INTRODUCTION:Chlorosilane is widely used in modern industry. The health effect in humans after chlorosilane exposure is still unclear. CASE SUMMARY:A 57-year-old male developed severe lung damage after accidental inhalation of chlorosilane. He received mechanical ventilation and experienced refractory CO2 retention with difficulty weaning. Bronchoscopy showed diffuse endobronchial polyposis two months after exposure. IMAGES:Serial radiographs, bronchoscopy images demonstrated the course of severe respiratory injury and an uncommon sequalae of diffuse inflammatory endobronchial polyps. DISCUSSION:The pathogenesis of polyp formation may be associated with prolonged inflammation. Interventional bronchoscopy was used to remove the polyps. Corticosteroids may be considered, but there is the risk of superimposed infection. CONCLUSION:Chlorosilane inhalation could induce severe lung damage. Multiple endobronchial polyps may be a severe sequela contributing to difficulty weaning.

Introduction: Second-generation anticoagulant rodenticides often cause severe bleeding that can be life threatening and have limited effective treatment options. This study aimed to evaluate the therapeutic efficacy of hemoperfusion in patients with rodenticide poisoning. Methods: We retrospectively analyzed data of 148 patients diagnosed with rodenticide poisoning at the Fifth Medical Center of the Chinese PLA General Hospital (China) between 2014 and 2021. The patients were divided into hemoperfusion and non-hemoperfusion groups based on whether or not they had received blood purification treatment. We compared clinical characteristics, serum drug concentrations, durations of hospital stay, and durations of vitamin K1 (VK1) therapy between the two groups using univariate and multivariate analyses. Subgroup analyses were also conducted to assess the effect of hemoperfusion in patients poisoned with brodifacoum and bromadiolone. Results: Of 148 screened patients, 115 patients were included (hemoperfusion [n = 24] and non-hemoperfusion [n = 91]). The rate of blood toxin clearance per unit time may have been faster in the hemoperfusion group. Subgroup analyses revealed that hemoperfusion significantly reduced the duration of VK1 therapy in patients poisoned with brodifacoum (p = 0.044). Conclusion: Hemoperfusion effectively reduced serum rodenticide concentrations in patients with poisoning. Moreover, hemoperfusion can reduce the duration of VK1 therapy in patients poisoned by brodifacoum.

Fat emulsion is a drug commonly used clinically for parenteral nutrition support in critically ill patients.With the development of the pharmaceutical industry, fat emulsion has formed a variety of different formulations, among which different types of fat emulsion have their own metabolic and body energy supply characteristics, and the application indications are also different. In addition to providing the supply of nutrients, the role of fat emulsion in anti-toxicity, immune regulation, anti-inflammatory, anti-shock, cardiopulmonary resuscitation and other aspects has gradually been discovered. This article reviews the existing evidence-based medical evidence and expounds the mechanism and therapeutic role of fat emulsion in the treatment of critically ill patients with poisoning. Its value in the treatment of critically ill patients with poisoning was discussed, and some references were provided for the application of non-nutritional functions of fat emulsion in the future.

The main toxic component of tetramine is tetramethylenedisulfotetramine (TETS).It is a sulfonamide derivative without special antidote, tasteless and tasteless, with high toxicity and high mortality. [1]It was first discovered by a German scientist Hagen in 1949.Although its use has been banned worldwide due to its high toxicity and mortality rate, it is still available in certain countries and has led to cases of intentional and unintentional poisoning.Tetramine blocks γ-neurons, leading to dizziness, fatigue, nausea, vomiting, convulsions, and other symptoms. [2-4]Due to the lack of recognized effective antidotes, many poisoned people suff ocate and die as a result of continuous spasms of the respiratory muscles. [5-7]Tetramine poisoning sometimes occurs, but it is rare for vegetables grown in tetraminecontaminated soil to cause group poisoning after being eaten.

Long‐acting anticoagulant rodenticide (LAAR) poisoning remains a serious public health problem. The aim of this study was to explore the clinical characteristics of different LAARs and a method of making a decision on the VK1 treatment course and the time to stop VK1 treatment safely.

