakest muscle group was rated as 3.1 of 5 (range, 2-4; SD, 0.9) and the mean peak CK was 5746 U/L (range, 1602-14,039; SD, 4911). Dysphagia was reported in 5 of the 7 patients at the time of IVMP. Four to six weeks after IVMP, the mean strength in the weakest muscle group was 3.3 of 5 (range, 1-5; SD, 1.5) and mean peak CK was 1064 U/L (range, 63-1788, SD, 712). Four to six weeks after IVMP, dysphagia had resolved in 2 and improved in 3. At the end of follow-up, mean strength in the weakest muscle group was 4.7 of 5 (range, 4-5; SD, 0.5), mean peak CK was 480 U/L (range, 37-1016; SD, 337), and the mean prednisone dosage was 15 mg (range, 2.5-60; SD, 21). Although our study has certain limitations, our cohort of adult patients with IIM had marked improvement in clinical and biochemical outcomes. Four to six weeks after IVMP infusion, there was a rapid improvement in muscle enzyme levels, muscle strength, and dysphagia. This therapy warrants further controlled trials.

Effect of L-arginine in combination with N-acetylcysteine on oxidative stress and left ventricular function in patients with acute coronary syndrome with st segment elevation

The aim of this study was to evaluate the effect of treatment on L-arginine (LA) with a combination of N-acetylcysteine (NAC) on oxidative stress, infarct size, and left ventricular (LV) as adjunctive therapy in acute coronary syndrome (ACS). Patients with ACS received either 15 g NAC infused over 24 h (n = 15) or no NAC (n = 15), combined with LA. Peripheral venous blood was serially sampled to measure creatine kinase (CK)-MB levels. Plasma malondialdehyde (MDA) level was measured at admission and after 4 and 24 h. Echocardiography was performed within 3 days of MI and after 3 months. In the NAC-treated patients plasma MDA levels decreased, whereas in the nontreated NAC patients MDA levels increased at 4 and 24 h (P < 0.01 and P < 0.001, respectively). Left ventricular ejection fraction was higher (P < 0.05) and LV end-systolic and end-diastolic diameters were lower (P < 0.001 and P < 0.001) in patients receiving NAC on day 3. Left ventricular wall motion score index was significantly lower in patients treated with NAC on day 3 (P < 0.05). Left ventricular diastolic parameters were not different whether patients were treated with NAC or not. No difference in reduction of infarct size was detected between the groups according to CK-MB levels. It was thus demonstrated that administration of NAC in combination with LA significantly diminished oxidative stress and improved LV function in patients with ACS. These encouraging results would justify the performance of a larger controlled study.

Lactate dehydrogenase as an indicator of liver, muscular and cancer diseases

Objective: To determine lactate dehydrogenase (LDH) level as an indicator of liver, muscular or cancer diseases in patients of more than 40 years of age. Methods: Ninety-one patients (43 females and 48 males) had been tested for LDH and liver function tests (LFTs). Creatine kinase (CK) levels were measurement only in patients who had high levels of LDH. Results: As an indicator for liver diseases, high levels of LDH and one or more of LFTs, especially alkaline phosphatase, had been observed in 12 patients (8 females and 4 males). For muscular damage, measurement of CK in patients with elevated levels of LDH and normal levels of LFT revealed that CK values elevated in three males and one female. Whereas high LDH levels, as an indicator for cancer diseases, were found in three males and one female who had normal values of LFTs and CK. Conclusions: LDH can be regarded as a good biomarker for diagnosis of liver, muscular and cancer diseases. There is little variable between males and females in the elevated value of LDH. Patients who had high values of LDH, although they had normal levels of LFTs and CK are proposed to have unidentified cancer disease.

