Adolescent Acetaminophen and Ibuprofen Self-Poisoning, 2017-2022.

BACKGROUND: Acetaminophen and ibuprofen are the most common agents involved in adolescent self-poisoning. With increasing suicidality observed during the COVID-19 pandemic, we sought to compare overdose trends, severity, and outcomes for both agents. METHODS: We performed a retrospective analysis of the National Poison Data System for acetaminophen and ibuprofen single-substance exposures in teenagers 13-19 years of age from 2017-2022. Acetaminophen and ibuprofen overdoses (per 100,000 persons) were plotted by year. Medical outcomes, clinical effects, and therapies were compared to determine if there were differences in overdose severity between the 2 agents. RESULTS: From 2017 to 2022, US poison centers recorded 50,902 single-substance acetaminophen exposures and 41,674 single-substance ibuprofen exposures in teenagers. Cases peaked in 2021 with 40.0 versus 29.1 cases (per 100,000 persons) for acetaminophen and ibuprofen, respectively. Acetaminophen self-poisoning was significantly more likely to result in death (odds ratio, 13.92; 95% confidence interval, 2.18-581.75; P < 0.001) or inpatient admission (odds ratio, 7.38; 95% confidence interval, 7.10-7.66; P < 0.001) compared with ibuprofen. Abdominal pain and vomiting were the most common clinical effects for both agents, and unsurprisingly, acetaminophen was more likely to cause transaminitis and liver dysfunction, whereas ibuprofen was more likely to cause central nervous system depression and metabolic acidosis. For the acetaminophen group, 19 teenagers underwent organ transplantation. CONCLUSIONS: Given the increased hospitalization and treatment resources needed for acetaminophen overdoses compared with ibuprofen, it is time to implement acetaminophen packaging policy change to protect US adolescents.

Optimizing Luminous Transmittance of a Three-Dimensional-Printed Fixed Bed Photobioreactor.

The development of innovative production processes and the optimization of photobioreactors play an important role in generating industrial competitive production technologies for phototrophic biofilms. With emerse photobioreactors a technology was introduced that allowed efficient surface attached cultivation of terrestrial cyanobacteria. However, the productivity of emerse photobioreactors depends on the available cultivation surface. By the implementation of biocarriers to the bioreactor volume, the cultivation surface can be increased which potentially improves productivity and thus the production of valuable compounds. To investigate the surface attached cultivation on biocarriers new photobioreactors need to be developed. Additive manufacturing (AM) offers new opportunities for the design of photobioreactors but producing the needed transparent parts can be challenging using AM techniques. In this study an emerse fixed bed photobioreactor was designed for the use of biocarriers and manufactured using different AM processes. To validate the suitability of the photobioreactor for phototrophic cultivation, the optical properties of three-dimensional (3D)-printed transparent parts and postprocessing techniques to improve luminous transmittance of the components were investigated. We found that stereolithography 3D printing can produce parts with a high luminous transmittance of over 85% and that optimal postprocessing by sanding and clear coating improved the clarity and transmittance to more than 90%. Using the design freedom of AM resulted in a bioreactor with reduced part count and improved handling. In summary, we found that modern 3D-printing technologies and materials are suitable for the manufacturing of functional photobioreactor prototypes.

Patient With Missed Right Ventricular Rupture From Blunt Trauma Remains Hemodynamically Stable for 3 Days.

Cardiac chamber rupture from blunt trauma is rare but can be fatal. Surprisingly, in some subsets of patients, it can be subtle and rather easily missed. Rapid recognition and management are essential. Percutaneous closure can be successful in iatrogenic chamber perforation (during pericardiocentesis) but possibly not in traumatic chamber rupture. (Level of Difficulty: Intermediate.).

Cannabis Toxicity in Children and Adolescents.

