Serum CK Levels Research Articles

Unusual presentation of PYGM gene mutation as late-onset McArdle disease with camptocormia: a case report

BackgroundGlycogen storage disease type 5 (McArdle disease) leads to a deficiency in the activity of myophosphorylase resulting in an impaired glucose utilization. The disease can be caused by a variety of mutations in the PYGM gene, and its typical clinical manifestation is muscles weakness within the first three decades of life.Case presentationIn this case report we present the diagnostic work-up of a physically active 78-year-old Caucasian patient suffering from a 2-year history of progressive camptocormia including clinical, radiologic, histological, and genetic tests. There was no history of neuro-muscular diseases in the family. Serum CK levels were moderately increased while other blood/urine parameters were normal. Magnetic resonance imaging showed fatty remodeling of the muscles of the back. Histochemical examination of a muscle biopsy revealed the absence of myophosphorylase activity, while gene analysis identified a known early-onset McArdle mutation in the PYGM gene.ConclusionThis case highlights that the clinical spectrum of PYGM gene mutation typically manifest during adolescence, but it is also a differential diagnosis in late onset muscle disorders and emphases the investigation of the role of ACE inhibitors in this disease.

Should Serum Levels of Creatine Kinase be Evaluated in Patients with Acne Vulgaris Treated with Systemic Isotretinoin

The laboratory tests that should be performed and their frequency during isotretinoin treatment are controversial. We wanted to investigate muscle and joint pain and laboratory tests in acne patients who received isotretinoin. Between April 2019 and February 2023, serum CK, AST, ALT, and GGT levels were retrospectively evaluated in acne patients before and three months after systemic isotretinoin treatment. This study included 410 patients. The median serum AST, ALT, and GGT levels significantly increased, whereas serum CK levels were similar in all patients three months after treatment. 23 (5.6%) patients revealed muscle or joint pain after treatment. No significant difference was detected in patients with or without pain in the median serum CK, AST, ALT, and GGT levels after treatment. Isotretinoin treatment at a dose of 10 mg/day was more common in patients with pain than in those without pain, whereas none of the patients who received isotretinoin 40 mg/day developed muscle or joint pain. We suggest that routine evaluation of serum CK levels is unnecessary in acne patients treated with isotretinoin. However, muscle and joint pain may develop even at doses as low as 10 mg/day. Furthermore, monitoring AST, ALT, and GGT levels may be beneficial in acne patients treated with isotretinoin.

Clinical Features in Boys with Duchenne/Becker Muscular Dystrophy: A Tertiary Center Experience

Background: Dystrophin-related muscular dystrophies are a group of diseases caused by mutations in the dystrophin gene that are inherited in an X-linked recessive manner. Objectives: We aimed to discuss the clinical, laboratory, genetic, treatment, and prognostic features, as well as diagnostic clues, of our DMD/BMD patients. Methods: The medical records of 39 children who were followed up with DMD/BMD diagnoses at Bursa Uludağ University Faculty of Medicine Child Neurology Clinic between August 2018 and September 2023 were evaluated retrospectively. DMD or BMD is diagnosed by genetic testing or muscle biopsy. Results: All patients were male, and the age of symptom onset was 3.44 ± 2.7 years (range: 1 - 12.2 years). Twenty-two cases were symptomatic, presenting with difficulty walking (N = 17), difficulty climbing stairs (N = 14), and getting tired quickly (N = 11). Seventeen cases were initially asymptomatic, identified through elevated CK, AST, and ALT levels. Conclusions: Early recognition that increased serum transaminase and CK levels reflect muscle disease accelerates the diagnosis of underlying conditions and protects patients from unnecessary, invasive, and costly diagnostic testing.

Deletion of Dux ameliorates muscular dystrophy in mdx mice by attenuating oxidative stress via Nrf2.

DUX4 has been widely reported in facioscapulohumeral muscular dystrophy, but its role in Duchenne muscular dystrophy (DMD) is unclear. Dux is the mouse paralog of DUX4. In Dux-/- mdx mice, forelimb grip strength test and treadmill test were performed, and extensor digitorum longus (EDL) contraction properties were measured to assess skeletal muscle function. Pathological changes in mice were determined by serum CK and LDH levels and muscle Masson staining. Inflammatory factors, oxidative stress, and mitochondrial function indicators were detected using kits. Primary muscle satellite cells were isolated, and the antioxidant molecule Nrf2 was detected. MTT assay and Edu assay were used to evaluate proliferation and TUNEL assay for cell death. The results show that the deletion of Dux enhanced forelimb grip strength and EDL contractility, prolonged running time and distance in mdx mice. Deleting Dux also attenuated muscle fibrosis, inflammation, oxidative stress, and mitochondrial dysfunction in mdx mice. Furthermore, Dux deficiency promoted proliferation and survival of muscle satellite cells by increasing Nrf2 levels in mdx mice.

