bluuebunny/crossref_metadata_2025 huggingface dataset:
Prognostic Predictors of Outcome in Patients with Snake Bite, Based on Initial Findings in the Emergency Department
Authors: Baek In Yeop , Kim Tae Kwon , Jin Sang Chan , Cho Woo Ik
Published: June 2023

Purpose: This study was conducted to identify predictors of serious poisoning in patients with snake bite based on initial findings. Methods: We conducted a retrospective study of patients with snake bite who were treated at the emergency department between January 2010 and December 2016. The patients were divided into two groups according to the severity of symptoms based on the traditional snakebite severity grading scale. The mild poisoning group (MP) was classified as those who had a grade I snakebite severity during the hospital stay, and the severe poisoning group (SP) was classified as patients who had grade I at the time of admission, but progressed to grade II-IV during hospitalization. Initial clinical manifestations and laboratory findings of the two groups were compared. Results: Bite to hospital time intervals of SP were longer than those of MP (p=0.034), and the local effect score (LES) was higher in SP (p<0.001). Laboratory analyses revealed that creatine phosphokinase (p=0.044), creatine phosphokinase MB isoenzyme (CK-MB, p=0.011) and serum amylase (p=0.008) were significantly higher in SP. LES, CK-MB and serum amylase were significant prognostic predictors as indicated by univariate logistic regression analysis. Multivariate analysis revealed the following two significant predictors: LES (odds ratio=3.983, p<0.001) and serum amylase (odds ratio=1.020, p=0.017). Conclusion: In managing cases of snake bites, clinical manifestations and laboratory findings must be carefully evaluated. LES and serum amylase are predictive factors for severe poisoning, which is especially important to rapid determination of the intensive care of the patient.
The Usefulness of Serum Lipid Concentration as a Predictor of Convulsion in Patients with Glufosinate Ammonium Poisoning
Authors: Lee Hyun Do , Sun Kyung Hoon , Kim Seong Jung
Published: June 2023

Purpose: Glufosinate ammonium (GA; phosphinothricin) can induce neurological complications such as altered mental status, amnesia, and convulsions. This study was conducted to evaluate whether blood lipid profiles can help predict convulsions in patients with GA poisoning. Methods: This study was a retrospective review of data acquired at a tertiary academic university hospital from March 2014 to July 2016. Independent t-test, Mann-Whitney test and Analysis of covariance (ANCOVA) of demographic and laboratory findings of 50 patients with GA poisoning were performed to identify correlations of general characteristics and laboratory findings, including blood lipid profiles of GA-poisoned patients between with and without convulsions. Results: Convulsion as a GA complication showed a significant association with poison volume, age, white blood cell count, and creatine phosphokinase (CK), albumin, lactate dehydrogenase (LDH), low-density lipoprotein (LDL), and high-density lipoprotein (HDL) content in blood according to an independent t-test and Mann-Whitney test. However, ANCOVA demonstrated significant association with LDL and triglyceride. Conclusion: Blood lipid profiles, especially serum LDL and triglyceride, were useful in predicting convulsions in patients with GA poisoning.
A Case Report of Acute Nicotine Poisoning from Subcutaneous Injection of Nicotine Solution for Electronic Cigarette
Authors: Choi Jiun , Ko Dong Ryul , You Je Sung , Chung Sung Phil
Published: June 2023

Nicotine-poisoning related to the electronic cigarettes (e-cigarette) is increasing worldwide. Moreover, the American Association of Poison Control Centers has advised the public to use caution with e-cigarette devices and highly concentrated liquid nicotine after a surge in related poisonings. We report here the first case of nicotine poisoning from self-injected e-cigarette fluid in Korea. A 17-year-old male patient subcutaneously injected himself with 0.5 ml of nicotine solution for an electronic cigarette via the dorsum of his hand, after which he complained of nausea, vomiting, dizziness and dyspnea. His vital signs were within the normal range, but his mental status was drowsy. He was admitted for observation and the symptoms disappeared the following day. Sinus bradycardia with a rate of 45/min was observed on the third hospital day, but improved after 6 hours. He was discharged without complications.
In vitro Protective Effects of Glehnia Littoralis on Alpha-amanitin Induced Hepatotoxicity
Authors: Kim Bo Hyun , Sun Kyung Hoon , Kim Sun Pyo , Park Yongjin
Published: June 2023

Purpose: Glehnia littoralis has been used to treat ischemic stroke, phlegm, cough, systemic paralysis, antipyretics and neuralgia. The pharmacological mechanisms of Glehnia littoralis include calcium channel block, coumarin derivatives, anticoagulation, anti-convulsive effect, as well as anti-oxidant and anti-inflammatory effects. Alpha-amanitin (${alpha}$-amanitin) is a major toxin from extremely poisonous Amanita fungi. Oxidative stress, which may contribute to severe hepatotoxicity was induced by ${alpha}$-amanitin. The aim of this study was to investigate whether Glehnia littoralis ethyl acetate extract (GLEA) has the protective antioxidant effects on ${alpha}$-amanitin -induced hepatotoxicity. Methods: Human hepatoma cell line HepG2 cells were pretreated in the presence or absence of GLEA (50, 100 and $200{mu}g/ml$) for 4 hours, then exposed to $60{mu}mol/L$ of${alpha}$-amanitin for an additional 4 hours. Cell viability was evaluated using the MTT method. AST, ALT, and LDH production in a culture medium and intracellular MDA, GSH, and SOD levels were determined. Results: GLEA (50, 100 and $200{mu}g/ml$) significantly increased the relative cell viability by 7.11, 9.87, and 14.39%, respectively, and reduced the level of ALT by 10.39%, 34.27%, and 52.14%, AST by 9.89%, 15.16%, and 32.84%, as well as LDH by 15.86%, 22.98%, and 24.32% in culture medium, respectively. GLEA could also remarkably decrease the level of MDA and increase the content of GSH and SOD in the HepG2 cells. Conclusion: In the in vitro model, Glehnia littoralis was effective in limiting hepatic injury after ${alpha}$-amanitin poisoning. Its antioxidant effect is attenuated by antidotal therapy.
Analysis of Characteristics in Children and Adolescents with Poisoning at Emergency Department
Authors: Kim Do Young , Kim Ji Hye , Paik Jin Hui , Han Seung Baek , Jung Hyun Min
Published: June 2023

