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1.
Proc Natl Acad Sci U S A ; 118(14)2021 Apr 06.
Artigo em Inglês | MEDLINE | ID: mdl-33782127

RESUMO

Nondipolar magnetic fields exhibited at Uranus and Neptune may be derived from a unique geometry of their icy mantle with a thin convective layer on top of a stratified nonconvective layer. The presence of superionic H2O and NH3 has been thought as an explanation to stabilize such nonconvective regions. However, a lack of experimental data on the physical properties of those superionic phases has prevented the clarification of this matter. Here, our Brillouin measurements for NH3 show a two-stage reduction in longitudinal wave velocity (V p) by ∼9% and ∼20% relative to the molecular solid in the temperature range of 1,500 K and 2,000 K above 47 GPa. While the first V p reduction observed at the boundary to the superionic α phase was most likely due to the onset of the hydrogen diffusion, the further one was likely attributed to the transition to another superionic phase, denoted γ phase, exhibiting the higher diffusivity. The reduction rate of V p in the superionic γ phase, comparable to that of the liquid, implies that this phase elastically behaves almost like a liquid. Our measurements show that superionic NH3 becomes convective and cannot contribute to the internal stratification.

2.
Pediatr Nephrol ; 38(4): 1115-1126, 2023 04.
Artigo em Inglês | MEDLINE | ID: mdl-35943576

RESUMO

BACKGROUND: Minimal change disease (MCD) is the major cause of childhood idiopathic nephrotic syndrome, which is characterized by massive proteinuria and debilitating edema. Proteinuria in MCD is typically rapidly reversible with corticosteroid therapy, but relapses are common, and children often have many adverse events from the repeated courses of immunosuppressive therapy. The pathobiology of MCD remains poorly understood. Prior clinical observations suggest that abnormal T-cell function may play a central role in MCD pathogenesis. Based on these observations, we hypothesized that T-cell responses to specific exposures or antigens lead to a clonal expansion of T-cell subsets, a restriction in the T-cell repertoire, and an elaboration of specific circulating factors that trigger disease onset and relapses. METHODS: To test these hypotheses, we sequenced T-cell receptors in fourteen MCD, four focal segmental glomerulosclerosis (FSGS), and four membranous nephropathy (MN) patients with clinical data and blood samples drawn during active disease and during remission collected by the Nephrotic Syndrome Study Network (NEPTUNE). We calculated several T-cell receptor diversity metrics to assess possible differences between active disease and remission states in paired samples. RESULTS: Median productive clonality did not differ between MCD active disease (0.0083; range: 0.0042, 0.0397) and remission (0.0088; range: 0.0038, 0.0369). We did not identify dominant clonotypes in MCD active disease, and few clonotypes were shared with FSGS and MN patients. CONCLUSIONS: While these data do not support an obvious role of the adaptive immune system T-cells in MCD pathogenesis, further study is warranted given the limited sample size. A higher resolution version of the Graphical abstract is available as Supplementary information.


Assuntos
Glomerulonefrite Membranosa , Glomerulosclerose Segmentar e Focal , Nefrose Lipoide , Síndrome Nefrótica , Criança , Humanos , Nefrose Lipoide/tratamento farmacológico , Glomerulosclerose Segmentar e Focal/complicações , Netuno , Síndrome Nefrótica/tratamento farmacológico , Proteinúria/etiologia , Glomerulonefrite Membranosa/complicações , Receptores de Antígenos de Linfócitos T/uso terapêutico , Recidiva
3.
J Pathol ; 253(3): 268-278, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33197281