The first reported familial case of statin-induced immune-mediated necrotizing myopathy associated with anti-hydroxy-3-methylglutaryl-CoA reductase autoantibodies and HLA DRB1*11:01

ABSTRACT Immune-mediated necrotizing myopathy (IMNM) is a rare type of auto-immune myositis, characterized by symmetric muscle pain, proximal weakness, elevated serum CK levels and pathologic findings of necrotized muscle fibers. IMNM may be seronegative, associated with anti-signal recognition particle (SRP) antibodies or anti-hydroxy-3-methylglutaryl-CoA reductase (HMGCR) antibodies, the last widely related with statin use. This last entity affects only 2 to 3 of 100,000 patients under statins. Recently, patients carrying the class II human leukocyte antigen (HLA) DRB1*11:01 were identified to be more at risk to present IMNM with anti-HMGCR antibodies. We describe the case of a daughter and father diagnosed with HMGCR-IMNM and both carrying HLA DRB1*11:01. To our knowledge, it is the first familial case reported in the literature.

Creatine kinase serum levels in children revisited: New reference intervals from a large cohort of healthy children and adolescents

BackgroundCreatine Kinase (CK) has become increasingly important in pediatrics as a commonly used laboratory screening parameter for neuromuscular diseases. Recent research suggests that hyperCKemia in children is not always associated with pathology and can occur due to several reasons. Little is known of various clinical factors that may influence CK throughout child development. ObjectiveThis study aimed to establish reliable age- and sex-specific reference ranges for serum CK levels in healthy infants, children, and adolescents. In addition, the effect of puberty, oral contraceptive (OC) use as well as steroid hormones on CK was examined. Materials and methodsThe data was collected from subjects of the longitudinal population-based “LIFE Child”-cohort between 2011 and 2016 in Leipzig, Germany. 5238 blood samples of 2707 healthy children, aged between 0.14 months and 18 years, were analyzed. ResultsSerum CK levels raised during the first year of life, peaking shortly after age one (P50girls = 2.7 µkat/L, P50boys = 2.90 µkat/L). There was a pronounced difference in the 97.5th percentile between boys and girls during adolescence with its maximum at age 18 (P97.5girls = 5.74 µkat/L, P97.5boys= 14.48 µkat/L). Also, mean CK serum levels were significantly higher in boys (bboys = 0.29, pboys < 0.001). Intake of oral contraceptives (OC), extreme underweight, underweight and obesity revealed a significant inverse correlation with CK serum levels. ConclusionAge, sex, OC intake and weight status affect serum CK levels, particularly during infancy and puberty. We recommend the use of age- and sex-specific reference values for CK serum levels to assess the clinical relevance of measurements.

Congenital Myasthenic Syndromes

Congenital myasthenic syndromes (CMS) are characterized by congenital defects in the neuromuscular signal transmission and are caused by pathogenic variants in 36 genes. Recently identified forms of CMS include TOR1AIP1-CMS, CHD8-CMS, PURA-CMS, and TEFM-CMS. Most forms of CMS are caused by autosomal recessive variants, whereas four forms of CMS are caused by autosomal dominant variants, in which adult-onset cases are not rare. As myasthenic features are not always observed and muscle hypotrophy is sometimes observed, CMS should be considered in differential diagnosis of congenital myopathies and other neuromuscular diseases. Low- and high-frequency repetitive nerve stimulation is essential to diagnose CMS for patients who develop muscle weakness at less than 2 years of age. Tubular aggregates are observed in muscle biopsy in four forms of CMS, and serum CK levels are elevated in some forms of CMS. As rational therapies are available for most forms of CMS, identification of causative gene variants by genetic analysis is required.

