Search Results (94)

Background/Objectives: Carbon monoxide (CO) poisoning remains a major cause of poisoning-related morbidity, and delayed neuropsychiatric sequelae (DNS) are important long-term complications. This study evaluated the association between the COGAS score and operationally defined 6-month DNS after acute CO poisoning. Methods: Overall, 272 patients with acute CO poisoning were included in this single-center observational cohort study. The primary outcome was operationally defined as 6-month DNS based on changes in the Global Deterioration Scale (GDS). Logistic regression analyses were performed to evaluate the association between the COGAS score and operationally defined 6-month DNS. Conventional and Firth penalized logistic regression models were used. Results: Among 272 patients, 14 (5.1%) met the criteria for operationally defined 6-month DNS. Each 1-point increase in the COGAS score was associated with higher odds of operationally defined 6-month DNS in univariable analysis (odds ratio [OR], 2.16; 95% confidence interval [CI], 1.30–3.65; p = 0.003) and in the fully adjusted model including initial GDS, troponin I, and CO exposure duration (OR, 2.19; 95% CI, 1.14–4.35; p = 0.020). Conclusions: Higher COGAS scores were associated with operationally defined 6-month DNS after acute CO poisoning. The COGAS score may provide prognostic information, but further validation in larger cohorts is needed. Full article

Background and Objectives: The diagnostic accuracy of an artificial intelligence (AI)-derived initial 12-lead electrocardiogram (ECG) analysis was evaluated for early carbon monoxide-induced cardiomyopathy (CO-CMP) risk detection. Materials and Methods: Retrospective medical data of carbon monoxide poisoning (COP) cases between 1 January 2015 and 31 December 2024 were screened for the primary outcome: odds ratio (OR) for echocardiographically confirmed CO-CMP among those with high-risk probability score per the AI-derived model. Secondary outcomes included left ventricular ejection fraction (LVEF) and AI-derived probability score, critical care requirements, including intubation and intensive care unit (ICU) admission, and cardiac arrest events. Results: A total of 51 patients with acute COP were included in the final analysis, with 13 (25.5%) being diagnosed with CO-CMP. The LVEF in the CO-CMP group was lower than that in the non-CO-CMP group (40.00 ± 13.80% vs. 63.76 ± 6.24%, p < 0.001). The AI-derived probability score was higher in the CO-CMP group (11.3 [3.8–32.7] vs. 0.5 [0.2–2.2], p < 0.001). Among cardiac biomarkers, troponin I (2.37 [0.32–7.88] vs. 0.06 [0.06–0.95] ng/mL, p = 0.002) was higher in the CO-CMP group. Patients with CO-CMP required recurrent ventilator support (76.9% vs. 21.1%, p < 0.001) and ICU admission (92.3% vs. 42.1%, p = 0.003). In multivariable regression analysis, the AI-derived prediction model was independently associated with CO-CMP (OR 1.14; 95% confidence interval (CI) 1.02–1.27; p = 0.017; Firth-penalized OR 1.11; 95% CI 1.03–1.25; p < 0.001). Receiver operating characteristic analysis of the AI-derived model showed an area under the curve of 0.85 (95% CI 0.70–0.96) for the AI score alone and 0.92 (95% CI 0.83–0.99) for the Combined AI–cardiac marker model, with a sensitivity of 92.3% and specificity of 81.6%. Pairwise DeLong comparisons between the Combined AI model and comparator models did not reach statistical significance (Combined vs. AI-only, p = 0.092; Combined vs. cardiac markers, p = 0.052); however, the likelihood-ratio test for adding the AI probability score to the cardiac marker-only model demonstrated significant incremental information (χ² = 13.68, p < 0.001). Conclusions: AI-based ECG analysis showed exploratory diagnostic association with LV systolic dysfunction observed in suspected CO-CMP patients. Given the limited sample size, low events-per-variable ratio, and lack of external validation, these findings suggest that AI-ECG analysis may provide incremental information for early cardiac risk stratification in selected patients. Full article