RESUMO

Inconsistencies in the preparation of histology slides and whole-slide images (WSIs) may lead to challenges with subsequent image analysis and machine learning approaches for interrogating the WSI. These variabilities are especially pronounced in multicenter cohorts, where batch effects (i.e. systematic technical artifacts unrelated to biological variability) may introduce biases to machine learning algorithms. To date, manual quality control (QC) has been the de facto standard for dataset curation, but remains highly subjective and is too laborious in light of the increasing scale of tissue slide digitization efforts. This study aimed to evaluate a computer-aided QC pipeline for facilitating a reproducible QC process of WSI datasets. An open source tool, HistoQC, was employed to identify image artifacts and compute quantitative metrics describing visual attributes of WSIs to the Nephrotic Syndrome Study Network (NEPTUNE) digital pathology repository. A comparison in inter-reader concordance between HistoQC aided and unaided curation was performed to quantify improvements in curation reproducibility. HistoQC metrics were additionally employed to quantify the presence of batch effects within NEPTUNE WSIs. Of the 1814 WSIs (458 H&E, 470 PAS, 438 silver, 448 trichrome) from n = 512 cases considered in this study, approximately 9% (163) were identified as unsuitable for subsequent computational analysis. The concordance in the identification of these WSIs among computational pathologists rose from moderate (Gwet's AC1 range 0.43 to 0.59 across stains) to excellent (Gwet's AC1 range 0.79 to 0.93 across stains) agreement when aided by HistoQC. Furthermore, statistically significant batch effects (p < 0.001) in the NEPTUNE WSI dataset were discovered. Taken together, our findings strongly suggest that quantitative QC is a necessary step in the curation of digital pathology cohorts. © 2020 The Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.


Assuntos
Interpretação de Imagem Assistida por Computador/métodos , Nefropatias/diagnóstico , Patologia Cirúrgica/métodos , Controle de Qualidade , Algoritmos , Biópsia , Humanos , Interpretação de Imagem Assistida por Computador/normas , Patologia Cirúrgica/normas
4.
Philos Trans A Math Phys Eng Sci ; 378(2187): 20190475, 2020 Dec 25.
Artigo em Inglês | MEDLINE | ID: mdl-33161861

RESUMO

The properties of ice giant normal mode oscillations, including their periods, spatial structure, stratospheric amplitudes and relative influence on the external gravity field, are surveyed for the purpose of formulating the best strategy for their eventual detection. Measurement requirements for detecting a normal mode's periodic pressure and temperature variations, including a possible stratospheric signal, and its effect on the external gravity field, are discussed in terms of its radial velocity amplitude at the 1 bar pressure level. It is found that for reasonable amplitudes, detection of the pressure and temperature variations of ice giant normal modes presents an extraordinary technical challenge. The prospects for detecting their gravitational influence on an orbiting spacecraft are more promising, with requirements that lie within the range of current technology. This article is part of a discussion meeting issue 'Future exploration of ice giant systems'.

5.
Philos Trans A Math Phys Eng Sci ; 378(2187): 20190478, 2020 Dec 25.
Artigo em Inglês | MEDLINE | ID: mdl-33161864

RESUMO

We review the current understanding of the upper atmospheres of Uranus and Neptune, and explore the upcoming opportunities available to study these exciting planets. The ice giants are the least understood planets in the solar system, having been only visited by a single spacecraft, in 1986 and 1989, respectively. The upper atmosphere plays a critical role in connecting the atmosphere to the forces and processes contained within the magnetic field. For example, auroral current systems can drive charged particles into the atmosphere, heating it by way of Joule heating. Ground-based observations of H3+ provides a powerful remote diagnostic of the physical properties and processes that occur within the upper atmosphere, and a rich dataset exists for Uranus. These observations span almost three decades and have revealed that the upper atmosphere has continuously cooled between 1992 and 2018 at about 8 K/year, from approximately 750 K to approximately 500 K. The reason for this trend remain unclear, but could be related to seasonally driven changes in the Joule heating rates due to the tilted and offset magnetic field, or could be related to changing vertical distributions of hydrocarbons. H3+ has not yet been detected at Neptune, but this discovery provides low-hanging fruit for upcoming facilities such as the James Webb Space Telescope and the next generation of 30 m telescopes. Detecting H3+ at Neptune would enable the characterization of its upper atmosphere for the first time since 1989. To fully understand the ice giants, we need dedicated orbital missions, in the same way the Cassini spacecraft explored Saturn. Only by combining in situ observations of the magnetic field with in-orbit remote sensing can we get the complete picture of how energy moves between the atmosphere and the magnetic field. This article is part of a discussion meeting issue 'Future exploration of ice giant systems'.