Sunitinib induces cardiotoxicity through modulating oxidative stress and Nrf2-dependent ferroptosis in vitro and in vivo

SUN, a multi-targeted tyrosine kinase inhibitor, exerts cardiotoxicity which hinders its clinical use. It is necessary to elucidate molecular mechanism of SUN-induced cardiotoxicity. To elucidate molecular mechanism of SUN-induced cardiotoxicity and whether it is related to Nrf2-dependent ferroptosis, in vitro model with H9c2 cells derived from rat heart tissue and in vivo model (C57BL/6J male mouse) were used in the present study. In vivo model was established by oral treatment of SUN at dose of 10, 20, 40 mg/kg for 14 days. Body weight, ECG, plasma enzyme activities, histology staining were performed to evaluate heart function. Western-blot was performed to analyze the level of ferroptosis-related proteins. In vitro results indicated that SUN markedly induced ferroptosis embodied as collapsed MMP, accumulated iron and elevated ROS. In vivo results showed that SUN significantly impaired cardiac function. Abnormal electrocardiogram, increased serum CK and lactate LDH levels were significantly observed in SUN groups. Histology staining showed that SUN caused structural injuries and fibrosis deposition. Moreover, SUN increased the level of MDA and Fe2+ content, decreased the level of GSH. Both in vitro and in vivo experiments indicated that SUN reduced the expression of Nrf2, HO-1, NQO1, GPX4 and FTH1, enhanced the TfR expression. This study suggested that oxidative stress and Nrf2-dependent ferroptosis played a vital role in SUN-induced cardiotoxicity.

What should we expect when two myositis-specific antibodies coexist in a patient

BackgroundThe coexistence of two myositis-specific autoantibodies (MSA) is considered extremely rare. We describe three patients with both anti-signal recognition particle (SRP) antibodies and another MSA in serum.MethodsWe performed a retrospective clinical data collection and follow-up studies of the clinical manifestations and treatment outcome of three patients positive with anti-SRP antibodies and other MSAs. IgG antibodies against MSAs were detected using commercial line immunoblot assay.ResultsThe tests of MSA showed positive result of anti-SRP antibodies and another one MSA including anti-TIF1-γ, anti-Jo1, or anti-EJ antibodies, respectively. The proximal muscle weakness appeared in 2 patients; interstitial lung disease presented in 2 patients. The serum CK level was elevated in 1 patient. The muscle biopsy showed necrotizing myopathy in 1 patient and deposition of membrane attack complex on scattered myofibers in the other one patient. One of the two patients with interstitial lung disease died because of respiratory failure. One patient had completely improved and the other one showed partial remission after immunosuppressive therapy.ConclusionsThe patients with anti-SRP antibodies co-occurred with the other MSA may have various clinical characteristics. The clinicopathological phenotypes of these patients seem to be mainly caused by one of the MSAs, namely the responsible antibody.

The anti-myotoxic effects and mechanisms of Sinonatrix annularis serum and a novel plasma metalloproteinase inhibitor towards Deinagkistrodon acutus envenomation

Non-venomous snakes commonly evolve natural resistance to venom to escape predators. Sinonatrix annularis serum has been shown to inhibit Deinagkistrodon acutus venom-induced hemorrhage and upregulation of serum CK, CK-MB, LDH, AST and ALT levels. Using TMT-labeled proteomics analysis, 168 proteins were found to be altered significantly in the envenomed gastrocnemius muscle and categorized into pathways such as complement and coagulation cascades, leukocyte transendothelial migration, and JAK/STAT signaling. These alterations were mitigated by S. annularis serum. Subsequently, a novel metalloproteinase inhibitor, SaMPI, was isolated from S. annularis serum by two-step chromatography. It showed strong antidotal effects against D. acutus envenomation, including inhibition of subcutaneous bleeding caused by crude venom and DaMP (a metalloproteinase derived from D. acutus) activity in a 1:1 ratio. Histology and immunoblotting analyses demonstrated that SaMPI mitigated myonecrosis, reduced neutrophil infiltration and local inflammatory factor release, and retarded JAK/STAT and MAPK signaling activation. Analysis of the SaMPI gene cloned by 5′-RACE revealed a shared sequence identity of 58–79% with other SVMP inhibitors. These findings demonstrate the protective effects of SaMPI and indicate its potential value as a candidate for viper bite adjuvant therapy.

Clinical and Laboratory Findings on Glycogen Storage Disease Type V: Results from a Retrospective Observational Study in a Tertiary Hospital.