The legalization of recreational and medical cannabis has increased the availability and potency of cannabis products in homes and communities. Although state laws regarding legalization and commercial sale often encompass adult use only, pediatric toxicity from unintentional exposures to cannabis edibles and adolescent harm from chronic use are increasing in states and countries that have relaxed laws on use. Unintentional edible ingestions are shown to increase in regions that legalize and commercialize cannabis products at the retail level. Long-term effects on teenagers regarding psychiatric changes as well as acute gastrointestinal effects from hyperemesis syndrome are well documented in the medical literature. This article provides clinical information on the presentation, evaluation, and management of adverse effects from pediatric and adolescent teen exposures to cannabis seen in acute care and emergent settings. [Pediatr Ann. 2023;52(5):e181-e186.].

Scaling waveguide-integrated superconducting nanowire single-photon detector solutions to large numbers of independent optical channels.

Superconducting nanowire single-photon detectors are an enabling technology for modern quantum information science and are gaining attractiveness for the most demanding photon counting tasks in other fields. Embedding such detectors in photonic integrated circuits enables additional counting capabilities through nanophotonic functionalization. Here, we show how a scalable number of waveguide-integrated superconducting nanowire single-photon detectors can be interfaced with independent fiber optic channels on the same chip. Our plug-and-play detector package is hosted inside a compact and portable closed-cycle cryostat providing cryogenic signal amplification for up to 64 channels. We demonstrate state-of-the-art multi-channel photon counting performance with average system detection efficiency of (40.5 ± 9.4)% and dark count rate of (123 ± 34) Hz for 32 individually addressable detectors at minimal noise-equivalent power of (5.1 ± 1.2) · 10-18 W/Hz. Our detectors achieve timing jitter as low as 26 ps, which increases to (114 ± 17) ps for high-speed multi-channel operation using dedicated time-correlated single photon counting electronics. Our multi-channel single photon receiver offers exciting measurement capabilities for future quantum communication, remote sensing, and imaging applications.

Ultrafast quantum key distribution using fully parallelized quantum channels.

The field of quantum information processing offers secure communication protected by the laws of quantum mechanics and is on the verge of finding wider application for the information transfer of sensitive data. To improve cost-efficiency, extensive research is being carried out on the various components required for high data throughput using quantum key distribution (QKD). Aiming for an application-oriented solution, we report the realization of a multichannel QKD system for plug-and-play high-bandwidth secure communication at telecom wavelengths. We designed a rack-sized multichannel superconducting nanowire single photon detector (SNSPD) system, as well as a highly parallelized time-correlated single photon counting (TCSPC) unit. Our system is linked to an FPGA-controlled QKD evaluation setup for continuous operation, allowing us to achieve high secret key rates using a coherent-one-way protocol.

Pediatric Edible Cannabis Exposures and Acute Toxicity: 2017-2021.

OBJECTIVES: This study evaluates trends in pediatric cannabis edible ingestions in children younger than age 6 years with regard to toxicity, medical outcome, and health care utilization for the years 2017-2021. METHODS: We performed retrospective analysis of the National Poison Data System data for pediatric exposures to edible cannabis products in children <6 years from 2017 to 2021. Data were analyzed quantitatively with a focus on incidence, common clinical effects, medical outcomes, health care utilization, and changes in acute toxicity between the pre-COVID years (2017-2019) to the COVID years (2020-2021). RESULTS: There were 7043 exposures reported during 2017-2021. In 2017, there were 207 reported cases, and in 2021 there were 3054 cases, an increase of 1375.0%. Most exposures (97.7%) occurred in a residential setting. Seventy percent of cases followed to a known outcome were reported to have central nervous system depression. Of all reported cases, 22.7% of patients were admitted to the hospital. There was a significant increase in both ICU and non-ICU admissions, whereas the number of patients treated and released decreased when comparing the pre-COVID years (2017-2019) to the COVID years (2020-2021) (P < .05). Major and moderate effects also significantly increased during the prepandemic years compared with the 2 years during the pandemic (P < .05). CONCLUSIONS: There has been a consistent increase in pediatric edible cannabis exposures over the past 5 years, with the potential for significant toxicity. It is important for providers to be aware of this in their practice and it presents an important opportunity for education and prevention.