Carbon monoxide (CO) is a poisonous gas because it disrupts functional oxygen transport of red blood cell (RBC) by binding heme of hemoglobin with high affinity. Contrarily, endogenous CO, which is constantly generated in the process of heme degradation by heme oxygenase, functions as a gaseous mediator necessary for maintaining physiological homeostasis. This toxicological (Yin) and physiological (Yang) duality presents a distinctive problem in medical and pharmaceutical applications, prompting the central question of this review: How can strict control over CO’s exposure dynamics, magnitude, kinetics, and tissue context be achieved to enable its safe therapeutic use? Here, we integrate the Yin and Yang of CO through an innovative exposure-engineering framework, leveraging the inherent RBC characteristics to offer a novel conceptualization for therapeutic development. We highlight the role of native RBCs as a biologically grounded platform that can convert hemoglobin binding—classically viewed as the basis of CO toxicity—into a measurable and controllable buffering mechanism. Then, reconciling the Yin and Yang of CO based on RBCs enables medical and pharmaceutical modulation that is attractive for clinical situations, therapeutics and diagnostics. Finally, we discuss key translational challenges—local concentration control, patient-specific risk stratification, manufacturability and critical quality attributes, and regulatory positioning—and outline how quantifiable exposure control can enable the safe clinical development of RBC-based CO therapy. Full article

The increasing risk of air pollution in closed areas like passenger vehicles requires smart and real-time air quality reading solutions. Gases such as carbon monoxide (CO)—which is colorless and odorless and is produced by exhaust systems—air conditioners, and combustion sources are very dangerous to health because they can cause respiratory distress and poisoning at high levels. Traditional in-vehicle CO monitoring systems use a single-point sensor and a fixed threshold, which are insufficient in a dynamic cabin environment subject to factors such as vehicle size, ventilation rate, number of occupants, and incoming traffic. To address these drawbacks, this paper proposes a new E-Nose system with Virtual Sensor-Augmented Embedded Intelligence to estimate the CO concentration in vehicle cabins in real time. The system combines data from cheap gas sensors and improves it using virtual sensor machine learning models trained to predict or enhance sensor responses in real time. Embedded intelligence, deployed locally on edge hardware, supports low-latency processing, dynamic calibration, and noise filtering to respond to fluctuating environmental conditions adaptively. This architecture enables more accurate, robust, and context-aware estimation of CO levels compared to traditional threshold-based methods. Experimental validation across varied vehicular scenarios demonstrates superior precision and responsiveness, providing timely warnings even under complex dispersion patterns. Classifier Gradient Boosting, which builds an ensemble of weak learners sequentially, matched the Random Forest with 99.94% training and 98.59% model accuracy, confirming its strong predictive capability. The system is designed to be cost-effective, scalable, and easily integrable into modern automotive platforms. This study also contributes to the field of smart ecological recording and demonstrates the effectiveness of the virtual sensor-enhanced embedded system as an effective way to improve passenger safety by providing pre-emptive on-board air quality monitoring. Full article

The term asphyxia refers to a disruption in brain function due to rapid and persistent cerebral hypoxia or anoxia as a consequence of accidental or non-accidental injury. Considering the different mechanisms that may determine asphyxiation, such injuries can be referred to different categories: strangulation (death by hanging, ligature or manual strangulation), suffocation (smothering, choking, confined spaces and vitiated atmosphere), mechanical asphyxia (positional and traumatic asphyxia) and drowning (submersion or immersion in liquid). In both human and veterinary forensic practice, fatal asphyxia is considered among the most diagnostically challenging categories of sudden death, as it often produces only subtle and non-pathognomonic macroscopic signs, which can be easily covered by post-mortem alterations. Therefore, a wide range of information is often needed for the diagnosis of asphyxiation, including medical history, crime scene analysis, testimonies and physical evidence, along with the macroscopic and histological findings. The following review addresses the main lesions, ancillary tests and diagnostic issues associated with non-drowning asphyxia in veterinary forensic pathology. Full article