Introduction - Glycogen storage disease type V (GSDV, MIM #232600) is an autosomal recessive metabolic myopathy caused by pathogenic variants in the PYGM gene. The characteristic symptoms of exercise intolerance, myalgia, and cramps, which improve after a few minutes of rest, are frequently unrecognized in affected children. When there is clinical suspicion, the initial approach with a forearm exercise test has diagnostic value by detecting low post-exercise plasma lactate-to-ammonia ratio values. The diagnostic algorithm is followed by genetic testing if the results suggest myophosphorylase deficiency. Methods - This was a retrospective observational study conducted based on reviewing medical records of patients with GSDV in a tertiary hospital. We assessed demographic variables, including the timing of onset and diagnosis, relevant clinical characteristics, and whether genetic testing was performed, including its results. Results/Case Report - Our goal was to review the GSDV cases in our center to assess our cohort's diagnostic timing and clinical and genetic characteristics. We identified 28 patients from 24 families, three with consanguinity. The mean age at the time of the study was 43 years. While most (26/28; 93%) recalled their first symptoms in childhood/adolescence, only 25% (7/28) were diagnosed then. All patients had exercise intolerance and CK elevation, while about half reported the second wind phenomenon. Genetic testing was performed in 22 patients, revealing biallelic PYGM variants (9 homozygous, 13 compound heterozygous) as the most common (p.R50*). Conclusion - GSDV is rare and presents in the pediatric age, with subtle manifestations often underestimated for decades. A late diagnosis may negatively impact the psychosocial development of affected children. It is essential to recognize some unique features that facilitate diagnosis: history of exercise intolerance, the second wind sign, and high resting serum CK levels. Identifying the disease-causing variants in PYGM is currently the gold standard for diagnosis as it is less invasive than performing a muscle biopsy, and may promptly diagnose the condition and avoid wrongful labelling of patients.

Anti-fatigue effect of ferulic acid in exercise trained mice

Ferulic acid (FA) was proved to have various pharmacological characteristics in muscle function. Fatigue is closely linked with muscle dysfunction. However, the correlation between fatigue and FA is unclear. Hence, our aim was to appraise anti-fatigue property of FA in exercise trained mice. Our results displayed FA enhanced exhaustion time and grip strength to postpone fatigue. In excessive exercise, FA reduced serum CK, LDH, ALT and AST levels to protect against liver and muscle damage. In liver and muscle, FA improved glycogen contents to increase substance of energy source. In skeletal muscle, FA restrained oxidative stress by accelerating SOD, CAT and GSH-PX activites, and mitigating MDA level. Moreover, FA also attenuated inflammatory response by decreasing TNF-a and IL-6 levels. Lastly, FA ameliorated energy metabolism by increasing Na+-K+-ATPase and SDH activities. In conclusion, FA protected against excessive exercise-fatigue through improvement of energy supply, oxidative stress, inflammatory response and energy metabolism-correlated enzymes.

Irbesartan has a curative effect on lipopolysaccharide-induced cardiotoxicity by antioxidant and antiapoptotic pathways

Introduction and ObjectiveLipopolysaccharide (LPS) has been associated with myocardial inflammation, oxidative stress, apoptosis, and cardiac dysfunction, as well as death by causing sepsis. In this study, we investigated the effect of irbesartan (IRB), an angiotensin receptor antagonist, on cardiotoxicity caused by LPS. MethodsThe experiment involved 24 Wistar albino rats divided into three groups of eight: control, LPS (5 mg/kg), and LPS (5 mg/kg)+IRB (3 mg/kg). Parameters including total oxidative status, total antioxidant status, oxidative stress index, and ischemia-modified albumin were measured to assess oxidative stress in heart tissues and serum. Serum CK, CK-MB, and LDH levels were measured spectrophotometrically. RT-qPCR was used to detect the mRNA expression levels of Bcl-2, BAX, p53, caspase-3, and sirtuin 1. Tissues taken from the heart and aorta were examined by immunohistochemistry and histopathology. ResultsWhile there was an increase in the parameters indicating heart damage, oxidative stress, and apoptosis in the group given LPS, there was an improvement in all parameters and heart damage in the group treated with IRB. ConclusionAs a result of our study, we determined that IRB has an ameliorating effect on myocardial damage caused by oxidative stress and apoptosis developed by the LPS-induced sepsis model.

Investigation of the biochemical and histopathological effects of vitamin C, selenium, and therapeutic ultrasound on muscle damage in rats.