Strength Properties of 316L and 17-4 PH Stainless Steel Produced with Additive Manufacturing.

The number of additive manufacturing methods and materials is growing rapidly, leaving gaps in the knowledge of specific material properties. A relatively recent addition is the metal-filled filament to be printed similarly to the fused filament fabrication (FFF) technology used for plastic materials, but with additional debinding and sintering steps. While tensile, bending, and shear properties of metals manufactured this way have been studied thoroughly, their fatigue properties remain unexplored. Thus, the paper aims to determine the tensile, fatigue, and impact strengths of Markforged 17-4 PH and BASF Ultrafuse 316L stainless steel to answer whether the metal FFF can be used for structural parts safely with the current state of technology. They are compared to two 316L variants manufactured via selective laser melting (SLM) and literature results. For extrusion-based additive manufacturing methods, a significant decrease in tensile and fatigue strength is observed compared to specimens manufactured via SLM. Defects created during the extrusion and by the pathing scheme, causing a rough surface and internal voids to act as local stress risers, handle the strength decrease. The findings cast doubt on whether the metal FFF technique can be safely used for structural components; therefore, further developments are needed to reduce internal material defects.

Influence of wettability and surface design on the adhesion of terrestrial cyanobacteria to additive manufactured biocarriers.

Productive biofilms are gaining growing interest in research due to their potential of producing valuable compounds and bioactive substances such as antibiotics. This is supported by recent developments in biofilm photobioreactors that established the controlled phototrophic cultivation of algae and cyanobacteria. Cultivation of biofilms can be challenging due to the need of surfaces for biofilm adhesion. The total production of biomass, and thus production of e.g. bioactive substances, within the bioreactor volume highly depends on the available cultivation surface. To achieve an enlargement of surface area for biofilm photobioreactors, biocarriers can be implemented in the cultivation. Thereby, material properties and design of the biocarriers are important for initial biofilm formation and growth of cyanobacteria. In this study, special biocarriers were designed and additively manufactured to investigate different polymeric materials and surface designs regarding biofilm adhesion of the terrestrial cyanobacterium Nostoc flagelliforme (CCAP 1453/33). Properties of 3D-printed materials were characterized by determination of wettability, surface roughness, and density. To evaluate the influence of wettability on biofilm formation, material properties were specifically modified by gas-phase fluorination and biofilm formation was analyzed on biocarriers with basic and optimized geometry in shaking flask cultivation. We found that different polymeric materials revealed no significant differences in wettability and with identical surface design no significant effect on biomass adhesion was observed. However, materials treated with fluorination as well as optimized biocarrier design showed improved wettability and an increase in biomass adhesion per biocarrier surface.

Temozolomide-induced hypermutation is associated with distant recurrence and reduced survival after high-grade transformation of low-grade IDH-mutant gliomas.

BACKGROUND: Chemotherapy improves overall survival after surgery and radiotherapy for newly diagnosed high-risk IDH-mutant low-grade gliomas (LGGs), but a proportion of patients treated with temozolomide (TMZ) will develop recurrent tumors with TMZ-induced hypermutation. We aimed to determine the prevalence of TMZ-induced hypermutation at recurrence and prognostic implications. METHODS: We sequenced recurrent tumors from 82 patients with initially low-grade IDH-mutant gliomas who underwent reoperation and correlated hypermutation status with grade at recurrence and subsequent clinical outcomes. RESULTS: Hypermutation was associated with high-grade disease at the time of reoperation (OR 12.0 95% CI 2.5-115.5, P = .002) and was identified at transformation in 57% of recurrent LGGs previously exposed to TMZ. After anaplastic (grade III) transformation, hypermutation was associated with shorter survival on univariate and multivariate analysis (HR 3.4, 95% CI 1.2-9.9, P = .024), controlling for tumor grade, subtype, age, and prior radiotherapy. The effect of hypermutation on survival after transformation was validated in an independent, published dataset. Hypermutated (HM) tumors were more likely to develop discontiguous foci of disease in the brain and spine (P = .003). To estimate the overall incidence of high-grade transformation among low-grade IDH-mutant tumors, data from a phase II trial of TMZ for LGG were analyzed. Eight-year transformation-free survival was 53.8% (95% CI 42.8-69.2), and 61% of analyzed transformed cases were HM. CONCLUSIONS: TMZ-induced hypermutation is a common event in transformed LGG previously treated with TMZ and is associated with worse prognosis and development of discontiguous disease after recurrence. These findings impact tumor classification at recurrence, prognostication, and clinical trial design.