Fatigue and Asthenia

The word fatigue implies a sense of exhaustion, lassitude, or inability to generate drive or energy. In taking a medical history of a patient with fatigue, the examiner should pursue questions of timing and circumstance. A medical or psychiatric diagnosis can be established in two thirds of patients who complain of fatigue, and in many cases, they are remediable. This chapter reviews the history of fatigue, including outbreaks. The clinical picture, diagnostic criteria, special considerations in diagnosis, general medical disorders, prescription drugs, postural orthostatic tachycardia syndrome, neutrally mediated hypotension, Chiari malformation, neurologic causes of fatigue, psychiatric investigation, laboratory investigations, magnetic resonance imaging (MRI) studies, pathophysiology, prognosis, and treatment are detailed. Asthenia is discussed in relation to clinical data, the central nervous system, muscle, and electromyography (EMG). Tables include terms and phrases used for indicating fatigue; definitions, features, and medical causes of chronic fatigue syndrome (CFS); blood tests to evaluate chronic fatigue; symptoms of CFS determined from laboratory studies; MRI studies for detecting CFS; outcomes of MRI studies of CFS; summary of CFS facts; summary of drugs used for fighting fatigue in multiple sclerosis patients; clinical testing for signs of asthenia; considerations when measuring creatine kinase; EMG testing in search of abnormalities; and decisive EMG findings. Figures show maps of sensory loss, an MRI of a relapsing-remitting multiple sclerosis patient, white matter hyperintensities, a diagram of EMG testing, and repetitive stimulation testing for neuromuscular transmission disorder. This chapter contains 5 highly rendered figures, 14 tables, 74 references, and 5 MCQs.

Fatigue and Asthenia

The word fatigue implies a sense of exhaustion, lassitude, or inability to generate drive or energy. In taking a medical history of a patient with fatigue, the examiner should pursue questions of timing and circumstance. A medical or psychiatric diagnosis can be established in two thirds of patients who complain of fatigue, and in many cases, they are remediable. This chapter reviews the history of fatigue, including outbreaks. The clinical picture, diagnostic criteria, special considerations in diagnosis, general medical disorders, prescription drugs, postural orthostatic tachycardia syndrome, neutrally mediated hypotension, Chiari malformation, neurologic causes of fatigue, psychiatric investigation, laboratory investigations, magnetic resonance imaging (MRI) studies, pathophysiology, prognosis, and treatment are detailed. Asthenia is discussed in relation to clinical data, the central nervous system, muscle, and electromyography (EMG). Tables include terms and phrases used for indicating fatigue; definitions, features, and medical causes of chronic fatigue syndrome (CFS); blood tests to evaluate chronic fatigue; symptoms of CFS determined from laboratory studies; MRI studies for detecting CFS; outcomes of MRI studies of CFS; summary of CFS facts; summary of drugs used for fighting fatigue in multiple sclerosis patients; clinical testing for signs of asthenia; considerations when measuring creatine kinase; EMG testing in search of abnormalities; and decisive EMG findings. Figures show maps of sensory loss, an MRI of a relapsing-remitting multiple sclerosis patient, white matter hyperintensities, a diagram of EMG testing, and repetitive stimulation testing for neuromuscular transmission disorder. This chapter contains 5 highly rendered figures, 14 tables, 74 references, and 5 MCQs.

Clinical outcome, biochemical and therapeutic follow-up in 14 Austrian patients with Long-Chain 3-Hydroxy Acyl CoA Dehydrogenase Deficiency (LCHADD).