Muscle injury is a common type of soft tissue injury. Increased oxidative damage has been reported after muscle injuries. Therapeutic ultrasound is commonly used for such injuries. This study compared the efficacy of therapeutic ultrasound treatment and various antioxidant agents in experimental muscle injuries. For this purpose, some serum enzymes, oxidative stress, and inflammatory markers were evaluated together with histopathological examinations. Six groups were formed with 6 male Wistar albino rats in each group. These groups were control, only injury (OI), ultrasound (U), vitamin C (Vit C), selenium (S), and mixture (M). Muscle injury was caused by a laceration of the gastrocnemius muscle in all groups except the control group. No treatment was performed in the OI group. At the end of the 6-day application, all rats were sacrificed. As for serum enzymes, CK, ALT, and AST levels returned to control values in almost all treatment groups. Total oxidative status (TOS) and oxidative stress index (OSI) increased in the OI group, while they decreased in the S and M groups. In addition, the decrease in MPO activity in the blood tissue of the Vit C group was statistically significant. There were no significant changes between groups in terms of serum inflammatory markers and histological findings. This study has shown that the ingestion of vitamin C and selenium may contribute to the treatment of muscle injury in addition to therapeutic ultrasound treatment. However, further studies are needed to support these results.

Creatine Kinase in SARS-CoV-2-Related Encephalopathy as a Prognostic Biomarker for Post-Acute Sequelae of COVID-19 (PASC) (P9-8.014)

<h3>Objective:</h3> To investigate whether creatine kinase is a prognostic factor in SARS-CoV-2 related encephalopathy in development of PASC. <h3>Background:</h3> Elevated CK levels have been demonstrated as a poor prognostic factor of outcomes in acute COVID-19 infection but its role as a marker of PASC is unclear. <h3>Design/Methods:</h3> A retrospective chart review was performed on hospitalized encephalopathic patients who developed COVID-19 infection during March-May of 2020 at an urban tertiary care center. Patients were divided into two subgroups according to elevated CK levels (E-CK) vs non-elevated CK levels (N-CK) with elevated defined as &gt;200 u/L. Charts were analyzed for patients who had follow-up between 4 weeks and 1 year from initial visit to analyze subsequent development of new or persisting respiratory, cardiac, renal, or neurological symptoms to determine incidence of PASC. <h3>Results:</h3> Of the 43 encephalopathic COVID-19 infection patients reviewed, 25 and 18 patients were found to be in the E-CK and N-CK groups, respectively (average serum CK level of 1485 u/L vs 87.11 u/L, p = 0.0026). Among the E-CK group, 14 patients (56%) had follow-up at least 4 weeks post admission in the outpatient setting vs 13 patients (72.22%) in the N-CK group (p &gt; 0.05), with an average total follow up time of 477.37 days post initial admission in the E-CK group and 466.7857 days for N-CK (p &gt; 0.05). In the follow-up E-CK group, 6 patients (42.85%) reported any one of the PASC symptoms whereas in the follow-up N-CK group, 9 patients (69.23%) reported any one of the PASC symptoms. (RR = 0.73, 95% CI [0.32–1.69], p = 0.47). <h3>Conclusions:</h3> Encephalopathic patients who had elevated CK levels on COVID-19 infection admission did not have an increased risk of developing PASC. Work is in progress to confirm these findings by expanding sample size, increasing follow up time, and stratifying for confounding factors. <b>Disclosure:</b> Ms. Faiz has nothing to disclose. Miss Jaffry has nothing to disclose. Ms. Mandava has nothing to disclose. Mr. Jaffry has nothing to disclose. Mr. Trivedi has nothing to disclose. Mr. Mandava has nothing to disclose. Miss Shaikh has nothing to disclose. Mr. Jaffry has nothing to disclose. Mr. Ors has nothing to disclose. Dr. Surathi has nothing to disclose. Dr. Tofade has nothing to disclose. Mr. Huff has nothing to disclose. Dr. Redko has nothing to disclose. Dr. Souayah has received publishing royalties from a publication relating to health care.

Clinical significance of anti-NT5c1A autoantibody in Korean patients with inflammatory myopathies.

