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Diquat poisoning, maybe another cause of osmotic demyelination syndrome: case report and literature review.

Diquat (1,1'-ethylene-2,2'-bipyridine), a non-selective herbicide with significant human toxicity, is increasingly used as a substitute for paraquat in weed management practices in China. Diquat intoxication is typified by multiple organ dysfunction syndrome (MODS), predominantly manifesting as acute renal and hepatic injury, and frequently resulting in central nervous system (CNS) impairment with a poor prognosis in severe instances. Despite the rising incidence of diquat poisoning, the imaging characteristics of diquat-induced toxic encephalopathy remain inadequately documented in the literature. In this report, we present a distinctive case involving a female pediatric patient who exhibited MODS affecting the neurologic, renal, hepatic, cardiac, and gastrointestinal systems, in conjunction with rhabdomyolysis. Magnetic resonance imaging (MRI) revealed multiple abnormal signals in the pons, bilateral brachium pontis, thalamus, caudate nucleus, putamen, posterior part of the external capsule, and posterior limb of the right internal capsule. These findings are consistent with the imaging characteristics of osmotic demyelination syndrome (ODS), which is under-recognized but important. After comprehensive systemic treatment, the patient was discharged on the 30th day post-admission.

https://pubmed.ncbi.nlm.nih.gov/40630495/

Epidemiological and clinical characteristics of severe poisonous mushroom poisoning in children in Yunnan Province: A retrospective analysis of 23 cases from 2020 to 2022.

Poisonous mushroom poisoning is a common and highly fatal foodborne disease in southwest China. Children are at higher risk of severe illness and death due to limited hepatic reserve. However, studies on the poisonous mushroom poisoning in children are still limited. To analyze the epidemiological characteristics, clinical features, laboratory findings, treatment modalities, and prognostic factors of severe poisonous mushroom poisoning in children in Yunnan Province from 2020 to 2022. This was a retrospective study that included 23 hospitalized pediatric cases diagnosed with poisonous mushroom poisoning in Yunnan Province from 2020 to 2022. The Mann-Whitney U test was used to analyze the difference between alanine aminotransferase (ALT) and prothrombin time (PT) levels between the death and survival groups, and Spearman correlation analysis was used to assess their correlation with prognosis; the Fisher exact test and Fisher-Freeman-Halton test were used to compare the prognostic effects of blood purification treatment with different purification modalities. Poisoning cases clustered in summer-autumn, with Amanita species predominance. Acute liver injury type was the most common. ALT and PT levels were significantly higher in the death group (P = .013 and P = .025) and positively correlated with mortality (ALT: R = 0.538, P = .008; PT: R = 0.485, P = .019). Blood purification therapy significantly improved survival (64.7% vs 16.7%, P = .026), with no significant difference among modalities (P = .162). Elevated ALT and prolonged PT are key prognostic indicators of mortality in pediatric mushroom poisoning. Blood purification therapy improves survival. Dynamic monitoring of ALT and PT may aid early risk stratification and optimization of treatment strategies.

https://pubmed.ncbi.nlm.nih.gov/40629598/

A single acute alcohol intoxication before fracture insult causes long-term elevated systemic RANKL and OPG levels in young adult mice.

Binge drinking is the most common form of alcohol abuse and 25-40% of orthopedic trauma patients are intoxicated upon admission. While alcohol consumption prolongs the healing time of bone fractures, the underlying mechanisms by which alcohol leads to this fracture healing disorder remain unclear. 240 young adult and aged male C57BL/6J mice were examined. Half of the animals were acutely alcoholized two hours before surgery. The isolated fracture (Fx) group underwent an externally stabilized osteotomy and another group (THFx) an additional trauma hemorrhage (TH). The Sham group only received catheterization and fixation. Histological, radiological, biomechanical and systemic examinations were performed. Data were analyzed using two-way ANOVA and p ≤ 0.05 was considered significant. After 3 weeks, acute alcoholization led to increased receptor activator of NF-κB ligand (RANKL), osteoprotegerin (OPG) and RANKL/OPG ratio after fracture in young adult mice. In aged animals, this effect of alcohol was not present as values were already increased in the sober ones. More osteoblasts and macrophages were found in alcoholized young Fx animals. In conclusion, one-time binge drinking before trauma causes a long-term change in the RANKL/OPG ratio towards more RANKL in young adult mice.

https://pubmed.ncbi.nlm.nih.gov/40628859/

Carbon monoxide poisoning triggers intestinal injury, inflammation, and microbiota dysbiosis that drive metabolic perturbations.