Background: Carbon monoxide poisoning (COP) has emerged as a significant health issue in Asian countries, including Taiwan. It poses serious risks, including long-term complications such as cardiovascular disease (CVD), neurological disorders, and even death. This study investigated the association of COP with the development of cardiovascular diseases and neurological sequelae, while evaluating all-cause and cause-specific mortality as secondary outcomes. Methods: This retrospective study utilized the National Health Insurance Research Database and included the patients aged ≥ 20 years hospitalized with a COP diagnosis between 1 January 2000 and 31 December 2015. The objective was to investigate long-term neurological complications, CVD (such as ischemic heart disease and other cardiac conditions), and associated risk factors. Cox proportional hazard regression was employed to analyze differences in long-term neurological sequelae and cardiovascular outcomes among various groups. Results: A total of 2421 COP patients were enrolled. COP patients with CVD history had a higher incidence of persistent neurological sequelae (PNS) in two different diagnostic codes (8.6%, p < 0.001 and 11.5%, p = 0.018), but COP patients without CVD history had a higher incidence of delayed neurological sequelae (DNS) only in one of the diagnostic codes (6.8%, p < 0.001). The risk from CVD factor was up to 11.92 times. Furthermore, the overall mortality was 8.8%, which is significantly higher than 3.7% in the general population. After adjusting for other factors, the mortality in COP individuals was 7.40 times higher than that of the general population. Conclusions: Patients with COP might be at high risk of developing CVD and have a significantly increased risk of CVD. COP is associated with a higher risk of long-term neurological complications and an increased incidence of CVD. These findings help mitigate the potential long-term health impacts of COP. Full article

One of the primary causes of casualties as a result of underground coal mine disasters is the generation of high concentrations of carbon monoxide (CO). In this study, a copper (Cu)–manganese (Mn)–tin (Sn) composite oxide catalyst was prepared using the co-precipitation method, and the effects of CO concentration (1–7%), reaction temperature (25–300 °C), and water poisoning degree (0–100%) on CO catalytic oxidation performance were systematically investigated using a dynamic activity testing system. The results demonstrated that within the CO concentration range of 1–7%, the catalyst was able to reduce the CO concentration to below 0.55% in a maximum of 248 s and maintain this level in a relatively stable state. Meanwhile, both the catalytic activity and maximum instantaneous reaction rate exhibited a linear increase with the rise in the CO concentration. Elevated temperature significantly shortened the equilibrium time and reduced the equilibrium concentration, achieving 99.99% elimination efficiency at 300 °C; however, catalyst activity decreased with increasing temperature due to adsorption step limitations. Water poisoning severely affected catalyst performance, with activity, elimination efficiency, and long-term stability exhibiting exponential decay as the water poisoning degree increased, with the most significant performance decline occurring in the 0–60% range. Based on the dynamic gas concentration analysis, the CO oxidation process with this catalyst exhibited characteristics consistent with the Mars–van Krevelen mechanism. These findings provide an experimental basis for evaluating the applicability of Sn-containing catalysts in extreme underground coal mine environments. Full article

Nitrogen oxides (NO_x), carbon monoxide (CO), sulfur dioxide (SO₂), and volatile organic compounds (VOCs) in industrial waste gases pose significant threats to environmental quality and human health. Catalytic purification is recognized as a leading abatement technology, crucial for meeting increasingly stringent emission regulations. Rare-earth (RE) catalytic materials, particularly those based on cerium (Ce), lanthanum (La), praseodymium (Pr), and neodymium (Nd) oxides, have attracted intense research due to their unique electronic configurations, high oxygen storage capacity (OSC), facile reversible redox reactions Ce⁴⁺, Ce³⁺, and exceptional thermal stability. This paper provides a comprehensive and methodical overview of RE catalysts used in industrial waste-gas purification. Initially, the physicochemical characteristics of RE elements and their multifaceted roles as active phases, supports, and promoters are explained. Subsequently, the latest developments in RE-based catalysts for NO_x abatement, CO oxidation, VOC degradation, and the removal of sulfur-bearing gas are critically reviewed. The discussion emphasizes structure–activity relationships, reaction mechanisms, and the synergistic interactions between RE elements and transition metals. Comparative analyses are presented through tables focusing on catalyst composition, reaction conditions, performance parameters, and stability. Special attention is given to the enhanced resistance to water vapor and sulfur poisoning afforded by RE materials. Finally, current challenges and future research prospects, including cost reduction, scalability, and long-term durability, are suggested. This review aims to provide practical guidance for the rational design and industrial translation of next-generation RE catalytic materials for air pollution control. Full article

Background: Survivors with chronic sequelae of carbon monoxide (CO) poisoning after the 1963 Miike–Mikawa coal mine disaster can exhibit persistent higher brain dysfunction in late life. We examined whether serum metabolic alterations remained detectable ~60 years later and assessed serum brain-derived neurotrophic factor (BDNF). Methods: In this cross-sectional case–control study, outpatients with chronic CO-poisoning sequelae (CO; n = 14) and former miners without CO exposure (CON; n = 16), all aged ≥ 75 years, underwent targeted serum metabolomics (1183 metabolites) and clinical assessments. Between-group differences were evaluated using Welch’s t-test, and age-matched propensity-score matching (1:1) served as a sensitivity analysis. BDNF was additionally compared using a linear regression/ analysis of covariancemodel adjusting for age and Mini–Mental State Examination (MMSE). Results: Relative to controls, the CO group showed higher valine, alanine, and betaine and lower 3-hydroxybutyric acid, inosine, and hypoxanthine; these contrasts persisted with concordant direction after matching. Serum BDNF was lower in the CO group (unadjusted trend) and was significantly reduced after age/MMSE adjustment (p = 0.0252). Exploratory correlations between clinical measures and selected metabolites/BDNF were attenuated after accounting for group. Conclusions: Six decades after exposure, chronic CO sequelae were associated with a reproducible serum profile combining amino-acid elevations with relative suppression of ketone-body and purine-related metabolites, suggesting enduring alterations in systemic substrate handling and bioenergetics. If replicated in larger cohorts, such signatures—potentially alongside BDNF—should be regarded as hypothesis-generating; biomarker development would require external validation, longitudinal tracking, and assessment of intervention responsiveness before any clinical use is considered. Full article

This article reports on how the length of the alkyl chain influences the morphological properties of thiol-stabilized silver nanoparticles (Ag NPs) and their subsequent effects on the performance and durability of proton exchange membrane fuel cells (PEMFCs). We synthesized thiol-stabilized Ag NPs by varying the alkyl chain length: 1-hexane thiol (C6), 1-octanethiol (C8), 1-decanethiol (C10), 1-dodecanethiol (C12), and 1-tetradecanethiol (C14), which we achieved using the two–phase Brust–Schiffrin method. X-ray Diffraction (XRD) patterns confirm the formation of crystalline Ag NPs. A morphological study conducted using a Transmission Electron Microscope (TEM) demonstrated that smaller alkyl chain length thiols (C6, C8, and C10) tend to coalesce, while C12 shows better uniformity with no agglomeration. C14 produces larger nanoparticles. A distinct pressure-area isotherm was observed when Ag NPs were spread at the water/air interface of a Langmuir–Blodgett (LB) trough. After obtaining the monolayer formation pressure range, we coated the Nafion 117 membrane of a polymer electrolyte membrane fuel cell with these nanoparticles to form monolayers of different Ag NPs (C6, C8, C12, C14) at various surface pressures (2 mN/m, 6 mN/m and 10 mN/m). Maximum power output enhancement was observed for C12, while other nanoparticles (C6, C8, C10, C14) did not exhibit noticeable power enhancement for PEMFCs. C12 Ag NPs deposited at surface pressure 6 mN/m give maximum power density increase (26.5%) at the fuel cell test station. In addition, we examined the carbon monoxide (CO) resistance test by mixing 0.1% CO with hydrogen (H2), and C12 Ag NPs showed the highest resistance to CO poisoning. However, no enhancement in power or CO tolerance was observed when C12 Ag NPs were coated by spray coating. These outcomes showcase that alkyl chain length plays a critical role in controlling the size and distribution of thiol-stabilized nanoparticles, which eventually has a direct impact on the performance and CO resistance of PEMFCs when applied to polymer electrolyte (Nafion 117). In addition, surface pressure during monolayer formation controls the distribution of Ag NPs (the distance between nanoparticles at the membrane interface), which is necessary to achieve catalytic activity for power improvement and to prevent platinum (Pt) poisoning by CO oxidation at ambient conditions. Full article

