Objective. The aim of this study was to validate and compare the performance of serum paraquat level, severity index of paraquat poisoning (SIPP), Acute Physiology And Chronic Health Evaluation II (APACHE II), modifi ed Simplifi ed Acute Physiology Score II (MSAPS II), and modifi ed Expanded Simplifi ed Acute Physiology Score II (MSAPS IIe) calculated immediately after arrival on emergency department (ED) for assessing the mortality of acute paraquat poisoning. Methods . A retrospective study design was employed with the main outcome measure being mortality from year 2001 to 2010. MSAPS II and MSAPS IIe were employed in that assessment of the 24-hour urine output were not included. The performance of APACHE II, MSAPS II, MSAPS IIe, serum paraquat level and SIPP for prediction of mortality in acute paraquat poisoning were compared. Results. A total of 102 patients were enrolled in the study. The area under the ROC curve for APACHE II (0.800) was statistically lower than those for MSAPS II, MSAPS IIe, SIPP and serum paraquat (0.879, 0.893, 0.924,and 0.951, respectively). The Hosmer-Lemeshow goodness-of-fi t test C statistic revealed that APACHE II, MSAPS II, MSAPS IIe and serum paraquat level showed good calibrations (chi-square 8.477 and p ϭ 0.388, chi-square 4.614 and p ϭ 0.798, chi-squared 5.301 and p ϭ 0.725, chisquared 1.009 and p ϭ 0.985 respectively), but poor calibration for SIPP (chi-square 21.293 and p ϭ 0.006). Conclusion. Serum paraquat level is still the most reliable prognosis factor in acute paraquat poisoning. But MSAPS II or MSAPS IIe calculated immediately after arrival on ED may be helpful to predict mortality in acute paraquat poisoning especially when hospital has no facility to measure serum paraquat level.

ObjectiveReliable biomarkers of delayed neuropsychological sequelae (DNS) after acute carbon monoxide (CO) poisoning are lacking. This study investigated the associations between potential serum markers and the development of DNS after acute CO poisoning.MethodsRetrospective chart reviews were conducted for patients diagnosed with acute CO poisoning during a 28-month period. The patients were divided into two groups according to the presence or absence of having developed DNS. Multivariate analysis was performed to identify predictors of DNS after CO poisoning.ResultsOf a total of 102 patients, 10 (9.8%) developed DNS. The levels of serum osmolarity, S100B protein, and serum lactate, as well as serum anion gap, were statistically significant in univariate analysis. Multiple logistic regression analysis showed that anion gap (adjusted odds ratio [AOR], 1.36; 95% confidence interval [CI], 1.11 to 1.88), serum lactate level (AOR, 1.74; 95% CI, 1.26 to 2.75), and serum S100B protein level ([AOR, 7.02×105; 95% CI, 4.56×102 to 9.00×1010] in model 1, [AOR, 3.69×105; 95% CI, 2.49×102 to 2.71×1011] in model 2) were independently associated with DNS development.ConclusionBased on our preliminary results, serum lactate level, serum anion gap, and serum S100B protein level in the emergency department could be informative predictors of DNS development in patients with acute CO poisoning. These markers might have the potential to improve early recognition of DNS in patients with acute CO poisoning.

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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College student volunteers (n = 142) completed a 580 km road march for 21 consecutive days. Each volunteer carried a backpack that weighed 14.1 ± 1.4 kg on the average. We investigated the incidence and location of blisters associated with the road march using a foot map along with other injuries. Overall, 95.1% of the subjects (135 of 142) sustained one or more injuries. All injured subjects had foot blisters, and 18% had other foot injuries. The most common locations of blister development were the right 5th toe (61%) and the left 5th toe (57%). The little toes seem to have been subjected to the greatest friction and shearing forces. March-related injuries, excluding foot injuries, were ankle pain (12.7%), knee pain (12.7%) and Achilles tendon pain (7.7%). Six subjects (4.2%) needed extra medical treatment for more than 2 weeks prior to returning to their daily lives after completion of the march due to associated injuries. The present study observed a very high incidence rate of injuries (95.1%) associated with the 580 km university students grand road march. These injuries posed an obstacle against completion of the road march and against returning to daily life. Active preventive interventions such as physical therapy and customized reinforced shoes and education program are recommended for reducing incidence rate and severity of injuries.