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Several studies have linked gut microbes to human diseases. Most of the mechanisms by which lactic acid bacteria have beneficial effects on the human body are related to immune modulation. Controlled studies of the ability of lactic acid bacteria to absorb phosphorus directly from the intestine and thereby control serum phosphorus level in in vivo uremic animal models are limited.We screened lactic acid bacteria living in Korean fermented foods to identify those that absorb the most phosphorus and noted Lactiplantibacillus paraplantarum KCCM 11826P. The mechanism through which better intracellular absorption of phosphorus occurs in this strain was studied using genomic DNA sequencing. After the strain was administered to 5/6 nephrectomized rats for 6 weeks, it was observed whether hyperphosphatemia had improved.The L. paraplantarum KCCM 11826P strain has a polyP gene cluster; thus, it absorbs phosphorus better than other bacteria and can suppress strains that produce indole. Supplementing the diets of 5/6 nephrectomized rats with this L. paraplantarum strain significantly decreased serum phosphate level (by 22 %) and reduced blood indoxyl sulphate concentration (by 40 %) compared with vehicle treatment.These results suggest that Lactiplantibacillus preparations can be used for multiple purposes, such as the removal of phosphorus and uremic toxins from patients with chronic kidney disease (CKD). This study also demonstrates the novel concept of a probiotic phosphate binder.

Objectives: Uremic pruritus is common in patients with chronic kidney disease (CKD). The retention of uremic solutes is thought to be associated with uremic pruritus. Meanwhile, activation of protease-activated receptor-2 (PAR-2) has been suggested to play an important role in pruritus. The present study was performed to investigate the effects of uremic solutes on the expression of PAR-2 in the skin. Methods: Indoxyl sulfate (IS), p-cresol (PC), and uremic sera from CKD patients were used to stimulate PAR-2 expression in normal human epidermal keratinocytes (NHEKs). Also, NHEKs were additionally pretreated with soybean trypsin inhibitor to evaluate its inhibitory effect on PAR-2 expression. Patterns of cutaneous PAR-2 expression were investigated in skin samples from five CKD patients and CKD mice. Results: In NHEKs, IS, PC, and sera from CKD patients significantly induced PAR-2 mRNA and protein expression. Soybean trypsin inhibitor significantly decreased PAR-2 mRNA and protein expression in NHEKs treated with IS, PC, and CKD sera. NHEKs treated with IS and PC exhibited significant increases in protease activity. Skin from both CKD patients and mice exhibited marked upregulation of PAR-2 expression compared to control skin. Conclusions: Results from the present study suggest that uremic solutes either directly or indirectly affect PAR-2 expression in the skin of CKD subjects, potentially playing an important role in the pathogenesis of uremic pruritus.

Rationale & Objective We aimed to elucidate whether a balanced salt solution decreases the occurrence of contrast-induced acute kidney injury (CI-AKI) after contrast-enhanced computed tomography (CE-CT) as compared to 0.9% saline solution. Study Design A randomized clinical trial. Setting & Participants The study was performed in 14 tertiary hospitals in South Korea. Patients with estimated glomerular filtration rates (eGFRs), Graphical abstract

Background Significant body fat accumulation is an inevitable but potentially serious problem in peritoneal dialysis (PD) patients. Whether excessive fat gain predicts long-term outcomes in these patients remains unknown. Methods In this prospective cohort study ( n = 297), the associations of excessive fat accumulation with patient survival and PD failure rate were examined. Based on dialysis duration at the time of study enrollment, patients were divided into short-(< 2 years) and long-term (> 2 years) groups. Body weight (BW) and body composition were measured twice, 12.8 ± 4.6 months apart. Excessive fat accumulation was defined as a 1-year change in the percentage of body fat (ΔPBF) over the highest quartile (5.0% for men, 5.4% for women). Results Substantial 1-year increases in BW and PBF were observed only in the short-term group ( p < 0.001 and p = 0.027, respectively); changes were insignificant in the long-term group. In the short-term group, the ΔPBF was associated closely with unfavorable baseline metabolic profiles, including old age, diabetes, obesity, elevated blood pressure, and edema. Accordingly, the mortality rate was significantly higher in patients with, than in those without, excessive fat accumulation (hazard ratio [HR] 3.26, 95% confidence interval [CI], 1.05 – 10.26). It also increased the incident risk of PD failure 2.22-fold (95% CI, 1.08 – 4.54), even after adjustment for diabetes, obesity, and fluid status. In the long-term group, fat gain had no impact on long-term prognosis. Conclusions Excessive fat accumulation during the early period of PD was associated with baseline unhealthy metabolic profiles, a higher mortality rate, and a higher PD failure rate, independent of baseline obesity and fluid status.