6.
Philos Trans A Math Phys Eng Sci ; 378(2187): 20190489, 2020 Dec 25.
Artigo em Inglês | MEDLINE | ID: mdl-33161863

RESUMO

Existing observations of Uranus and Neptune's fundamental physical properties can be fitted with a wide range of interior models. A key parameter in these models is the bulk rock:ice ratio and models broadly fall into ice-dominated (ice giant) and rock-dominated (rock giant) categories. Here we consider how observations of Neptune's atmospheric temperature and composition (H2, He, D/H, CO, CH4, H2O and CS) can provide further constraints. The tropospheric CO profile in particular is highly diagnostic of interior ice content, but is also controversial, with deep values ranging from zero to 0.5 parts per million. Most existing CO profiles imply extreme O/H enrichments of >250 times solar composition, thus favouring an ice giant. However, such high O/H enrichment is not consistent with D/H observations for a fully mixed and equilibrated Neptune. CO and D/H measurements can be reconciled if there is incomplete interior mixing (ice giant) or if tropospheric CO has a solely external source and only exists in the upper troposphere (rock giant). An interior with more rock than ice is also more compatible with likely outer solar system ice sources. We primarily consider Neptune, but similar arguments apply to Uranus, which has comparable C/H and D/H enrichment, but no observed tropospheric CO. While both ice- and rock-dominated models are viable, we suggest a rock giant provides a more consistent match to available atmospheric observations. This article is part of a discussion meeting issue 'Future exploration of ice giant systems'.

7.
Philos Trans A Math Phys Eng Sci ; 378(2187): 20190488, 2020 Dec 25.
Artigo em Inglês | MEDLINE | ID: mdl-33161865

RESUMO

Future missions to an ice giant planet, especially orbital missions, are technologically challenging. But with one exception, radioisotope power sources (RPSs), the technologies that would enable such missions are currently available. RPSs are not a new technology, but devices used in the past that are appropriate to an ice giant mission are no longer available without engineering development work (currently unfunded), and it is uncertain whether the new NASA unit under development will be available for flight in time to take advantage of the best transfer trajectories of the next 15 years. This paper describes technologies already in hand that enable an ice giant mission, but for them to be useful they must be maintained. If an enabling technology is lost a replacement must be developed, potentially impacting the cost and schedule of a mission. In addition to the enabling technologies, there are a number of technologies that, while not enabling, could greatly enhance the science return and science value of a mission, making the programmatic aspects of approval an easier task and the funding of those development tasks a high priority. This article is part of a discussion meeting issue 'Future exploration of ice giant systems'.

8.
Philos Trans A Math Phys Eng Sci ; 378(2187): 20190482, 2020 Dec 25.
Artigo em Inglês | MEDLINE | ID: mdl-33161854

RESUMO

All four giant planets are encircled by distinctive systems of rings and small, inner satellites. These all reside within or near their central planet's Roche limit, the rough boundary within which bodies held together by self-gravity will be disrupted by tidal forces. However, the similarities of the four ring-moon systems end here; in most other regards, they are remarkably diverse. We study these systems for three key reasons: (1) for the information they reveal about the properties, history and ongoing evolution of the planetary systems of which they are a part; (2) as dynamical analogues for other astrophysical systems such as protoplanetary disks; and (3) for the wealth of fascinating properties and origin scenarios that make them worthy of study in their own right. The inner Uranus system is characterized by 10 narrow rings, some quite dense, as well as a variety of more tenuous structures. These are accompanied by 13 known moons all orbiting interior to Miranda. Nine of these, Bianca through Perdita, comprise the most densely packed set of moons in the solar system, with orbits so close that their interactions appear to drive chaos over time scales approximately 106 years. Neptune has five named rings, all optically thin, interleaved with seven inner moons. The most notable feature is a set of arcs embedded within the Adams ring; two of these arcs have been stable for time scales of decades. This article is part of a discussion meeting issue 'Future exploration of ice giant systems'.

