Perioral Paresthesia, Generalize Muscle Cramps, and Rhabdomyolysis After a Socotra Island Blue Baboon Tarantula (Monocentropus Balfouri) Bite.

BACKGROUND: Literature on systemic envenomation caused by tarantula bites, particularly from the Theraphosidae family, is relatively scarce. This case report provides a formal description of the first known instance of systemic envenomation caused by the Socotra Island Blue Baboon Tarantula (Monocentropus balfouri). CASE REPORT: In this case, a 23-year-old employee of an exotic pet shop suffered from perioral paresthesia, generalized muscle cramps, and rhabdomyolysis because of a Monocentropus balfouri bite. His symptoms were successfully relieved with oral benzodiazepines. EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case highlights the potential for serious complications resulting from the bite of Monocentropus balfouri, a species gaining popularity among global exotic pet collectors.

Cholinergic Mushroom Poisoning With a Detection of Muscarine Toxin in Urine.

We report an uncommon case of cholinergic poisoning following an ingestion of wild mushrooms. Two middle-aged patients presented to the emergency unit with acute gastrointestinal symptoms including epigastric pain, vomiting and diarrhea, followed by miosis, palpitations and diaphoresis which were compatible with a cholinergic toxidrome. The patients volunteered a history of taking two tablespoons of cooked wild mushrooms collected in a country park. Mildly elevated liver transaminase was noted in one female patient. Mushroom specimens were sent to a mycologist for identification using morphological analysis. Muscarine, a cholinergic toxin found in mushrooms such as Inocybe and Clitocybe species, was subsequently extracted from and identified in the urine specimens of both patients, using a liquid-chromatography tandem mass spectrometry method. In this report, the variable clinical presentation of cholinergic mushroom poisoning is discussed. Key issues in the management of these cases were presented. In addition to conventional mushroom identification methods, this report also highlights the use of toxicology tests on different biological and non-biological specimens for diagnosis, prognosis and surveillance purposes.

Meaning in Life, Social Axioms, and Emotional Outcomes during the First Outbreak of COVID-19 in Hong Kong.

Social unrest, coupled with the outbreak of COVID-19, was a double-hit for Hong Kong in early 2020. Those stressful societal situations not only trigger negative emotions, such as anxiety and/or depression, but also consolidate a person's belief towards oneself (i.e., meaning in life) and society (i.e., social axioms). The study included 2031 participants from the Formation and Transformation of Beliefs in Chinese (FTBC) project dataset. The data were collected in Hong Kong from February 2020 to March 2020 (double-hit). Path analysis and multiple regression were used to examine the mediating and moderating effects of the presence subscale (P) of the Meaning in Life Questionnaire (MLQ) on the relations between social axioms and negative emotions. Results showed that low MLQ-P mediated the associations between cynicism and negative emotions and between low religiosity and negative emotions and moderated the relation between social cynicism and emotional outcomes. Exploratory analyses showed that MLQ-Search (S) mediated the relations between reward for application and negative emotions, between social complexity and negative emotions, and between fate control and negative emotions, and moderated the relation between religiosity and stress. As far as we know, this study reported the first evidence of the role of meaning in life in explaining and modifying the associations between social axioms and mood states. The presence of and search for meaning in life seem to work differently with respect to the relations between social axioms and negative emotions, with important implications for understanding the dynamics of social and personal beliefs in affecting mental health in times of large-scale public crisis.

Derivation and internal validation of a clinical prediction score to predict major effect or death in acute metamfetamine toxicity.