Cluster of differentiation 93 (CD93) is a glycoprotein expressed in activated endothelial cells. The extracellular portion of CD93 can be secreted as a soluble form (sCD93) under inflammatory conditions. As diabetic nephropathy (DN) is a well-known inflammatory disease, we hypothesized that sCD93 would be a new biomarker for DN. We prospectively enrolled 97 patients with type 2 diabetes and evaluated the association between serum sCD93 and DN prevalence. The association between CD93 and development of DN was investigated using human umbilical cord endothelial cells (HUVECs) in vitro and diabetic db/db mice in vivo. Subjects with higher sCD93 levels had a lower estimated glomerular filtration rate (eGFR). The sCD93 level was an independent determinant of both the albumin-to-creatinine ratio (ACR) and the eGFR. The risk of prevalent DN was higher in the high sCD93 group (adjusted odds ratio 7.212, 95% confidence interval 1.244&ndash, 41.796, p = 0.028). In vitro, CD93 was highly expressed in HUVECs and both CD93 expression and secretion were upregulated after lipopolysaccharides (LPS) stimulation. In vivo, peritoneal and urine sCD93 levels and the renal glomerular expression of CD93 were significantly higher in the db/db mice than in the control db/m+ mice. These results suggest the potential of sCD93 as a candidate biomarker associated with DN.

Background The 24-hour uric acid excretion measurement is important in assessing disease status and helping to select the appropriate uric acid-lowering agent for patients with gout, however, it is inconvenient. The authors investigated the efficacy of the random urine uric acid-to-creatinine (UA/CR) ratio to screen the patients who under-secreted 24-hour urine uric acid. Methods This was a retrospective cross-sectional study. Ninety patients with gout, without undergoing uric acid-lowering treatment were enrolled. Twenty-four-hour urine and random urine samples were obtained on the same day. Six hundred mg of uric acid in the 24-hour urine sample was used as a standard for distinguishing between over and under-excretion groups. Results The random urinary UA/CR ratio showed positive correlation with 24-hour urine uric acid excretion (γ = 0.398, P < 0.001). All the patients with the random UA/CR less than 0.2 excreted less than 600 mg uric acid in 24-hour urine collection. When the random urine UA/CR ratio < 0.2 was regarded as a positive result, the positive predictive value, negative predictive value, sensitivity, and specificity in the uric acid under-excretion were 100% (8 of 8), 64.6% (53 of 82), 21.6% (8 of 37), and 100% (53 of 53), respectively. Conclusion There is a moderate positive correlation between the random urinary UA/CR ratio and 24-hour urine uric acid excretion, so that UA/CR ratio may not be a good predictor of 24-hour urine uric acid excretion. However, the random urine UA/CR ratio 0.2 can be a useful predictor to screen the gouty patients who need to be treated with uricosuric drugs., Graphical Abstract

PURPOSE The purpose of study was to investigate the effect of muscle activation of Erector spinae, Gluteus Maximus and Biceps femoris muscle during modified bridge exercise in patients with chronic low back pain. METHODS The electromyogram was used to measure activation of Erector spinae, Gluteus Maximus and Biceps femoris muscle during five modified bridge exercise with electromyography electrodes in 21 patients (9 men, 12 women) who have suffered chronic low back pain. RESULTS The muscle activation of the erector spine to compare with NB, the posture of DB, TB, ABDB is statistically significant (p