9.
Philos Trans A Math Phys Eng Sci ; 378(2187): 20190485, 2020 Dec 25.
Artigo em Inglês | MEDLINE | ID: mdl-33161855

RESUMO

More than 30 years have passed since the Voyager 2 flybys of Uranus and Neptune. This paper outlines a range of lessons learned from Voyager, broadly grouped into 'process, planning and people.' In terms of process, we must be open to new concepts, whether new instrument technologies, new propulsion systems or operational modes. Examples from recent decades that could open new vistas in the exploration of the deep outer Solar System include the Cassini Resource Exchange and the 'sleep' mode from the New Horizons mission. Planning is crucial: mission gaps that last over three decades leave much scope for evolution both in mission development and in the targets themselves. The science is covered in other papers in this issue, but this paper addresses the structure of the US Planetary Decadal Surveys, with a specific urging to move from a 'destination-based' organization to a structure based on fundamental science. Coordination of distinct and divergent international planning timelines brings both challenges and opportunity. Complexity in the funding and political processes is amplified when multiple structures must be navigated; but the science is enriched by the diversity of international perspectives, as were represented at the Ice Giant discussion meeting that motivated this review. Finally, the paper turns to people: with generational-length gaps between missions, continuity in knowledge and skills requires careful attention to people. Lessons for the next generation of voyagers include: how to lead and inspire; how to develop the perspective to see their missions through decades-long development phases; and cultivation of strategic thinking, altruism and above all, patience. This article is part of a discussion meeting issue 'Future exploration of ice giant systems'.

10.
Philos Trans A Math Phys Eng Sci ; 378(2187): 20190476, 2020 Dec 25.
Artigo em Inglês | MEDLINE | ID: mdl-33161859

RESUMO

The ice giants Uranus and Neptune have hydrogen-based atmospheres with several constituents that condense in their cold upper atmospheres. A small number of bright cloud systems observed in both planets are good candidates for moist convective storms, but their observed properties (size, temporal scales and cycles of activity) differ from moist convective storms in the gas giants. These clouds and storms are possibly due to methane condensation and observations also suggest deeper clouds of hydrogen sulfide (H2S) at depths of a few bars. Even deeper, thermochemical models predict clouds of ammonia hydrosulfide (NH4SH) and water at pressures of tens to hundreds of bars, forming extended deep weather layers. Because of hydrogen's low molecular weight and the high abundance of volatiles, their condensation imposes a strongly stabilizing vertical gradient of molecular weight larger than the equivalent one in Jupiter and Saturn. The resulting inhibition of vertical motions should lead to a moist convective regime that differs significantly from the one occurring on nitrogen-based atmospheres like those of Earth or Titan. As a consequence, the thermal structure of the deep atmospheres of Uranus and Neptune is not well understood. Similar processes might occur at the deep water cloud of Jupiter in Saturn, but the ice giants offer the possibility to study these physical aspects in the upper methane cloud layer. A combination of orbital and in situ data will be required to understand convection and its role in atmospheric dynamics in the ice giants, and by extension, in hydrogen atmospheres including Jupiter, Saturn and giant exoplanets. This article is part of a discussion meeting issue 'Future exploration of ice giant systems'.

11.
Philos Trans A Math Phys Eng Sci ; 378(2187): 20190477, 2020 Dec 25.
Artigo em Inglês | MEDLINE | ID: mdl-33161866

RESUMO

Comparatively little is known about atmospheric chemistry on Uranus and Neptune, because remote spectral observations of these cold, distant 'Ice Giants' are challenging, and each planet has only been visited by a single spacecraft during brief flybys in the 1980s. Thermochemical equilibrium is expected to control the composition in the deeper, hotter regions of the atmosphere on both planets, but disequilibrium chemical processes such as transport-induced quenching and photochemistry alter the composition in the upper atmospheric regions that can be probed remotely. Surprising disparities in the abundance of disequilibrium chemical products between the two planets point to significant differences in atmospheric transport. The atmospheric composition of Uranus and Neptune can provide critical clues for unravelling details of planet formation and evolution, but only if it is fully understood how and why atmospheric constituents vary in a three-dimensional sense and how material coming in from outside the planet affects observed abundances. Future mission planning should take into account the key outstanding questions that remain unanswered about atmospheric chemistry on Uranus and Neptune, particularly those questions that pertain to planet formation and evolution, and those that address the complex, coupled atmospheric processes that operate on Ice Giants within our solar system and beyond. This article is part of a discussion meeting issue 'Future exploration of ice giant systems'.

