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Background: Urinary microRNA (miRNA)-21 is a biomarker for acute kidney injury (AKI). We conducted this study to determine if a urinary exosomal analysis for this biomarker could serve as a novel d...

Background : : Abnormal chest radiographs are frequently encountered in patients with scrub typhus. This study aimed to investigate whether chest radiography on admission is significant as a predictive factor for acute kidney injury (AKI) in patients with scrub typhus. Methods : : From 2010 to 2016, 467 patients were diagnosed with scrub typhus in our hospital. We divided the patients into two groups: normal chest radiograph (NCR) and abnormal chest radiograph (AbNCR), based on chest radiography findings. The incidence, clinical characteristics, and severity of AKI were compared between AKI and non-AKI groups according to the RIFLE classification. Results : : Of the 467 patients, 96 (20.6%) constituted the AbNCR group. Compared with NCR patients, AbNCR patients were older (71 ± 11 vs. 62 ± 13 years, P < 0.001) and had higher total leukocyte counts (9.43 × 103/mL vs. 6.98 × 103/mL, P < 0.001). The AbNCR group had significantly longer duration of hospital stay (8.9 ± 5.5 vs. 6.3 ± 2.8 days, P < 0.001) and higher incidence of AKI (46.9% vs. 15.1%, P < 0.001). The common abnormal chest radiographic findings were pulmonary abnormalities, such as pulmonary congestion and pleural effusion. The overall AKI incidence was 21.6%, of which 12.4%, 7.9%, and 1.3% cases were classified as risk, injury, and failure, respectively. In a multivariable logistic regression analysis for association with AKI, old age, presence of chronic kidney disease or hypertension, leukocytosis, hypoalbuminemia, and chest radiographic abnormalities on admission were significant predictors of AKI. Conclusion : : Chest radiographic abnormalities on admission were independently associated with AKI in patients with scrub typhus.

The colonization of vancomycin-resistant Enterococci before and after solid organ trans plantation is associated with an increased risk of its infection. The prevalence of these bacterial colonies in renal transplant recipients are as high as that in intensive care unit patients. However, it is unclear whether donors with vancomycin-resistant Enterococci colonization can be considered in renal transplantation. Herein, we report a case wherein a kidney was transplanted from a deceased donor with vancomycin-resistant Entero cocci colonies in urine and rectal swab. After transplant, the recipient had no vancomy cin-resistant Enterococci infection and maintained relatively good renal function.

Background This study aimed to investigate the clinical significance of hypoalbuminemia (HA) in patients with scrub typhus complicated by acute kidney injury (AKI). Methods From 2009 to 2018, 611 patients were diagnosed with scrub typhus. We divided the patients into two groups [normoalbuminemia (NA) vs. HA] based on the serum albumin level of 3.0 g/dL and compared the incidence, clinical characteristics, and severity of AKI based on the RIFLE classification between the two groups. Results Of the total 611 patients, 78 (12.8%) were categorized into the HA group. Compared to patients in the NA group, patients in the HA group were older (73 ± 9 vs. 62 ± 14 years, P Conclusion Serum albumin level is helpful to predict the development and severity of scrub typhus-associated AKI.

Background and Aims Urinary microRNA (miRNA)-21 is reported to be a biomarker for detection of acute kidney injury (AKI). Analysis of urinary exsome may serve as a novel diagnostic approach in kidney disease. The aim of this study is to investigate the clinical significance of urinary exosomal miRNA-21 for AKI in patients with scrub typhus. Method In a cross-sectional study, we collected 138 urine samples at the time of admission from 145 patients with scrub typhus. For 25 patients with scrub typhus-associated AKI and 25 age, sex-matched scrub typhus patient without AKI, we measured miRNA-21 in urinary exosomal fraction and compared diagnostic value in predictiong AKI. Results Compared with patients in the non-AKI group, patients in the AKI group were more likely to have one or more comorbidity such as diabetes (50% vs. 5%, P Conclusion Urinary exosomal miRNA-21 could be a surrogate markers for the diagnosis of scrub typhus–associated AKI.

