PURPOSE: Acute kidney injury (AKI) is a common complication during hospitalization and is an accepted risk factor for in-hospital mortality. However, the association of severity of AKI with the long-term risk of death is not well known. This study aimed to investigate the incidence and clinical significance of AKI in patients with acute myocardial infarction (AMI). METHODS: To examine the effect of the severity of AKI on 1-year risk of death following AMI, we performed an observational study of 1,224 patients admitted for AMI. We evaluated the association between AKI and all-cause mortality. Patients with maintaining hemodialysis treatment (n=7), and who died during hospitalization (n=71) were excluded. Remaining 1146 patients were divided into three groups according to the Acute Kidney Injury Network (AKIN) criteria (Stage-1, -2, and-3). The primary end point of the study was 1-year all-cause mortality after hospital discharge. The relation between the severity of AKI and 1-year mortality after AMI was analyzed. RESULTS: AKI was developed in 222/1,146 (19.3%) patients during the hospital stay. Adjusted hazard ratio for 1-year mortality was 3.064 (95% CI 1.618 to 5.803, p=0.001), 6.112 (95% CI 2.344 to 15.935, p<0.001) and 20.030 (95% CI 5.428 to 73.912, p<0.001) in stage-1, -2, and stage-3 AKI groups compared with that of no AKI group. CONCLUSION: The severity of AKI is strongly related to 1-year all cause mortality in patients with AMI.
Acute Kidney Injury ; Fatal Outcome ; Hospital Mortality ; Hospitalization ; Humans ; Incidence ; Length of Stay ; Myocardial Infarction ; Renal Dialysis ; Risk Factors

Renal sodium and water reabsorption occurs through epithelial sodium transporters and aquaporin (AQP) water channels in various segments of tubules. We have demonstrated altered regulation of these transporters and channels in various pathophysiological conditions. In nephrotic syndrome and liver cirrhosis, expression of epithelial sodium channels (ENaC) was increased in the late distal convoluted tubule, connecting tubule, and collecting duct. In spontaneously hypertensive rats, the expression of Na,K-ATPase as well as that of ENaC was increased. In contrast, AQP1-3 and sodium transporters was decreased in the kidney from deoxycorticosterone acetate-salt hypertension. In two-kidney, one clip hypertension, the expression of Na,K-ATPase, NHE3, NKCC2 and ENaC subunits was decreased in the clipped kidney while remained unchanged in the contralateral kidney. We have also shown an increased activity of renal atrial natriuretic peptide system in postobstructive natriuresis/ diuresis. In acute kidney injury (cisplatin-, gentamicin- and ischemia/reperfusion-induced), the expression of Na,K-ATPase, NHE3, NKCC2 and AQP1-3 was decreased. The altered regulation of sodium transporters and AQP may be causally related with various kidney diseases and hypertension.
Acute Kidney Injury ; Aquaporins ; Desoxycorticosterone ; Diuresis ; Epithelial Sodium Channels ; Hypertension ; Kidney ; Kidney Diseases ; Liver Cirrhosis ; Nephrotic Syndrome ; Rats, Inbred SHR ; Sodium

Renal sodium and water reabsorption occurs through epithelial sodium transporters and aquaporin (AQP) water channels in various segments of tubules. We have demonstrated altered regulation of these transporters and channels in various pathophysiological conditions. In nephrotic syndrome and liver cirrhosis, expression of epithelial sodium channels (ENaC) was increased in the late distal convoluted tubule, connecting tubule, and collecting duct. In spontaneously hypertensive rats, the expression of Na,K-ATPase as well as that of ENaC was increased. In contrast, AQP1-3 and sodium transporters was decreased in the kidney from deoxycorticosterone acetate-salt hypertension. In two-kidney, one clip hypertension, the expression of Na,K-ATPase, NHE3, NKCC2 and ENaC subunits was decreased in the clipped kidney while remained unchanged in the contralateral kidney. We have also shown an increased activity of renal atrial natriuretic peptide system in postobstructive natriuresis/ diuresis. In acute kidney injury (cisplatin-, gentamicin- and ischemia/reperfusion-induced), the expression of Na,K-ATPase, NHE3, NKCC2 and AQP1-3 was decreased. The altered regulation of sodium transporters and AQP may be causally related with various kidney diseases and hypertension.
Acute Kidney Injury ; Aquaporins ; Desoxycorticosterone ; Diuresis ; Epithelial Sodium Channels ; Hypertension ; Kidney ; Kidney Diseases ; Liver Cirrhosis ; Nephrotic Syndrome ; Rats, Inbred SHR ; Sodium