BackgroundLCHADD is a long-fatty acid oxidation disorder with immediate symptoms and long-term complications. We evaluated data on clinical status, biochemical parameters, therapeutic regimens and outcome of Austrian LCHADD patients.Study designClinical and outcome data including history, diagnosis, short- and long-term manifestations, growth, psychomotor development, hospitalizations, therapy of 14 Austrian patients with LCHADD were evaluated. Biochemically, we evaluated creatine kinase (CK) and acyl carnitine profiles.ResultsAll LCHADD patients are homozygous for the common mutation. Three are siblings. Diagnosis was first established biochemically. Nine/14 (64%) were prematures, with IRDS occurring in six. In nine (64%), diagnosis was established through newborn screening, the remaining five (36%) were diagnosed clinically. Four pregnancies were complicated by HELLP syndrome, one by preeclampsia. In two, intrauterine growth retardation and placental insufficiency were reported. Five were diagnosed with hepatopathy at some point, seven with cardiomyopathy and eight with retinopathy, clinically relevant only in one patient. Polyneuropathy is only present in one. Three patients have a PEG, one is regularly fed via NG-tube. Growth is normal in all, as well as psychomotor development, except for two extremely premature girls. In 11 patients, 165 episodes with elevated creatine kinase concentrations were observed with 6-31 (median 14) per patient; three have shown no elevated CK concentrations. Median total carnitine on therapy was 19 μmol/l (range 11-61). For 14 patients, there have been 181 hospitalizations (median 9 per patient), comprising 1337 in-patient-days. All centres adhere to treatment with a fat-defined diet; patients have between 15% and 40% of their energy intake from fat (median 29%), out of which between 20% and 80% are medium-chain triglycerides (MCT) (median 62%). Four patients have been treated with heptanoate (C7).ConclusionOur data show LCHADD outcome can be favourable. Growth and psychomotor development is normal, except in two prematures. Frequency of CK measurements decreases with age, correlating with a decreasing number of hospitalizations. About 50% develop complications affecting different organ systems. There is no relevant difference between the patients treated in the respective centers. Concluding from single case reports, anaplerotic therapy with heptanoate should be further evaluated.

Effect of high-level spinal cord injury on myocardial energy metabolism in rats

Objective To evaluate the effect of high-level spinal cord injury (SCI) on the myocardial energy metabolism in rats. Methods Sixty healthy male Sprague-Dawley rats, weighing 250-300 g, were randomly divided into 2 groups (n=30 each) using a random number table: sham operation (group S) and SCI group. SCI was induced in anesthetized rats by dropping a 10 g weight onto C7 spinal cord from 5 cm height falling freely inside a vertical hollow glass tube. At 6, 12, 24, 48 and 72 h after SCI, 6 rats in each group were chosen and arterial blood samples were taken for measurement of serum creatine kinase (CK) and creatine kinase isoenzyme-MB (CK-MB) activities. The rats were then sacrificed and myocardial specimens were obtained for examination of myocardial ultrastructure and for determination of ATP weight ratio, levels of Na+-K+-ATPase, Ca2+-Mg2+-ATPase, non-esterified fatty acids (NEFA) and lactic acid (LD), and expression of peroxisome proliferator-activated receptor alpha (PPARα) mRNA and protein (using fluorescent quantitative PCR and Western blot). Results Compared with group S, the serum CK and CK-MB activities were significantly increased, the ATP weight ratio, activities of Na+-K+-ATPase and Ca2+-Mg2+-ATPase and levels of NEFA and LD were decreased, and the expression of PPAR-α mRNA and protein was down-regulated in SCI group. No pathological changes of myocardium were found in group S, and the pathological changes of myocardium were obvious in SCI group. Conclusion High-level SCI can lead to decrease in the myocardial energy metabolism in rats, and down-regulated expression of PPARα is involved in the mechanism. Key words: Spinal cord injuries; Myocardium; Energy Metabolism; Peroxisome proliferators

Two repetition time saturation transfer (TwiST) with spill-over correction to measure creatine kinase reaction rates in human hearts.

