MicroRNA (miRNA), miR-181a, is enriched in the brain, and inhibition of miR-181a reduced astrocyte death in vitro and infarct volume after stroke in vivo. This study investigated the role of miR-181a in neuronal injury in vitro and hippocampal neuronal loss in vivo after forebrain ischemia. miR-181a levels were altered by transfection with mimic or antagomir. N2a cells subjected to serum deprivation and oxidative stress showed less cell death when miR-181a was reduced and increased death when miR-181a increased; protection was associated with increased Bcl-2 protein. In contrast, transfected primary neurons did not show altered levels of cell death when miR-181a levels changed. Naive male rats and rats stereotactically infused with miR-181a antagomir or control were subjected to forebrain ischemia and cornus ammonis (CA)1 neuronal survival and protein levels were assessed. Forebrain ischemia increased miR-181a expression and decreased Bcl-2 protein in the hippocampal CA1 region. miR-181a antagomir reduced miR-181a levels, reduced CA1 neuronal loss, increased Bcl-2 protein, and significantly prevented the decrease of glutamate transporter 1. Thus, miR-181a antagomir reduced evidence of astrocyte dysfunction and increased CA1 neuronal survival. miR-181a inhibition is thus a potential target in the setting of forebrain or global cerebral ischemia as well as focal ischemia.

Patients with carbon monoxide (CO) poisoning have been found to have a correlation between initial clinical severity on admission and blood lactate levels. Recently, it is suggested that the lactate level may be a useful prognostic factor in cases study. The purpose of this study was to determine whether lactate levels were associated with the short-term outcome of patients with CO poisoning and identify the characteristics of patients with high initial lactate levels. Eighty patients that presented to the Chonnam National University Hospital after CO poisoning, over 5 years, were enrolled in this retrospective study. Fifty-six (70.0%) patients had high lactate (>2.1 mmo/L) on admission. Thirty-three (41.3%) patients had medical complications and one patient (1.3%) died. The patients with high initial lactate had an altered mental status more frequently, higher WBC, glucose and carboxyhemoglobin (COHb), and lower base deficit on admission. The multivariate analysis showed that lactate was an independent factor associated with serious complications and the need for intensive medical treatment, along with advanced age, WBC, and altered mental status on admission. The results of this study show that the initial lactate was useful for patient prognosis after CO poisoning.

Background. Glyphosate herbicide intoxication results in a range of mortality and morbidity, depending on patients' factors. Predicting which patient will need intensive medical treatment might help reduce mortality by providing prompt treatment, as well as triage those patients not likely to develop complications. Thus, we sought to identify independent factors that could predict which patient will develop subsequent medical complications. Methods. Seventy-six patients presenting with acute glyphosate herbicide ingestion at Chonnam National University Hospital were enrolled in this retrospective study. To identify the predictive factors for complications, objective variables easily assessed at presentation including previously reported predictive factors for mortality, such as age, vital signs, X-ray abnormalities, and laboratory findings, were analyzed by univariate and multivariate stepwise logistic regression analyses. Results. Of the 76 patients, 32 (42.1%) had medical complications and 2 (2.6%) died. Metabolic acidosis was the most common medical complication. Whereas metabolic acidosis, respiratory failure, hypotension, acute kidney injury, hyperkalemia, and seizures developed within 24 h, acute pancreatitis occurred a few days after the ingestion. The univariate analysis showed that an advanced age, amount ingested >100 mL, X-ray abnormalities, elevated amylase, alanine aminotransferase (ALT), and blood nitrogen urea were significant factors. However, the multivariate analysis showed that advanced age, elevated ALT, and X-ray abnormalities were independent factors associated with serious complications and the need for intensive medical treatment. Conclusions. The results of this study showed that age > 50 years, X-ray abnormalities, and ALT > 40 U/L were significant predictive factors for complications in patients with glyphosate surfactant herbicide poisoning; patients with these findings might require admission to the intensive care unit.

Endosulfan is a widely used insecticide that is associated with a high fatality rate in humans when ingested accidentally or with the aim of suicide. However, the literature concerning human endosulfan exposure is limited to case reports. Thus, we sought to 1) describe the clinical features of patients with acute endosulfan poisoning and 2) identify independent factors to predict patients’ outcome. Fifty-two patients who presented with acute endosulfan poisoning between January 2001 and January 2007 were enrolled in this retrospective study. Sixteen (30.7%) of the 52 patients died, and 48 patients experienced seizures. Endosulfan poisoning caused the hypotension and the abnormalities on electrocardiogram at presentation. Over half of the patients developed complications, such as rhabdomyolysis, hepatic toxicity, and hypotension. These complications resolved without sequelae in the survival group. Refractory status epilepticus was the most common cause of death in this series (75.0%). Amount ingested being greater than 35 g of endosulfan was the most found to be an independent variable that predicted patient mortality. Patients with this risk factor must be treated aggressively during the early stage of endosulfan poisoning.

Paraquat (PQ) poisoning is an extremely difficult condition to manage clinically because of the lack of effective treatments. The purpose of this study was to assess the effect of high doses of vitamin C in combination with anti-inflammatory and immunosuppressant therapy in patients with PQ poisoning. The medical records of 134 patients who presented to the emergency department within 24 hours after PQ poisoning were reviewed retrospectively. The 57 patients presented between January 2004 and September 2005 were group 1; they received pulse therapy, which included cyclophosphamide and methylprednisolone, followed by the administration of dexamethasone over 2 weeks. The 77 patients that presented between October 2005 and January 2008 were group 2; they received the above-mentioned therapy and high-dose vitamin C for 2 weeks. There was no difference in the distribution of baseline variables between the 2 groups. However, group 2 showed a significant reduction in acute kidney injury related to PQ. Furthermore, a multivariate logistic regression analysis showed that the addition of vitamin C to the treatment was significantly associated with an increased survival of the patients. Larger trials will be needed to verify the effect of high-dose vitamin C on survival in patients with PQ poisoning.