The present study investigated the prognostic factors predicting survival of patients with sepsis and acute kidney injury (AKI) undergoing continuous renal replacement therapy (CRRT). This retrospective observational study included 165 sepsis patients treated with CRRT. The patients were divided into two groups; the survivor group (n=73, 44.2%) vs. the nonsurvivor group (n=92, 55.8%). AKI was defined by the 2012 Kidney Disease: Improving Global Outcomes Clinical Practice Guidelines. We analyzed medical histories, clinical characteristics and laboratory findings of the enrolled patients when they started CRRT. In addition, we performed binary logistic regression and cox regression analysis. In the survivor group, urine output during the first day was significantly higher compared with the nonsurvivor group (55.7±66.3 vs. 26.6±46.4, p=0.001). Patients with urine output <30 mL/hour during the 1st day showed worse outcomes than ≥30 mL/hour in the logistic regression (hazard ratio 2.464, 95% confidence interval 1.152-5.271, p=0.020) and the cox regression analysis (hazard ratio 1.935, 95% confidence interval 1.147-3.263, p=0.013). In conclusion, urine output may predict survival of septic AKI patients undergoing CRRT. In these patients, urine output <30 mL/hour during the first day was the strongest risk factor for in-hospital mortality.
Acute Kidney Injury ; Biomarkers ; Hospital Mortality ; Humans ; Kidney Diseases ; Logistic Models ; Observational Study ; Renal Replacement Therapy ; Retrospective Studies ; Risk Factors ; Sepsis ; Survivors

A 44-year-old man with chronic alcoholism presented with seizure and loss of consciousness. He was diagnosed with alcoholic hepatic encephalopathy, and his neurologic symptoms recovered after lactulose enema treatment. His initial serum sodium level was 141 mEq/L. However, his mental state became confused after treatment with lactulose enema for five days, and his serum sodium level increased to 178 mEq/L. After five days of gradual correction of serum sodium level from 178 mEq/L to 140 mEq/L, the patient’s mental state recovered, but motor weakness in both limbs remained. Therefore, magnetic resonance imaging of the brain was performed. T2-weighted brain images showed bilateral symmetrical hyperintensities in the central pons, basal ganglia, thalami, hippocampi and unci, which were consistent with central pontine and extrapontine myelinolysis. We report a rare case of osmotic demyelination syndrome that occurred as a result of a rapid increase from a normal sodium level to hypernatremia caused by lactulose enema administered to treat alcoholic hepatic encephalopathy.

PURPOSE: Neuroendocrine tumor is a rare tumor in the rectum, but incidence has been increasing. Local excision is an option for treatment of small tumors, and transanal excision or endoscopic resection can be undergone. But indications for local excision have not been established yet. This study was to compare the long-term oncologic outcomes between transanal excision and endoscopic resection for rectal neuroendocrine tumor.METHODS: Patients diagnosed and treated with rectal neuroendocrine tumor from 2000 to 2015 were collected prospectively, and medical records were analyzed retrospectively.RESULTS: Forty patients were included, mean age was 50.20±13.35 years (male:female=23:17). Transanal excision and endoscopic resection were performed in 28 (70%) and 12 (30%) patients, respectively. Mean tumor size was 0.63±0.37 cm, and tumor location was 5.45±1.89 cm from anal verge. Tumor location was more distal rectum in transanal excision (5.04±1.73 cm vs. 6.42±1.98 cm, P=0.049). Pathologic T stage was T1 in all patients. Most of the patients (90%) showed tumor grade 1. After median 24 months (range, 0–86 months) follow-up, one patient (2.5%) experienced local recurrence. The patient underwent further transanal excision. There was no mortality after local excision.CONCLUSION: Local excision is a safe and effective treatment for small-sized neuroendocrine tumors in rectum.
Carcinoid Tumor ; Follow-Up Studies ; Humans ; Incidence ; Medical Records ; Mortality ; Neuroendocrine Tumors ; Prospective Studies ; Rectal Neoplasms ; Rectum ; Recurrence ; Retrospective Studies