Purpose: This study was conducted to analyze the features of poisoning in individuals aged 0-18 years to understand the characteristics of potential victims and eventually prevent poisoning. Methods: We retrospectively analyzed poisoned children and adolescents (0-18 years) who visited the emergency department of one tertiary hospital from January 2003 through December 2013. We collected data including their age, sex, reason for poisoning, components and dose of poison, results of treatment, and psychiatric diagnosis. Results: During the study period, there were 436 cases of poisoning (male 47.2% (n=206); female 52.8% (n=230)). Subjects were classified into four groups (0-1 years, 2-5 years, 6-12 years, 13-18 years). The most common cause of poisoning in all age groups was accidental poisoning (72.9%), but intentional poisoning increased as age increased (p<0.001). Moreover, females were more often subject to intentional poisoning than males (p<0.001). The most common poisoning material was drugs (41.7%). Among intentional poisoning patients, 62.7% patients had consulted a psychiatrist, and their most common diagnosis was adjustment disorder (44.6%). Conclusion: The most common cause of poisoning in individuals aged 0-18 years was accidental poisoning, while intentional poisoning was most common among adolescents. Guardians should take care to prevent accidental poisoning, while psychiatric consultation and national moderation will be needed to prevent intentional poisoning.
Trends in Korean Pediatric Poisoning Patients: Retrospective Analysis of National Emergency Department Information System
Authors: Lee Kyeongjae , Kim Kyung Hwan , Shin Dong Wun , Park Junseok , Kim Hoon , Jeon Woochan , Park Joon Min , Kim Hyunjong
Published: June 2023

Purpose: This study reports the clinical features of infant, child, school aged and adolescent patients treated for acute poisoning in nationwide emergency departments (EDs). Methods: We retrospectively analyzed clinical data pertaining to patients under 19 years of age who were treated for acute poisoning in nationwide EDs from 2013 to 2015. The data were collected by the National Emergency Department Information System (NEDIS). All patients were divided into three groups: 'Infant and child group' (0 to 5 years), 'school age group' (6 to 12 years) and 'adolescent group' (13 to 18 years). General characteristics, Korea Standard Classification of Disease $7^{th}$ (KCD-7) codes and results of care were collected. Results: There were 14,500 pediatric poisoning cases during the study period. The distribution of patient age was bimodal with two peaks among infant, child and adolescent group. The proportion of alert mentality at the ED visit of the infant and child group was 99.3%, while that of the adolescent group was 86.4%. The proportion of intentional intoxication was higher in the adolescent group (40.7%) than other age groups. Among children less than 13 years of age, various poisonous substances and therapeutic drugs were common. Conclusion: There were some clinical differences in acute poisoning patients between age groups. It is necessary to establish a preventive plan considering characteristics by age. Since the KCD-7 code has limitations in analyzing the characteristics of poisoning patients, it is necessary to consider the registration system of poisoning patients.
Fomepizole for Ethylene Glycol or Methanol Poisoning in Children
Authors: Min Ha Na , Hwang Yoon Jung , Ko Dong Ryul , Joo Young Seon , Kong Tae Young , Choa Min Hong , Park In Cheol , Chung Sung Phil
Published: June 2023

Purpose: The purpose of this study is to evaluate the effectiveness and adverse effect of fomepizole in the management of acute ethylene glycol or methanol poisoning in children. Methods: Databases such as PubMed, Embase, Cochrane library, and KoreaMed were searched using terms related to fomepizole, ethylene glycol, methanol and pediatric. All studies, regardless of study design, reporting effectiveness or safety endpoints in children were included. Reference citations from identified publications were reviewed. Only reports written in English or Korean languages were included. The reference search was performed by two authors. Results: Twenty-two relevant literatures were finally included. They were one narrative review, 4 retrospective case series, and 17 case reports (19 cases). Case reports were classified as 5 fomepizole only, 8 fomepizole with other therapies, and 6 no fomepizole. All patients from the literatures were fully recovered without long term sequelae. Adverse effects of fomepizole were reported including anaphylaxis, thrombophlebitis and nystagmus. Conclusion: There are insufficient literatures regarding fomepizole treatment in children with ethylene glycol or methanol poisoning. The benefits or harms are not clearly established based on the clinical evidences. More prospective comparative studies are required in the future.
Is it Adequate to Determine Acetaminophen Toxicity Solely on Patients' History? An Analysis on Clinical Manifestation of Intoxication Patients with Positive Serum Acetaminophen Concentrations
Authors: Kim Jee Hyun , Jeong Won-joon , Ryu Seung , Cho Yong Chul , Moon Jang Hyuck , Choi Hyun Soo , Yang Song Hee , Chung Hee Sun
Published: June 2023

