LAUSR

The current issue of Shock contains six clinical studies (1–6), 10 basic studies (7–16), and one editorial comment (17). Loftus et al. (1) from the University of Florida studied the acute kidney injury (AKI) following the exploratory laparotomy and temporary abdominal closure. This is a very important clinical study because the exploratory laparotomy and temporary abdominal closure using negative pressure wound therapy are common procedures in the field of acute care surgery and they sometimes complicate with AKI. The authors found that AKI following exploratory laparotomy and temporary abdominal closure reached greatest prevalence 48 h after initial laparotomy, and that it was associated with increased mortality. Furthermore, they found that fluid loss during temporary abdominal closure using negative pressure wound therapy was a risk factor for AKI. Thus, the results of the present study suggest that the adequate body water management following exploratory laparotomy and temporary abdominal closure using negative pressure wound therapy might be very important for the prevention of AKI. As shown in the above study by Loftus et al. (1), AKI is one of the serious complications in the field of critical care and it is suggested that early diagnosis and early initiation of therapeutic approach are the key for better outcomes. Therefore, many studies have been investigated on the effective and useful biomarkers for the early diagnosis of AKI. Hu et al. (2) from Southeast University, Nanjing, China, investigated the usefulness of urinary mitochondrial DNA (UmtDNA) as a biomarker for the diagnosis of AKI on surgical intensive care unit (ICU) patients. They employed the quantitative polymerase chain reaction (PCR) for the measurement of UmtDNA. And they found that elevated UmtDNA levels could identify newly developed AKI and could predict renal replacement therapy or hospital mortality in those patients. They also suggested the involvement of mitochondrial injury in kidney damage among surgical critical illness patients. This is a very interesting study. Recently, mitochondrial DNA is paid much attention not only as a mere biomarker, but also as one of the very important damage-associated molecular patterns that initiate inflammatory response following injury. Since UmtDNA levels in the present study were measured with PCR which is not easily available in clinical settings, easier measurement method of UmtDNA is needed for UmtDNA to be widely measured as a biomarker for the diagnosis of AKI in clinical settings.