Rhabdomyolysis-associated acute kidney injury: clinical characteristics and intensive care unit transfer analysis.

BACKGROUND: Information on rhabdomyolysis-associated acute kidney injury (AKI) in the emergency department or general ward is limited. AIM: To assess the risk factors, outcomes and clinical correlates with intensive care unit (ICU) transfer of patients with rhabdomyolysis-associated AKI. METHODS: Patients with rhabdomyolysis were divided into the rhabdomyolysis-associated AKI group and the rhabdomyolysis without AKI group. Inhospital outcomes, including ICU transfer, mortality, length of stay, daily cost and renal recovery were analysed. Multivariate regression analysis was performed to identify the association between rhabdomyolysis-associated AKI and ICU transfer. RESULTS: Among 149 patients with rhabdomyolysis, 68 (45.6%) developed AKI. Age and urine protein were important risk factors for incidence of rhabdomyolysis-associated AKI. Patients with rhabdomyolysis-associated AKI had higher levels of undergoing dialysis (19.1% vs 2.5%; P < 0.01), all-cause mortality (13.2% vs 1.2%; P < 0.01), cost of hospitalisation (10.8 1000 yuan, IQR (5.5, 3.5) vs 5.9 1000 yuan, IQR 5.9 (3.6, 9.9); P = 0.03), as well as longer length of hospital stay (8.0 days (5.0, 14.0)) versus (6.0 days (4.0, 11.0); P = 0.02). Additionally, the percentage of patients with AKI who transferred to ICU was higher than patients without AKI (33.8% vs 12.3%; P < 0.002) and rhabdomyolysis-associated AKI was an independent risk factor for ICU transfer (adjusted odds ratio = 2.58; 95% confidence interval, 1.12-6.8, P = 0.03). CONCLUSION: Rhabdomyolysis-associated AKI was common in the emergency department or general ward and led to more severe outcomes. It was also associated with an increased risk of ICU transfer.

Two new species and a new combination from Zhejiang, East China.

As the supplement of the flora of Zhejiang, East China, two new species were described with illustrations. Cerastiumhuadingense Y.F.Lu, W.Y.Xie & X.F.Jin (Caryophyllaceae) differs from C.qingliangfengicum in having sterile stems absent, leaves sessile, petals slightly longer than sepals, and stamens slightly shorter than sepals. Ixeridiumdimorphifolium Y.L.Xu, Y.F.Lu & X.Cai (Asteraceae) differs from I.beauverdianum in having plant stoloniferous, basal leaves dimorphic, involucre 8‒10 mm long, inner phyllaries 8, and florets 7‒10. Paraphlomissetulosa C.Y.Wu & H.W.Li (Lamiaceae) was reviewed and morphological characters of the corolla and stamens of its type and the specimens collected in the field survey were critically examined. With barbate anthers and strongly divergent anther cells, Paraphlomissetulosa was transferred to Sinopogonanthera, and S.setulosa (C.Y.Wu & H.W.Li) H.W.Zhang & X.F.Jin was consequently combined.

Didymocarpus lobulatus (Gesneriaceae), a new species from Zhejiang Province, East China.

Didymocarpus lobulatus, a new species endemic to Zhejiang province, eastern China, is described and illustrated with photographs. The new species is morphologically similar to D. heucherifolius, D. cortusifolius and D. salviiflorus in leaf morphology, but can be easily distinguished by a combination of characters, including the shape of bracts, calyx and calyx lobes.

[Analysis on regional homogeneity of resting brain during balance acupuncture-induced analgesic effect in migraine patients without aura].

OBJECTIVE: To observe the relationship between the analgesic effect of balance acupuncture and functional changes in brain in patients with migraine without aura. METHODS: A total of 40 cases of migraine without aura were equally randomized into a headache-acupoint group and a sham-acupoint group. When acupuncture given, a filiform needle was inserted into the headache-acupoint (the midpoint of the depression region anterior to the juncture of the first and second metatarsal bones on the dorsum of the foot) or the sham point (the midpoint of the depression region anterior to the juncture site between the 3rd and 4th metatarsal joints of the dorsum of the foot) about 25-40 mm deep and manipulated for a while till the patient experienced feelings of electric shock and numbness, then withdrawn immediately. The treatment was conducted once daily for 4 weeks. The visual analogue scale (VAS) was used to evaluate the severity of pain, and the regional homogeneity (ReHo) analysis of resting state functional magnetic resonance imaging (fMRI) was used to assess changes of the spontaneous brain activity. RESULTS: After acupuncture, the analgesic effect of headache-acupoint was better than that of the sham-acupoint in both intervention stage and the follow-up stage (P< 0.05), and was also stronger in the intervention stage than in the follow-up stage (P<0.05). There was no significant difference in the analgesic effect between the intervention stage and the follow-up stage in the sham-acupoint group (P>0.05). Compared with pre-intervention, 4-weeks' intervention at the headache-acupoint showed an increase of ReHo values in the anterior cingulate gyrus, anterior central gyrus, superior orbital frontal gyrus, insula, inferior lobule, left anterior cingulate gyrus, ventral lateral nucleus and ventral posteromedial nucleus of the thalamus, pontine nucleus, cerebellar tonsils and orbital frontal inferior gyrus of the brain (P<0.05), and a decrease of ReHo values in the right brain bridge, central posterior gyrus, posterior cingulate gyrus, left central anterior gyrus, posterolateral nucleus of thalamus, and hippocampus (P<0.05), separately. In the sham-acupoint group, the ReHo value was increased in the right tongue gyrus, the left anterior lobe, the anterior cingulate gyrus and the lower occipital gyrus of the brain (P<0.05), and reduced in the left ventral posterolateral nucleus of the thalamus, separately (P<0.05). CONCLUSION: Balance acupuncture stimulation of headache acupoint has an analgesic effect in migraine patients without aura, which may be related to its effect in regulating resting state brain function of the limbic-system-dominated multiple brain regions.