Purpose: Acute acetaminophen intoxication is a common occurrence that can cause lethal complications. In most domestic emergency departments, clinicians tend to treat acetaminophen intoxication based on patients' history alone, simply due to the lack of a rapid acetaminophen laboratory test. We performed a 20-month study of intoxication patients to determine the correlation between the history of patients and serum laboratory tests for acetaminophen. Methods: We took blood samples from 280 intoxication patients to evaluate whether laboratory findings detected traces of acetaminophen in the sample. Patients were then treated according to their history. Laboratory results came out after patients' discharge. Agreement between patients' history and laboratory results were analyzed. Results: Among the 280 intoxicated patients enrolled, 38 patients had positive serum acetaminophen concentrations; 18 out of 38 patients did not represent a history suggesting acetaminophen intoxication. One patient without the history showed toxic serum acetaminophen concentration. Among the patients with the history, two patients with toxic serum acetaminophen concentration did not receive N-acetylcysteine (NAC) treatment due to their low reported doses, while other 2 patients without significant serum acetaminophen concentration did receive NAC treatment due to their high reported doses. Conclusion: This study showed a good overall agreement between history and laboratory test results. However, some cases showed inconsistencies between their history and laboratory test results. Therefore, in treating intoxication patients, a laboratory test of acetaminophen with rapid results should be available in most domestic emergency departments.
Different Clinical Courses for Poisoning with WHO Hazard Class Ia Organophosphates EPN, Phosphamidon, and Terbufos in Humans
Authors: Mun Jong Gu , Moon Jeong Mi , Lee Mi Jin , Chun Byeong Jo
Published: June 2023

Purpose: Extremely hazardous pesticides are classified as World Health Organization (WHO) hazard class Ia. However, data describing the clinical course of WHO class Ia OP (organophosphate) poisonings in humans are very scarce. Here, we compare the clinical features of patients who ingested hazard class Ia OPs. Methods: This retrospective observational case study included 75 patients with a history of ingesting ethyl p-nitrophenol thio-benzene phosphonate (EPN), phosphamidon, or terbufos. The patients were divided according to the chemical formulation of the ingested OP. Data regarding mortality and the development of complications were collected and compared among groups. Results: There were no differences in the baseline characteristics and severity scores at presentation between the three groups. No fatalities were observed in the terbufos group. The fatality rates in the EPN and phosphamidon groups were 11.8% and 28.6%, respectively. Patients poisoned with EPN developed respiratory failure later than those poisoned with phosphamidon and also tended to require longer mechanical ventilatory support than phosphamidon patients. The main cause of death was pneumonia in the EPN group and hypotensive shock in the phosphamidon group. Death occurred later in the EPN group than in the phosphamidon group. Conclusion: Even though all three drugs are classified as WHO class Ia OPs (extremely hazardous pesticides), their clinical courses and the related causes of death in humans varied. Their treatment protocols and predicted outcomes should therefore also be different based on the chemical formulation of the OP.
Changes in Toxicological Characteristics after Sales of Nonprescription Drugs in Convenience Stores
Authors: Kim Chang Yeong , Lee Eui Jung , Lee Sung Woo , Kim Su Jin , Han Kap Su
Published: June 2023

Purpose: On November 15, 2012, sales of OTC (Over-The-Counter) drugs began at convenience stores, which changed the accessibility of some drugs. As a result, the exposure and access patterns of these drugs could have changed. In this study, we reviewed the changes in the characteristics of drug poisoning patients because of the reposition of nonprescription drugs according to the revised Pharmaceutical Affairs Act. Methods: A retrospective study was conducted to evaluate changes in characteristics of drug poisoning patients between 2008 and 2016. A registry was developed by an emergency medical center in a local tertiary teaching hospital, and patients who visited the center were enrolled in this registry. We compared two periods, from 2008 to 2012 (Pre OTC) and from 2013 to 2016 (Post OTC), for type of intoxicant, time from poisoning to visiting the emergency center, intention, psychiatric history, previous suicidal attempt, alcohol status, and emergency room outcomes. The primary outcome was the number of patients who took acetaminophen and NSAIDs (nonsteroidal anti-inflammatory drugs). Secondary outcomes were ICU admission rate, mortality rate, and number of patients who visited the ER when the pharmacy was closed after taking acetaminophen and NSAIDs (nonsteroidal anti-inflammatory drugs). Results: Among 1,564 patients, 945 and 619 patients visited the emergency room during pre and post OTC periods. The number of patients with acetaminophen and NSAIDs poisoning decreased from 9.2% to 6.1% (p=0.016). The ICU admission rate and mortality rate in the emergency room did not show significant results in the relevant patient groups, and so was the number of patients visiting ER when the pharmacy was closed taking acetaminophen and NSAIDs. Conclusion: Despite the sales of nonprescription drugs at convenience stores, the number of acetaminophen and NSAIDs poisoning patients decreased.
Relationship between Serum Neuron Specific Enolase Level and Seizure in Patients with Acute Glufosinate Ammonium Poisoning
Authors: An Gyo Jin , Lee Yoonsuk , Chan Yong Sung , Kim Hyun
Published: June 2023

