Serum Creatinine Phosphokinase Research Articles

Effects of statin use on serum creatinine phosphokinase levels in normal thyroid function.

Statins are common lipid-lowering agents used in dyslipidemia. However, they increase serum creatinine phosphokinase (CPK) levels. Currently, there are no studies on the effect of thyroid-stimulating hormone (TSH) levels on CPK levels after statin administration. Therefore, this study aimed to investigate CPK level alterations after statin administration according to TSH quartiles in participants with euthyroidism. This retrospective analysis included 25,047 patients with euthyroidism. CPK levels were measured before and 6 months after statin administration. Normal TSH levels were divided into four quartiles, and the CPK levels and proportions of patients with normal CPK levels after statin administration for each TSH quartile were evaluated. The baseline CPK level was significantly higher in the lowest TSH quartile (Q1) compared to the other quartiles but decreased after statin administration. Thus, the difference between the CPK levels and the other quartile groups was not significant. The proportion of patients with normal CPK levels was also significantly lowest in Q1 before statin administration; however, no significant difference was noted in the ratio among each group after statin administration. These findings were consistent with the findings of the analysis according to statin intensity. In patients in the lowest TSH quartile of the normal TSH range, the CPK level decreased, and the proportion of normal CPK levels increased significantly after statin administration. However, similar changes were not observed in other TSH quartiles. Therefore, further studies are required to mechanistically confirm these conclusions.

Impacts of Serum Creatinine Phosphokinase on Heart, Diabetes and Anaemia Patients

Impacts of Serum Creatinine Phosphokinase on Heart, Diabetes and Anaemia Patients

Usefulness of Ultrasound Shear Wave Elastography for Detection of Quadriceps Contracture in Immobilized Rats.

Quadriceps contracture is an abnormal pathological shortening of the muscle-tendon unit. To improve the prognosis of quadriceps contracture, improvement of its diagnostic method is needed. In this study, we evaluated the diagnostic utility of ultrasound shear wave elastography in a rat model of quadriceps contracture induced by immobilization. Fifty Wistar rats were randomly divided into control and immobilization groups. During up to 4 weeks of joint immobilization, the quadriceps elastic modulus, muscle hardness, creatinine phosphokinase levels, joint range of motion, histopathologic parameters, and levels of fibrosis-associated mRNA expression were measured every week in the immobilization and control groups and compared. In the immobilization group, the elastic modulus gradually but significantly increased (p < 0.05) throughout the immobilization period. However, muscle hardness and serum creatinine phosphokinase levels only increased at 1 and 2 weeks after the start of immobilization, respectively. Muscle atrophy and shortening progressed throughout the immobilization group. Collagen type I and III, α-SMA protein, and mRNA expression of IL-1β and TGF-β1 significantly increased (p < 0.05) throughout in the immobilization group. Ultrasound shear wave elastography is the most useful method for clinical assessment of muscle contracture.

Serum creatinine phosphokinase: A potential prognostic marker in assessing clinical severity with organophosphorus poisoning.

Organophosphorus compound (OPC) poisoning undoubtedly being a major concern in cultivation sites of the developing world, including Bangladesh. Two potential biomarkers, for example, serum creatine phosphokinase (CPK) and lactate dehydrogenase (LDH), are widely used in OPC poisoning severity indicators in patients. In this study, we sought to correlate the severity score of acute OPC poisoning with CPK or LDH level and subsequently explore their prognostic value. This study was performed on a total of 70 patients with OPC poisoning admitted to the inpatient care unit at a territory-based hospital in Bangladesh. Sociodemographics and poison types were recorded, and severity was assessed according to Peradeniya Organophosphorus Poisoning (POP) scale. Serum CPK and LDH levels were measured and recorded. A total of seventy OPC patients were included with male to female ratio of 1.33:1, respectively, with a mean age of 28.7 ± 12.8 years. Chlorpyrifos and methylparathion were the most commonly utilized OP compounds, accounting for 42.9% and 28.6%, respectively. Among the OPC patients, the majority were married homemakers from rural areas. According to POP score, 55.7% and 37.1% of patients were categorized as mild and moderate, whereas very few were found to be severe. The mean serum CPK and LDH of OPC-patients at admission time were 235.6 ± 79.8 IU/L and 348.3 ± 154.1 IU/L, respectively. Serum CPK, atropine dose and hospital stay strongly correlated with clinical severity. We conclude that the serum CPK level strongly correlates with the degree of OPC poisoning and can be used as a predictor of the clinical intervention approaches.