12.
Philos Trans A Math Phys Eng Sci ; 378(2187): 20190480, 2020 Dec 25.
Artigo em Inglês | MEDLINE | ID: mdl-33161869

RESUMO

The ice giant planets provide some of the most interesting natural laboratories for studying the influence of large obliquities, rapid rotation, highly asymmetric magnetic fields and wide-ranging Alfvénic and sonic Mach numbers on magnetospheric processes. The geometries of the solar wind-magnetosphere interaction at the ice giants vary dramatically on diurnal timescales due to the large tilt of the magnetic axis relative to each planet's rotational axis and the apparent off-centred nature of the magnetic field. There is also a seasonal effect on this interaction geometry due to the large obliquity of each planet (especially Uranus). With in situ observations at Uranus and Neptune limited to a single encounter by the Voyager 2 spacecraft, a growing number of analytical and numerical models have been put forward to characterize these unique magnetospheres and test hypotheses related to the magnetic structures and the distribution of plasma observed. Yet many questions regarding magnetospheric structure and dynamics, magnetospheric coupling to the ionosphere and atmosphere, and potential interactions with orbiting satellites remain unanswered. Continuing to study and explore ice giant magnetospheres is important for comparative planetology as they represent critical benchmarks on a broad spectrum of planetary magnetospheric interactions, and provide insight beyond the scope of our own Solar System with implications for exoplanet magnetospheres and magnetic reversals. This article is part of a discussion meeting issue 'Future exploration of ice giant systems'.

13.
Philos Trans A Math Phys Eng Sci ; 378(2187): 20190479, 2020 Dec 25.
Artigo em Inglês | MEDLINE | ID: mdl-33161852

RESUMO

The Voyager 2 flybys of Uranus and Neptune revealed the first multipolar planetary magnetic fields and highlighted how much we have yet to learn about ice giant planets. In this review, we summarize observations of Uranus' and Neptune's magnetic fields and place them in the context of other planetary dynamos. The ingredients for dynamo action in general, and for the ice giants in particular, are discussed, as are the factors thought to control magnetic field strength and morphology. These ideas are then applied to Uranus and Neptune, where we show that no models are yet able to fully explain their observed magnetic fields. We then propose future directions for missions, modelling, experiments and theory necessary to answer outstanding questions about the dynamos of ice giant planets, both within our solar system and beyond. This article is part of a discussion meeting issue 'Future exploration of ice giant systems'.

14.
Philos Trans A Math Phys Eng Sci ; 378(2187): 20190474, 2020 Dec 25.
Artigo em Inglês | MEDLINE | ID: mdl-33161856

RESUMO

Uranus and Neptune form a distinct class of planets in our Solar System. Given this fact, and ubiquity of similar-mass planets in other planetary systems, it is essential to understand their interior structure and composition. However, there are more open questions regarding these planets than answers. In this review, we concentrate on the things we do not know about the interiors of Uranus and Neptune with a focus on why the planets may be different, rather than the same. We next summarize the knowledge about the planets' internal structure and evolution. Finally, we identify the topics that should be investigated further on the theoretical front as well as required observations from space missions. This article is part of a discussion meeting issue 'Future exploration of ice giant systems'.

15.
Philos Trans A Math Phys Eng Sci ; 378(2187): 20190473, 2020 Dec 25.
Artigo em Inglês | MEDLINE | ID: mdl-33161857

RESUMO

The international planetary science community met in London in January 2020, united in the goal of realizing the first dedicated robotic mission to the distant ice giants, Uranus and Neptune, as the only major class of solar system planet yet to be comprehensively explored. Ice-giant-sized worlds appear to be a common outcome of the planet formation process, and pose unique and extreme tests to our understanding of exotic water-rich planetary interiors, dynamic and frigid atmospheres, complex magnetospheric configurations, geologically-rich icy satellites (both natural and captured), and delicate planetary rings. This article introduces a special issue on ice giant system exploration at the start of the 2020s. We review the scientific potential and existing mission design concepts for an ambitious international partnership for exploring Uranus and/or Neptune in the coming decades. This article is part of a discussion meeting issue 'Future exploration of ice giant systems'.