Purpose: Glufosinate ammonium poisoning can cause seizures, even after a symptom-free period. This study was conducted to evaluate the relationship between serum neuron specific enolase (NSE) level and the occurrence of seizures in patients with acute glufosinate ammonium poisoning. Methods: For this retrospective observational study, data from patients diagnosed with acute glufosinate ammonium poisoning were collected between January 2016 and June 2016. Serum NSE was measured within 2 hours of arrival at the emergency department. The patients were divided into a seizure group and a non-seizure group. Results: The seizure group included eight of the 15 total patients (53.3%). The serum NSE level was significantly higher in the seizure group than in the non-seizure group ($32.4{pm}11.9ng/mL$ vs. $19.5{pm}5ng/mL$, p=0.019). The amount of glufosinate ingested and initial and peak serum ammonia levels were significantly higher in the seizure group than in the non-seizure group. There was no significant difference in the area under the curve of the serum NSE level or the initial and peak serum ammonia levels in terms of predicting the occurrence of seizures. Conclusion: In acute glufosinate poisoning, initial serum NSE levels may help in prediction of seizures.
Guillain-barré Syndrome after Multiple Bee Stings
Authors: Jin Sang-Chan
Published: June 2023

Severe systemic responses including neurologic complications such as myasthenia gravis, myeloradiculopathy, optic neuropathy, parkinsonism, stroke and Guillain-$barr{acute{e}}$ syndrome can occur after bee stings. This case describes a 78-year-old female who presented with symptoms of acute progressive bilateral symmetrical weakness in both lower legs after multiple bee stings. Nerve conduction study findings were consistent with acute sensorimotor axonal neuropathy and recovered by treatment with intravenous immunoglobulin. This case highlights that bee stings can result in acute onset Guillain-$barr{acute{e}}$ syndrome, although the pathophysiologies of bee venoms need to be investigated accurately.
CT Findings of Perforation of the Stomach after Ingestion of Glacial Acetic Acid
Authors: Kim Hohyun , Yeom Seok Ran , Cho Hyun Min , Yeo Kwang-Hee , Kim Jae-Hun
Published: June 2023

The ingestion of corrosive substances often leads to severe morbidity and mortality. Acids produce coagulation necrosis with a lesser degree of penetration, whereas alkalis produce liquefactive necrosis with penetration. Acetic acid is a clear, colorless organic acid with a pungent, vinegar-like odor. The ingestion of highly concentrated acetic acid (glacial acetic acid) may cause a range of complications. On the other hand, perforation of the stomach is extremely rare but it has a high mortality rate. This paper reports a case of perforation of the stomach after the ingestion of glacial acetic acid with suicidal intent in an otherwise healthy 76-year-old woman.
Extracorporeal Membrane Oxygenation and Continuous Renal Replacement Therapy for Treatment of Calcium Channel Blockers, Angiotensin II Receptor Blockers, and Metformin Overdose
Authors: Jeong Jae Han , Sun Kyung Hoon , Park Yong Jin , Kim Sun Pyo
Published: June 2023

An overdose of antihypertensive agents, such calcium channel blockers (CCBs) and angiotensin II receptor blocker (ARBs), and the antihyperglycemic agent, metformin, leads to hypotension and lactic acidosis, respectively. A 40-year-old hypertensive and diabetic man with hyperlipidemia and a weight of 110 kg presented to the emergency room with vomiting, dizziness, and hypotension following an attempted drug overdose suicide with combined CCBs, ARBs, 3-hydroxy-3-methylglutaryl-coemzyme A reductase inhibitors, and metformins. A conventional medical treatment initially administered proved ineffective. The treatment was then changed to simultaneous extracorporeal membrane oxygenation (ECMO) and continuous renal replacement therapy (CRRT), which was effective. This shows that simultaneous ECMO and CRRT can be an effective treatment protocol in cases of ineffective conventional medical therapy for hypotension and lactic acidosis due to an overdose of antihypertensive agents and metformin, respectively.
Classify the Acute Drug Intoxication Patients with Poisoning Severity Score(PSS) and Calculate the Optimal Cutoff Value of PSS, PSSsum to Predict Poor Prognosis
Authors: Park Hyun Woo , Park Ha Young , Kim Han Byeol , Park Keon Woo , Lee Sang Hun , Lee Hyun Wook , Lee Je Won , Hwang Tae Sik
Published: June 2023

Purpose: This study examined the Poisoning Severity Score (PSS) from acute poisoning patients, to determine the relationships among the PSS, PSSsum, the primary outcome (prolonged stay at the ER over 24 hours, general ward and ICU admission and the application of intubation and mechanical ventilator, and the administration of inotropes). Methods: A retrospective study was conducted through the EMR for 15 months. The PSS grade was classified according to the evidence of symptoms and signs. The differences in the primary outcomes between the PSS of when a single organ was damaged, and the PSS, PSSsum combined with the grade of when multiple organs were damaged, were studied. The cutoff value was calculated using the receiving operating characteristics (ROC) curve. Results: Of the 284 patients; 85 (29.9%) were men with a mean age of 48.8 years, and their average arrival time to the ER was $4.4{pm}6.7;hours$. The most frequently used drug was hypnotics. The number of patients with PSS grade 0, 1, 2, 3, and 4 was 17, 129, 122, 24, and one, respectively. No ICU admissions, application of intubation and mechanical ventilators, administration of inotropes were observed among the patients with PSS grades 0 and 1 but only on patients with PSS grades 2 to 4. At PSS, when separating the patients according to the number of damaged organs, 17 had no symptoms, 133 had one organ damaged, 75 had two organs damaged, 36 had three organs damaged, and 23 had four organs damaged. Significant differences were observed between increasing number of damaged organs and the primary outcome. Conclusion: Among the acute poisoning patients, the PSS was higher in severity when the grade was higher. The number of damaged organs and the primary outcome showed meaningful statistical differences. This study confirmed that when the patients' PSS>2 and PSSsum>5, the frequency of ICU admission was higher, and they were considered to be severe with an increased prescription risk of application of intubation and mechanical ventilator, and the administration of inotropes.
Comparison of Mortality Rate according to Hospital Level among Patients with Poisoning Based on Korean Health Insurance and Assessment Service
Authors: Kim Soyoung , Choi Sangchun , Kim Hyuk-Hoon , Yang Hee Won , Yoon Sangkyu
Published: June 2023