肉毒素（Botulinum Neurotoxins，BoNT）是由肉毒梭菌分泌的一类具有极强致死性的神经毒素，在国际上归为A类生物战剂 [1]。BoNT中毒所致的综合征有6种形式：4种自然发生，2种人为引起。即食源性BoNT中毒、外伤型中毒、婴儿BoNT中毒和成人肠道BoNT中毒都是由肠道定植和原位产生毒素引起的；医源性BoNT中毒是注射大剂量的BoNT所致，吸入性BoNT中毒可发生在生物恐怖袭击时 [2]。所有形式的BoNT中毒都会产生类似的综合征：对称性颅运动神经麻痹，随后出现下行、对称性运动无力，并可能发展为需要插管和呼吸支持的呼吸衰竭。由于临床医生对BoNT中毒的知识了解较少，加之毒物检测手段匮乏，误诊漏诊和延迟诊断的现象比较普遍。诊断不精准，治疗不及时，可导致患者死亡。作者时常关注并诊治了大量的BoNT中毒患者 [3,4,5]，结合既往的经验和教训，针对食源性BoNT中毒诊治中的难点和热点问题与同仁们探讨。

Colchicine is a neutral lipophilic tricyclic alkaloid toxic to human cells containing tubulin,[1-2] and primarily stops the proliferation of active cells in the mitotic metaphase, such as intestinal mucosal cells and hematopoietic cells. It is widely used in treating gout and familial Mediterranean fever, while it is also used in establishing animal and plant experimental model.[3] In the recent study, treatment of patients affected by coronavirus disease 2019 (COVID-19) with colchicine may prove a viable path.[4] The course of colchicine poisoning can be divided into three stages,[5] and most of the patients died in the second stage (2–7 d, the multiple organ injury stage). The cause of death was heart failure [6] and bone marrow hematopoietic failure in the terminal phase.[7] Hematopoiesis is a classic sign of colchicine poisoning. Many cases of colchicine poisoning have been comprehensively reported, and the target organs included heart, digestive tract, muscle, lung, kidney, hematopoietic system, etc.[8-11] This study aimed to investigate the injury of bone marrow hematopoietic system after colchicine poisoning and evaluate the therapeutic effect of bone marrow hematopoietic stimulation drugs.

Objective: To summarize the clinical characteristics and treatment effect of patients with acute oral 84 disinfectant poisoning, so as to improve the understanding, diagnosis and treatment of the disease. Methods: In January 2022, 25 hospitalized patients with acute oral 84 disinfectant poisoning admitted to our department from March 2016 to August 2021 were selected as the research objects, and their general conditions, poisoning reasons, poisoning time, dose of poisoning, clinical manifestations, blood routine and biochemical indicators, diagnosis, treatment and prognosis were selected. Results: A retrospective analysis was performed. Among the 25 patients, there were 4 males and 21 females, aged from 20 to 91 years, and M (Q(1), Q(3)) was 38.7 (27, 46) years; The poisoning time (from exposure to poison to treatment) was 1~72 h, and M (Q(1), Q(3)) was 10.5 (3, 11.5) h. The length of stay was 1~20 days, and M (Q(1), Q(3)) was 5.72 (2, 7) days.The dose was 40-500 ml, and the M (Q(1), Q(3)) was 219.6 (100, 330) ml. Chest CT showed exudative changes in both lungs in 4 patients, excessive decreased permeability in 1 case and pleural effusion in 1 case. Gastroscope showed 2 cases of erosive inflammation of gastric body and antrum, 1 case of esophageal ulcer and cardiac ulcer, 1 case of corrosive gastritis, gastric fundus ulcer and esophageal stenosis. Abdominal X-ray showed 1 case of abdominal intestinal dilatation and pneumatosis with multiple gas-liquid planes.There were 1 case of type I respiratory failure, 6 cases of gastrointestinal bleeding and 1 case of incomplete intestinal obstruction. There were 19 cases of nausea and vomiting, 9 cases of abdominal pain, 6 cases of pharyngeal pain and 6 cases of retrosternal burning pain, 1 case of cough and 2 cases of fatigue. Conclusion: Acute oral 84 disinfectant will cause varying degrees of damage to the human digestive tract and lungs. In severe cases, gastrointestinal bleeding, intestinal obstruction, hypoxemia, etc, and even life-threatening, should be paid attention to clinically. The treatment is mainly symptomatic support treatment, such as protecting gastrointestinal mucosa, controlling acute inflammatory reaction, protecting the functions of liver and kidney and other important organs.