OBJECTIVE: Metamfetamine use can cause serious complications or death. We aimed to derive and internally validate a clinical prediction score to predict major effect or death in acute metamfetamine toxicity. METHODS: We performed secondary analysis of 1,225 consecutive cases reported from all local public emergency departments to the Hong Kong Poison Information Centre between 1 January 2010 and 31 December 2019. We split the entire dataset chronologically into derivation (first 70% of cases) and validation (the remaining 30% of cases) cohorts. Univariate analysis was conducted, followed by multivariable logistic regression in the derivation cohort to identify independent predictors of major effect or death. We developed a clinical prediction score based on the regression coefficients of the independent predictors in the regression model and compared its discriminatory performance with five existing early warning scores in the validation cohort. RESULTS: The MASCOT (Male, Age, Shock, Consciousness, Oxygen, Tachycardia) score was derived based on the six independent predictors: male gender (1 point), age (≥35 years, 1 point), shock (mean arterial pressure <65 mmHg, 3 points), consciousness (Glasgow Coma Scale <13, 2 points), need for supplemental oxygen (1 point), and tachycardia (pulse rate >120 beats/min, 1 point). The score ranges from 0-9, with a higher score indicating higher risk. The area under the receiver operating characteristic curve of the MASCOT score was 0.87 (95% CI 0.81-0.93) in the derivation cohort and 0.91 (95% CI 0.81-1.00) in the validation cohort, with a discriminatory performance comparable with existing scores. CONCLUSIONS: The MASCOT score enables quick risk stratification in acute metamfetamine toxicity. Further external validation is warranted before wider adoption.

Factors associated with seizure in tramadol overdose: a 12-year retrospective study in Hong Kong.

BACKGROUND: Early identification of patients at risk of seizure after acute tramadol overdose is crucial. Yet, current evidence has been inconclusive regarding the factors associated with the seizure. There is a lack of study on the Chinese population and the value of electrocardiogram (ECG) in risk prognostication has not been fully evaluated. OBJECTIVES: We aimed 1) to characterise the clinical presentations of isolated tramadol overdose in Hong Kong; 2) to study the frequency of seizure in such overdose and the factors associated with it using multivariable analysis; and 3) to explore the association between individual ECG parameters and seizure. METHODS: This was a retrospective observational study on consecutive patients reported to the Hong Kong Poison Information Centre for tramadol overdose from 1 January 2008 to 30 November 2020. Duplicate cases or patients with an overdose of other co-ingestants were excluded. Univariate and multivariable logistic regression was performed to identify factors significantly associated with seizures in general and seizures that occurred after emergency department (ED) arrival. RESULTS: We identified 93 patients, including 54 women and 39 men, with a median age of 38 years during the study period. The majority was Chinese (90%) and only five patients had a history of seizure. The seizure occurred in 23 patients. Multivariable analysis showed that sinus tachycardia > 100 beats/min was significantly associated with a higher seizure risk (OR 27.95, 95% CI 2.22-351.84, p = 0.010) and age per 10 years increase was associated with a lower risk (OR 0.61; 95% CI 0.39-0.96, p = 0.033). No reliable predictors of seizure after ED arrival were identified. Many patients had ECG features consistent with sodium channel blockade but none of them was predictive of seizure. CONCLUSIONS: A younger age and sinus tachycardia > 100 beats/min were associated with a higher seizure risk after tramadol overdose but no reliable predictors of seizure after ED arrival were identified. Individual ECG parameters were not predictive of seizure.

Awareness of meaning and quest for meaning: The mechanisms between future orientation and prosociality among youth during pandemic.

Introduction: The positive relationship between future orientation and prosocial tendency has been consistently reported. However, the possible mechanism has not been examined yet. Previous research revealed the positive relationship between future orientation and meaning in life, as well as between meaning in life and prosocial tendency. Hence, it is hypothesized that the two components of meaning in life (presence of meaning and search for meaning) possibly mediate the relationship between future orientation and prosocial tendency. Methods: During the first half of 2020, 430 Hong Kong youths aged 15-35 (male: 30.5%; female: 69.5%) were recruited to participate an online cross-sectional survey. The survey included three scales: (1) The Scale for Measuring Adult's Prosocialness, (2) Consideration of Future Consequence Scale, and (3) Meaning in Life Questionnaire. Results: The key findings showed that: (1) females had higher level of prosocial tendency than males, and (2) significant partial mediating effects of both presence of meaning and search for meaning on the relationship between future orientation and prosocial tendency. Nevertheless, the multi-group mediation model did not show significant gender difference. Discussion: These findings implied that future-oriented and meaning-focused interventions could possibly enhance youth's sense of meaning in everyday life and foster their meaning searching tendency, which further strengthen the positive effect of their future orientation on prosocial tendency, even during life adversities.