A STUDY ON BIOCHEMICAL PARAMETERS IN ASSESSING THE SEVERITY OF ACUTE ORGANOPHOSPHORUS POISONING

Objectives: Organophosphorus (OP) poisoning is an important global health issue with increasing mortality rate for every year particularly in developing countries since its overuse in agricultural activity. The present study was performed to analyze the clinical profile and biochemical parameters such as serum cholinesterase, serum creatinine phosphokinase (CPK), liver enzymes, serum amylase, lipase, serum k+, troponin, serum urea, and creatinine on day 1 for correlation with clinical severity of poisoning. Methods: A observational study was performed on 100 cases with OP poisoning at a tertiary care center. Peradeniya OP Poisoning Scale was applied to all cases at the time of admission and the severity was designated as mild, moderate, and severe taking into account 5 vital parameters such as miosis, fasciculations, respiration rate, bradycardia, and level of consciousness and data were statistically analyzed by SPSS. Results: Rise in clinical severity of poisoning and substantial reduction in the level of serum cholinesterase was observed. The mean serum CPK, troponin T (Trop T), amylase, lipase, bilirubin, aspartate aminotransferase, and alanine aminotransferase showed marked elevation according to the severity of OP poisoning. In addition, serum potassium levels showed decreased level as per the severity level. Conclusion: Initial serum cholinesterase and serum Trop T are strong predictors of the clinical severity of OP poisoning.

A machine learning approach for risk factors analysis and survival prediction of Heart Failure patients

In this study, we propose machine learning (ML) for risk factors analysis and survival prediction of Heart Failure (HF) patients using a survival dataset. Five supervised ML methods are applied to the dataset: Decision Tree (DT), Decision Tree Regressor (DTR), Random Forest (RF), XGBoost, and Gradient Boosting (GB) algorithms. We compare the applied algorithms’ performances based on accuracy, precision, recall, F-measure, and log loss value and show RF provides the highest accuracy of 97.78%. The analysis of the risk factors shows the most predictive features based on coefficients and feature importance. The top six risk factors for HF patients are serum creatinine (SC), age, ejection fraction (EF), platelets, creatinine phosphokinase (CPK), and SS (SS). Further analysis of these factors shows significant clustering of the features. The survival analysis finds that the increment of SC, age, and SS and the decrement of EF are the most significant risk factors for HF patients. Our results suggest that HF survival prediction is possible with higher accuracy using the proposed model. Our ML models are useful in clinical settings for screening patients with HF probability.

Assessment of Serum cholinesterase and Serum Creatinine Phosphokinase Levels in Organophosphorus Poisoning Patients at a Tertiary Care Centre of Northern India

Introduction: Poisoning with Organophosphorus compounds is an important global health problem, possibly the most common acute poisoning in developing countries. This study was done to correlate the severity of acute organophosphorus poisoning with serum cholinesterase and serum creatine phosphokinase level.Materials and Methods: A Prospective observational clinical study was done on 42 patients suspected of Organophosphorus poisoning of age &gt;15 years admitted to the emergency unit at a tertiary healthcare center in northern India. Serum cholinesterase levels and serum Creatinine phosphokinase levels were estimated at the time of admission in all patients and the severity of Organophosphorus poisoning was assessed according to Peradeniya Organophosphorous Poisoning (POP) Scale.Results: In this study, among 42 patients of acute organophosphorus poisoning 32(76.2%)were males and 10(23.8%) were females. Our study authors observed a significant correlation between the severity of poisoning categorized by the POP scale and the serum cholinesterase and Serum CPK level at the time of the patients’ initial presentation. Also found that there was a significant correlation between serum cholinesterase and serum CPK with the outcome of the patients.Conclusion: In our study severity as well as outcomes of OP poisoning was directly correlated with serum cholinesterase level and serum Creatinine phosphokinase.

AASLD practice guidance on drug, herbal, and dietary supplement-induced liver injury.