BackgroundPhosphorus saturation transfer (ST) magnetic resonance spectroscopy can measure the rate of ATP generated from phosphocreatine (PCr) via creatine kinase (CK) in the human heart. Recently, the triple-repetition time ST (TRiST) method was introduced to measure the CK pseudo-first-order rate constant kf in three acquisitions. In TRiST, the longitudinal relaxation time of PCr while γ-ATP is saturated, T1`, is measured for each subject, but suffers from low SNR because the PCr signal is reduced due to exchange with saturated γ-ATP, and the short repetition time of one of the acquisitions. Here, a two-repetition time ST (TwiST) method is presented. In TwiST, the acquisition with γ-ATP saturation and short repetition time is dropped. Instead of measuring T1`, an intrinsic relaxation time T1 for PCr, T1intrinsic, is assumed. The objective was to validate TwiST measurements of CK kinetics in healthy subjects and patients with heart failure (HF).MethodsBloch equation simulations that included the effect of spillover irradiation on PCr were used to derive formulae for T1intrinsic and kf measured by both TRiST and TwiST methods. Spillover was quantified from an unsaturated PCr measurement used in the current protocol for determining PCr and ATP concentrations. Cardiac TRiST and TwiST data were acquired at 3 T from 12 healthy and 17 HF patients.ResultsSimulations showed that both kf measured by TwiST and T1intrinsic require spill-over corrections. In human heart at 3 T, the spill-over corrected T1intrinsic = 8.4 ± 1.4 s (mean ± SD) independent of study group. TwiST and TRiST kf measurements were the same, but TwiST was 9 min faster. Spill-over corrected TwiST kf was 0.33 ± 0.08 s−1 vs. 0.20 ± 0.06 s−1 in healthy vs HF hearts, respectively (p < 0.0001).ConclusionTwiST was validated against TRiST in the human heart at 3 T, generating the same results 9 min faster. TwiST detected significant reductions in CK kf in HF compared to healthy subjects, consistent with prior 1.5 T studies using different methodology.Electronic supplementary materialThe online version of this article (doi:10.1186/s12968-015-0175-4) contains supplementary material, which is available to authorized users.

Correlation between serum levels of IL-15 and IL-17 in patients with idiopathic inflammatory myopathies

Objectives: To assess the serum levels of interleukin (IL)-15 and IL-17 in patients with idiopathic inflammatory myopathies (IIM) and correlate them with levels of IL-1 receptor antagonist (IL-1ra), IL-6, IL-10, interferon (IFN)-γ, monocyte chemoattractant protein (MCP)-1, macrophage inflammatory protein (MIP)-1α, and MIP-1β. Possible correlations with disease activity parameters were also evaluated.Method: Sera from 14 patients with new-onset polymyositis (PM), 10 with dermatomyositis (DM), seven with anti-synthetase syndrome (ASS) and 19 healthy controls (HC) were analysed by multiplex immunoassay. Sera from 19 patients were analysed after a median follow-up of 5 months. All patients underwent physical examination, manual muscle testing (MMT) using the five-point MMT scales, the Health Assessment Questionnaire (HAQ), and serum creatine kinase (CK) measurement. All patients received glucocorticoids, and 13 were taking immunosuppressive therapy.Results: At baseline, serum levels of IL-15, IL-17, MCP-1, and MIP-1β were significantly higher in IIM patients than in HC. IL-17 serum levels were directly correlated (r = 0.39, p = 0.02) with disease duration while a significant inverse correlation was detected between IL-17 levels and MMT scores (r = –0.4, p = 0.02). The highest IL-15 levels were present in DM patients (p = 0.02 vs. PM). The most striking finding was the strong correlation between IL-15 and IL-17 levels (r = 0.60, p = 0.0001), and this correlation was even stronger in DM patients (r = 0.82, p = 0.006).Conclusions: The strong correlation between IL-15 and IL-17 in IIM patients, and especially in DM, suggests that there may be an interplay between the two cytokines in the pathogenesis of myositis. Further studies of larger patient cohorts and of muscle biopsies are needed to confirm these preliminary data.

Possible interplay between interleukin-15 and interleukin-17 into the pathogenesis of idiopathic inflammatory myopathies.