Purpose: Mortality rate in the health services research field is frequently considered as a proxy for measuring healthcare quality. We compared the mortality rate and hospitalization levels among patients with poisoning. Methods: A population-based study of hospital size and level based on the Korean health insurance and assessment service was conducted to identify the impact of hospital level on patient mortality. Results: We analyzed a total of 16,416 patients, of which 7,607 were from tertiary hospitals, 8,490 were from general hospitals, and 319 were from hospitals. The highest mortality rate of diagnosis regarding poisoning was T60.31 (other herbicides and fungicides, 16%), followed by T60.0 (organophosphate and carbamate insecticides, 12.7%). There was no statistical difference in mortality among hospital levels for gender. Among age groups, tertiary hospitals had lower mortality than general hospitals and hospitals for patients aged more than 70 years (11.9% mortality at tertiary vs 14.2% at general and 23% at hospital; p=0.003, adjusted z score=-6.9), general hospitals had lower mortality than tertiary hospitals and hospitals for patients aged 18 to 29 (0.6% at general vs 2.4% at tertiary and 3.7% at hospital; p=0.01, adjusted z score=-4.3), and hospitals had lower mortality than tertiary hospitals and general hospitals for patients between 50 and 59 years of age (0% at hospital vs 6.4% at general and 8.3% at tertiary; p=0.004). Conclusion: Overall, there was no significant difference between mortality and hospital level among poisoned patients. However, to establish an efficient treatment system for patients with poisoning, further studies will be needed to identify the role of each facility according to hospital level.
Symptomatic Hypocalcemia Associated with Dioscorea tokoro Toxicity
Authors: Yoon Jae Chol , Lee Jae Baek , Jeong Tae Oh , Jo Si On , Jin Young Ho
Published: June 2023

Dioscorea tokoro has long been used in Korean traditional medicine as a pain killer and anti-inflammatory agent. A 53-year-old male who consumed water that had been boiled with raw tubers of D. tokoro as tea presented with numbness and spasm of both hands and feet. Laboratory results showed hypocalcemia, hypoparathyroidism, and vitamin D insufficiency. During his hospital stay, colitis, acute kidney injury, and toxic encephalopathy developed. The patient received calcium gluconate intravenous infusion and oral calcium carbonate with alfacalcidol. His symptoms improved gradually, but hypocalcemia persisted despite the calcium supplementation. We suggest that ingestion of inappropriately prepared D. tokoro can cause symptomatic hypocalcemia in patients with unbalanced calcium homeostasis.
A Study of Predicting the Severity Following Glufosinate Ammonium Containing Herbicide Poisoning Experienced in Single Emergency Medical Institution
Authors: Lee Doo Sung , Choi Kyoung Ho
Published: June 2023

Purpose: Owing to the increased agricultural use of the herbicide glufosinate ammonium (GLA), the incidence of GLA poisoning has recently increased. Therefore, we investigated the possible predictive factors associated with severe complications following GLA poisoning. Methods: A retrospective analysis of medical records was conducted based on 76 patients who had visited our regional emergency medical center with GLA poisoning from 2006 to 2017. Severe complications were defined as respiratory failure requiring intubation, systolic blood pressure less than 90 mmHg, Glasgow Coma Scale (GCS) less than 8, and presence of seizure. Results: Age, ingested amount and ingested amount per weight were significantly greater in the severe group (p<0.001). PSS grade 2 or higher was more common in the severe group (p<0.001), and In addition, the APACHE II score was significantly higher in the severe group (p<0.001), as were the SOFA scores (p=0.002). Serum ammonia levels were significantly higher in the severe group (p=0.007), while MDRD-GFR was smaller in the severe group (p=0.002). The spot urine protein levels were significantly higher in the severe group (p=0.005), as was the urine protein to creatinine ratio (p=0.001). Upon multivariate analysis, the amount ingested per weight and PSS grade 2 or higher were identified as significant predictors. Conclusion: Our study showed that MDRD-GFR was significantly lower in the severe group after GLA poisoning. PSS grade 2 or higher and ingested amount per weight may be useful to evaluate the severity of complications after GLA poisoning.
ALLOMETRIC RELATIONSHIPS BETWEEN SAPWOOD AREA AND SHRUB DIMENSIONS FOR 6 COMMON SOUTHERN AFRICAN SAVANNA BUSH ENCROACHER SPECIES: UNIVERSAL OR SPECIES-SPECIFIC?
Authors: Hendler Roi , Herkenrath Tim , Shikangalah Rosemary , Blaum Niels , Geissler Katja
Published: June 2023

