Creatinine as predictor value of mortality and acute kidney injury in rhabdomyolysis.

BACKGROUND: Rhabdomyolysis (RB) is a syndrome characterised by decomposition of skeletal muscle that could be life threatening, so the identification of biomarkers of its severity could help us in its treatment. Creatine kinase (CK) is usually taken as a reference in patients with RB in order to stratify prognosis, however that is not probably the most effective parameter. AIMS: The present study was designed to analyse the specific features and mortality of patients with RB and the relation between creatinine, CK and mortality. METHODS: Retrospective cohort analysis among patients admitted to San Pedro Hospital in Logroño (Spain) with RB (CK levels higher than 2000 U/L) diagnosed since 1 January 2009 until 31 December 2; 013 522 patients with RB patients diagnosed of RB were collected. The aetiology and the analytical feature (creatinine, CK, calcium, phosphorus, pH and bicarbonate), as well as 30-year mortality, were investigated. RESULTS: Among the 522 patients, there were 138 deaths. Four patients required renal replacement therapy. The most common cause of RB was trauma (29%). Infectious aetiology had the highest mortality (41.2%). The median CK was 3451 u/L (interquartile range 3348), and the mean creatinine at admission was 132.6 umol/L (±110.5). Initial CK levels do not have predictive ability on mortality or renal dysfunction in contrast to initial creatinine values. Each state of acute kidney injury (AKI) increased mortality compared with those who have not presented this renal dysfunction (P < 0.0001). Age, calcium, phosphorus, bicarbonate and pH are associated with AKI. CONCLUSION: Despite being a diagnostic marker for RB, initial CK levels do not predict mortality. However, creatinine initial levels are related to progression to acute renal injury and mortality at 30 days.

A simplified and convenient laboratory-scale preparation of 14N or 15N high molecular weight poly(dichlorophosphazene) directly from PCl5.

A simple and convenient one-pot synthesis of THF solutions of high molecular weight poly(dichlorophosphazene) [NPCl(2)](n), or the (15)N isotopomer [(15)NPCl(2)](n), starting directly from PCl(5) and NH(4)Cl or (15)NH(4)Cl in a solution of 1,2,4-trichlorobenzene in the presence of sulfamic acid and calcium sulfate dihydrate, is described. The solutions of [NPCl(2)](n) in THF, which are obtained free of poly(tetrahydrofuran) by preparing them in the presence of K(2)CO(3), can be reacted directly with phenols, biphenols, or even HO-CH(2)CF(3) in the presence of K(2)CO(3) or Cs(2)CO(3) to obtain, after a very simple workup, the corresponding polyphosphazene derivatives almost free of chlorine.

Structural features and molecular assembly of amorphous phosphazenic materials in the bulk--combined theoretical and experimental techniques: Tris-(2,2'-dioxy-1,1'-binaphthyl)cyclotriphosphazen.

The structure and the assembly of tris-(2,2'-dioxy-binaphthyl)cyclotriphosphazene [(+)-[NP3(O2C20H12)3], DBNP, in the solid amorphous state was studied using molecular dynamics (MD) including ad hoc quantum mechanically derived force field (FF) parameters, in combination with the energy dispersive X-ray diffraction (EDXD) technique. The atom-atom radial distribution function (RDF) curve obtained through the EDXD experiment revealed low intensity peaks not attributable to the intramolecular distances of the single molecule, but clearly featuring a low energy state of long-distance three-dimensional assembly. The radial distribution functions (RDF) were calculated for various models of DBNP submitted to theoretical MD simulations. Based on the comparison of theoretically calculated RDFs and those obtained from the EDXD experiment, the predominant structural motif of the material in the bulk was found to have DBNP molecules laid one upon the other to form tubular nanostructures. These contain eight DBNP units each (length ca. 46 A) with two and three of these units aligned in parallel and held together. The material can be represented as a bulk of tubular snake-like chains undergoing distortions with a step of eight DBNP units. The bending angles, that vary randomly, attain limited values sufficient to induce disorder and thus nonperiodic structure. The present application of MD simulations combined with EDXD data appear to be a general approach to solve for the first time otherwise intractable issues concerning structural features and assembly of molecular materials in the bulk.