Background Depression is prevalent in patients with chronic kidney disease (CKD) and continues to increase in elderly adults. Therefore, the aim of our study was to examine the relationship between CKD and depression in older patients. Methods We conducted a cross-sectional study based on 2013 Korea National Health and Nutrition Examination Survey data. In total, data of 973 subjects aged ≥65 years were analyzed, and the estimated glomerular filtration rate (eGFR) was calculated using the Chronic Kidney Disease Epidemiology Collaboration equation. Results The prevalence of depression in older adults was 4.1% in men and 8.8% in women (P=0.004). The prevalence of depression did not differ according to CKD stage in women (normal eGFR and CKD stages 1 and 2 women, 41/474 [8.6%]) vs. CKD stages 3-5 women, 6/63 [9.5%]); however, the prevalence of depression in men with CKD stages 3-5 (8/83 [9.6%]) was significantly higher than in men with normal eGFR and CKD stage 1 and 2 (10/353 [2.8%], P=0.010). Multivariate logistic regression analysis showed that the odds ratio for depression in men with CKD stages 3-5 was 3.822 (95% confidence interval, 1.229 to 11.879) after adjusting for social status and chronic diseases (P=0.021). Conclusion The prevalence of depression was higher in elderly women than in men, while the prevalence of depression increased in elderly men with CKD stages 3-5 and was almost equal to that of women. Therefore, elderly men with progressive renal function impairment should be counseled and monitored for psychological problems.

PURPOSE Dysregulated microRNAs (miRNAs) can contribute to cancer development by leading to abnormal proliferation of cells, apoptosis, and differentiation. Although several miRNAs that are related to gastric cancer have been identified, the reported results have been inconsistent. The aim of this study was to determine miRNA expression profiles and validate miRNAs up- and down-regulated in gastric cancer. MATERIALS AND METHODS We evaluated 34 primary gastric cancer tissues and paired adjacent nontumorous gastric tissues. Total RNA was extracted, and low-molecular-weight RNAs (

Background: Helicobacter pylori (HP) infection causes many diseases, such as peptic ulcers, gastritis and gastric cancer, and MALToma. It has been gradually accepted that all HP-infected patients should be treated because HP is regarded as an infection. Therefore, the importance of selecting the optimal treatment regimen has increased. Although the 14-day standard triple therapy (STT) is recommended in the current guidelines, prolonging treatment duration is controversial in real practice because of inconsistent results from previous data and the risk of adverse effects. Additionally, the effect of STT using ilaprazole has not been reported until now. We aimed to compare the eradication rate between 7 and 10 days STT using ilaprazole. Methods: A prospective randomized controlled trial was conducted, which was divided into 2 treatment groups: the control group was 7 days of STT, and the test group was 10 days of STT. The eradication regimen was 10 mg ilaprazole, 500 mg clarithromycin, and 1000 mg amoxicillin twice daily. We included patients who were diagnosed with positive results of H pylori examination. We compared the HP eradication rate according to treatment duration, CYP2C19 subtype and endoscopic diagnosis. Results: We enrolled a total of 254 patients consisting of 127 patients in each treatment arm. The eradication rates of the control and test groups were 65.4% (82/127) and 74.8% (95/127), respectively, in the intention-to-treat analysis (P = .1). In the per-protocol analysis, 70.3% (83/118) and 82.6% (94/115) were eradicated in each group, which was statistically significant (P = .027). The CYP2C19 subtype was examined in 230 patients. The eradication rate was 79.2% (57/72), 75.4% (92/122), and 72.2% (26/36) in each group, which was not significantly different (P = .704). Conclusion: Ten-day STT was more effective than 7-day STT for HP eradication. The eradication rate was not affected by the CYP2C19 genotype.