BACKGROUND Misuse of disinfectants during the coronavirus disease 2019 pandemic has led to several poisoning incidents. However, there are few clinical case reports on poisoning caused by improper mixing of household disinfectants.AIM To summarize the clinical characteristics and treatment effects of chlorine poisoning caused by improper mixing of hypochlorite bleach with acidic cleaning agents.METHODS We retrospectively analyzed baseline and clinical data, clinical symptoms, and treatment methods of seven patients with chlorine poisoning who were admitted to the National Army Poisoning Treatment Center.RESULTS Among the seven patients, the average poisoning time（exposure to admission） was 57 h（4-240 h）. All patients were involved in cleaning bathrooms. Chest computed tomography scans revealed bilateral lung effusions or inflammatory changes in five patients. The partial pressure of oxygen decreased in six patients, and respiratory failure occurred in one. Five patients had different degrees of increase in white blood cell count. Humidified oxygen therapy, non-invasive mechanical ventilation, anti-inflammatory corticosteroids, antioxidants, and antibiotics were administered for treatment. The average length of hospital stay was 7 d（4-9 d）. All seven patients recovered and were discharged.CONCLUSION Improper mixing of household disinfectants may cause damage to the respiratory system due to chlorine poisoning. Corticosteroids may improve lung exudation in severe cases, and symptomatic supportive treatment should be performed early.

该研究基于暴露生物标记物溯源思路,应用于解决芥子气(SM)临床早期诊断、溯源确证难题.建立了芥子气中毒患者尿液中7 种游离代谢产物的两步固相萃取/超高效液相色谱-串联质谱(SPE/UPLC-MS/MS)同时定量方法,检出限为5 pg/mL～1 ng/mL,定量下限为10 pg/mL～5 ng/mL;结合前期建立的4 种游离碱基加合物的同位素稀释-UPLC-MS/MS 定量方法,对1 例疑似芥子气中毒人员尿液中可能赋存的生物标记物进行了全筛查分析.尿液中共检出3 类10 种生物标记物,包括首次报道的游离代谢产物芥子亚砜,可确证患者为芥子气中毒;除硫二甘醇外,标记物含量均在暴露后3～4 d 达到峰值,随后降低,至7d 仍可检出,其中谷胱甘肽加合物的β 裂解产物含量相对较高,可作为芥子气中毒早期诊断与疗效评估的重要指标.

BACKGROUND:Botulinum toxin is a neurotoxin generated during the growth of Clostridium botulinum and can lead to a rare but life-threatening disease with neurologic symptoms. Relatively little is known about the many types of botulinum toxins in China. The clinical symptoms of the different types of botulism toxin-induced illnesses appear after an incubation period and vary greatly by the serotype and degree of exposure to the toxin. CASE REPORT:We describe 4 patients who consumed vacuum-packaged salted fish and ham and then presented with severe gastrointestinal symptoms, resulting in vomiting and one death. Blood serum and urine samples tested by the botulinum neurotoxin Endopep-MS assay were positive for botulinum toxin types A, B, and E. The patient who consumed the largest amount of fish and ham died after 36 h, and the other patients were treated with botulism antitoxin after being diagnosed with a botulinum toxin-induced illness and recovered after 1 month. These cases illustrate the importance of early diagnosis and early treatment of botulism type E, in particular, because of the risk of respiratory failure and treatment delays, which can result in increased mortality and poorer overall outcomes. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Our cases illustrate the importance of early diagnosis and especially the treatment of illnesses related to botulism type E because of the risk of respiratory failure and because treatment delays can result in increased mortality and worsened overall outcomes.