Cultural Differences in the Hedonic Rewards of Recalling Kindness: Priming Cultural Identity with Language.

Recent theory suggests that members of interdependent (collectivist) cultures prioritize in-group happiness, whereas members of independent (individualist) cultures prioritize personal happiness (Uchida et al. Journal of Happiness Studies, 5(3), 223-239 Uchida et al., 2004). Thus, the well-being of friends and family may contribute more to the emotional experience of individuals with collectivist rather than individualist identities. We tested this hypothesis by asking participants to recall a kind act they had done to benefit either close others (e.g., family members) or distant others (e.g., strangers). Study 1 primed collectivist and individualist cultural identities by asking bicultural undergraduates (N = 357) from Hong Kong to recall kindnesses towards close versus distant others in both English and Chinese, while Study 2 compared university students in the USA (n = 106) and Hong Kong (n = 93). In Study 1, after being primed with the Chinese language (but not after being primed with English), participants reported significantly improved affect valence after recalling kind acts towards friends and family than after recalling kind acts towards strangers. Extending this result, in Study 2, respondents from Hong Kong (but not the USA) who recalled kind acts towards friends and family showed higher positive affect than those who recalled kind acts towards strangers. These findings suggest that people with collectivist cultural identities may have relatively more positive and less negative emotional experiences when they focus on prosocial interactions with close rather than weak ties. Supplementary Information: The online version contains supplementary material available at 10.1007/s42761-020-00029-3.

Astrocytic Regulation of Synchronous Bursting in Cortical Cultures: From Local to Global.

Synchronous bursting (SB) is ubiquitous in neuronal networks and independent of network structure. Although it is known to be driven by glutamatergic neurotransmissions, its underlying mechanism remains unclear. Recent studies show that local glutamate recycle by astrocytes affects nearby neuronal activities, which indicate that the local dynamics might also be the origin of SBs in networks. We investigated the effects of local glutamate dynamics on SBs in both cultures developed on multielectrode array (MEA) systems and a tripartite synapse simulation. Local glutamate uptake by astrocytes was altered by pharmacological targeting of GLT-1 glutamate transporters, whereas neuronal firing activities and synaptic glutamate level was simultaneously monitored with MEA and astrocyte-specific glutamate sensors (intensity-based glutamate-sensing fluorescent reporter), respectively. Global SB properties were significantly altered on targeting GLT-1. Detailed simulation of a network with astrocytic glutamate uptake and recycle mechanisms, conforming with the experimental observations, shows that astrocytes function as a slow negative feedback to neuronal activities in the network. SB in the network can be realized as an alternation between positive and negative feedback in the neurons and astrocytes, respectively. An understanding of glutamate trafficking dynamics is of general application to explain how astrocyte malfunction can result in pathological seizure-like phenomena in neuronal systems.

Establishment and characterization of new tumor xenografts and cancer cell lines from EBV-positive nasopharyngeal carcinoma.

The lack of representative nasopharyngeal carcinoma (NPC) models has seriously hampered research on EBV carcinogenesis and preclinical studies in NPC. Here we report the successful growth of five NPC patient-derived xenografts (PDXs) from fifty-eight attempts of transplantation of NPC specimens into NOD/SCID mice. The take rates for primary and recurrent NPC are 4.9% and 17.6%, respectively. Successful establishment of a new EBV-positive NPC cell line, NPC43, is achieved directly from patient NPC tissues by including Rho-associated coiled-coil containing kinases inhibitor (Y-27632) in culture medium. Spontaneous lytic reactivation of EBV can be observed in NPC43 upon withdrawal of Y-27632. Whole-exome sequencing (WES) reveals a close similarity in mutational profiles of these NPC PDXs with their corresponding patient NPC. Whole-genome sequencing (WGS) further delineates the genomic landscape and sequences of EBV genomes in these newly established NPC models, which supports their potential use in future studies of NPC.