AASLD practice guidance on drug, herbal, and dietary supplement-induced liver injury.

Efficacy and Safety of SH-1028 in Patients With EGFR T790M-Positive NSCLC: A Multicenter, Single-Arm, Open-Label, Phase 2 Trial

IntroductionAs a novel third-generation EGFR tyrosine kinase inhibitor (TKI), SH-1028 (formerly oritinib) is developed to inhibit both sensitizing EGFR mutations and EGFR T790M mutation. MethodsThis was a multicenter, single-arm, open-label, phase 2 trial (NCT03823807). Eligible patients were those with advanced NSCLC with centrally confirmed EGFR T790M mutation who progressed after first- or second-generation EGFR TKIs or with primary EGFR T790M mutations. Each patient received SH-1028 tablets orally at 200 mg/d until disease progression or intolerable toxicity. Tumor response was evaluated every 6 weeks per the Response Evaluation Criteria in Solid Tumors, version 1.1. The primary end point was objective response rate by an independent review committee. The secondary end points were progression-free survival, overall survival (OS), disease control rate, safety, and so on. ResultsA total of 286 patients with EGFR T790M-positive advanced NSCLC were enrolled in this study, including 59 patients in part A (dose-verification study) and 227 patients in part B (second-line registration study). By data cutoff on September 17, 2021, the independent review committee–assessed objective response rate was 55.9% (95% confidence interval [CI]: 42.4–68.8) in part A and 60.4% (95% CI: 53.7–66.8) in part B. The median progression-free survival was 12.4 months (95% CI: 8.3–20.8) in part A and 12.6 months (95% CI: 9.7–15.3) in part B. The median OS was 26.0 months (95% CI: 23.3–not reached) in part A, and OS was immature in part B. Among the 286 patients, 44 of them experienced at least one grade 3 or higher treatment-related adverse event, with the most common ones as increased serum creatinine phosphokinase level (13 [4.5%]), diarrhea (six [2.1%]), and prolonged QT interval (three [1.0%]). Treatment-related skin rash was reported in 26 patients (9.1%), all grade 1 or 2. There was no interstitial lung disease reported in this study. ConclusionsSH-1028 is efficacious and tolerable in second-line treatment of patients with advanced NSCLC with positive EGFR T790M.

POS0841 HIGH-INTENSITY INDUCTION THERAPY COMBINING TOFACITINIB, RITUXIMAB, AND PLASMAPHERESIS IN RAPIDLY PROGRESSIVE INTERSTITIAL LUNG DISEASE ASSOCIATED WITH ANTI-MDA5 ANTIBODY POSITIVE DERMATOMYOSITIS