Southern African savanna rangelands are facing a widespread degradation
pattern called bush encroachment. This is associated with implications
for various aspects of the water cycle and in particular canopy
transpiration. At the individual-tree scale, it is estimated by scaling
sap-flux density by sapwood area. However, the direct measurement of
sapwood area is impracticable at landscape scale and general allometric
equations of the West-Brown-Enquist (WBE) model relating sapwood area to
primary size measures seem to fail for some species and climates.
Therefore, we conducted intensive field measurements to establish
species-specific allometric relationships between sapwood area and sizes
(stem diameter, crown area) in six dominant shrub species involved in
bush encroachment in Namibia ( Colophospermum mopane, Senegalia
mellifera, Vachellia reficiens, Dichrostachys cinerea, Vachellia
nebrownii, Catophractes alexandri). We found strong allometric
relationships between sapwood area and stem diameter as well as between
sapwood area and crown area for all six species. These relations are
largely in line with the WBE theory but still provide estimates that are
more accurate. Only in D. cinerea, the sapwood area was
significantly smaller than predicted by the WBE theory, which might be
caused by a larger need for stabilizing heartwood. Our results are
useful to estimate water loss via transpiration at a large scale using
remote sensing techniques and can promote our understanding of the
ecohydrological conditions that drive species specific bush encroachment
in savannas. This is particularly important in the light of climate
change, which is considered to have major implications on
ecohydrological processes in savannas.
The Association between Leukotriene-Modifying agents Use and Depression in Adults: A Population-based Analysis of the NHANES from 2007 to 2016
Authors: Yan Jingchao , Sun Hong , Xin Xiu , Huang Taomin , Shen Jianwen
Published: June 2023

Introduction Post-market monitoring has revealed an association
between the use of leukotriene-modifying agents (LTRAs) and an increased
occurrence of neuropsychiatric events. However, the results of
observational studies have been inconclusive. Objective To
assess the potential correlation between LTRAs exposure and depression
in US outpatient adults. Method This population-based
cross-sectional study used data from U.S. adults aged 20 to 59 years
from the National Health and Nutrition Examination Survey (NHANES)
2007-2016 cycle. The Patient Health Questionnaire-9 was used to assess
depression. Multivariable regression was used to evaluate the
association between LTRAs exposure and depression. Results
Among the 9,539 participants (mean age 40.4 years; 56.2% male), 602
(6.3%) were classified as having depression. LTRAs exposure was
associated with a higher prevalence of depression (16.7% [50] vs.
6.0% [552]). In the multivariable logistic regression model LTRAs
exposure was associated with depression (odds ratio [OR], 1.85; 95%
confidence interval [CI], 1.22~2.83). An association
between LTRAs exposure and depression was found in sensitivity analyses
that conducted multivariable linear regression with the PHQ-9 score as a
continuous variable (β, 0.86; 95% CI, 0.39~1.33),
regardless of the PHQ-9 cut-off of 5 or 10, and the multivariable
logistic regression results showed that LTRAs use increased the risk of
depression (OR = 1.51 [95% CI, 1.12~2.05]; OR =
1.85 [95% CI, 1.22~2.83]). Conclusion
Long-term LTRAs exposure is positively associated with depression in the
adult outpatient population in the US. Therefore, the risk for
depression in patients receiving long-term LTRAs treatment should be
considered.
Preliminary Exploration: Clinical Significance of Time to Negative Conversion of Influenza Virus Nucleic Acid in Children with Severe Influenza Virus Infection
Authors: Liu Jun , Qian Suyun , Yang Zixuan , Han Xia , Liu Gang
Published: June 2023

Background: This study aims to preliminarily explore the impact of
delayed influenza virus nucleic acid conversion (more than five days) to
negative on treatment and length of hospital stay in children with
severe influenza. Methods: This was a single-center retrospective study.
General information, influenza virus nucleic acid test (per 3-5 days)
results after receiving antiviral medication, antiviral drug usage,
comorbid infections, invasive mechanical ventilation, and discharge
prognosis of children with severe influenza were collected. Results: A
total of 39 patients were included in the study. The patients were
divided into four groups based on the time when the patient’s viral
nucleic acid turned to negative after receiving antiviral medication:
3-5 days (35.8%, 14/39), 6-10 days (38.4%, 15/39), >10
days (12.8%, 5/39), and maintaining as positive when discharge (12.8%,
5/39). More than half of pediatric patients with severe influenza
exhibited delayed nucleic acid conversion (more than 5 days) after
antiviral medication. The >10 days group had a longer time
from onset to PICU admission, PICU stay, and antiviral drug use
duration, as well as a higher proportion of CBP use (P < 0.05,
respectively). Within the first 3 days of PICU admission, the proportion
of patients with persistently reduced lymphocytes was lower in the 3-5
days group (28.6% (4/14)) than other two groups (P >
0.05). Conclusions: Delayed nucleic acid conversion was associated with
longer PICU length of stay. Persistent fever, co-infections, and
impaired cellular immune function may contribute to the delay.
Leaf micromorphological adaptations and ecotaxanomic outlook of selected Adiantum species from Poonch region AJK, Pakistan
Authors: Khan Faraz , Ahmed Ehzaz , Hussain Sajjad , Ahmed Khawaja Shafique , Mehmood Ansar , Mustafa Amna , Razzaq Tahsin , Ashraf Nabeela
Published: June 2023