Will Victims Become Aggressors or Vice Versa? A Cross-Lagged Analysis of School Aggression.

Peer aggression and victimization are ubiquitous phenomena in schools which warrant the attention of educators and researchers. The high connection between aggression and victimization behooves researchers to look into how the comorbidity of them develops over time. The present study investigated the associations between aggression and victimization over 3 years in early adolescence and whether these associations are moderated by gender and teacher support. Participants were 567 Grade 7, 8 and 9 students (49.38% girls) from 3 schools in Hong Kong. Over the course of study, they were asked to fill in a set of questionnaires that consisted of items related to peer aggression, victimization, and teacher support at 5 time points. Four models of cross-lagged relations between peer aggression and victimization were tested. The results supported a reciprocal model of peer aggression and victimization for both boys and girls although girls engaged in less peer aggression and victimization than boys. Further analyses also revealed that teacher support acted as a suppressor of the reciprocal relations. The present study sheds lights on intervention strategies that may remediate peer aggression and victimization in schools.

Predictors for compliance of standard precautions among nursing students.

BACKGROUND: We aimed to investigate the frequency of standard precautions (SPs) compliance and the factors affecting the compliance among nursing students (NSs). METHODS: A cross-sectional survey study guided by the health belief model was conducted in 2009. The study questionnaire is valid (content validity index, 0.81) and reliable (Cronbach α range, 0.65-0.94). RESULTS: There were 678 questionnaires analyzed, with a response rate of 68.9%. The mean frequency score of SPs compliance was 4.38 ± 0.40 out of 5. Tukey honest significant difference post hoc test indicated that year 2 and year 4 students had better SPs compliance than year 3 students. Further analysis using a univariate general linear model identified an interaction effect of perceived influence of nursing staff and year of study (F1,593 = 3.72; P < .05). The 5 following predictors for SPs compliance were identified: knowledge of SPs, perceived barriers, adequacy of training, management support, and influence of nursing staff. CONCLUSION: Although the SPs compliance among NSs was high, the compliance varied by year of study and was affected by the nursing staff. Furthermore, SPs compliance among NSs can be enhanced by increasing SPs knowledge, providing more SPs training, promoting management support, reducing identified SPs barriers, and improving nursing staff compliance to SPs.

A latent class growth analysis of school bullying and its social context: the self-determination theory perspective.

The contribution of social context to school bullying was examined from the self-determination theory perspective in this longitudinal study of 536 adolescents from 3 secondary schools in Hong Kong. Latent class growth analysis of the student-reported data at 5 time points from grade 7 to grade 9 identified 4 groups of students: bullies (9.8%), victims (3.0%), bully-victims (9.4%), and typical students (77.8%). There was a significant association between academic tracking and group membership. Students from the school with the lowest academic performance had a greater chance of being victims and bully-victims. Longitudinal data showed that all 4 groups tended to report less victimization over the years. The victims and the typical students also had a tendency to report less bullying over the years, but this tendency was reversed for bullies and bully-victims. Perceived support from teachers for relatedness significantly predicted membership of the groups of bullies and victims. Students with higher perceived support for relatedness from their teachers had a significantly lower likelihood of being bullies or victims. The findings have implications for the theory and practice of preventive interventions in school bullying.

Development and validation of a Clostridium difficile risk assessment tool.

The incidence of Clostridium difficile infection has increased rapidly during the past decade, increasing lengths of stays in the hospital, costs, and mortality rates. To address this increased incidence, we performed a retrospective case-control study using known risk factors to develop a tool to determine which patients are at risk for infection. Multivariate analysis generated a combination of risk factors associated with development of infection including prior admission, endoscopy within 30 days, cephalosporin/fluoroquinolone use, length of stay 7 days or longer, age 65 years or older, body mass index less than 25, and albumin level less than 2.7 g/dL. A weighted scoring tool was created that predicted disease with a sensitivity of 86% and a specificity of 44% in the derivation sample, and 92% sensitivity and a specificity of 39% when applied to the validation sample. Application of this 8-item tool by nurses in multiple settings could aid in the determination of patients who are at risk, allowing prophylactic treatment, prompt isolation of patients, restricted antibiotic use, and decreased testing of low-risk patients.