Rising incidence and high mortality in intentional sodium nitrite exposures reported to US poison centers.

INTRODUCTION: Sodium nitrite is an oxidizing agent capable of producing profound methemoglobinemia. Large quantities of sodium nitrite can be purchased online, and recent literature has identified several cases of intentional self-poisoning, including multiple cases of mortality. This has raised concern that intentional sodium nitrite poisoning and resultant severe methemoglobinemia may be increasing in incidence and could represent a substantial public health threat. MATERIALS AND METHODS: This study used data obtained from the National Poison Data System (NPDS) to evaluate the incidence and mortality rate of intentional sodium nitrite poisoning of suicidal intent reported to US poison centers over a five-year period. Patient demographics, exposure characteristics, treatments administered, and patient outcomes were analyzed. Temporal patterns in exposure were also investigated. RESULTS: Forty-seven cases were identified in the NPDS database, of which three were excluded due to lack of outcome data. Median patient age was 23 years, 52% of patients were female and 86% of exposures occurred at the patient's residence. Serious outcomes were observed in 84% of cases, 77% of patients included were treated with methylene blue and 30% of patients died. No intentional sodium nitrite exposures were reported in the first two years studied, but we observed an increase in the incidence of exposures reported through the remainder of the investigation period. DISCUSSION/CONCLUSIONS: The incidence of intentional self-poisoning with sodium nitrite has been increasing since 2017. Many of these exposures result in toxicity requiring antidotal therapy, and a high mortality rate was observed. Recent literature indicates that this trend may be the result of ready access to this poison through online vendors combined with recommendations shared in online communities that sodium nitrite be used as an effective method of suicide. Further study is needed to better characterize this phenomenon and develop public health interventions to prevent future morbidity and mortality.

Severe Vitamin K-dependent Coagulopathy from Rodenticide-contaminated Synthetic Cannabinoids: Emergency Department Presentations.

INTRODUCTION: Synthetic cannabinoids are a rapidly expanding subset of designer drugs widely available in the United States since 2008. In Illinois during the spring of 2018, over 160 documented cases of bleeding and prolonged coagulopathy occurred secondary to contaminated synthetic cannabinoids. METHODS: We conducted a retrospective cohort study consisting of 38 patients to describe the initial emergency department (ED) presentation, diagnosis, and treatment. RESULTS: Through serum testing we found that three long-acting anticoagulant rodenticides (LAAR) were detected in patients who had inhaled these tainted products: brodifacoum, difenacoum, and bromodialone. DISCUSSION: This study encompasses the largest ED presentation of LAAR poisoning via the inhalational route known to date. CONCLUSION: The emergency physician should be aware of the potential for tainted coingestants as the cause of undifferentiated coagulopathy.

Dental implant surgery and risk of bleeding in patients on antithrombotic medications: A review of the literature.