The aim of this study was to assess the serum levels of interleukin (IL)-15 and IL-17 in patients with idiopathic inflammatory myopathies (IIM) and correlate them with IL-6, IL-10, monocyte chemoattractant protein-1 (MCP-1), macrophage inflammatory protein-1α (MIP-1α), MIP-1β levels. Possible correlations with disease activity parameters were also evaluated. Sera from 14 polymyositis (PM), 10 dermatomyositis (DM), 7 anti-synthetase syndrome new onset patients and 19 healthy controls (HCs) were analyzed by multiplex immunoassay. Sera from 19 patients were analyzed after 5 months median follow-up. All patients underwent physical examination, the 5-points manual muscle test (MMT), the health assessment questionnaire and serum creatine kinase measurement. All patients received glucocorticoids, and 13 were taking also immunosuppressive therapy. At baseline, serum levels of IL-15, IL-17, MCP-1 and MIP-1β were significantly higher in IIM patients than in HCs. IL-17 serum levels were directly correlated with disease duration (r=0.39, P=0.02), while a significant inverse correlation was detected between IL-17 levels and MMT scores (r=-0.4, P=0.02). The highest IL-15 levels were present in DM patients (P=0.02 vs PM). The most striking finding was the strong correlation between IL-15 and IL-17 levels (r=0.60, P=0.0001), and this correlation was even stronger in DM patients (r=0.82, P=0.006). The strong correlation between IL-15 and IL-17 in IIM patients, and especially in DM, suggests that there may be a interplay between the two cytokines in the pathogenesis of myositis. Further studies of larger patient cohorts and muscle biopsies are needed to confirm these preliminary data.

지연성 근육통에 대한 미세전류자극치료가 통증과 CK에 미치는 영향

Purpose : Delayed onset muscle soreness(DOMS) is a common problem that can interfere with rehabilitation as well as activities of daily living. The purpose of this study was to compare the effect of both trascutaneous electrical nerve stimulation(TENS) Micro current(MC) and only normal Therapy on Delyed Onset Muscle Soreness(DOMS). Method : The Methods ten untrained and male volunteer subjects were randomly assigned to one of two treatment groups: 1) a group that received TENS (60Hz) MC(<TEX>$60{\mu}A$</TEX>, 3pps) a control group that received no MC treatment. Subjects performed repeated eccentric exercise of the non-dominant forearm flexor muscle with submaximal intensity by the simply designed eccentric exercise devices. Treatments were applied after 24hours and 48hours. Subjects attended on two consecutive days for treatment and measurement of paining(visual analogue scale: VAS) and CK(Creatine kinase) on a daily basis. Measurements were taken after treatment. Results : 1) There were no significant differences between TENS and MENS by two-way repeated ANOVA. The Results that t-test for VAS revealed significant differences within TENS group. 3) The t-test for VAS, and Creatine Kinase of time revealed significant differences within MC group. Conclusion : These findings suggest that both TENS and MENS had effect on DOMS.

Neuromuscular electrical stimulation via the peroneal nerve is superior to graduated compression socks in reducing perceived muscle soreness following intense intermittent endurance exercise

A novel technique of neuromuscular electrical stimulation (NMES) via the peroneal nerve has been shown to augment limb blood flow which could enhance recovery following exercise. The present study examined the effects of NMES, compared to graduated compression socks on muscle soreness, strength, and markers of muscle damage and inflammation following intense intermittent exercise. Twenty-one (age 21 ± 1 years, height 179 ± 7 cm, body mass 76 ± 9 kg,) healthy males performed a 90-min intermittent shuttle running test on three occasions. Following exercise, the following interventions were applied: passive recovery (CON), graduated compression socks (GCS) or NMES. Perceived muscle soreness (PMS) and muscle strength (isometric maximal voluntary contraction of knee extensors and flexors) were measured and a venous blood sample taken pre-exercise and 0, 1, 24, 48 and 72 h following exercise for measurement of creatine kinase (CK) and Lactate dehydrogenase (LDH) activity and IL-6 and CRP concentrations. PMS increased in all conditions immediately, 1 and 24 h post-exercise. At 24 h PMS was lower in NMES compared to GCS and CON (2.0 ± 1.6, 3.2 ± 2.1, 4.6 ± 2.0, respectively). At 48 h PMS was lower in NMES compared to CON (1.3 ± 1.5 and 3.1 ± 1.8, respectively). There were no differences between treatments for muscle strength, CK and LDH activity, IL-6 and CRP concentrations. The novel NMES technique is superior to GCS in reducing PMS following intense intermittent endurance exercise.