BACKGROUND: The bioincompatability of the conventional peritoneal dialysis can be partly attributed to the presence of GDPs, which are generated during the heat sterilization. Formation of GDPs can be significantly reduced by the use of multi-chamber bag systems because high concentrated glucose is separated from alkaline lactate. In order to investigate whether multi-chamber bag system can improve the in vivo biocompatibility, we performed a randomized, prospective study comparing the multi-chamber bag system with the conventional PD system, measuring CA125 and PIIINP levels in the effluent dialysates as well as the other clinical and biochemical parameters. METHODS: Forty five patients who were stable on CAPD were enrolled randomly assigned to experiment group (n=27), and control group (n=18). Overnight effluent was collected for measurement of CA125 and PIIINP and the other clinical, biochemical parameters were compared including the number of peritonitis, the ultrafiltration volume. RESULTS: In patients treated with the multiple chamber bag system, there were significantly higher levels of CA125 and PIIINP from 1 month. No clinical and biochemical parameters influenced on their levels. The incidence of peritonitis or ultrafiltration volume did not differ between the two groups. CONCLUSION: Using the low GDP solution resulted in a better preservation of peritoneal mesothelial mass and an improvement of local peritoneal homeostasis, which are supposed to contribute to the biocompatibility of peritoneal dialysis fluid.
Dialysis Solutions ; Glucose ; Guanosine Diphosphate* ; Homeostasis ; Hot Temperature ; Humans ; Incidence ; Lactic Acid ; Peritoneal Dialysis* ; Peritoneal Dialysis, Continuous Ambulatory ; Peritonitis ; Prospective Studies ; Sterilization ; Ultrafiltration

PURPOSE: To evaluate the effect of repeated debulking surgery for high-grade pseudomyxoma peritonei (PMP) originating from the appendix.METHODS: Between January 1998 and December 2014, fifty patients, who underwent debulking surgery for high-grade PMP originating from the appendix, were obtained from a prospectively collected database and retrospectively analyzed. Two groups according to the number of operations were divided and analyzed.RESULTS: A total of 118 operations were performed. Thirty-one patients received more than two operations. The median interval between operations was 18.2 months (range, 2–170 months). Complications developed after 26 operations (22.0%), including ileus (n=10), intra-abdominal fluid collection (n=7), surgical site infection (n=5), and others. There were two mortalities within 30 days after operation. Between two groups of patients who received one operation only and patients who received more than two operations, transfusion, diversion operation, and postoperative complication rate showed statistically significant differences. Two groups of patients had no differences in overall survival rates.CONCLUSION: Our results indicate that the number of operations does not affect the survival rate of high-grade appendiceal PMP, in which repeated debulking surgery is vital to relieve symptoms of the tumor burden.
Appendix ; Cytoreduction Surgical Procedures ; Humans ; Ileus ; Mortality ; Postoperative Complications ; Prospective Studies ; Pseudomyxoma Peritonei ; Recurrence ; Retrospective Studies ; Surgical Wound Infection ; Survival Rate ; Tumor Burden