Background Gout is one of a heterogeneous group of diseases related to hyperuricemia. The measurement of 24 hour urinary uric acid excretion is frequently used to evaluate disease status and select drugs that lower uric acid level. However, 24 hour urine collection is inconvenient and frequently unreliable, due to errors in collection. Therefore, a simpler alternative to the 24 hour urine collection is needed. Objectives We investigated the utility of the random urine uric acid-to-creatinine (UA/CR) ratio in predicting 24 hour urine uric acid excretion in patients with gout. Methods Ninety patients with gout without any use of uric acid lowering agents were enrolled in this study. The mean age was 50.0±16.7 years old and the male patient was 90.0% (81/90) of all participants. For the evaluation of uric acid excretion and renal function, patients were collected 24 hour urine. Random urine uric acid and creatinine specimens were gained on the same day of 24 hour urine collection. Chronic kidney disease was defined as a creatinine clearance (CCr) level of less than 60 ml/min/1.73m2 measured in 24 hour urine collection sample. Excretion of more than 600 mg of uric acid in the 24 hour urine sample was defined as uric acid over-excretion. Results Mean serum uric acid level was 7.73±1.89 mg/dl, and the mean 24 hour uric acid excretion was 666.5±236.2 mg. The random urinary UA/CR ratio showed positive correlation with 24 hour urine uric acid excretion (γ=0.398, p Conclusions The random urine UA/CR ratio correlated with 24 hour urine uric acid excretions in patients with gout. The best cut-off random urine UA/CR ratio value to discriminate uric acid over-excretion was 0.342, with a sensitivity of 74.1% and a specificity of 66.7%. The random urine UA/CR ratio would be a useful predictor to detect patients with urinary uric acid underexcretion, who could then be treated with uricosuric drugs. Disclosure of Interest None declared

Toxic megacolon is a rare clinical complication of fulminant Clostridium difficile infection. The mortality rate of fulminant C. difficile infection is reported to be as high as 50%. Fecal microbiota transplantation is a highly effective treatment in patients with recurrent or refractory C. difficile infection. However, there are few published articles on the use of such transplantation for fulminant C. difficile infection. Here, we report on a patient with toxic megacolon complicated by C. difficile infection who was treated successfully with fecal microbiota transplantation. (Gut Liver, 2015;9:247-250)

Background Contrast-induced acute kidney injury (CI-AKI) is one of the most common causes of iatrogenic kidney injury and, therefore, its prevention is an important issue. However, whether the administration of 0.9% saline is the optimal prophylaxis method remains uncertain due to its supra-physiologic chloride component. In particular, recent studies suggest that chloride-restricted solutions showed superiority over 0.9% saline in several clinical settings. Methods/design The investigators designed a multicenter randomized controlled trial to compare the efficacy of a balanced salt solution and 0.9% saline in CI-AKI prophylaxis. This study will recruit patients who are scheduled for contrast-enhanced computed tomography (CT) scans with CI-AKI prophylaxis. In this study, participants will be randomized into two study arms; the study group will receive a balanced salt solution, and the control group will receive 0.9% saline. Fluids will be administered as designated in the protocol before and after the CT scan, and an evaluation of baseline clinical status will be performed by obtaining blood and urine samples. During the follow-up visits, the incidence of CI-AKI and long-term outcomes, including the start of renal replacement therapy or all-cause mortality, will be assessed. Discussion To our knowledge, this study will be the first study assessing the preventive value of a balanced salt solution over 0.9% saline for CI-AKI. If the trial shows that the balanced salt solution is as effective for CI-AKI prophylaxis as 0.9% saline, the use of the balanced salt solution could be promoted due to the reduced possibility of consequent metabolic acidosis compared to 0.9% saline. Trials registration ClinicalTrials.gov, ID: NCT02799368. Registered on 14 June 2016. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2202-2) contains supplementary material, which is available to authorized users.