Background and Aims The aim of this study is to investigate the clinical significance of hypoalbuminemia (HA) for acute kidney injury (AKI) in patients with scrub typhus. Method From 2010 to 2017, 449 patients were diagnosed with scrub typhus. We divided the patients into two groups [normoalbuminemia (NA) vs. hypoalbuminemia (HA)] based on the serum albumin level of 3.5 g/dL, and compared the incidence, clinical characteristics, and severity of AKI based on RIFLE classification between two groups. Results Of the total 449 patients, 52 (11.6%) were categrized as HA group. Compared with patients in NA group, patients in HA group were older (74 ± 8 vs. 63 ± 13, P Conclusion Hypoabluminemia was closely associated with scrub typhus associated with AKI.

Previously, we reported that the hot water extract of Hydrangea serrata leaves (WHS) and its active component, hydrangenol, possess in vitro and in vivo effects on skin wrinkles and moisturization. We conducted a randomized, double-blind, placebo-controlled trial to clinically evaluate the effect of WHS on human skin. Participants (n = 151) were randomly assigned to receive either WHS 300 mg, WHS 600 mg, or placebo, once daily for 12 weeks. Skin wrinkle, hydration, elasticity, texture, and roughness parameters were assessed at baseline and after 4, 8, and 12 weeks. Compared to the placebo, skin wrinkles were significantly reduced in both WHS groups after 8 and 12 weeks. In both WHS groups, five parameters (R1&ndash, R5) of skin wrinkles significantly improved and skin hydration was significantly enhanced when compared to the placebo group after 12 weeks. Compared with the placebo, three parameters of skin elasticity, including overall elasticity (R2), net elasticity (R5), and ratio of elastic recovery to total deformation (R7), improved after 12 weeks of oral WHS (600 mg) administration. Changes in skin texture and roughness were significantly reduced in both WHS groups. No WHS-related adverse reactions were reported. Hence, WHS could be used as a health supplement for skin anti-aging.

Darbepoetin-alfa is an erythropoiesis-stimulating agent (ESA) with a long elimination half-life that achieves better hemoglobin (Hb) stability than short-acting ESAs. We aimed to evaluate the efficacy and safety of intravenous CKD-11101 (a biosimilar of darbepoetin-alfa) compared with those of darbepoetin-alfa in hemodialysis patients. The study was performed in 24 centers in Korea between June 2015 and June 2017. The study subjects were randomized in a double-blind manner. The follow-up duration was 24 weeks, which consisted of 20 weeks of maintenance and 4 weeks of evaluation period. All patients underwent a stabilization period to achieve a target baseline Hb of 10–12 g/dL before randomization. Following randomization, patients received darbepoetin-alfa or CKD-11101 weekly or biweekly. A total of 403 patients were randomized into two groups, and a total of 325 patients (80.6%) completed the investigation. The differences between the two groups in terms of change in the average Hb level from baseline to evaluation were not significant. The average administered dose of ESA was similar between the groups. There was no difference in the proportion of patients who maintained the target Hb during the evaluation period [60.4% vs. 66.2% in the CKD-11101 and darbepoetin-alfa groups, respectively (p = 0.3038)]. In addition, the safety analysis, consisting of adverse events and adverse drug reactions, showed comparable results between the two groups. The changes in the level of Hb, dose of erythropoietin, and achievement rate of the target Hb during the study period were comparable between the groups. CKD-11101 has an equivalent efficacy and safety compared with darbepoetin-alfa in patients undergoing hemodialysis.

