Pit viper venom commonly causes venom-induced consumptive coagulopathy (VICC), which can be complicated by life-threatening hemorrhage. VICC has a complex pathophysiology affecting multiple steps of the coagulation pathway. Early detection of VICC is challenging because conventional blood tests such as prothrombin time (PT) and activated partial thromboplastin time (aPTT) are unreliable for early-stage monitoring of VICC progress. As the effects on the coagulation cascade may differ, even in the same species, the traditional coagulation pathways cannot fully explain the mechanisms involved in VICC or may be too slow to have any clinical utility. Antivenom should be promptly administered to neutralize the lethal toxins, although its efficacy remains controversial. Transfusion, including fresh frozen plasma, cryoprecipitate, and specific clotting factors, has also been performed in patients with bleeding. The effectiveness of viscoelastic monitoring in the treatment of VICC remains poorly understood. The development of VICC can be clarified using thromboelastography (TEG), which shows the procoagulant and anticoagulant effects of snake venom. Therefore, we believe that TEG may be able to be used to guide hemostatic resuscitation in victims of VICC. Here, we aim to discuss the advantages of TEG by comparing it with traditional coagulation tests and propose potential treatment options for VICC.

In this study, ambient TSP, PM10, and PM2.5 in a residential area located in the northern part of Seoul were monitored every other month for 1 year from April 2005 to February 2006. The monthly average levels of TSP, PM10, and PM2.5 had ranges of 71 approximately 158, 40 approximately 106, and 28 approximately 43 microg/m(3), respectively. TSP and PM10 showed highest concentration in April; this seems to be due to Asian dust from China and/or Mongolia. However, the fine particle of PM2.5 showed a relatively constant level during the monitoring period. Heavy metals in PM 10 and PM2.5, such as Cr, As, Cd, Mn, Zn and Pb, were also analysed during the same period. The monthly average concentrations of heavy metal in PM2.5 were Cr:1.9 approximately 22.7 ng/m(3); As:0.9 approximately 2.5 ng/m(3); Cd: 0.6 approximately 7 ng/m(3); Mn:6.1 approximately 22.6 ng/m(3); Zn: 38.9 approximately 204.8 ng/m(3), and Pb: 21.6 approximately 201.1 ng/m(3). For the health risk assessment of heavy metals in ambient particles, excess cancer risks were calculated using IRIS unit risk. As a result, the excess cancer risks of chromium, cadmium, and arsenic were shown to be more than one per million based on the annual concentration of heavy metals, and chromium showed the highest excess cancer risk in ambient particles in Seoul.

Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp diomyopathy (CMP) is not an established concept yet, and reports on its epidemiology and clinical characteristics are scarce. Therefore, clinical characteristics of CO-induced CMP and its significance need to be elucidated.Stress-induced CMP, also known as takotsubo CMP, is a type of heart failure characterized by rapid reversibility and distinctive contraction patterns in the left ventricle. 13-16 It can be triggered by emotional events, and is found predominantly in postmenopausal women. 13,15 Takotsubo CMP occurs under the condition of catecholamine excess, as in exogenous epinephrine, pheochromocytoma, and acute neurologic disorders (eg, intracranial bleeding and cerebral infarction). 17-21There are a number of common factors between CO-induced CMP and takotsubo CMP, although the clinical features are not completely identical. Here, we investigate CO-induced CMP in terms of its epidemiology, clinical characteristics, and prognosis.arbon monoxide (CO) is an odorless, colorless, and nonirritating gas. 1,2 Even a small amount of CO exposure is possibly associated with organ damage and specific toxic effects. Acute CO poisoning is a major cause of mortality and morbidity worldwide. 1,2 According to previous reports, the main mechanism of CO toxicity is ischemic hypoxia secondary to hypoxemia. 1,3,4 Specifically, the heart is the major target organ of acute CO poisoning. 3 Cardiovascular manifestations demonstrated in previous reports include arrhythmia, pulmonary edema, heart failure, and myocardial infarction. 5-10 Cardiac failure was presented in patients who experienced acute CO poisoning. Background: Previous reports demonstrated mechanisms of cardiac toxicity in acute carbon monoxide (CO) poisoning. Still, none established CO-induced cardiomyopathy (CMP) as a clinical entity. The aim of this study is to investigate CO-induced CMP in patients with acute CO poisoning in terms of its epidemiology, clinical characteristics, and prognosis.