BackgroundRapidly progressive interstitial lung disease (RP-ILD) associated with anti-melanoma differentiation-associated protein 5 (MDA5) autoantibody (Ab) -positive dermatomyositis (DM) is one of the most life-threatening autoimmune conditions. The clinical course is very rapid, leading to death within three months after the onset of symptoms. Although triple therapy which consists of corticosteroids, cyclophosphamide, and tacrolimus has been considered as standard therapy and additional treatments including plasma exchange (PE) and rituximab (RTX) have been reported, the survival rate of patients with poor prognostic factors is still poor even if all of these treatments were applied. Recently, there exist increasing evidences regarding the efficacy of tofacitinib (TOF) in refractory DM. We have treated anti-MDA5Ab-positive RP-ILD with multiple poor prognostic factors with high-intensity induction therapy which combined triple therapy, PE, RTX, and TOF.ObjectivesThis study aimed to investigate the therapeutic efficacy of high-intensity induction therapy for patients with anti-MDA5Ab-positive RP-ILD with multiple poor prognostic factors.Methods31 patients who were diagnosed with anti-MDA5Ab-positive DM during 2014 to 2021 in our institution were included in this study. The clinical characteristics for poor prognosis were retrospectively analyzed, and the outcomes of high-intensity induction therapy were analyzed for the survival and adverse events.Results17 cases were treated before the introduction of TOF. Although triple therapy with RTX, PE, or intravenous immunoglobulin (IVIG) were used, eight out of 10 RP-ILD cases with a ferritin level &gt;400 ng/mL (range, 402.5-5,831; mean, 2,342 ± 2,069) died in median 2.5 months. Poor prognosis was predicted by followings; elevated levels of serum ferritin, lactate dehydrogenase, transaminases, creatinine phosphokinase, and C-reactive protein; decrease in platelets, serum albumin, and oxygen saturation; use of oxygen; higher age; shorter disease duration to admission. The addition of RTX and PE was not enough to control RP-ILD in anti-MDA5Ab positive DM, and prevention of the initial exacerbation of ILD following induction therapy was considered to be important. Based on these observations, high-intensity induction therapy was consisted as follows; triple therapy with decreasing the dose of methylprednisolone by half from 1g to 1 mg/kg, liposteroid to suppress macrophage activity, TOF, PE, and RTX. High-intensity induction therapy was applied in eight patients (ferritin levels; range, 412.2-7,095 ng/mL; mean, 3,558±3,152 ng/mL) with multiple poor prognostic factors described above. Although deaths at two months and eight months due to ILD were observed, significant improvement of survival was documented (Figure 1). Two patients in whom RTX was not initially administered, exacerbation of ILD was observed one month later, which prompted the use of RTX. Several adverse events were observed in high-intensity induction therapy. The most common events were reactivation of cytomegalovirus, meanwhile herpes zoster was not documented. Sustained leukocytopenia and thrombocytopenia were observed in three patients, and two patients developed thrombotic microangiopathy which led to the discontinuation of tacrolimus. Fungal infections in lung were also documented. These adverse events were controllable.Figure 1.ConclusionSignificant improvement of survival was observed in patients treated with high-intensity induction therapy. Meanwhile, stratification of patients for poor prognosis would be important.ReferencesNoneDisclosure of InterestsNone declared

Short- and Long-Term Recovery after Moderate/Severe AKI in Patients with and without COVID-19.

Severe AKI is strongly associated with poor outcomes in coronavirus disease 2019 (COVID-19), but data on renal recovery are lacking. We retrospectively analyzed these associations in 3299 hospitalized patients (1338 with COVID-19 and 1961 with acute respiratory illness but who tested negative for COVID-19). Uni- and multivariable analyses were used to study mortality and recovery after Kidney Disease Improving Global Outcomes Stages 2 and 3 AKI (AKI-2/3), and Machine Learning was used to predict AKI and recovery using admission data. Long-term renal function and other outcomes were studied in a subgroup of AKI-2/3 survivors. Among the 172 COVID-19-negative patients with AKI-2/3, 74% had partial and 44% complete renal recovery, whereas 12% died. Among 255 COVID-19 positive patients with AKI-2/3, lower recovery and higher mortality were noted (51% partial renal recovery, 25% complete renal recovery, 24% died). On multivariable analysis, intensive care unit admission and acute respiratory distress syndrome were associated with nonrecovery, and recovery was significantly associated with survival in COVID-19-positive patients. With Machine Learning, we were able to predict recovery from COVID-19-associated AKI-2/3 with an average precision of 0.62, and the strongest predictors of recovery were initial arterial partial pressure of oxygen and carbon dioxide, serum creatinine, potassium, lymphocyte count, and creatine phosphokinase. At 12-month follow-up, among 52 survivors with AKI-2/3, 26% COVID-19-positive and 24% COVID-19-negative patients had incident or progressive CKD. Recovery from COVID-19-associated moderate/severe AKI can be predicted using admission data and is associated with severity of respiratory disease and in-hospital death. The risk of CKD might be similar between COVID-19-positive and -negative patients.

Acute kidney injury following rhabdomyolysis due to multiple wasp stings

Wasp stings are a common form of envenomation in tropical countries. Multiple wasp stings may cause fatal complications such as anaphylactic reactions, intravascular hemolysis, rhabdomyolysis, acute kidney injury (AKI), or even death also. Here we report a 9-year-old boy who was admitted to a tertiary care hospital in Bangladesh with complaints of multiple wasp stings all over the body 15 days back. He had oliguria and generalized edema for 7 days. The urine test was negative for red blood cells and his renal function was gradually deteriorating. His serum creatinine phosphokinase was gradually rising. Intermittent hemodialysis through a central venous catheter was started immediately. Renal biopsy revealed myoglobin cast nephropathy. On the basis of history, clinical manifestations, and laboratory investigation, he was diagnosed as AKI following rhabdomyolysis due to multiple wasp stings. Clinical and biochemical picture started to improve including urine output was normalized on seventh day of post-admission. Timely initiation of dialysis and supporting therapy can improve renal survival in case of AKI due to wasp stings.