Background The aim of this study was to investigate the incidence and clinical characteristics of intravenous (IV) or inhaled (IH) colistin-associated acute kidney injury (AKI) using the Risk, Injury, Failure, Loss, End-stage Renal Disease criteria. Methods From 2010 to 2014, 160 patients were treated with IV or IH colistin. Of these, we included 126 patients who received colistin for > 72 hours for the treatment of pneumonia and compared the incidence and clinical characteristics of patients in the IV (n = 107) and IH (n = 19) groups. Results The patients included 104 men and 22 women, with a mean age of 69 years (range, 24–91 years). The mortality rate was 45%, and AKI occurred in 75 (60%) patients. At the end of therapy, the bacteriologic cure rate was 66%. There were no differences in the clinical characteristics between the IV and IH groups except for age. In comparison with patients in the IV group, the patients in the IH group were older (74 ± 8 vs. 68 ± 12 years, P = 0.026). The incidence of AKI was not different between the 2 groups (62 vs. 47%, P = not significant), and there was no difference in the severity of AKI according to the Risk, Injury, Failure, Loss, End-stage Renal Disease criteria. Of the 83 patients with AKI, 6 and 1 patients underwent renal replacement therapy, respectively. Conclusion The incidence of AKI in patients with colistin therapy is 60% in our center. It seems that IH colistin therapy could not be better in safety than IV colistin therapy.

Backgound: This study evaluated whether the hydration status affected health-related quality of life (HRQOL) during 12 months in peritoneal dialysis (PD) patients. Methods: The hydration status and the HRQOL were examined at baseline and after 12 months using a bioimpedance spectroscopy and Kidney Disease Quality of Life-Short Form, respectively in PD patients. Four hundred eighty-one patients were included and divided according to the baseline overhydration (OH) value; normohydration group (NH group, -2L≤ OH ≤+2L, n=266) and overhydration group (OH group, OH >+2L, n=215). Baseline HRQOL scores were compared between the two groups. The subjects were re-stratified into quartiles according to the OH difference (OH value at baseline - OH value at 12 months

Background: In this study, we assessed whether red blood cell distribution width (RDW) was associated with all-cause mortality in patients on peritoneal dialysis (PD) and evaluated its prognostic value. Methods: This study included 136 patients who had RDW levels at PD initiation from January 2007 to January 2014 at the Presbyterian Medical Center and Seoul St. Mary's Hospital. We divided these patients into 2 groups (survivors vs. non-survivors), compared their clinical characteristics, and analyzed the predictors of survival. Results: The study included 79 men and 57 women, with a mean age of 54 years (range, 15-85 years). The mean follow-up duration was 32 months (range, 1-80 months). Of 136 patients, 14 died during the follow-up period. When clinical characteristics of survivors (n = 122) and nonsurvivors (n = 14) were compared, no differences were identified, with the exception of serum albumin, total iron-binding capacity (TIBC), left ventricular ejection fraction, total leukocyte count, and RDW value. Survivors had higher serum albumin (3.4 +/- 0.5 vs. 3.0 +/- 0.5 g/dL, P < 0.001) and left ventricular ejection fraction (56.8 +/- 9.8 vs. 48.7 +/- 12.8, P = 0.040) and lower TIBC (213.4 +/- 40.9 vs. 252.8 +/- 65.6, P = 0.010), total leukocyte counts (6.9 +/- 10(3)/mu L vs. 8.6 x 10(3)/mu L, P = 0.009), and serum RDW values (13.9 +/- 1.7 vs. 16.0 +/- 1.8, P < 0.001). Patients with high RDW levels (>= 14.8) showed significantly higher all-cause mortality than patients with low RDW levels (< 14.8, P < 0.001). In multivariate-adjusted Cox analysis, RDW and TIBC at the start of PD were independent risk predictors for all-cause mortality. Conclusion: RDW could be an additive predictor for all-cause mortality in patients on PD. Copyright (C) 2016. The Korean Society of Nephrology. Published by Elsevier.