OBJECTIVES: This literature review was performed to assess the risk of bleeding in dental implantation procedures in patients taking antiplatelet drugs (APs), oral anticoagulants (OACs) and direct oral anticoagulants (DOACs). STUDY DESIGN: MEDLINE and SCOPUS databases were searched for English language publications through October 2019, using the keywords "dental implants," "dental implantation," "anticoagulants," "platelet aggregation inhibitors," and "hemorrhage." Reference lists of relevant articles were also hand searched. Collected data regarding dental implantation procedures, type of medications (APs, OACs and DOAC), and postoperative bleeding episodes were analyzed. RESULTS: Nine studies were included in the review. Postoperative bleeding occurred in 10 (2.2%) of 456 of cases involving dental implant placements; in all of those cases, bleeding was controlled with the use of local hemostatic agents. The bleeding incidence in patients on antiplatelet medications was 0.4% (range 1 of 253 to 1 of 261). Among those taking oral anticoagulants, the bleeding incidence was 5.7% (range 6 of 105 to 6 of 113), and among those on direct oral anticoagulants, the bleeding incidence was 3.3% (3 of 90). The numbers of more extensive surgical procedures (i.e., sinus lift and bone augmentation procedures) were small, and additional information regarding the surgery, the specific antithrombotic used, or bleeding was often not provided, so further analysis was not possible. CONCLUSIONS: Evidence supports continuing OACs, DOACs, or APs during dental implant surgery.

Development of a lightweight multi-skin sheet photobioreactor for future cultivation of phototrophic biofilms on facades.

This article covers the development of a novel emerse photobioreactor (ePBR), using a polycarbonate multi-skin sheet (MSS), to cultivate terrestrial cyanobacteria as surface-associated phototrophic biofilms in an aerosol-based cultivation process. The aerosol, generated by ultrasonic transduction, moistens and nourishes the biofilm inside the multi-skin sheet emerse photobioreactor (MSSePBR). Advantages of the MSSePBR, such as its low weight design and reduced water consumption due to the usage of aerosol, simplify the development for future facade bioreactors. To develop the MSSePBR, surface roughness, static contact angle and luminous transmittance were investigated to characterize the properties of the cultivation surface for phototrophic cultivation. The polymeric MSS showed good luminous transmittance and proofed its optical suitability for the cultivation of terrestrial cyanobacteria. Using the MSSePBR, the terrestrial cyanobacteria Coleofasciculus chthonoplastes and Trichocoleus sociatus were cultivated with either ambient air, air with increased CO2 content or flue gas. The cultivation of terrestrial cyanobacteria showed higher productivities for biomass in the MSSePBR than in suspended systems. Cultivation with increased CO2 contents and flue gas was possible, thus a combination with flue gas treatment is feasible. An up-scaled prototype of the MSSePBR was introduced to show the possibilities for future industrial-sized and facade applications.

Public Health Surveillance for the Prevention of Pesticide-Related Illness in Illinois.

OBJECTIVES: There is no pesticide related illness (PRI) surveillance program in Illinois. This study examines the quality of state-based data sources for their ability to inform public health surveillance on PRI. METHODS: We estimated the counts of PRI by probabilistic data linkage of hospital discharge, emergency department, and poison center databases from 2010 to 2015. We characterized identified PRI cases. RESULTS: We identified 3867 unique cases of PRI and 6269 asymptomatic pesticide exposures. Out of the 3867 PRI cases, there were 1319 emergency department visits and 321 hospitalizations. We identified 13 deaths and 1640 major or moderate effects from PRI. Over half of ingestion related exposures occurred in children aged 0 to 4 years. Workers' compensation and Emergency Medical Service data were unusable. CONCLUSION: An effective public health surveillance on PRI requires reliable state data sources and cost-effective methods of assembling data from multiple sources.

Photon arrival time tagging with many channels, sub-nanosecond deadtime, very high throughput, and fiber optic remote synchronization.