To explore the clinical significance of anti-cytosolic 5'-nucleoditase 1A (NT5c1A) antibody seropositivity in inflammatory myopathies, we measured anti-NT5c1A antibodies and analyzed their clinical features. Anti-NT5c1A antibodies were measured in the sera of 103 patients with inflammatory myopathies using an enzyme-linked immunosorbent assay. Positivity for anti-NT5c1A antibody was found in 13 (12.6%) of 103 patients with inflammatory myopathy. Anti-NT5c1A antibody was most frequently identified in patients with inclusion body myositis (IBM) (8/20, 40%), followed by dermatomyositis (2/13, 15.4%), immune-mediated necrotizing myopathy (2/28, 7.1%), and polymyositis (1/42, 2.4%). In eight patients with the anti-NT5c1A antibody-seropositive IBM, the median age at symptom onset was 54 years (interquartile range [IQR]: 48-57 years), and the median disease duration was 34 months (IQR: 24-50 months]. Knee extension weakness was greater than or equal to hip flexion weakness in eight (100%) patients, and finger flexion strength was less than shoulder abduction in three (38%) patients. Dysphagia symptoms were found in three (38%) patients. The median serum CK level was 581 IU/l (IQR: 434-868 IU/L]. Clinically significant differences were not found between anti-NT5c1A antibody-seropositive and seronegative IBM groups with respect to gender, age at symptom onset, age at diagnosis, disease duration, serum CK values, presence of other autoantibodies, dysphagia, and the pattern of muscle impairment. Although anti-NT5c1A antibody is known to be associated with IBM, seropositivity has also been noted in non-IBM inflammatory myopathies, and is insufficient to have clinical significance by itself. These findings have important implications for interpreting anti-NT5c1A antibody test results as the first study in Korea.

Duchenne Muscular Dystrophy in Kazakhstan: A Journey from Diagnosis to the Treatment, the Biases and Achievements.

Neuro-muscular disorders constitutes a group of rare but heterogeneous conditions. The onset of these diseases ranges widely from birth to elderly. Many of them are life threatening and progressive. Neuromuscular science is a very specialised medical field for which specific knowledge and expertise are necessary. Such an expertise is available only partially in Kazakhstan where underdiagnosis, misdiagnosis and mismanagement of patients with muscle diseases are commonplace. Hopefully, times are changing. With the implementation of international guidelines for the diagnosis and treatment of Duchenne Muscular Dystrophy (DMD), patients are now given better care including pharmacological interventions (including steroids in DMD), respiratory and nutritional support. To report on clinical data and genetic variants in a nationwide cohort of DMD patients. To describe and analyse management strategies applied in Kazakhstan in these patients. The medical records of 84 patients recruited by the national expert-consulting board based at the national multidisciplinary centre of reference in neuro-muscular disorders in Astana, Kazakhstan, have been ascertained for the study. The national expert committee meets monthly to decide over the prescription of disease-modifying therapies in paediatric neuromuscular disorders. Data on the age of disease onset, the age at genetic testing, spectrum of genetic variants, the stage of disease and the serum CK levels have been collected.ResultsThe mean age of 84 examined patients was 10 years. In Kazakhstan, the average age of disease manifestation was 3 years and 3 months. The vast majority of patients passed through genetic test due to the clinical manifestations. The average age of genetic confirmation was 7 years and 6 months. There were 58,33%of gross variations, of which 55,95%were deletions and 2,38%were duplications. Nonsense mutations were identified in 29,7%. The authors contend that strictly keeping the clinical guides in the diagnosis of DMD is essential, as the genetic variations may affect the stage and feasibility of novel therapies. The way of management of neuro-muscular diseases used in Kazakhstan is strictly recommended for implementation in developing countries.

The Influence of Percutaneous Endoscopy-Assisted Transforaminal Lumbar Decompression and Fusion in the Treatment of Single-Level Lumbar Spinal Stenosis on Multifidus Muscle from the Perspective of Traditional Chinese Medicine

Objective: To analyze the effect of percutaneous endoscopy assisted transforaminal lumbar spinal stenosis on multiissuis. Methods: Ten patients of single-segment lumbar spinal stenosis were selected from January 2020 to January 2021. All patients were treated with percutaneous endoscopic-assisted transforaminal lumbar decompression and fusion. Postoperative basic information was recorded, comparing efficacy related indicators before and after surgery, and lumbar polyfiis injury before and after surgery. Results: All patients completed the operation successfully, with no symptom aggravation or recurrence, and no serious complications. VAS score and VAS score of leg pain at 7d, March and June, and ODI level at 3 and June were significantly better than those before surgery, with P &lt;0.05. In terms of patient serum CK level, postoperative 1d was significantly higher than preoperative, P &lt;0.05, and no significant difference between postoperative 7d, P&gt; 0.05. In Max-CSA, postoperative 7d was significantly greater than preoperative, P &lt;0.05; no significant difference between postoperative March and June months compared with preoperative, P&gt; 0.05. In terms of patient PI level, postoperative 7d was significantly greater than preoperative, with P &lt;0.05, neither postoperative March nor June months were significant compared with preoperative difference, with P&gt; 0.05. Conclusion: From the perspective of traditional Chinese medicine, the application of percutaneous endoscopy-assisted transforaminal lumbar decompression and fusion in the treatment of single segment lumbar spinal stenosis can achieve good early effect, and will not have a significant impact on the changes of polyfiis morphology and blood perfusion.