Objective: The aim of this study was to investigate the clinical characteristics of sepsis-induced acute kidney injury (AKI) in patients undergoing continuous renal replacement therapy (CRRT). Methods: From 2011 to 2015, we enrolled 340 patients who were treated with CRRT for sepsis at the Presbyterian Medical Center. In all patients, CRRT was performed using the PRISMA platform. We divided these patients into two groups (survivors and non-survivors) according to the 28-day all-cause mortality. We compared clinical characteristics and analyzed the predictors of mortality. Results: The 28-day all-cause mortality was 62%. Survivors were younger than non-survivors and had higher platelet counts (178 ± 101 × 103/mL vs. 134 ± 84 × 103/mL, p 0.05 mL/kg/h (66% vs. 86%, p = .001) in the first day. In a multivariate logistic regression analysis, age, platelet count, RDW score, APACHE II score, serum creatinine level, and a urine output of

Acute interstitial nephritis (AIN) is an important cause of reversible acute kidney injury and pathologically characterized by inflammatory infiltrate in the renal interstitium. Solanum nigrum (S. nigrum) is a medicinal plant member of the Solanaceae family. Although S. nigrum has been traditionally used to treat various ailments such as pain, inflammation, and fever, it has also been reported to have a toxic effect, resulting in anticholinergic symptoms. However, there have been no reports of AIN caused by S. nigrum. Here, we report the first case of biopsy-confirmed AIN after ingestion of S. nigrum. The patient was successfully treated using corticosteroid therapy.

Division of Nephrology, Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Department of Pathology, Division of Nephrology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea Hyun Ju Yoon, M.D., In O Sun, M.D., Min Kyung Yeo, M.D., Byung Ha Chung, M.D., Yeong Jin Choi, M.D., Chul Woo Yang, M.D. and Kwang Young Lee, M.D.

Background Organophosphates and carbamates are insecticides that are associated with high human mortality. The purpose of this study is to investigate the prognostic factors affecting survival in patients with cholinesterase inhibitor (CI) poisoning. Material/Methods This study included 92 patients with CI poisoning in the period from January 2005 to August 2013. We divided these patients into 2 groups (survivors vs. non-survivors), compared their clinical characteristics, and analyzed the predictors of survival. Results The mean age of the included patients was 56 years (range, 16–88). The patients included 57 (62%) men and 35 (38%) women. When we compared clinical characteristics between the survivor group (n=81, 88%) and non-survivor group (n=11, 12%), there were no differences in renal function, pancreatic enzymes, or serum cholinesterase level, except for serum bicarbonate level and APACHE II score. The serum bicarbonate level was lower in non-survivors than in survivors (12.45±2.84 vs. 18.36±4.73, P

Hypothermia, defined as an unintentional decline in the core body temperature to below 35℃, is a life-threatening condition. Patients with malnutrition and diabetes mellitus as well as those of advanced age are at high risk for accidental hypothermia. Due to the high mortality rates of accidental hypothermia, proper management is critical for the wellbeing of patients. Accidental hypothermia was reported to be associated with acute kidney injury (AKI) in over 40% of cases. Although the pathogenesis remains to be elucidated, vasoconstriction and ischemia in the kidney were considered to be the main mechanisms involved. Cases of AKI associated with hypothermia have been reported worldwide, but there have been few reports of hypothermia-induced AKI in Korea. Here, we present a case of hypothermia-induced AKI that was treated successfully with rewarming and supportive care.