Leaf micromorphological characters of the genus Adiantum L. were
studied using standard protocols of light microscopy (LM). The study was
aimed at investigation of morpho-anatomical variation in three species
of genus Adiantum viz A. capillus veneris, A. venustum and
A. incisum sampled along the altitude as an ecological variable.
Stomatal density, number and type of subsidiary cells, stomatal complex
type and stomatal index were studied through light microscopy (LM).
Results revealed that leaf length decreased with increase in altitude.
Stomatal type varied from anisocytic to diacytic in A.capillusveneris as well as in A.venustum
whereas it was restricted to anomocytic in Adiantum incisum.
Unweighted paired group method using arithmetic averages (UPGMA) was
used to examine the similarities among the species . A. capillus
veneris was found to be the most adapted species showing epistomatic,
hypostomatic and amphistomatic leaf types. Hypostomatic and
amphistomatic leaf type were found in A.vensutum whereas
A. incisum was found to be restricted only to hypostomatic
leaves. Cluster analysis using UPGMA explained that A.capillus
veneris usually thrives in areas of lower altitude, while the
occurrence of A.venustum as well as A. Incisum in higher
altitudes reveals a narrow range of adaptations for latter. Moreover,
absence of stomata on abaxial surface in both A.venustum as well
as A.incisum indicates the relationship of these two species with
ambient ecological conditions on higher altitude. Variations in stomatal
types within and among the species confirm that stomatal density and
complex type are key factors for species delimitation. Research
Highlights
Sensitivity of seismic-noise based methods to controlled water content changes : insight from laboratory measurements
Authors: Bastide Thomas Gaubert , Bordes Clarisse , Garambois Stéphane , Brito Daniel , Collet Olivia , Voisin Christophe
Published: June 2023

In recent years, seismic-noise based methods have shown great potential
for the monitoring of various processes occurring in the Earth’s crust.
Among them, the fine detection of hydrological variations at different
scales is a major issue in the context of water resources management
(Gaubert-Bastide et al. 2022). In order to better understand the
sensitivity of continuous seismic wavefields to water content variations
affecting both saturated and unsaturated zones, we have set up a dynamic
and meter-scale laboratory experiment. This sandbox experiment
reproduces field surveys based on the recording and processing of
seismic background noise (hundred to kiloHertz range) in the context of
hydrological variations. These multiple measurements, which benefit from
independent measurements of pressure and water saturation at different
depths, allow us to refine the sensitivity of the seismic wavefield to
variations in water content and hysteretic behavior related to different
phases of imbibition/drainage.
Influence of ENSO on stratospheric sulfur dioxide injection in the CESM2 ARISE-SAI-1.5 simulations
Authors: Diao Chenrui , Barnes Elizabeth A. , Hurrell James Wilson
Published: June 2023

Climate and Earth system models are important tools to assess the
benefits and risks of stratospheric aerosol injection (SAI) relative to
those associated with anthropogenic climate change. A “controller”
algorithm has been used to specify injection amounts of sulfur dioxide
in SAI experiments performed with the Community Earth System Model
(CESM). The experiments are designed to maintain specific temperature
targets, such as limiting global mean temperature to 1.5ºC above the
pre-industrial level. However, the influence of natural climate
variability on the injection amount has not been extensively documented.
Our study reveals that more than 70% of the year-to-year variation in
the total injection amount (excluding the long-term trend) in CESM SAI
experiments is attributed to the El Niño-Southern Oscillation (ENSO). A
simplified statistical model further suggests that the intrinsic, lagged
response of the controller to the climate can increase the variance of
global mean temperature in the model simulations.
Moisture transport axes and their relation to atmospheric rivers and warm moist intrusions
Authors: Spensberger Clemens , Konstali Kjersti , Spengler Thomas
Published: June 2023

The water vapor transport in the extratropics is mainly organized in
narrow elongated filaments. These filaments are referred to with a
variety of names depending on the contexts. When making landfall on a
coastline, they are generally referred to as atmospheric rivers; when
occurring at high latitudes, many authors regard them as warm moist
intrusions; when occurring along a cold front and near a cyclone core,
the most commonly used term is warm conveyor belt. Here, we propose an
algorithm that detects these various lines of moisture transport in
instantaneous maps of the vertically integrated water vapor transport.
The detection algorithm extracts well-defined maxima in the water vapor
transport and connects them to lines that we refer to as moisture
transport axes. By only requiring a well-defined maximum in the vapor
transport, we avoid imposing a threshold in the absolute magnitude of
this transport (or the total column water vapor). Consequently, the
algorithm is able to pick up moisture transport axes at all latitudes
without requiring region-specific tuning or normalization. We
demonstrate that the algorithm can detect both atmospheric rivers and
warm moist intrusions. Atmospheric rivers sometimes consist of several
distinct moisture transport axes, indicating the merging of several
moisture filaments into one atmospheric river. Finally, we showcase the
synoptic situations and precipitation patterns associated with the
occurrence of the identified moisture transport axes in example regions
in the low, mid, and high latitudes.
Statistical properties of lower band rising tone chorus waves
Authors: He Jiabei , Xia Zhiyang , Chen Lunjin
Published: June 2023