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Electronic cigarettes (ECs) are a device that aerosolize liquid nicotine by heating a solution of nicotine, glycerol and flavoring agents. The awareness and the usage of ECs has increased in many countries. Due to the online sales and the absence of EC regulations, the prevalence of EC usage is especially high in adolescents and young adults. Due to the large amount and the high nicotine concentration of EC liquid, the ingestion for suicide can lead to cardiac death. We had two patients, a 27-year-old male who ingested about 23 mg/kg of nicotine and a 17-year-old female who ingested about 30 mg/kg of nicotine. Both patients presented seizure-like movement and cardiac arrest. They had metabolic acidosis and transient cardiomyopathy. They were ultimately discharged with a cerebral performance category of 2 and 4, respectively. Increasing EC use may produce more cases of medical problems or suicide by nicotine intoxication.

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Early and precise neurological prognostication without self-fulfilling prophecy is challenging in post-cardiac arrest syndrome (PCAS), particularly during the targeted temperature management (TTM) period. This study aimed to investigate the feasibility of vasomotor reactivity (VMR) using transcranial Doppler (TCD) to determine whether final outcomes of patients with comatose PCAS are predicted. This study included patients who had out-of-hospital cardiac arrest in a tertiary referral hospital over 4 years. The eligible criteria included age ≥18 years, successful return of spontaneous circulation, TTM application, and bedside TCD examination within 72 h. Baseline demographics and multimodal prognostic parameters, including imaging findings, electrophysiological studies, and TCD-VMR parameters, were assessed. The final outcome parameter was cerebral performance category scale (CPC) at 1 month. Potential determinants were compared between good (CPC 1–2) and poor (CPC 3–5) outcome groups. The good outcome group (n = 41) (vs. poor (n = 117)) showed a higher VMR value (54.4% ± 33.0% vs. 25.1% ± 35.8%, p < 0.001). The addition of VMR to conventional prognostic parameters significantly improved the prediction power of good outcomes. This study suggests that TCD-VMR is a useful tool at the bedside to evaluate outcomes of patients with comatose PCAS during the TTM.

Background: Postcardiac arrest patients with a return of spontaneous circulation (ROSC) are critically ill, and high body mass index (BMI) is ascertained to be associated with good prognosis in patients with a critically ill condition. However, the exact mechanism has been unknown. To assess the effectiveness of skeletal muscles in reducing neuronal injury after the initial damage owing to cardiac arrest, we investigated the relationship between estimated lean body mass (LBM) and the prognosis of postcardiac arrest patients. Methods: This retrospective cohort study included adult patients with ROSC after out-of-hospital cardiac arrest from January 2015 to March 2020. The enrolled patients were allocated into good- and poor-outcome groups (cerebral performance category (CPC) scores 1–2 and 3–5, respectively). Estimated LBM was categorized into quartiles. Multivariate regression models were used to evaluate the association between LBM and a good CPC score. The area under the receiver operating characteristic curve (AUROC) was assessed. Results: In total, 155 patients were analyzed (CPC score 1–2 vs. 3–5, n = 70 vs. n = 85). Patients’ age, first monitored rhythm, no-flow time, presumed cause of arrest, BMI, and LBM were different (p < 0.05). Fourth-quartile LBM (≥48.98 kg) was associated with good neurological outcome of postcardiac arrest patients (odds ratio = 4.81, 95% confidence interval (CI), 1.10–25.55, p = 0.04). Initial high LBM was also a predictor of good neurological outcomes (AUROC of multivariate regression model including LBM: 0.918). Conclusions: Initial LBM above 48.98kg is a feasible prognostic factor for good neurological outcomes in postcardiac arrest patients.