The effect of tourniquet on early postoperative quadriceps muscle wasting in ACL arthroscopic surgery

Background: The main goals of anterior cruciate ligament (ACL) reconstruction and rehabilitation are to reestablish knee function. Quadriceps weakness is one of the most important complications associated with ACL injury and represents a major rehabilitation challenge. This study is designed to test the early effect of tourniquet on muscle wasting and to differentiate weather it is because muscle disuse or injury. Methods: Twenty six male patients who submit to arthroscopic ACL reconstruction were randomly assigned to the use of an inflated (group T, n _ 13) or deflated (group NT, n _ 13) tourniquet. Patients with preoperative quadriceps wasting or abnormal electro conductive studies were excluded. The primary measures were thigh girth preoperatively and after two weeks, serum creatinine phosphokinase (CPK) preoperatively and one day postoperatively and electro conductive studies preoperatively and 1 month postoperatively. Results: Patients' mean age was comparable in both groups. There was a significant difference between T and NT groups in term of thigh girth, CPK and electro conductive studies. Mean thigh girth in T group was 2.6 ± 0.5 while in NT group 1.4 ± 0.5. Mean CPK in T group was 813 ± 149 while in NT group 520 ± 203. Mean femoral latency was 1.85 ± 0.4 in T group and 1 ± 0 in NT group; mean femoral conduction velocity was 1.77 ± 0.4 in T group and 1 ± 0 in NT group; mean muscle denervation was 1.92 ± 0.3 in T group and 1.54 ± 0.5 in NT group; mean motor unit number estimation was 1.9 ± 0.3 in T group and 1.5 ± 0.5 in NT group. Conclusion: This comparative study show that tourniquet play a significant role in direct muscle injury proved by measurement of postoperative CPK and thigh girth in T group comparing it with NT group.

Tamarindus indica. Linn leaves ameliorates experimental induced heart failure in Wistar rats

Cardiovascular diseases (CVDs) are highly prevalent in various countries, and heart failure accounts for the majority of deaths. The present study focuses on determining the protective effect of ethanol extract of leaves of Tamarindus indica (TIEE) by in vitro and in vivo methods. In vitro cardiotonic activity was determined using Langendorff's heart perfusion assembly. In vivo studies were performed using Doxorubicin (1.5mg/kg, i.p for sevendays) induced cardiotoxicity in rats. These animals were simultaneously treated with the TIEE at a low dose (200mg/kg, p.o), high dose (400mg/kg, p.o) and standard drug Digoxin (100μg/kg, p.o) for sevendays. At the end of the study, various parameters like electrocardiogram (ECG) recording, serum levels of serum glutamic pyruvic transaminase (SGPT), lactate dehydrogenase (LDH), creatinine phosphokinase (CPK), and presence of cardiac troponin (cTnI) were determined. Isolated hearts were subjected to histopathological studies. The TIEE at a concentration of 60μg/mL showed a significant cardiotonic effect in vitro that was evident by increased force of contraction, heart rate, and cardiac output. In vivo studies revealed that the TIEE decreased the prolongation of QT and RR interval of ECG, lowered the serum enzyme levels like LDH, CPK indicating cardiac protection, and the same was established by the absence of cTnI in blood. Histopathological examinations of heart tissue sections showed improved architecture in the treatment groups when compared with diseased groups. The study revealed the cardioprotective activity of T.indica leaf extract by both in vitro and in vivo methods.