Background The aim of this study is to investigate the clinical significance of neutrophil gelatinase–associated lipocalin (NGAL) and kidney injury molecule-1 (KIM-1) for acute kidney injury (AKI) in patients with scrub typhus. Methods From 2014 to 2015, 145 patients were diagnosed with scrub typhus. Of these, we enrolled 138 patients who were followed up until renal recovery or for at least 3 months. We measured serum and urine NGAL and KIM-1 levels and evaluated prognostic factors affecting scrub typhus–associated AKI. Results Of the 138 patients, 25 had scrub typhus–associated AKI. The incidence of AKI was 18.1%; of which 11.6%, 4.3%, and 2.2% were classified as risk, injury, and failure, respectively, according to RIFLE criteria. Compared with patients in the non-AKI group, patients in the AKI group were older and showed higher total leukocyte counts and hypoalbuminemia or one or more comorbidities such as hypertension (72% vs 33%, p

The aim of this study was to investigate the clinical characteristics of patients with hyponatremia who received thiazide diuretics, psychotropic drugs, or both.From 2007 to 2013, 266 patients were diagnosed with hyponatremia (P-Na135 mol/L) associated with thiazide diuretics (T), psychotropic drugs (P), or both (C). We compared clinical characteristics among the thiazide (T) group (n = 93), the psychotropic drug (P) group (n = 83), and the combination (C) group (n = 90).There were no differences in clinical characteristics except for correction time among the three groups. We evaluated the clinical severity among the three groups through initial serum sodium levels (mild:125 mmol/L, moderate: 120 - 125 mmol/L, severe:120 mmol/L), patient symptoms (mild: general weakness, moderate: nausea or vomiting, severe: syncope or seizure). There were no significant differences in the incidence of severe hyponatremia on the basis of initial serum sodium levels (73.1% vs. 67.5% vs. 71.1%, p = 0.710) and symptoms (20.4% vs. 30.1% vs. 17.8%, p = 0.192) among groups. However, correction time was significantly longer in group C than in groups T or P (41.98 ± 26.89 vs. 34.91 ± 23.96 vs. 51.10 ± 43.86 mg/dL, p = 0.026).Although patients in group C did not have clinical features that were any more severe than those of the other two groups in terms of initial serum sodium levels and symptoms, correction time was significantly longer for group C than for groups T or P. Therefore, it is of utmost importance to closely monitor patients who receive a thiazide and psychotropic drug simultaneously.

Background Paraquat (PQ) concentration–time data have been used to predict prognosis for 3 decades. The aim of this study was to find a more accurate method to predict the probability of survival. Methods This study included 788 patients with PQ poisoning who were diagnosed using plasma PQ concentration between January 2005 and August 2012. We divided these patients into 2 groups (survivors vs. nonsurvivors), compared their clinical characteristics, and analyzed the predictors of survival. Results The mean age of the included patients was 57 years (range, 14–95 years). When we compared clinical characteristics between survivors (n = 149, 19%) and nonsurvivors (n = 639, 81%), survivors were younger (47 ± 14 years vs. 59 ± 16 years) and had lower plasma PQ concentrations (1.44 ± 8.77 μg/mL vs. 80.33 ± 123.15 μg/mL) than nonsurvivors. On admission, serum creatinine was lower in survivors than in nonsurvivors (0.95 ± 0.91 mg/dL vs. 1.88 ± 1.27 mg/dL). In multivariate logistic regression analysis, age and logarithmically converted serum creatinine [ln(Cr)], [ln(time)], and [ln(PQ)] were assessed as prognostic factors to predict survival in PQ poisoning. The predicted probability of survival using significant prognostic factors was exp (logit)/[1 + exp(logit)], where logit = –1.347 + [0.212 × sex (male = 1, female = 0)] + (0.032 × age) + [1.551 × ln(Cr)] + [0.391 × ln(hours since ingestion)] + [1.076 × ln(plasma PQ μg/mL)]. With this equation, the sensitivity and specificity were 86.5% and 98.7%, respectively. Conclusion Age, ln(Cr), ln(time), and ln(PQ) were important prognostic factors in PQ poisoning, and our equation can be helpful to predict the survival in acute PQ poisoning patients.