Abstract Background There are no reports on the incidence of chronic mercury poisoning in a large population in China. This study investigated the epidemiology, clinical manifestations, treatment, and follow-up of Chinese patients with chronic mercury poisoning. Methods Data for 288 mercury poisoning patients were collected at our hospital from July 2014 to September 2019, including sex, age, admission time, blood mercury content, urine mercury content, creatinine, urinary mercury/creatinine ratio, 24-h urinary protein levels, electromyography (EMG) findings, renal biopsy, and follow-up. Patient characteristics were evaluated by statistical and correlation analyses. Results First, mercury poisoning in China mainly occurred through occupational exposure and the inappropriate use of mercury-containing cosmetics and Chinese folk remedies (CFRs). Second, the most common symptoms were nervous system (50.3 %), kidney (16.4 %) and breathing (8.0 %). Mercury poisoning-induced Nephrotic syndrome (NS) and peripheral neuropathy are common long-term complications. The complications of occupational and cosmetics-induced mercury poisoning are consistent with international belief. However, the NS caused by CFRs is mainly membranous nephropathy and the probability of peripheral neuropathy caused by CFRs is higher than other pathogens. Third, follow-up data shows that 13 patients with EMG-confirmed neurological injury, 10 showed full recovery after 38.50 ± 8.03 months. Furthermore, among 18 patients with NS, 15 had normal urine protein and serum albumin levels after 22.67 ± 10.26 months. Conclusions Regulation of skin-lightening cosmetic products, safety surveillance of CFRs, and prevention and control of occupational exposure must be improved to decrease the incidence of mercury poisoning in China.

蜡样芽胞杆菌(Bacillus cereus)是一种常见的食源性致病菌.从食物中毒病人的食物残渣中分离到1株产呕吐毒素的蜡样芽胞杆菌BC307,其对青霉素类抗生素具有较强的抗性.抗SigP因子RsiP是蜡样芽胞杆菌族(Bacillus cereus sensu lato)细菌青霉素耐药的重要调控因子.该实验利用原核系统表达RsiP蛋白并利用亲和层析法进行纯化,免疫小鼠后获得高效价多克隆抗体.结果表明,RsiP蛋白在炭疽芽胞杆菌、蜡样芽胞杆菌、苏云金芽胞杆菌中高度同源,在Western Blotting实验中RsiP抗血清与这3种菌的全菌蛋白均能发生特异性免疫反应.研究结果为探究RsiP对蜡样芽胞杆菌群细菌的青霉素耐药性调控打下了良好的基础.

[This corrects the article DOI: 10.1093/toxres/tfab074.].

目的 研究我国一氧化碳(CO)中毒死亡的变化趋势.方法 从2017年全球疾病负担研究中收集1990至2017年我国及全球CO中毒的详细信息,根据性别、年龄、社会人口指数(SDI)等计算CO中毒年龄标准化死亡率(ASMR)的估计年百分比变化(EAPC),以量化CO中毒ASMR的变化趋势,并将我国及全球趋势进行对比.结果 2017年全球CO中毒死亡人数较1990年有所下降,而我国死亡人数上升,从1990年的13779例增长至2017年的14255例,增长了3.45％;在此期间全球及我国的CO中毒ASMR均呈下降趋势,但我国ASMR下降趋势(EAPC=-0.46;95％CI-0.56～-0.36)明显低于全球水平(EAPC=-1.83;95％CI-2.10～-1.56);我国CO中毒ASMR的下降趋势在不同性别及年龄中是不同的,其中,男性呈下降趋势,女性呈上升趋势;最明显的下降为<5岁的人群,而≥50岁的人群呈明显的上升趋势.结论 CO中毒在我国仍是一个重要的公共卫生问题,尤其应针对老年人建立更有效的预防及治疗方案.

Acute mercury poisoning, involving a number of organs, leads to severe dysfunctions, such as acute renal failure (ARF), and even threatens patients' lives. A case of acute severe mercuric chloride (HgCl2) poisoning with multiple organ failure was reported in this study. A 38-year-old woman orally took about 50 g HgCl2 powder in 2015, and showed nausea, emesis, clouding of consciousness, lip and nail cyanosis, and dark red bloody fluid from bilateral nostrils. Based on chest and abdominal CT examinations, gastroscopy, and colonoscopy, the patient was found to suffer oral mucosal hyperemia and ulceration, gastrointestinal bleeding (haematemesis and hemafecia), ARF, metabolic acidosis, collapse and shock. Despite assisted respiration and relevant active treatments, the patient's condition deteriorated gradually and she was dead eventually. The study suggests that the best treatments for acute HgCl2 poisoning accompanied with ARF are early blood purification and mercury elimination on the basis of conventional therapy.