To determine whether carbon monoxide poisoning (COP) increases the long-term risk of intestinal diseases and to elucidate the underlying mechanisms through translational investigation using both population data and animal experiments. An epidemiological study using the Taiwan National Health Insurance Research Database identified 11,025 COP patients and matched controls to assess long-term intestinal disease risk. A rat COP model was used to evaluate intestinal injury, permeability, and tight junction integrity. Systemic inflammation and immune cell populations were assessed. Gastrointestinal and stress/metabolic hormones and metabolic markers were measured. Gut microbiota was analyzed by 16S rRNA sequencing, with functional prediction using Tax4Fun and KEGG. COP increased long-term intestinal disease risk in humans. Rats showed duodenal and jejunal injury with elevated permeability and barrier disruption. Systemic inflammation (increased CX3CL1, CXCL7, IL1-α/β, CXCL5, CCL20, TIMP-1, CD54) and immune activation (increased CD86+ macrophages, neutrophils, CD4+ T cells) were observed. Hormones (decreased cholecystokinin and insulin; increased glucagon-like peptide-1, ghrelin, glucose-dependent insulinotropic polypeptide, cortisol) and metabolism were altered (increased glucose and lipids). Microbiota alterations, including increased Mycoplasma, Streptococcus, and Desulfovibrio, were associated not only with proinflammatory cytokine responses but also with metabolic dysregulation, including lipid imbalance and pathways linked to type II diabetes mellitus. This study provides the first integrated clinical and experimental evidence linking COP to intestinal and metabolic dysfunction. A pathogenic axis involving gut barrier disruption, microbiota dysbiosis, and metabolic-immune imbalance may underlie COP-related chronic diseases. These findings suggest targets for early monitoring and intervention.

https://pubmed.ncbi.nlm.nih.gov/40628312/

High ciguatoxin-producing Gambierdiscus clade (Gonyaulacales, Dinophyceae) as a source of toxins causing ciguatera poisoning.

Ciguatera Poisoning (CP) is caused by neurotoxins (Ciguatoxins, CTXs) produced by microbial eukaryotes (Gambierdiscus, Fukuyoa: Dinophyceae) that accumulate in seafood and can result in severe human illness. More than 80 % of the world's CP occurs in the South Pacific, and climate change is projected to increase cases. However, our understanding of CP is hindered because Gambierdiscus spp. directly associated with CP remain uncertain. Most Gambierdiscus/Fukuyoa spp. demonstrate little CTX-like activity, which appears to be unlikely to cause CP at scale. We characterised Gambierdiscus from the Great Barrier Reef (Australia), a region with endemic CP, including G. bagnisii sp. nov., using light and scanning electron microscopy, morphometric analysis, and phylogenomics. Using LC-MS/MS, G. holmesii produced M-seco-CTX4A/B, the second taxon after G. polynesiensis with chemically detectable CTXs in the Pacific region. G. bagnisii sp. nov. and G. holmesii produced an uncharacterised compound found previously only in G. polynesiensis, however its bioactivity and relationship, if any, to CP is unknown. A close relationship between G. bagnisii sp. nov., G. holmesii, and G. polynesiensis (as Clade III) was found, and taxa were distributed from the far north to southern Great Barrier Reef and throughout the South Pacific. Our analyses indicate that CTXs produced by Gambierdiscus from Clade III, such as G. polynesiensis, are important in relation to CP and might be responsible for the majority of CP in the South Pacific.

https://pubmed.ncbi.nlm.nih.gov/40628156/

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