Serial Measurement of Heart-Type Fatty Acid Binding Protein for the Rapid Diagnosis of Acute Coronary Syndromes in the Emergency Department

Introduction We aimed to investigate the diagnostic accuracy of heart-type fatty acid binding protein (H-FABP) at admission and the third and sixth hour after admission in patients presenting to the emergency department (ED) with chest pain or equivalent symptoms. Methods This prospective study was performed over two months in the ED. Patients presenting with ischaemic-type chest pain or other symptoms suggestive of myocardial ischaemia were included in the study. A bedside, point-of-care, quantitative H-FABP level was measured. If the initial electrocardiography (ECG) was non-diagnostic, the patients were observed for six hours. During the observation period, serial H-FABP measurements were obtained at admission, the third hour and the sixth hour; serial measurements of total creatine kinase (CK), CK-MB, troponin I and myoglobin were recorded at admission and the sixth hour. Results A total of 183 patients were included in the study. Initial H-FABP was measured in a joint group of ST segment elevation myocardial infarction (STEMI) and non ST segment elevation myocardial infarction (NSTEMI) patients, with a sensitivity of 80.9%, specificity of 19.2%, positive predictive value (PPV) of 23% and negative predictive value (NPV) of 77.1%. The third-hour H-FABP was measured in the NSTEMI group, with a sensitivity of 46.7%, specificity of 80.2%, PPV of 42.4% and NPV of 82.6%. The sixth-hour H-FABP had a sensitivity of 33.3%, specificity of 73.9%, PPV of 24.2% and NPV of 81.5%. Conclusion H-FABP is superior to myoglobin for diagnosing myocardial infarction in a joint group of STEMI and NSTEMI patients. The third-hour NPV value for H-FABP indicates that, for safety considerations, the cardiac observation time should not be shortened. (Hong Kong j.emerg.med. 2014;21:213-221)

Pharmacokinetics and pharmacodynamics of the myotoxic venom of Pseudechis australis (mulga snake) in the anesthetised rat

Context. Myotoxicity is a common clinical effect of snake envenoming and results from either local or systemic myotoxins in snake venoms. Although numerous myotoxins have been isolated from snake venoms, there has been limited study on the relationship between the time course of venom concentrations (pharmacokinetics) and the time course of muscle injury measured as a rise in creatine kinase (CK) (pharmacodynamics). Objective. The aim of this study was to develop an in vivo model of myotoxicity to investigate the time course of myotoxicity and the effect of antivenom. Materials and methods. Anesthetised rats were administered Pseudechis australis (mulga snake) venom either through i.v., i.m. or s.d. route, including a range of doses (5–100 μg/kg). Serial blood samples were collected for measurement of venom using enzyme immunoassay and measurement of CK and creatinine. Antivenom was administered before, 1 and 6 h after venom administration to investigate its effect on muscle injury. Plots of venom and CK versus time were made and the area under the curve (AUC) was calculated. Results. There was a significant dose-dependent increase in CK concentration after administration of P. australis venom, which was greatest for i.v. administration. Timed measurement of venom concentrations showed a rapid absorption through s.d. and i.m. routes and a delayed rise in CK concentrations following any route. Antivenom prevented myotoxicity shown by a decrease in the CK AUC, which was most effective if given earliest. There was a rise in creatinine following i.v. venom administration. Conclusion. The study shows the delayed relationship between venom absorption and the rise in CK, consistent with the delayed onset of myotoxicity in human envenoming. Antivenom prevented myotoxicity more effectively if given earlier.

AB0056 Correlation between Serum Levels of IL-15 and IL-17 in Patients with Idiopathic Inflammatory Myopathies

BackgroundThe pathogenesis of Idiopathic Inflammatory Myopathies (IIM), including Polymyositis (PM), Dermatomyositis (DM) and the specific phenotype called anti-synthetase syndrome (ASS), is not yet entirely understood. Recently, Interleukin-15 (IL-15) and IL-17...