Severe acute myopathy following SARS-CoV-2 infection: a case report and review of recent literature

BackgroundSARS-CoV2 virus could be potentially myopathic. Serum creatinine phosphokinase (CPK) is frequently found elevated in severe SARS-CoV2 infection, which indicates skeletal muscle damage precipitating limb weakness or even ventilatory failure.Case presentationWe addressed such a patient in his forties presented with features of severe SARS-CoV2 pneumonia and high serum CPK. He developed severe sepsis and acute respiratory distress syndrome (ARDS) and received intravenous high dose corticosteroid and tocilizumab to counter SARS-CoV2 associated cytokine surge. After 10 days of mechanical ventilation (MV), weaning was unsuccessful albeit apparently clear lung fields, having additionally severe and symmetric limb muscle weakness. Ancillary investigations in addition with serum CPK, including electromyogram, muscle biopsy, and muscle magnetic resonance imaging (MRI) suggested acute myopathy possibly due to skeletal myositis.ConclusionWe wish to stress that myopathogenic medication in SARS-CoV2 pneumonia should be used with caution. Additionally, serum CPK could be a potential marker to predict respiratory failure in SARS-CoV2 pneumonia as skeletal myopathy affecting chest muscles may contribute ventilatory failure on top of oxygenation failure due to SARS-CoV2 pneumonia.

COMPARISON BETWEEN RHABDOMYOLYSIS INDUCED AND SEPTIC ACUTE KIDNEY INJURY IN CENTRAL NEPAL

Background: Acute kidney injury (AKI) is one of the most serious complications of rhabdomyolysis (RM). We studied the clinical manifestations and prognosis of rhabdomyolysis induced AKI and compared it with septic AKI among hospitalized patients.&#x0D; Methods: A prospective study was conducted at Chitwan Medical College between January 2017 to June 2018 to compare AKI secondary to rhabdomyolysis (RM-AKI) and sepsis (SA-AKI). AKI was diagnosed as per Kidney Disease Improving Global Outcomes (KDIGO) 2012 guidelines. Rhabdomyolysis was diagnosed if serum creatinine phosphokinase raised &gt;5 times the upper limit of normal level and sepsis as an increase of two or more points in the Sequential Organ failure Assessment (SOFA) score with the evidence of infection.&#x0D; Results: A total of 145 patients with AKI (21 with RM and 124 with sepsis) were included in the study. Mean age of the patients was 43.7 years with majority (54%) being males. Wasp bite and bee sting combined together (47.6%) were the most common causes for RM-AKI whereas pneumonia accounted for 46.6% of the septic AKI. Serum creatinine (SCr) at admission and at discharge were 3.8 and 1.4 mg/dL respectively in RM-AKI group; and 2.4 and 1.6 mg/dL in septic AKI group. Duration of stays in the hospital (9.2 versus 6.4 days) and ICU (4.2 versus 3.7 days) were longer in RM than in septic AKI. In hospital mortality was 4.8% in RM and 8.9% in septic AKI.&#x0D; Conclusions: This study has found that, despite a longer duration of hospital stay, RM-AKI had a lower in-hospital mortality than septic AKI.

Impact of Anesthetic Agents on Endothelial Glycocalyx Injury during Total Knee Arthroplasty: Desflurane- vs. Propofol-Based Anesthesia-A Prospective Randomized Controlled Trial.

Background Ischemia-reperfusion injury and inflammation after tourniquet deflation in total knee arthroplasty are known to be associated with endothelial glycocalyx (EG) injury. This study is aimed at comparing EG injury between desflurane- and propofol-based anesthesia in patients undergoing total knee arthroplasty. Materials and Methods Patients were allocated to the desflurane group or propofol group. The opioid remifentanil was administered intraoperatively in both groups. Blood samples were obtained from the arterial line preoperatively, immediately before and 5 min after tourniquet deflation, and at 1, 6, and 24 h, postoperatively. Serum syndecan-1, cytokines (interleukin-1β, 6, 10, and tumour necrosis factor-α), and other laboratory values were investigated. Results Eighty patients were included in the final analysis. The change in syndecan-1 did not significantly differ between the desflurane and propofol groups (peak median level of syndecan-1; 754.5 pg/ml vs. 780.3 pg/ml, respectively, P = 0.512). Laboratory values (serum cytokines, creatinine phosphokinase, lactate dehydrogenase, and lactate levels) were also similar between the two groups. Pulmonary oxygenation was briefly improved after tourniquet deflation in the desflurane group but was similar between the two groups begging at 1 h, postoperatively. Conclusions The effect of desflurane was not superior to that of propofol in protecting the EG from ischemia-reperfusion injury during total knee arthroplasty. This trial is registered with Trial Registry Number NCT02756715 (http://clinicaltrials.gov).