Psychrobacter sanguinis has been described as a Gram-negative, aerobic coccobacilli originally isolated from environments and seaweed samples. To date, 6 cases of P. sanguinis infection have been reported. A 53-year-old male was admitted with a generalized tonic seizure lasting for 1 minute with loss of consciousness and a mild fever of 37.8℃. A Gram stain revealed Gram-negative, small, and coccobacilli-shaped bacteria on blood culture. Automated microbiology analyzer identification using the BD BACTEC FX (BD Diagnostics, Germany) and VITEK2 (bioMérieux, France) systems indicated the presence of Methylobacterium spp., Aeromonas salmonicida, and the Moraxella group with low discrimination. The GenBank Basic Local Alignment Search Tool and an Ez-Taxon database search revealed that the 16S rRNA gene sequence of the isolate showed 99.30% and 99.88% homology to 859 base-pairs of the corresponding sequences of P. sanguinis, respectively (GenBank accession numbers JX501674.1 and HM212667.1). To the best of our knowledge, this is the first human case of P. sanguinis bacteremia in Korea. It is notable that we identified a case based on blood specimens that previously had been misidentified by a commercially automated identification analyzer. We utilized 16S rRNA gene sequencing as a secondary method for correctly identifying this microorganism.
Aeromonas salmonicida ; Bacteremia* ; Bacteria ; Databases, Nucleic Acid ; Discrimination (Psychology) ; Fever ; Genes, rRNA ; Humans ; Korea ; Male ; Methods ; Methylobacterium ; Middle Aged ; Moraxella ; Psychrobacter* ; RNA, Ribosomal, 16S ; Seaweed ; Seizures ; Unconsciousness

PURPOSE: Dexmedetomidine, a full agonist of alpha2B-adrenoceptors, is used for analgesia and sedation in the intensive care units. Dexmedetomidine produces an initial transient hypertension due to the activation of post-junctional alpha2B-adrenoceptors on vascular smooth muscle cells (SMCs). The aims of this in vitro study were to identify mitogen-activated protein kinase (MAPK) isoforms that are primarily involved in full, alpha2B-adrenoceptor agonist, dexmedetomidine-induced contraction of isolated rat aortic SMCs. MATERIALS AND METHODS: Rat thoracic aortic rings without endothelium were isolated and suspended for isometric tension recording. Cumulative dexmedetomidine (10(-9) to 10(-6) M) dose-response curves were generated in the presence or absence of extracellular signal-regulated kinase (ERK) inhibitor PD 98059, p38 MAPK inhibitor SB 203580, c-Jun NH2-terminal kinase (JNK) inhibitor SP 600125, L-type calcium channel blocker (verapamil and nifedipine), and alpha2-adrenoceptor inhibitor atipamezole. Dexmedetomidine-induced phosphorylation of ERK, JNK, and p38 MAPK in rat aortic SMCs was detected using Western blotting. RESULTS: SP 600125 (10(-6) to 10(-5) M) attenuated dexmedetomidine-evoked contraction in a concentration-dependent manner, whereas PD 98059 had no effect on dexmedetomidine-induced contraction. SB 203580 (10(-5) M) attenuated dexmedetomidine-induced contraction. Dexmedetomidine-evoked contractions were both abolished by atipamezole and attenuated by verapamil and nifedipine. Dexmedetomidine induced phosphorylation of JNK and p38 MAPK in rat aortic SMCs, but did not induce phosphorylation of ERK. CONCLUSION: Dexmedetomidine-induced contraction involves a JNK- and p38 MAPK-mediated pathway downstream of alpha2-adrenoceptor stimulation in rat aortic SMCs. In addition, dexmedetomidine-induced contractions are primarily dependent on calcium influx via L-type calcium channels.
Adrenergic alpha-2 Receptor Agonists/*pharmacology ; Animals ; Anthracenes/pharmacology ; Aorta/cytology ; Dexmedetomidine/*pharmacology ; Enzyme Inhibitors/pharmacology ; Extracellular Signal-Regulated MAP Kinases/antagonists & inhibitors/physiology ; Flavonoids/pharmacology ; Imidazoles/pharmacology ; JNK Mitogen-Activated Protein Kinases/antagonists & inhibitors/*physiology ; Male ; *Muscle Contraction ; Muscle, Smooth, Vascular/drug effects/enzymology/*physiology ; Protein Isoforms/antagonists & inhibitors/physiology ; Pyridines/pharmacology ; Rats ; Rats, Sprague-Dawley ; p38 Mitogen-Activated Protein Kinases/antagonists & inhibitors/physiology