Eschar is an important finding for the diagnosis of scrub typhus. The IFA test for possible scrub typhus was performed. The presence or absence of eschar was thoroughly examined. Among the 176 scrub typhus cases confirmed by IFA, 162 (92.0%) cases had eschar; 128 patients (79.5%) had eschars on the front of the body. Eschars were primarily detected in males within 30 cm below the umbilicus (19 patients, 35.8%). Distributions on the lower extremities and the front chest above the umbilicus were 22.6% (12 patients) and 20.8% (11 patients), respectively. A different pattern was seen in females. The most prevalent area was the front chest above the umbilicus, which accounted for 40.7% (44 patients) of all the detected eschars. Our study is the first report of a schematic diagram that shows the differences between the males and females with respect to eschar location in scrub typhus patients.

We describe a scrub typhus patient with acute renal failure for whom a diagnosis was made based on serology as well as immunohistochemical (IHC) staining and an electron microscopic examination (EM) of a renal biopsy specimen. For our case, we demonstrated by IHC staining and EM that renal failure was caused by acute tubular necrosis due to a direct invasion of Orientia tsutsugamushi. CASE REPORTA healthy-looking, 33-year-old male patient received a drug treatment for a 2-week history of cough and sputum. One day before admission to our hospital, he complained of abdominal pain and nausea after he played football. He was suspected of having renal failure on examination at a local clinic and was transferred to Chosun University Hospital in Gwang-ju, South Korea. At the time of admission, his vital signs were a blood pressure of 120 over 80 mm Hg, a pulse rate of 72 times/min, a respiratory rate of 20 breaths/min, and a body temperature of 37.2°C. A urinalysis showed no gross hematuria, with a urine output of 50 ml/h. His mental status was alert. There was no skin rash or lymphadenopathy. The patient's complete blood count showed a white blood cell count of 11,630/mm 3 , a hemoglobin count of 14.5 g/dl, and a platelet count of 243,000/ mm 3 . An arterial blood gas analysis showed a pH of 7. , 120 meq/liter; blood urea nitrogen, 39.3 mg/dl; and creatinine, 5.0 mg/dl. The biochemistry results showed a total protein level of 6.73 g/dl, albumin at 3.78 g/dl, aspartate transaminase at 30 IU/liter, alanine aminotransferase at 18 IU/liter, creatine phosphokinase at 446 U/liter, lactate dehydrogenase at 565 U/liter, myoglobin at 168.4 ng/ml, fibrin degradation products at 1 mg/ml (range, 0 to ϳ5.0 mg/ml), and a D-dimer concentration of 143.6 ng/ml (range, 0 to ϳ255 ng/ml). On urinalysis, hematuria (score, ϩ3) and proteinuria (score, ϩ4) were shown to be present. A microscopic urinalysis revealed 10 to 19 red blood cells/high-power field (HPF), 2% dysmorphic red blood cells/HPF, 1 to 4 white blood cells/HPF, and no cast/HPF. A urinalysis using urine collected during 24 h detected selective proteinuria (albumin, 895 mg/day). Serologic tests were all negative for rheumatoid factor, antinuclear antibody, antineutrophil cytoplasmic antibody, and cold agglutinin, human immunodeficiency virus, hepatitis B virus, and hepatitis C virus antibodies, and the VDRL test was negative. Antistreptolysin O and complement levels were all normal.A self-employed person, our patient presented with no typical symptoms of scrub typhus, including rash, fever, and headache.

The eschar PCR assay was useful as a rapid and reliable test to confirm the diagnosis of scrub typhus, even though the patients received treatment with appropriate antibiotics, such as macrolides, quinolones, and tetracycline, which are all active against Orientia and Rickettsia species.

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This study shows that DFX is effective in reducing S-ferritin and LIC level in transfusional iron overload patients with MDS or AA and is well tolerated. In addition, positive effects in hematologic and hepatic function can be expected with DFX. Iron chelation treatment should be considered in transfused patients with MDS and AA when transfusion-related iron overload is documented.

We have prepared amide dendrons having alkyl peripheral units and various focal moieties through a convergent synthetic approach. The amphiphilic properties, due to hydrophilic amide branches and the hydrophobic peripheral units, provide an opportunity for the amide dendrons to self-organize in water. The dendritic architecture itself is also one of the critical factors in the self-organization of the amide dendrons in water. In particular, functionalization was performed at the focal point to elucidate the relationship between the focal functionality and the self-organized structures of the dendritic building blocks in the aqueous phase. The dendron having a short poly(ethylene glycol) monomethyl ether (MeO-PEG) unit (M n = 750) as the focal moiety formed a vesicular organization in water. As the size of the hydrophilic focal MeO-PEG increased to M n = 2,000 and 5,000, the self-organized structures became rod-type and spherical micelles, respectively. Our observation of multiple morphologies for amide dendrons is in good agreement with previous reports that indicated that the micellar structures changed from vesicles to rod-types and then to spheres upon increasing the size of the hydrophilic moiety of the amphiphiles.

The presence of lupus anticoagulant is associated with an elevated risk of venous and arterial thrombosis, and recurrent miscarriages as well. For some cases, this disease can present with bleeding as a consequence of lupus anticoagulant-hypoprothrombinemia (LAHPS). LAHPS is a rare disease and it is reported to be most frequent in young females with/without systemic lupus erythematosus or in healthy children who are suffering with a viral infection. In such cases, steroid therapy is usually effective in normalizing the biological abnormalities and controlling the bleeding problems.A 34-year-old previously healthy man was admitted to our department because of his prolonged coagulation times; these abnormalities were discovered before performing orthopedic surgery. The prothrombin time (PT) was 15.2 sec, and the activated partial thromboplastin time (APTT) was 37.7 sec. A 1:1 dilution of patient plasma with normal plasma nearly corrected the PT, but this failed to correct the APTT. Evaluation of the clotting factors revealed decreased levels of factors II, V, VIII, IX and XI. The presence of LA was demonstrated by the dRVVT test, and the patient was diagnosed with LAHPS. He was successfully treated with corticosteroid before performing the orthopedic surgery.

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