Retroperitoneal fibrosis (RPF) is a rare disease characterized by the presence of fibroinflammatory tissue around the abdominal aorta and ureteral entrapment in most cases. Idiopathic RPF is frequently reported in association with autoimmune diseases; however, there have been few reports of idiopathic RPF associated with Hashimoto's thyroiditis. Here, we report a case of idiopathic RPF with Hashimoto's thyroiditis in a patient with a single functioning kidney, which was successfully treated by corticosteroid therapy and transient intraureteral stent insertion with a double-J catheter.

See Article on Page 420-427 Paraquat (PQ; 1,1'-dimethyl-4,4'-bipyridinium) dichloride is a nonselective herbicide that has been used in many countries since the 1960s because of its strong activity against weeds and rapid deactivation upon soil contact [1]. However, it is highly toxic to humans, and there is no specific antidote or effective treatment. Self-poisoning with PQ is a major public health problem associated with high mortality (> 50%) in developing countries in Asia, the Pacific Islands, and the Caribbean, where its use is regulated less strictly than in Europe or the United States [2]. PQ poisoning can cause severe multiple-organ failure of the kidneys, liver, lungs, adrenal glands, and central nervous system. Ingestion of more than 20 mL of a 20% preparation is likely to cause death from multiorgan failure and cardiogenic shock within 1 to 4 days, while smaller quantities (10 to 20 mL) can initiate irreversible lung fibrosis and renal failure that result in death within several weeks [3]. PQ is rapidly distributed in the body, accumulating at the highest concentrations within the lung and kidney [1]. Kidneys exposed to PQ demonstrate the development of large vacuoles in the proximal convoluted tubules, leading to necrosis and a decline in renal function [2]. In addition, because PQ is primarily excreted unchanged via the kidney, the reduction in renal function also leads to an increased plasma concentration, which contributes to its toxicity in other nonrenal organs, especially the lungs. Respiratory failure in the presence of PQ-induced acute kidney injury is responsible for most PQ-associated deaths. The toxic effect of PQ on the lung results in pulmonary edema, hypoxia, respiratory failure, and pulmonary fibrosis [1]. The mechanism of PQ-induced organ injury is thought to be production of reactive oxygen species by enzymatic one-electron reduction of PQ, followed by one-electron transfer to dioxygen with the generat ion of the superoxide anion [1]. PQ-induced lung injury consists of two phases: an early destructive period when the alveolar epithelial cells are damaged, and a late proliferative period characterized by infiltration of inflammatory cells, alveolitis, pulmonary edema, and finally pulmonary fibrosis [1]. Cytokines such as tumor necrosis factor-α, interleukin (IL)-1, and IL-6 are involved in PQ-induced acute lung injury, whereas transforming growth factor (TGF)-β1 functions primarily in fibrogenesis, stimulating collagen deposition by newly replicated myofibroblasts [4]. Several parameters-such as liver enzymes, serum creatinine, potassium, arterial blood bicarbonate, the respiratory index, and plasma and urinary PQ concentrations-have been proposed as prognostic indicators [1]. Measurement of the plasma PQ concentration is useful for assessing the severity and predicting the outcome of PQ poisoning. PQ concentration-time data have been used to predict prognosis for three decades. Proudfoot et al. [5] presented a nomogram of the relationship between outcome and the plasma PQ concentration on admission and the time interval between ingestion and blood collection. Hart et al. [6] created six plasma PQ concentration-time curves representing estimates of the probability of survival, which ranged from 10% to 90%. Sawada et al. [7] developed a severity index for paraquat poisoning to predict patients' prognosis. More recently, the Acute Physiology and Chronic Health Evaluation II system was applied in predicting the mortality of these patients [8]. All of these curves and formulae have been used to predict outcomes with acceptable performance, but none have been validated independently and prospectively [3]. Recently, biomarkers such as pentraxin-3 or neutrophil gelatinase-associated lipocalin were used to predict prognosis in patients with PQ poisoning [9,10]. The management of PQ intoxication involves removal of PQ from the gastrointestinal tract (preventing absorption), increasing its removal from the blood, and preventing pulmonary damage with antioxidants and anti-inflammatory agents. Gastric lavage has been recommended for patients presenting within 1 to 2 hours of ingestion, and activated charcoal or Fuller's earth has been used to prevent PQ absorption; however, neither procedure has been proven beneficial in PQ poisoning [1,3]. Extracorporeal elimination through hemoperfusion or hemodialysis is performed to remove PQ from the circulation and prevent its uptake by pneumocytes and Clara cells of the lungs. Commencing charcoal hemoperfusion at an early stage (within 2 to 4 hours of ingestion), when PQ is concentrated in the central compartment, can remove PQ from the plasma but does not reduce PQ uptake by the lungs sufficiently to change the overall outcome [1]. Because the main biochemical mechanism of the lung injury is initiated by oxygen free radicals produced by peroxidation, a number of antioxidants-such as vitamins C and E, xanthine oxidase inhibitors, deferoxamine, N-acetylcysteine, and superoxide dismutase-have been evaluated to determine whether they interfere with the process. Unfortunately, none of these treatments has been proven effective [1,2]. In addition, anti-inflammatory and immunosuppressive agents such as cyclophosphamide (CP) and glucocorticoids (dexamethasone and methylpredisolone) have been used to reduce the extent of pulmonary inflammation and fibrosis [1,2]. CP, which has a wide range of immunomodulatory actions that affect virtually all components of the cellular and humoral immune response and decrease the severity of inflammation, has been used since the 1980s. However, the adequate dose for treatment of patients with PQ poisoning has not been determined. Some studies used a CP dose of 5 mg/kg, whereas others administered CP at a dose of 15 mg/kg [1]. In addition, fatal lung injuries developed when high doses of CP (200 mg/kg) were administered in an adult rat model [11]. In the present issue of The Korean Journal of Internal Medicine, Choi et al. [12] reported that a CP dose of > 15 mg/kg was effective in reducing the severity of PQ-induced lung injury in a rat model. They also suggested that reduction of the severity of PQ-induced lung injury was possibly due to modulation of antioxidant enzymes and TGF-β1. The authors also used microtomography to determine the size of the lung lesions and demonstrated the effectiveness of 15 mg/kg CP. This article is notable because no other study has compared the effectiveness of various CP doses on the severity of lung lesions in PQ intoxication. Recently, a new antifibrotic agent, pirfenidone, was reported to decrease pulmonary fibrosis following PQ poisoning in a rat model [13]. However, no clinical trial has shown that pirfenidone is effective in human PQ poisoning. Therapeutic approaches such as mechanical ventilation with additional inhalation of nitric oxide, induction of P-glycoprotein, and sodium salicylate have been proposed based on the pathologic mechanism of toxicity [1], but further studies are needed to demonstrate their clinical efficacy. Furthermore, although a CP dose of 15 mg/kg was effective in reducing the severity of PQ-induced lung injury, further studies are required to determine whether a CP dose of 15 mg/kg is also effective when combined with a glucocorticoid. Respiratory failure is a frequent cause of death in moderate-to-severe PQ poisoning, and various therapeutic approaches have been used to prevent lung damage [1]. Of these, CP and steroids are the primary agents used to reduce the inflammatory process. Although an adequate dose of CP was determined in a PQ rat model [12], there have been no controlled trials of human poisoning. Moreover, although immunosuppressive medications (CP and glucocorticoids) and antioxidants (N-acetylcysteine, vitamin C and E, salicylate) appear to be effective to counter the PQ poisoning, more evidence is needed to guide the choice of dose, duration, and combination. In conclusion, well-designed controlled trials with multidisciplinary "cocktail" approaches that combine these agents, preferably with prognostic parameters such as PQ concentration-time data, should be conducted and their efficacy should be validated to win the war against PQ poisoning.

