OBJECTIVETo explore the acting mechanism of electrical field in electrical injury.

METHODSThirty-six New Zealand white rabbits were employed in the study and were randomly divided into 7 groups. There were 12 rabbits in group 1 and 4 in each group of other 6 groups. The animal model of nonthermal electrical injury previously replicated was employed in the study. Experiment with paralleled muscular fibers in electrical field was carried out in groups 2 approximately 4, while that of vertical muscular fibers in electrical field in groups 5-7. Anatomical examination was done to determine the index of deep burn injury (IDBI) in all groups of rabbits at 0, 2 and 24 postburn hour (PBH). Histological and ultrastructural examination, gamma picturing and isotope scanning with 99mTc were done in group 1 at 2 PBH.

RESULTSThere was no obvious skin injury in the white rabbits in group 1. Deep tissue necrosis was identified under the small electrode. Constant muscular spasm was observed in the inner side of the thigh. The muscles in paralleled electrical field suffered more severe injury than those in vertical one. Tissue injury was more severe in those areas with higher current density, less soft tissue, and also in the central area of the axis of the electric field. There were obvious changes in the perfusion and blood pool phases in these areas as observed with the aid of 99mTc. Light microscopic examination revealed swelling and necrosis of muscular fibers. Under electron microscopy, it was found that there were edema and dissolution with separation of lipid molecular layers of cell membrane, Shortened nucleus with partial dissolution of nuclear membrane, increased heparin granules within nucleus, swelling of mitochondria and endoplasmic reticulum, myofilament dissolution, expanded gap between myofilament and decreased number of heparin granules.

CONCLUSIONNon-thermal tissue injury in the electrical field, in terms of cell, ultrastructural and molecular levels, was induced and aggravated by all the factors constituting high voltage electrical field.

Animals ; Electric Injuries ; pathology ; Lower Extremity ; injuries ; Necrosis ; Rabbits ; Soft Tissue Injuries ; pathology

OBJECTIVE: To explore the clinical effect and adverse reactions of Strychnos nux-vomica in bortezomib-induced peripheral neuropathy (BIPN) of patients with multiple myeloma (MM). METHODS: A total of 19 MM patients with BIPN were enrolled and Nux Vomica Capsule (NVC, 0.4 g, thrice daily) were orally administrated for 30 days. Comparative analysis on parameters between pre- and post-therapy, including peripheral neuropathy (PN) grade, neurotoxicity score, Chinese medicine (CM) syndrome score, total neuropathy score (TNS), coagulation function, and serum nerve growth factor (NGF) levels were conducted. The adverse events were monitored. RESULTS: In BIPN of MM patients who received NVC, PN grade was lowered, neurotoxicity score was obviously decreased (P⩽0.01), and both CM syndrome score and TNS were remarkably decreased (P<0.01). After the therapy, activated partial thromboplastin time was prolonged (P<0.01) and fibrinogen was declined (P<0.05), showing improvement in the hypercoagulable state of patients. No significant difference of NGF recovery degrees was detected between pre- and post-therapy (P>0.05). No evident adverse reactions were observed during the course of treatment. CONCLUSION Strychnos nux-vomica L. has significantly effect with a good safety in treatment of BIPN in MM patients.

BACKGROUNDUrine output (UO) is an essential criterion of the Kidney Disease Improving Global Outcomes (KDIGO) definition and classification system for acute kidney injury (AKI), of which the diagnostic value has not been extensively studied. We aimed to determine whether AKI based on KDIGO UO criteria (KDIGOUO) could improve the diagnostic and prognostic accuracy, compared with KDIGO serum creatinine criteria (KDIGOSCr).

METHODSWe conducted a secondary analysis of the database of a previous study conducted by China Critical Care Clinical Trial Group (CCCCTG), which was a 2-month prospective cohort study (July 1, 2009 to August 31, 2009) involving 3063 patients in 22 tertiary Intensive Care Units in Mainland of China. AKI was diagnosed and classified separately based on KDIGOUOand KDIGOSCr. Hospital mortality of patients with more severe AKI classification based on KDIGOUOwas compared with other patients by univariate and multivariate regression analyses.

RESULTSThe prevalence of AKI increased from 52.4% based on KDIGOSCrto 55.4% based on KDIGOSCrcombined with KDIGOUO. KDIGOUOalso resulted in an upgrade of AKI classification in 7.3% of patients, representing those with more severe AKI classification based on KDIGOUO. Compared with non-AKI patients or those with maximum AKI classification by KDIGOSCr, those with maximum AKI classification by KDIGOUOhad a significantly higher hospital mortality of 58.4% (odds ratio [OR]: 7.580, 95% confidence interval [CI]: 4.141-13.873, P< 0.001). In a multivariate logistic regression analysis, AKI based on KDIGOUO (OR: 2.891, 95% CI: 1.964-4.254, P< 0.001), but not based on KDIGOSCr (OR: 1.322, 95% CI: 0.902-1.939, P = 0.152), was an independent risk factor for hospital mortality.

CONCLUSIONUO was a criterion with additional value beyond creatinine criterion for AKI diagnosis and classification, which can help identify a group of patients with high risk of death.

Acute Disease ; mortality ; Aged ; Creatinine ; blood ; Critical Illness ; mortality ; Female ; Hospital Mortality ; Humans ; Kaplan-Meier Estimate ; Kidney Diseases ; blood ; mortality ; pathology ; urine ; Logistic Models ; Male ; Middle Aged ; Prognosis ; Prospective Studies ; Risk Factors