Objective:To analyze and summarize the basic characteristics and clinical features of botulism patients caused by cosmetic injection of botulinum toxin.Methods:Retrospective investigation and analysis method were used to analyze the data of botulism patients caused by cosmetic injection of botulinum toxin admitted to the Poisoning Treatment Center of the PLA from March 2016 to June 2019.Results:Total of 380 cases were included in this study, including 114 hospitalized cases and 266 emergency cases. The majority patients (97.4%) were female, and most of them (39.5%) were among 30-39 years old. Most of the cases occurred in beauty salons or beauty studios, and most of the botulinum toxin injected was fake and inferior products. Onset latency were mainly distributed in 3 to 6 days. Common clinical symptoms included dizziness, blurred vision, eyes open weakness, dysphagia, chest tightness of breath, fatigue, diplopia, nausea, bilateral eyelid drooping, and dysarthria. The "4D" sign of cranial nerve injury occurred less frequently, mainly with mild and moderate poisoning; The occurrence rates of dysarthria, dysphagia, eyes open weakness, blurred vision, choking in drinking water, chewing weakness, bilateral eyelid drooping, decreased limb muscle strength, and chest tightness of breath in the hospitalized case were significantly higher than those in the emergency cases (all P < 0.05). Three hundred and nine patients received botulinum antitoxin therapy. The dose of botulinum antitoxin was 20 000 (20 000-30 000) U, with a total treatment duration of 4 (3-7) days in the emergence cases, and 30 000 (30 000-50 000) U with a total treatment time of 8 (5-11) days in the hospitalized cases, and there were significant differences between the two groups ( P < 0.05). All cases were followed up with good prognosis. Conclusions:Cosmetic injection of botulinum toxin has certain risk. If symptoms of poisoning occur such as dizziness, blurred vision, eyes open weakness and dysphagia, patients should be treated promptly, and early treatment with botulinum antitoxin can improve the prognosis.

目的 分析急性铊中毒的临床特征及误诊原因、防范措施.方法 回顾性分析误诊为其他疾病的急性铊中毒30例的临床资料.结果 本组7例明确为他人投毒,23例中毒史不详;主要表现为双下肢或四肢疼痛、肢体麻木、腹痛、脱发等症状.本组误诊时间2 d～1年,平均65.3 d;误诊为Guillain-Barre综合征6例,急性胃肠炎4例,周围神经病、胰腺炎、阑尾炎各2例,急性炎症性脱髓鞘性多发性神经病、多发性周围神经炎、癔症、躯体形式障碍、胸膜炎、胃肠感冒、神经炎、痛风、腰椎间盘突出症、胆囊炎、结肠炎、胃炎、类风湿关节炎、急腹症各1例.所有患者入院后均完善血细胞分析、生化检查、凝血功能检测、毒物检测、头颅CT、头颅MRI、肌电图、心电图等医技检查,结合临床表现,确诊为急性铊中毒,给予补液促排、口服普鲁士蓝、营养神经、维持水电解质平衡、血液净化等对症支持治疗.29例病情好转或痊愈出院,1例死亡.出院后随访3～6个月,重症4例遗留神经系统损伤后遗症.结论 急性铊中毒起病隐匿,临床表现多样,对于高度怀疑铊中毒患者,尤其是相继出现消化系统症状、神经系统损伤、脱发等时,要尽快完善相关检查,争取早期明确诊断,以改善预后.

Background: Malignant hyperthermia (MH) is a pharmacogenetic disease triggered by anesthesia. In recent years, next generation sequencing(NGS) technology, targeted sequencing approaches have been used to identify regions related to MH and can not only detect known MH variant sites but also allow the exploration of novel MH-related variants. Methods : Twenty-four volunteer’s blood samples were collected, genomic DNA was then extracted, target regions were amplified, and through targeted sequencing of these target regions, both known and novel variants were identified, and analysis of these variants identified some that may damage protein function. Online prediction tools were also used to determine the possibility of variants that may cause MH. Results : We performed next-generation sequencing of 53 positions on 4 genes, in which 36 variants of the RYR1 gene were found. Three of these caused a change in the amino acid sequence. Additionally, 11 variants of the CACNA1S gene were found, of which 3 led to amino acid sequence changes. Five variants of the JSRP1 gene were found, and four variants caused the amino acid sequence to change. Conclusions : In healthy volunteers, variants in RYR1 and CACNA1S were more common, and variants in JSRP1 more commonly had amino acid sequence changes. Whether a variant is pathogenic can be predicted using a prediction website, but the sensitivity and specificity still need to be improved.