Intrinsic fluctuations of cell migration under different cellular densities.

The motility of the Dictyostelium discoideum (DD) cell is studied by video microscopy when the cells are plated on top of an agar plate at different densities, n. It is found that the fluctuating kinetics of the cells can be divided into two normal directions: the cell's forward-moving direction and its normal direction. Along the forward-moving direction, the slope of the amplitude of fluctuation vs. velocity (R||(v)) increases with n, while along the normal direction the slope of R⊥ is independent of n. Both R|| and R⊥ are functions of the cell speed v. The observed linearity in R⊥(v) indicated that the amplitude of orientational fluctuation (κ) of DD cells is a constant independent of v. The independence of the slope of R⊥(v) on n indicated that κ is also not affected by cellular interactions. The independence of κ on both v and n suggests that orientational fluctuation originates from the intrinsic property of motion fluctuations in DD.

Academic achievement trajectories of homeless and highly mobile students: resilience in the context of chronic and acute risk.

Analyses examined academic achievement data across third through eighth grades (N = 26,474), comparing students identified as homeless or highly mobile (HHM) with other students in the federal free meal program (FM), reduced price meals (RM), or neither (General). Achievement was lower as a function of rising risk status (General > RM > FM > HHM). Achievement gaps appeared stable or widened between HHM students and lower risk groups. Math and reading achievement were lower, and growth in math was slower in years of HHM identification, suggesting acute consequences of residential instability. Nonetheless, 45% of HHM students scored within or above the average range, suggesting academic resilience. Results underscore the need for research on risk and resilience processes among HHM students to address achievement disparities.

Prediction of prognosis in acute paraquat poisoning using severity scoring system in emergency department.

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), modified Simplified Acute Physiology Score II (MSAPS II), and modified Expanded Simplified 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-fit test C statistic revealed that APACHE II, MSAPS II, MSAPS IIe and serum paraquat level showed good calibrations (chi-square 8.477 and p = 0.388, chi-square 4.614 and p = 0.798, chi-squared 5.301 and p = 0.725, chi-squared 1.009 and p = 0.985 respectively), but poor calibration for SIPP (chi-square 21.293 and p = 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.

Dextrose 50% as a better substitute for saturated salt solution in mothball float test.

We describe the use of dextrose 50% solution to differentiate naphthalene and paradichlorobenzene in the mothball float test. Its advantages over saturated salt solution are discussed.

Academic achievement of homeless and highly mobile children in an urban school district: longitudinal evidence on risk, growth, and resilience.

Longitudinal growth trajectories of reading and math achievement were studied in four primary school grade cohorts (GCs) of a large urban district to examine academic risk and resilience in homeless and highly mobile (H/HM) students. Initial achievement was assessed when student cohorts were in the second, third, fourth, and fifth grades, and again 12 and 18 months later. Achievement trajectories of H/HM students were compared to low-income but nonmobile students and all other tested students in the district, controlling for four well-established covariates of achievement: sex, ethnicity, attendance, and English language skills. Both disadvantaged groups showed markedly lower initial achievement than their more advantaged peers, and H/HM students manifested the greatest risk, consistent with an expected risk gradient. Moreover, in some GCs, both disadvantaged groups showed slower growth than their relatively advantaged peers. Closer examination of H/HM student trajectories in relation to national test norms revealed striking variability, including cases of academic resilience as well as problems. H/HM students may represent a major component of "achievement gaps" in urban districts, but these students also constitute a heterogeneous group of children likely to have markedly diverse educational needs. Efforts to close gaps or enhance achievement in H/HM children require more differentiated knowledge of vulnerability and protective processes that may shape individual development and achievement.