Supplemental Digital Content is available in the text, Proteinuria is a major determinant of adverse renal outcome, and its reduction slows renal progression in glomerular diseases. However, the optimal target of proteinuria in glomerular diseases is unclear, and discrepancies in the definition of proteinuria produce ambiguous findings. Here we investigated the optimal target of proteinuria by using different definitions of proteinuria. We analyzed 574 IgA nephropathy (IgAN), 175 membranous nephropathy (MGN), and 177 focal segmental glomerulosclerosis (FSGS) cases from 3 Korean kidney centers. We evaluated the impact of proteinuria on renal outcome with 2 definitions: time-average proteinuria (TAP) and time-varying proteinuria (TVP). The endpoint was renal progression, defined as a 50% decline in glomerular filtration rate or end-stage renal disease. During a median follow-up of 57.3 months, the primary outcome occurred in 54 patients with IgAN, 26 with MGN, and 30 with FSGS. Multivariate Cox regression using TAP indicated that there was a linear association between proteinuria and risk of renal progression in IgAN. However, moderate proteinuria was not associated with an increased risk of renal progression in MGN and FSGS. In contrast, the analysis by TVP showed that the risk significantly increased in proportion to proteinuria during follow-up in all 3 diseases. Our findings suggest that TVP-based model can delineate association between proteinuria and risk of renal progression better than TAP-based model, considering that TVP reflects the dynamic change of proteinuria over time. Thus, proteinuria reduction to the lowest possible level is required to improve renal outcomes in patients with glomerular diseases.

Background/Aims: Gastroesophageal reflux disease (GERD) is diagnosed based on symptoms of heartburn and regurgitation but is a heterogeneous condition which can be subclassified according to endoscopy and esophageal reflux monitoring. The aim of this study was to identify differences in demographic characteristics and reflux symptom patterns among patients with various spectrum of GERD. Methods: Patients having weekly heartburn or acid regurgitation were classified into four pathophysiological subgroups according to endoscopy and pH monitoring: reflux esophagitis (RE), endoscopy-negative reflux disease with pathological reflux (PR+), hypersensitive esophagus (HE), and normal acid exposure with negative symptom association (pH-). Results: A total of 195 patients were enrolled. The numbers of patients in the subgroups were: RE, 39.0%; PR+, 20.0%; HE, 10.3%; and pH-, 30.8%. Grossly, reflux symptom patterns and relieving/exacerbating factors did not differ between subgroups. Prevalence of extraesophageal syndrome was higher in patients with PR+ than in other groups. Overlapping functional dyspepsia was common in all groups. The SCL-90-R depression score was higher in PR+ patients than in RE patients (p

Background/aims The drink test has been regarded as a surrogate marker of gastric accommodation. The aims of this study were to develop a novel nutrient drink test (NDT) protocol and investigate its potential for application to a clinical trial of functional dyspepsia (FD). Methods A novel NDT was designed, involving drinking 125 mL of nutrient 4 times at 5-minute intervals or until maximal tolerability. Healthy volunteers and patients with FD rated their symptoms every 5 minutes for 20 minutes in a developmental study. Patients with FD were enrolled in an open trial of itopride for 4 weeks. NDT was performed before and after treatment. Improvement of integrative symptoms score during NDT after treatment for more than 50% compared with baseline was de-fined as responder. Results Total aggregate symptom scores, sum of symptom scores measured during NDT, were higher in FD patients (n = 40, 368.1 ± 245.3) than in controls (n = 19, 215.9 ± 171.2) (P = 0.018) in a developmental study. In an open trial of itopride, symp-tom scores measured during NDT decreased significantly at all time points after treatment in responders (n = 49), whereas did not in non-responders (n = 25). Total aggregate symptom score for NDT correlated significantly with integrative dyspeptic symptom score, sum of 8 symptom scores of NDI questionnaire, at baseline (r = 0.374, P = 0.001) and after treatment (r = 0.480, P ＜ 0.001). Conclusions Our novel NDT can quantify dyspeptic symptoms and reflected therapeutic effects of itopride treatment in a clinical trial of FD patients. This NDT can be used as an effective parameter in clinical trials or drug development programs for assessing effects of novel therapies on postprandial symptoms.

