Among the captivating world of venomous snakes, an outstanding group of cobras from the family Elapidae is characterized by a distinctive structure of proteroglyphous venom apparatus that allows the ejection of venom from the fangs and formation of aerosol particles. The venom of “spitting” cobras is innocuous when sprayed over the intact skin, but contact with the eye surface is followed by ophthalmia and a temporary blindness, that may remain permanent, unless immediate and adequate medical interventions are carried out. The aim of this work was to monitor and evaluate induced vasoactive effects as well as embryotoxic effects with the regard to the whole crude venom of four “spitting” cobra species (African species Naja ashei and Naja nigricollis, Asian species Naja siamensis and Naja sumatrana). Vasoactive effects were visualized using the Hen’s Egg Test – Chorioallantoic membrane (HET-CAM) test. The Chick Embryotoxicity Screening Test (CHEST) was used to estimate embryotoxicity and the data were then processed using statistical analysis. The highest embryonic mortality rate was observed after administration of venom from Naja nigricollis among the whole crude venoms tested. All tested venoms induced fast spreading of pathological alterations in the blood vessels on the chorioallantoic membrane. Our study discloses a detailed insight into microscopic level processes in venom-induced changes observed on the chicken embryos and on the vascular network in their chorioallantoic membrane. This article also highlights the increasing importance of the role of the chicken embryos and the importance of observing changes in the chorioallantoic membrane applied for toxicological and medical research as an appropriate alternative animal model in relation to 3R’s principles.Gloydius tsushimaensis is an endemic species inhabiting only Tsushima, a remote Japanese island, and is a distinct species from Gloydius blomhoffii widely distributed throughout mainland Japan and Gloydius brevicaudus and Gloydius ussuriensis which are geographically distributed in South Korea. This is the first multicenter retrospective study of G. tsushimaensis bites in Japan. A study of seventy-two patients who visited the former Izuhara Hospital, the former Naka Tsushima Hospital, Tsushima Hospital, and Kamitsushima Hospital during the fourteen years from January 1, 2005, to December 31, 2018, revealed the typical clinical characteristics of G. tsushimaensis bites. Five out of seventy-two cases (6.9%) showed severe hypofibrinogenemia, in which fibrinogen levels were below 100 mg/dl, which is an unreported clinical finding for G. blomhoffii bites. Generally, when fibrinogen levels are lower than 100 mg/dl, the bleeding risk increases, and it is perilous. Severe hypofibrinogenemia cases did not improve after G. blomhoffii antivenom administration. Additionally, all five cases had disseminated intravascular coagulation, and there were two cases of acute kidney injury and one death. #link# five cases had a median maximum creatine kinase level of 5171 IU/l (Interquartile range 4992-41,310). Although the mechanism is not precise, coagulation tests showed that the G. tsushimaensis venom contains a thrombin-like enzyme. Based on this research, we created an algorithm for the treatment of G. tsushimaensis bites and unified the treatment methods used on the island.

Calciphylaxis is a rare thrombotic vasculopathy characterized by high morbidity and mortality. There is a paucity of studies examining longitudinal outcomes.

To assess mortality, days spent in the hospital, and amputations in patients with calciphylaxis.

A retrospective medical record review was conducted in 145 patients diagnosed with calciphylaxis at an urban tertiary care hospital from 1/2006-12/2018.

Six-month mortality was 37.2% and one-year mortality was 44.1%. Patients with nephrogenic calciphylaxis had worse survival than those with non-nephrogenic calciphylaxis (p=0.007). This difference in survival disappeared when limiting mortality to deaths due to calciphylaxis. Age (p=0.003) and ESRD (p=0.01) were risk factors associated with one-year mortality. Diabetes mellitus was associated with greater total hospitalization days (coefficient 1.1, 95% CI 1.01 – 1.4); bedside debridement was associated with fewer hospitalization days (coefficient 0.8, 95% CI 0.7 – 0.9). EI1 concentration were not associated with any of the examined risk factors. Use of warfarin and transitioning to non-warfarin anticoagulation was associated with decreased hazard of death (p=0.01).

Retrospective nature.

Calciphylaxis remains a complex, heterogeneous disease. Mortality is lower in patients with non-nephrogenic disease. These findings may be incorporated during goals of care discussion to facilitate informed shared decision-making.

Calciphylaxis remains a complex, heterogeneous disease. Mortality is lower in patients with non-nephrogenic disease. These findings may be incorporated during goals of care discussion to facilitate informed shared decision-making.Insufficient sleep during childhood can lead to physical and mental health issues. In adults, sleep disturbances have been associated with altered levels of stress hormones and inflammatory cytokines, but data in youth is lacking. The aim of this study was to explore relationships between objective measures of sleep and salivary biomarkers in children and adolescents. Participants (N = 55, aged 8-16 years, 53% female) wore an actigraph sleep monitor in their home for seven nights and completed sleep diaries and the School Sleep Habits Survey (SSHS). Participants also donated first waking saliva samples, which were later assayed for α-amylase (sAA), cortisol, interleukin (IL)-6, and IL-1β. While sAA was not associated with objective sleep it did show a positive association with self-reported sleep disturbance. Morning cortisol levels were associated with objective sleep variables, including minutes spent awake the night before sampling, and sleep efficiency and awakenings the night after sampling. Morning IL-6 was associated with prior night sleep efficiency and minutes spent awake the night after saliva sampling. Likewise, IL-1β levels were associated with sleep duration and sleep onset latency during the nighttime sleep period prior to and after saliva sampling. These results align with other data to indicate objective elements of sleep are related to salivary cortisol, IL-6, and IL-1β in youth. Thus, quality of sleep on the night prior to sampling should be considered when investigating levels of salivary mediators in children.