Time-Correlated Single Photon Counting (TCSPC) and time tagging of individual photon detections are powerful tools in many quantum optical experiments and other areas of applied physics. Using TCSPC, e.g., for the purpose of fluorescence lifetime measurements, is often limited in speed due to dead-time losses and pileup. We show that this limitation can be lifted by reducing the dead-time of the timing electronics to the absolute minimum imposed by the speed of the detector signals while maintaining high temporal resolution. A complementing approach to speedy data acquisition is parallelization by means of simultaneous readout of many detector channels. This puts high demands on the data throughput of the TCSPC system, especially in time tagging of individual photon arrivals. Here, we present a new design approach, supporting up to 16 input channels, an extremely short dead-time of 650 ps, very high time tagging throughput, and a timing resolution of 80 ps. In order to facilitate remote synchronization of multiple such instruments with highest precision, the new TCSPC electronics provide an interface for White Rabbit fiber optic networks. Beside fundamental research in the field of astronomy, such remote synchronization tasks arise routinely in quantum communication networks with node to node distances on the order of tens of kilometers. In addition to showing design features and benchmark results of new TCSPC electronics, we present application results from spectrally resolved and high-speed fluorescence lifetime imaging in medical research. We furthermore show how pulse-pileup occurring in the detector signals at high photon flux can be corrected for and how this data acquisition scheme performs in terms of accuracy and efficiency.

An outbreak of severe coagulopathy from synthetic cannabinoids tainted with Long-Acting anticoagulant rodenticides.

Objective: To describe a large regional poison center's experience managing an outbreak of long-acting anticoagulant rodenticide (LAAR) poisoning associated with synthetic cannabinoid (SC) use.Methods: This is a retrospective review of exposures reported to the Illinois Poison Center between March 10 and August 1, 2018. All cases coded as exposure to Δ9-tetrahydrocannabinol homologs were identified. Patients with suspected SC use, positive LAAR testing, and coagulopathy (signs or symptoms of bleeding or international normalized ratio [INR] > 2) were included. If confirmatory LAAR testing was performed and resulted as negative, the patient was excluded from this analysis. In the absence of LAAR testing, patients with suspected SC use, an INR >2, and no alternative explanation of coagulopathy were included. Suspected SC use was defined as use suspected by a member of the treating team or reported by the patient. Presenting signs and symptoms, laboratory findings, management, healthcare utilization, outcomes, and disposition of patients affected by this outbreak were reported.Results: One hundred seventy-eight cases met inclusion criteria. Most patients were male (73%) and young to middle-aged (median age 32, IQR 25-40). Most presented to hospitals in Peoria (35%) and Cook (31%) counties. Median hospitalization was three days (IQR 2-4). Eighty-eight percent of patients presented with an INR >10. Eighteen cases had qualitative anticoagulant testing, all of which were positive for brodifacoum. Other identified LAARs included difenacoum (10/18) and bromadiolone (1/18). Sixty-three percent of patients had back, flank or abdominal pain; 70% of patients presented with hematuria. One hundred six cases received IV vitamin K1; no adverse or anaphylactoid reactions were reported. Forty-one (22%) patients left AMA. Thirty-eight patients (21%) were re-hospitalized during the study period. Patients leaving AMA were 1.6 times more likely to be re-hospitalized than patients with other dispositions. Intracranial hemorrhage, present in 3% of total cases, was present in 4 of 5 fatalities.Conclusions: We describe an outbreak of multiple LAARs contaminating SCs. Patients presented with bleeding from varied sites, often required blood products, factor replacement, and high dose vitamin K1 for stabilization.

The Public Health Response to a Large Poisoning Outbreak Involving an Illicit Substance: Synthetic Cannabinoids Contaminated With a Long-Acting Anticoagulant Rodenticide, Illinois, March-July, 2018.

During March-July 2018, the Illinois Department of Public Health responded to an acute outbreak of severe coagulopathy among patients with recent synthetic cannabinoid use. Toxicological testing indicated that cases were exposed to brodifacoum, a long-acting anticoagulant rodenticide. A total of 174 confirmed and probable cases, including 5 deaths, were linked to this outbreak. On the basis of the experience of responding to this complex outbreak, we recommend several steps for consideration to improve health department preparation for acute outbreaks involving illicit substances including strengthening communication between public health and law enforcement agencies, reviewing legal authority to investigate noninfectious acute disease outbreaks, continuing strong partnerships with state poison control centers, partnering with substance abuse and mental health agencies to provide services to patients, and determining health department ability to rapidly enter into public-private partnership agreements.