There are limited data available on the validity of the RIFLE classification for AKI in patients with scrub typhus. We investigated the incidence and clinical characteristics of scrub typhus associated AKI using the RIFLE criteria. From 2010 to 2012, 238 patients were diagnosed with scrub typhus. Of these, we included 223 patients who were followed up until renal recovery or for at least three months. We evaluated the incidence, clinical characteristics, and severity of AKI based on the RIFLE classification. Of the 223 patients, 47 (21%) had scrub typhus-associated AKI. The incidence of AKI was 21.1%; of which, 10.7%, 9.4% and 1% were classified as Risk, Injury and Failure, respectively. In comparison with patients in the non-AKI group, the patients in the AKI group were older (70 ± 9 vs 61 ± 14 year, P = 0.01) and had one or more comorbidities such as hypertension, diabetes, and chronic kidney disease (77% vs 22%, p = 0.01). In the AKI group, forty-four patients had AKI prior to admission, and three patients experienced AKI during their hospitalization. By multivariate logistic regression analysis, age and comorbidity were significant predictors of AKI. All patients recovered baseline renal function without renal replacement therapy following antibiotics therapy and supportive care. The incidence of AKI in patient with scrub typhus is 21%. Age and co-morbidity are significant predictors of AKI in scrub typhus. In cases of scrub typhus-associated AKI, anti-rickettsia agent and supportive care are very important.

Paraquat concentration-time data have been used to predict the clinical outcome following ingestion. However, these studies have included only small populations, although paraquat poisoning has a very high mortality rate. The purpose of this study was to develop a simple and reliable model to predict survival according to the time interval post-ingestion in patients with acute paraquat poisoning. Data were retrospectively collected for patients who were admitted with paraquat poisoning to Soonchunhyang University Choenan Hospital between January 2005 and December 2012. Plasma paraquat levels were measured using high-performance liquid chromatography. To validate the model we developed, we used external data from 788 subjects admitted to the Presbyterian Medical Center, Jeonju, Korea, between January 2007 and December 2012. Two thousand one hundred thirty six patients were included in this study. The overall survival rate was 44% (939/2136). The probability of survival for any specified time and concentration could be predicted as (exp(logit))/(1+exp(logit)), where logit = 1.3544+[-3.4688 × log10(plasma paraquat μg/M[Formula: see text])]+[-2.3169 × log10(hours since ingestion)]. The external validation study showed that our model was highly accurate for the prediction of survival (C statics 0.964; 95% CI [0.952-0.975]). We have developed a model that is effective for predicting survival after paraquat intoxication.

Objectives: The purpose of this study was to investigate the usefulness of the Alcohol Use Disorders Identification Test (AUDIT) and the relationship between AUDIT score and liver function test. Methods: AUDIT questionnaires were distributed to 440 blue-collar workers. We compared liver function test with firstly, normal and hazardous drinking as defined by WHO, and secondly, with normal, hazardous and harmful drinking as measured by Kim et al.(1999). We also compared influencing factors on abnormal liver function. Results: By simple analysis in the normal BMI group, abnormal liver function was significantly affected by hazardous drinking (odds ratio 2.81) based on the guideline of WHO. By chisquare test for linear trend in the normal BMI group, abnormal liver function was significantly affected by hazardous drinking (odds ratio 1.23) and harmful drinking (odds ratio 2.14) based on the guideline of Kim et al. By multiple logistic regression analysis, abnormal liver function was significantly affected by AUDIT questionnaires No. 1-3 (odds ratiohigh risk 2.39), age (odds ratiothirties 1.95, forties 2.40, fifties 3.85), BMI (odds ratiooverweight 1.66, obesity 4.53), guideline by WHO (odds ratiohazardous drinking 2.10), and guideline by Kim et al (odds ratioharmful drinking 2.20) C o n c l u s i o n s: We found that the problem of alcohol drinking as measured by AUDIT was significantly associated with abnormal liver function. Therefore we suggest that AUDIT will be useful for the predictive test of abnormal liver function and screening test of hazardous and harmful drinking.