Food residue in the remnant stomach after subtotal gastrectomy (STG) interferes with endoscopic observation. We investigated whether intravenous erythromycin improves gastric mucosa visualization in patients with STG. This study was conducted from April 2012 to October 2012 as a double-blinded, placebo-controlled, randomized trial. Patients who received STG with complete resection (stage T1–2N0M0) were included. Exclusion criteria were diabetes mellitus, neurologic disease, myopathy, recent viral enteritis history, concomitant therapy influencing gastrointestinal motility and severe comorbidity. Patients were instructed to consume a soft diet for dinner between 1800 and 2000 h, and endoscopies were performed between 0900 and 1200 h. Patients were assigned randomly to receive either erythromycin (125 mg in normal saline 50 cc) or placebo saline. The endoscopy was performed 15 min after infusion. Grade of residual food was rated as follows: G0, no residual food; G1, a small amount of residual food; G2, a moderate amount of residual food; G3, a moderate amount of residual food that hinders observation of the entire surface, even with body rolling; G4, a great amount of residual food such that endoscopic observation is impossible. When good visibility was defined as G0+G1, visibility was significantly better in the erythromycin group (61 + 19 %) than in the placebo group (38 + 12 %, p

Palliative self-expandable metal stent placement for colonic obstruction arising from an extracolonic malignancy might be as useful as that for colorectal cancer, but data are limited. The purposes of this study were to investigate success and complications of stent placement in patients with extracolonic malignancy and to compare long-term clinical outcomes for an extracolonic malignancy group with those for a colorectal cancer group. We reviewed short-term and long-term outcomes for patients treated with palliative stents for colonic obstruction by extracolonic malignancy (n = 44) or unresectable colorectal cancer (n = 53) from January 2006 to March 2011. Neither the technical success (93.2 vs. 98.1 %, respectively; P = 0.326) nor clinical success (77.3 vs. 84.9 %, respectively; P = 0.433) of stent placement differed significantly in the two groups. Complications as a result of stent placement also differed only slightly in the two groups (perforation: 4.8 % (two cases) vs. 0 %, respectively; migration: 4.8 vs. 5.8 %, respectively, P = 0.343). With regard to long-term outcomes, although stent patency was shorter in the extracolonic malignancy group (P = 0.015), because overall survival in this group was also shorter (P = 0.018), it was sufficient for palliative purposes. Palliative stent placement was equally effective and safe for treatment of colonic obstruction arising from either extracolonic malignancy or unresectable colorectal cancer. Even in cases of colonic obstruction arising from extracolonic malignancy, stent placement should be considered as primary palliative therapy.

Background: The autonomic nervous system plays a central role in the maintenance of hemodynamic stability. Cardiac autonomic dysfunction may result in serious complications, such as sudden cardiac death. Heart rate variability (HRV) is significantly reduced in patients undergoing chronic hemodialysis (HD). The aim of this study was to evaluate the effect of on-line hemodiafiltration (OL-HDF) on the autonomic nervous system in chronic HD patients. Methods: Forty chronic HD patients were prospectively studied. The participants were divided into conventional HD and OL-HDF groups. They received regular high-flux HD or OL-HDF for 4-hour sessions, three times a week. Time-and frequency-domain measures of the 24-hour HRV were analyzed during the interdialytic period prior to postdilution OL-HDF and every 6 months for 24 months. The 7-year survival was also evaluated. Results: Among the 40 participants, 15 patients in the HD group and 11 patients in the OL-HDF group completed the study. There was no difference in the baseline characteristics. After 24 months of treatment, β2-microglobulin concentration decreased (from 33.4±15.2 mg/dL to 28.4±6.2 mg/dL, P =0.02) in the OL-HDF group, while there was no change in the HD group. In the HRV analysis, the frequency-domain HRV parameters increased significantly compared with baseline in the OL-HDF group [natural logarithmic high frequency (lnHF), 3.15±3.36 ms2 vs. 4.42±3.81 ms2; ln low frequency (LF), 3.56±3.17 ms2 vs. 4.78±3.99 ms2; ln very low frequency (VLF), 4.90±4.62 ms2 vs. 6.38±5.54 ms2; LF/HF ratio, 1.4±0.4 vs. 2.5±0.1]. The survival rate was similar between the groups. Conclusion: This study shows that OL-HDF improved autonomic nervous system dysfunction in chronic HD patients.