Postconditioning Protects Skeletal Muscle Against a Long-Lasting Vascular Occlusion

ABSTRACTPurpose/Aim of the Study: Long-lasting lower limb arterial occlusion is a condition with high incidence and complication rates. With the absence of appropriate treatment to cure advanced complications, mortality rates are high. Postconditioning (PC) might be capable of limiting the degree of ischemic-reperfusion (IR) injuries, thus reducing complications and mortality rates. The aim of this study was to evaluate the impact of postconditioning during the first postoperative day on skeletal muscle after a long-lasting arterial occlusion. Materials and Methods: Male Wistar rats (n = 72) underwent 8 hr of infrarenal aortic occlusion followed by 2, 6, 12, or 24 hr of reperfusion. In one group of each reperfusion period, postconditioning was applied. Muscle samples were collected for histological examinations. Furthermore, muscle fiber viability and muscle wet-to-dry ratio were assessed. Blood samples were taken for creatine-kinase measurements. Results: Postconditioning strongly reduced morphological injury compared to the corresponding ischemic-reperfusion group (p < .001). Serum creatine-kinase levels showed a peak at 6 hr post-ischemia (IR: 6702.2 ± 797.5; PC: 5523.3 ± 769.3 IU/l) and decreased to normal level by the end of the experiment (Sham: 171.5 ± 71.6; IR: 186.2 ± 82.7; PC: 174.2 ± 72.4 IU/l). Creatine-kinase levels were significantly reduced by postconditioning (p2hr = .028; p6hr = .06; p12hr = .042). A marked decrease in viability was observed in the ischemic-reperfusion groups (2 hr: 11.0 ± 4.1; 6 hr: 10.3 ± 3.6; 12 hr: 9.4 ± 3.3; 24 hr: 8.6 ± 2.8%), whereas with postconditioning, viability was preserved (2 hr: 26.4 ± 5.5; 6 hr: 24.6 ± 4.5; 12 hr: 24.5 ± 6.8; 24 hr: 26.2 ± 6.1%; p < .001); moreover, a significant decrease in the wet-to-dry ratio was achieved (p < .001). Conclusion: Postconditioning was able to reduce local complications after a long-lasting lower limb vascular occlusion.

Serum Transaminases Are Frequently Elevated at Time of Diagnosis of Idiopathic Inflammatory Myopathy and Normalize With Creatine Kinase

Despite multiple reports of elevated transaminases in muscle injury, aspartate aminotransferase (AST) and alanine aminotransferase (ALT) are not always considered indicators of muscle damage. The purpose of this study was to examine the relationship between serum AST, ALT, and creatine kinase (CK) levels at time of diagnosis of idiopathic inflammatory myopathy (IIM) and at the time of CK normalization. We conducted a retrospective chart review of all adult patients attending rheumatology clinics at a county hospital with a diagnosis of IIM. Data collected included patient demographics, serial CK measurements, and serial serum transaminase measurements. We identified 85 patients with IIM. At myositis presentation, 75 (88%) had CK above the upper limit of normal (ULN), 72 (85%) had AST above the ULN, and 68 (80%) had ALT above the ULN. The average CK was 5302 U/L (range, 23-38,461 U/L [SD, 7096]), average AST 215 U/L (range, 16-1270 [SD, 227]), and average ALT 137 U/L (range, 10-621 [SD, 137]). The average AST and ALT at first available normalized CK was 26 U/L (range, 9-139 [SD, 18]) and 26 U/L (range, 5-96 [SD, 19]). We found a strong correlation between CK and AST (r= 0.832; P < 0.001) and ALT (r = 0.775; P < 0.001) at initial presentation and also at the time of peak CK levels (r = 0.874 [P < 0.001] and r = 0.842 [P < 0.001], respectively). In our series, we found a strong correlation between CK and serum transaminases. Serum transaminases were elevated in 80% of patients at the time of presentation and normalized in 85% of the patients at the time of CK normalization. Appropriate recognition of these laboratory changes in IIM may help reduce unnecessary hepatic evaluation, delayed diagnosis, unnecessary avoidance of second line immunosuppressants, and misdiagnosis of primary liver disease.