16.
Philos Trans A Math Phys Eng Sci ; 378(2179): 20190517, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-32762432

RESUMO

John Couch Adams predicted the location of Neptune in the sky, calculated the expectation of the change in the mean motion of the Moon due to the Earth's pull, and determined the origin and the orbit of the Leonids meteor shower which had puzzled astronomers for almost a thousand years. With his achievements Adams can be compared with his good friend George Stokes. Not only were they born in the same year but were also both senior wranglers, received the Smith's Prizes and Copley medals, lived, thought and researched at Pembroke College, and shared an appreciation of Newton. On the other hand, Adams' prediction of Neptune's location had absolutely no influence on its discovery in Berlin. His lunar theory did not offer a physical explanation for the Moon's motion. The origin of the Leonids was explained by others before him. Adams refused a knighthood and an appointment as Astronomer Royal. He was reluctant and slow to publish, but loved to derive the values of logarithms to 263 decimal places. The maths and calculations at which he so excelled mark one of the high points of celestial mechanics, but are rarely taught nowadays in undergraduate courses. The differences and similarities between Adams and Stokes could not be more striking. This volume attests to the lasting legacy of Stokes' scientific work. What is then Adams' legacy? In this contribution, I will outline Adams' life, instances when Stokes' and Adams' lives touched the most, his scientific achievements and a usually overlooked legacy: female higher education and support of a woman astronomer. This article is part of the theme issue 'Stokes at 200 (part 2)'.

17.
Philos Trans A Math Phys Eng Sci ; 378(2187): 20200222, 2020 Dec 25.
Artigo em Inglês | MEDLINE | ID: mdl-33161860

RESUMO

Robotic space exploration to the outer solar system is difficult and expensive and the space science community works inventively and collaboratively to maximize the scientific return of missions. A mission to either of our solar system Ice Giants, Uranus and Neptune, will provide numerous opportunities to address high-level science objectives relevant to multiple disciplines and deliberate cross-disciplinary mission planning should ideally be woven in from the start. In this review, we recount past successes as well as (NASA-focused) challenges in performing cross-disciplinary science from robotic space exploration missions and detail the opportunities for broad-reaching science objectives from potential future missions to the Ice Giants. This article is part of a discussion meeting issue 'Future exploration of ice giant systems'.

18.
Adv Exp Med Biol ; 875: 1205-11, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26611088

RESUMO

NEPTUNE Canada is a cabled ocean observatory system containing five nodes located in the northeast Pacific Ocean. Using passive acoustic data recorded at two nodes (Folger Passage Deep and Barkley Canyon Axis) between June 2010 and May 2011, we sought to quantify the levels of vessel traffic and the occurrence of biological sounds to determine the potential impact of anthropogenic sound in masking acoustic communication. The results from a comparison of the relative amplitude and occurrence of low-frequency biotic sounds to broadband sounds resulting from vessel traffic are presented. Additional contributions to the marine soundscape from self-generated instrument noise are discussed.


Assuntos
Acústica , Oceanos e Mares , Som , Canadá , Ilhas , Espectrografia do Som
19.
Space Sci Rev ; 220(4): 46, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38873000

RESUMO

A team of Earth-based astronomical observers supporting a giant planet entry-probe event substantially enhances the scientific return of the mission. An observers' team provides spatial and temporal context, additional spectral coverage and resolution, viewing geometries that are not available from the probe or the main spacecraft, tracking, supporting data in case of a failure, calibration benchmarks, and additional opportunities for education and outreach. The capabilities of the support program can be extended by utilizing archived data. The existence of a standing group of observers facilitates the path towards acquiring Director's Discretionary Time at major telescopes, if, for example, the probe's entry date moves. The benefits of a team convened for a probe release provides enhanced scientific return throughout the mission. Finally, the types of observations and the organization of the teams described in this paper could serve as a model for flight projects in general.

20.
Cureus ; 16(2): e55120, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38558634

RESUMO

Tianeptine is an atypical tricyclic antidepressant approved for the treatment of major depressive disorder in some European, Asian, and Latin countries. Along with its serotonergic properties, tianeptine also acts as a full agonist at the mu-opioid receptor, creating sensations of euphoric highs and significant risks of addiction and withdrawal. For this reason, along with increased reports of adverse effects and fatalities, tianeptine has not been approved in the US. Despite this, tianeptine continues to be accessible through unregulated online stores and small retailers under street names such as Zaza, Tia, Tianna, 'gas-station dope', and a product not mentioned in the literature previously: Neptune's Fix Elixir. In this report, we discuss the case of a 34-year-old male who presented to the ED via EMS after being found unresponsive secondary to the ingestion of Neptune's Fix Elixir, whose main active ingredient is tianeptine.

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