Urinary biomarkers of acute kidney injury (AKI) have been revealed recently to be useful for prior prediction of AKI. However, it is unclear whether these urinary biomarkers can also detect recovery from established AKI. Urinary biomarkers, including neutrophil gelatinase-associated lipocalin (NGAL) and cystatin C, were measured every 2 days for 8 days in 66 patients with AKI. At day 0, there were no significant differences in plasma creatinine, BUN, and urine cystatin C between AKI patients in the recovery (n = 33) and non-recovery (n = 33) groups. Plasma creatinine concentrations were significantly lower in the recovery group (3.0 ± 2.0 mg/dL) than in the non-recovery group (5.4 ± 1.9 mg/dL) on day 4 after AKI diagnosis (P < 0.001). In contrast, there were significant differences in urine NGAL between the two groups starting on day 0 (297.2 ± 201.4 vs 407.6 ± 190.4 ng/mL, P = 0.025) through the end of the study (123.7 ± 119.0 vs 434.3 ± 121.5 ng/mL, P < 0.001). The multiple logistic regression analysis showed that urine NGAL could independently predict recovery from AKI. Conclusively, this prospective observational study demonstrates that urine NGAL can be a highly versatile marker for early detection of the recovery phase in established AKI patients.

Purpose During continuous renal replacement therapy (CRRT), anticoagulation of the extracorporeal circuit is required. The aim of this study was to assess the efficacy and safety of nafamostat mesilate, a serine protease inhibitor, compared with heparin. Methods We retrospectively studied 222 patients treated with CRRT in the intensive care unit (ICU). Clinical and filter-related data were extracted. Results We reviewed the medical records of the patients treated with CRRT. Initial anticoagulation methods were 56 heparin and 25 nafamostat mesilate; 10 patients received infused heparin systemically, and 131 patients were treated without anticoagulation. Total number of filters used was 1,236. Median filter lifespan with nafamostat mesilate was significantly greater than heparin (24.3 vs. 17.5 hours, pConclusions Nafamostat mesilate anticoagulation was associated with prolonged filter survival compared with heparin. These data suggest that nafamostat mesilate is a good choice for anticoagulant with prolonged filter survival during CRRT in critically ill patients.

Background/Aims Available data about reflux patterns and symptom determinants in the gastroesophageal reflux disease (GERD) subtypes off proton pump inhibitor (PPI) therapy are lacking. We aimed to evaluate reflux patterns and determinants of symptom perception in patients with GERD off PPI therapy by impedance-pH monitoring. Methods We retrospectively reviewed the impedance-pH data in patients diagnosed as GERD based on results of impedance-pH monitoring, endoscopy and/or typical symptoms. The characteristics of acid and weakly acidic reflux were evaluated. Symptomatic and asymptomatic reflux were compared according to GERD subtypes and individual symptoms. Results Forty-two patients (22 males, mean age 46 years) were diagnosed as GERD (17 erosive reflux disease, 9 pH(+) non-erosive reflux disease [NERD], 9 hypersensitive esophagus and 7 symptomatic NERD). A total of 1,725 reflux episodes were detected (855 acid [50%], 857 weakly acidic [50%] and 13 weakly alkaline reflux [< 1%]). Acid reflux was more frequently symptomatic and bolus clearance was longer compared with weakly acidic reflux. In terms of globus, weakly acidic reflux was more symptomatic. Symptomatic reflux was more frequently acid and mixed reflux; these associations were more pronounced in erosive reflux disease and symptomatic NERD. The perception of regurgitation was related to acid reflux, while that of globus was more related to weakly acidic reflux. Conclusions In patients not taking PPI, acid reflux was more frequently symptomatic and had longer bolus clearance. Symptomatic reflux was more frequently acid and mixed type; however, weakly acidic reflux was associated more with globus. These data suggest a role for impedance-pH data in the evaluation of globus.