Value of 3D ultrasound flow imaging combined with serum AFP, β-hCG, sFlt-1 and CK in the diagnosis of placenta accreta

PurposeTo analyze the diagnostic value of placenta three-dimensional (3D) energy blood flow parameters combined with maternal serum AFP, β-hCG, sFlt-1 and CK levels for PA.Methods30 pregnant women with PA and 30 pregnant women with normal placenta were randomly selected in the Affiliated Maternal and Child Health Hospital of Nantong University from January 2021 to December 2021. Thereafter, the 3D energy ultrasound was applied to detect the placenta VI, FI and VFI. Moreover, the diagnostic value of different parameters combined with serum AFP, β-hCG, sFlt-1 and CK levels for PA was analyzed.ResultsMultivariate analysis results indicated that, gravidity > 2 and with/without placenta previa were the independent risk factors for PA (P < 0.05). In PA group, the AFP, β-hCG, CK, placenta VI, FI and VFI values were higher than those in non-PA group, while sFlt-1 was apparently lower than that in non-PA group. With the increase in PA degree, the serum AFP, β-hCG and CK levels increased. Meanwhile, serum sFlt-1 level was negatively correlated with PA degree. Serum AFP, β-hCG, sFlt-1, CK and placenta VFI showed prediction potency for PA, and their combined detection attained the optimal diagnostic value for predicting PA. ROC curve analysis suggested that, serum AFP, β-hCG, sFlt-1, CK and 3D ultrasound VFI value had the greatest AUC values in predicting PA, which might provide reference for the clinical diagnosis and disease evaluation of PA. Conclusion Serum AFP, β-hCG, sFlt-1, CK and placental VFI can increase the consistency in the diagnosis of PA. Serum markers combined with 3D ultrasound blood flow imaging can improve the sensitivity and specificity of prenatal diagnosis of PA, which provides an important reference for clinical diagnosis and treatment.

P.89 Immune-mediated necrotizing myopathy associated with anti-SRP Antibodies: Three cases in Korea

Immune-mediated necrotizing myopathy associated with anti-SRP antibodies (anti-SRP myopathy) is characterized by progressive proximal muscle weakness and markedly elevated creatinine kinase (CK. Here, we report the clinical features of three Korean patient with anti-SRP myopathy. A 63-year-old man presented with progressive proximal muscle weakness and dysphagia. He showed symmetrical proximal weakness. The serum CK was 5,560U/L. The muscle biopsy of the biceps brachii showed mild muscle fiber size variation and a few degenerating muscle fibers. Muscle weakness and dysphagia improved after using steroids and azathioprine, but gradually worsen. At the last follow-up study, serum CK was 1,252 IU/L and the serum anti-SRP antibody was positive. A 46-year-old man was referred to our clinic due to progressive proximal muscle weakness. The serum CK was 6,114 U/L. The muscle biopsy of the vastus lateralis muscle showed marked size variation in muscle fibers and many necrotic fibers. Steroid pulse therapy lowered serum CK level, but muscle weakness did not improve. The serum anti- SRP antibody was positive. After the diagnosis, steroid, methotrexate, and intravenous immunoglobulin were used, but his muscle strength did not improve significantly. 43-year-old woman presented with proximal muscle weakness and elevated serum CK level. The serum CK was greater than 13,000 U/L. Needle EMG showed active generalized myopathy. The muscle biopsy of vastus lateralis muscle revealed a few necrotic fibers without endomysial inflammatory cell infiltration. The serum anti-SRP antibody was positive. After steroid pulse therapy, her muscle weakness did not improve and dysphagia was newly developed. She was currently treated with steroid and azathioprine. Anti-SRP myopathy is one of the most disabling and less responsiveness to treatment and we would like to report cases have rarely been reported in Korea.