Effect of Different Tourniquet Pressure on Postoperative Pain and Complications After Total Knee Arthroplasty: A Prospective, Randomized Controlled Trial

BackgroundTourniquet pressure inflation is commonly selected between 100 and 150 mm Hg above the systolic blood pressure (SBP). Given the lack of evidence to support a given inflation pressure, our study aimed to ascertain the lowest tourniquet pressure that facilitated total knee arthroplasty (TKA) and resulted in the least postoperative pain and complications. MethodsIn a double-blind, randomized controlled trial of patients scheduled for unilateral primary TKA, 150 were assigned to use tourniquet pressures of SBP + 75 mm Hg (group I), SBP + 100 mm Hg (group II), and SBP + 150 mm Hg (group III). The quality of the bloodless field, total blood loss, and limb swelling were determined perioperatively. Clinical outcomes were evaluated by visual analog scale for pain at thigh and surgical site, serum creatinine phosphokinase levels, wound complications, range of motion, and Knee Society Score. ResultsVisual analog scale for pain at thigh and surgical site were lowest in group I (P < .01) and highest in group III (P < .01). However, the quality of bloodless field at the tibial cutting surface was significantly better in group III compared to group I/II but not at the femoral cutting surface. The total blood loss and limb swelling showed no difference among 3 groups. Postoperative serum creatinine phosphokinase levels at 24 and 48 hours and wound complications in group III were significantly higher than group I (P < .01) and group II (P < .01). Nevertheless, postoperative knee range of motion and Knee Society Score were not significantly different among 3 groups. ConclusionPost TKA, the lowest tourniquet pressure was associated with significantly less postoperative tourniquet and surgical site pain, muscle damage, and wound complications.

Efficacy and Safety of Pitavastatin in a Real-World Setting: Observational Study Evaluating SaFety in Patient Treated with Pitavastatin in Korea (PROOF Study).

BackgroundWhile randomized controlled trials provide useful information about drug safety and efficacy, they do not always reflect the observed results in the real world. The prospective, observational, non-comparative trial in South Korea was designed to evaluate the efficacy and safety of pitavastatin in clinical practice in 28,343 patients.MethodsThis study was conducted in 893 facilities in Korea from April 2, 2012 to April 1, 2017. This study was designed to administer 1, 2, or 4 mg pitavastatin to patients with hyperlipidemia at the age of 20 or older for at least 8 weeks.ResultsFor 126 days of mean duration of administration of pitavastatin, the % change of low density lipoprotein cholesterol indicated a dose dependent reduction: −23.4%, −29.1%, and −35.2% in the 1, 2, and 4 mg groups, respectively in patients who have not been treated with lipid lowering medications prior to study. Only 1.74% (492/28,343) of pitavastatin-treated patients experienced adverse events, of which 0.43% (123/28,343) were adverse drug reactions. Less than 1% of patients experienced the grade 2 or more toxicity (Common Terminology Criteria for Adverse Events v4.03) in alanine aminotransferase, aspartate aminotransferase, serum creatinine, and serum creatine phosphokinase. Although there were no rhabdomyolysis in 28,343 patients, 0.04% of patients had been reported pitavastatin-related musculoskeletal disorders.ConclusionOverall, this observational study showed that pitavastatin was well tolerated and effectively modified the lipid profile, reducing cardiovascular and cerebrovascular risk in Korean patients with hypercholesterolemia in the real world.

DMD – BIOMARKERS & OUTCOME MEASURES: P.131 A longitudinal study of creatine-phosphokinase and creatinine levels in Duchenne muscular dystrophy

Management of Duchenne muscular dystrophy (DMD) has entered an era featuring novel treatments. Trackable non-invasive biomarkers could improve our ability to monitor disease progression, detect drug effect and help clinicians provide meaningful anticipatory guidance. This study investigates the change of the serum creatinine phosphokinase (CPK), serum creatinine (Cr), urine creatinine (Ucr) and urine creatinine/urine osmolality (Ucr/Uosm) ratio with increasing age and worsening motor function characterized by functional mobility score (FMS).