Lower-band chorus waves are known to play dual roles in radiation belt
dynamics (electron acceleration and precipitation), and understanding
their properties and excitation is very important. A systematic study of
chorus waves properties in terms of background plasma parameters
(electron perpendicular beta β and the ratio of plasma
frequency to electron cyclotron frequency f
/f) has not been performed previously. We use burst
mode data from Van Allen Probe A from 2014 to 2017 and develop an
algorithm to extract individual lower band rising tone chorus elements.
We statistically analyze four properties of rising tone chorus elements:
time duration τ , frequency width ∆f , chirping rate Γ, and maximum
intensity I. Statistical results show typical
properties of chorus waves: I ∼ 0.09 nT, ∆f
∼0.08f , Γ ∼2 × 10 Hz/s, τ ∼ 0.015
− 0.25 s. On the nightside and dawnside, Γ shows wider spread and is
more distributed over larger values, which is associated with the wider
distribution of β. Chorus waves at duskside and dayside
have larger values of τ , associated with smaller β and
larger f /f. The dependence of
chorus wave properties on background plasma parameters is also examined.
We show that normalized ∆f has positive correlation with
β and f /f.
Normalized τ shows negative correlation with β and
positive correlation with f /f ,
respectively. Normalized Γ shows positive correlation with
β and negative correlation with f
/f. These results help us better understand chorus
waves excitation and their relation to the microburst.
CATKE: a turbulent-kinetic-energy-based parameterization for ocean microturbulence with dynamic convective adjustment
Authors: Wagner Gregory LeClaire , Hillier Adeline , Constantinou Navid C , Silvestri Simone , Souza Andre Nogueira , Burns Keaton , Ramadhan Ali , Hill Christopher N. , Campin Jean-Michel , Marshall John C , Ferrari Raffaele
Published: June 2023

We describe CATKE, a parameterization for ocean microturbulence with
scales between 1 and 100 meters. CATKE is a one-equation model that
predicts diffusive turbulent vertical fluxes a prognostic turbulent
kinetic energy (TKE) and a diagnostic mixing length that features a
dynamic model for convective adjustment (CA). With its convective mixing
length, CATKE predicts not just the depth range where microturbulence
acts but also the timescale over which mixing occurs, an important
aspect of turbulent convection not captured by convective adjustment
schemes. As a result, CATKE can describe the competition between
convection and other processes such as baroclinic restractification or
biogeochemical production-destruction. We estimate CATKE’s free
parameters with a posteriori calibration to eighteen large eddy
simulations of the ocean surface boundary layer, and validate CATKE
against twelve additional large eddy simulations with stronger and
weaker forcing than used during calibration. We find that a
CATKE-parameterized single column model accurately predicts the depth
structure of buoyancy and momentum at vertical resolutions between 2 and
16 meters and with time steps of 10-20 minutes. We propose directions
for future model development, and future efforts to recalibrate CATKE’s
parameters against more comprehensive and realistic datasets.
Solution for the density parameter of dark energy
Authors: Pellis Stergios
Published: June 2023

In this paper we will propose a possible solution for the density parameter of dark energy. From the dimensionless unification of the fundamental interactions will be presended the formulas for the density parameter of dark energy. Also we will show the geometric representation of the density parameter for dark energy and the geometric representation of the relationship between the de Sitter radius and the Hubble length.
Investigating Ecosystem-Scale Responses to Compost Amendments in a Grazed Grassland
Authors: Fenster Tommy , Torres Isabel , Zeilinger Adam , Chu Housen , Oikawa Patricia Yoshino
Published: June 2023

Compost amendments to rangelands is a proposed nature-based climate
solution to increase plant productivity and soil carbon sequestration.
However, it has not been evaluated using semi-continuous ecosystem-scale
measurements. Here we present the first study to utilize eddy covariance
and footprint partitioning to monitor carbon exchange in a grassland
with and without compost amendment, monitoring for one year before and
one year after treatment. Compost amendments to an annual California
grassland were found to enhance net ecosystem removal of C. Our study
confirmed that compost-amended grasslands, similar to non-amended
grasslands, are net carbon sources to the atmosphere; however amendments
appear to be slowing down the rate at which these ecosystems lose carbon
by 0.71 Mg C ha-1 per growing season. Digital repeated imagery of the
canopy revealed that compost-amended grasslands experienced an earlier
green-up, resulting in an overall longer growing season by more than 30
days. Scale-emergent processes such as changes in phenology are
understudied in nature-based climate solutions and need to be better
investigated before widespread adoption. Notably, we did not detect
significantly higher amounts of soil C in compost-amended soils. High
variability in soil C demands greater sampling replication in future
studies. A longer growing season and higher productivity are
hypothesized to be a result of greater availability of macro and
micronutrients in the top layer of soil (specifically N, P and Zn).
A possible long-term and very-deep aseismic slip event activating seismicity off Tohoku
Authors: Tomita Fumiaki
Published: June 2023

Various slips at plate interfaces in subduction zones have been
documented, and the role of aseismic slips in strain release and stress
re-distribution has been revealed. Prior to the M9 2011 Tohoku
earthquake in Japan, various small-scale aseismic slip events which
possibly affected the occurrence of the 2011 Tohoku earthquake had been
reported. However, the small-scale aseismic slip behaviors after the M9
2011 Tohoku earthquake have not been well-clarified because the dominant
postseismic deformation of the 2011 Tohoku earthquake has hidden minor
aseismic slips. In this study, we performed trajectory models for the
GNSS time-series after eliminating the postseismic deformation of the
2011 Tohoku earthquake, and we extracted afterslips followed by M7 class
earthquakes, and an ongoing long-term aseismic slip event (L-ASE) since
late 2019. The spatial extent of these aseismic slips was also
clarified, and the 2019 L-ASE was estimated to be in the down-dip area
of the seismogenic zone. As a similar L-ASE was also found before the
2011 Tohoku earthquake, a comparison of these L-ASEs suggests that the
repeated L-ASEs promoted strain accumulation in the shallow plate
interface, including the M9 rupture area, and may be markers preceding
M7 class seismicity. Because L-ASEs are key phenomena in assessing
sequential seismic behaviors in the Tohoku subduction zone, monitoring
the ongoing L-ASE and investigating its physical interaction with other
slip behaviors is important.