Background. Determining the cause and manner of death in scenes involving multiple and putrified bodies found in the same environment is a real challenge for forensic pathologists. While common scenarios include fires, vehicle crashes, and natural disasters, one of the most common causes is drug intoxication or poisoning, and the scene must be carefully evaluated based on circumstantial evidence. Carbon monoxide (CO) (also called “the silent killer”) remains one of the leading agents capable of producing simultaneous fatalities. In multi-body scenes, distinguishing between homicide–suicide, double suicide, and accidental deaths adds further complexity. The aim of this study is to highlight the limitations of toxicological and pathological investigations in advanced putrefaction and to emphasize the role of scene investigation in the interpretation of suspected CO-related deaths. Methods. The authors report a case of suspected CO intoxication involving two bodies in an advanced stage of decomposition recovered from the same room. The scene investigation, coupled with the presence of a malfunctioning combustion source, raised suspicion of CO exposure; however, analytical interpretation was severely constrained by the altered condition of biological samples. Results. Advanced decomposition magnifies these challenges. Putrefactive changes can mimic traumatic injuries, hide hypostasis, and compromise both macroscopic and microscopic evaluations due to autolysis and gas formation. Toxicological investigations are frequently hindered by the degradation or absence of key biological matrices such as blood, cavity fluids, or vitreous humor, rendering carboxyhaemoglobin quantification unreliable or impossible. These limitations may lead to incorrect medico-legal conclusions. Conclusions. Determining the cause and manner of death in complex multi-body scenes requires careful evaluation of circumstantial evidence and scene investigation, particularly when advanced decomposition compromises biological analyses and toxicological interpretation. Full article

Many confined-space accidents have happened in wastewater treatment tanks, mainly caused by hazard gases. To identify the factors affecting the distribution of toxic and harmful gases in wastewater treatment tanks, in this study, we collected data on confined-space accidents occurring in wastewater treatment tanks in China and analyzed accident types, the substances that caused the accidents and the purpose of entry. We carried out field tests to detect the concentrations of oxygen, hydrogen sulfide, combustible gas and carbon monoxide in 222 wastewater treatment tanks from 28 industrial enterprises and investigated the influence of wastewater treatment tank type, cover type and industry type on gas distribution. Through continuous monitoring, the concentrations of hydrogen sulfide and carbon monoxide in the regulating tanks of two industrial enterprises were monitored for a few days. The mechanism of harmful gas generation and control approaches were explored and analyzed. The results showed that more than 90% of confined-space accidents in wastewater treatment tanks were poisoning accidents, and the levels of harmful gas in wastewater collection tanks, regulating tanks, hydrolysis acidification tanks, sedimentation tanks and sludge tanks were high, qualifying them as high-risk wastewater treatment tanks prone to accidents. Without disturbance, there is basically no harmful gas in wastewater treatment tanks with completely uncovered tops. In addition, the concentration of toxic and hazardous gases in wastewater treatment tanks is not always stable, instead fluctuating greatly with time. The main purposes of this study are to identify the factors affecting the concentration of toxic and harmful gases in wastewater treatment tanks and to assess the risks of using wastewater treatment tanks. Full article

New-onset vertigo, dizziness and gait imbalance are amongst the most common symptoms presenting to the emergency department, accounting for 2.1–4.4% of all patients. The broad spectrum of underlying causes in these patients cuts across many specialties, which often results in diagnostic challenges. For patients meeting the diagnostic criteria for acute vestibular syndrome (AVS, i.e., presenting with acute-onset prolonged vertigo/dizziness with accompanying gait imbalance, motion intolerance, nausea/vomiting, with or without nystagmus), the typical differential diagnosis is vertebrobasilar stroke and acute unilateral vestibulopathy. However, other disorders may also present with AVS. These include non-neurological causes such as drug side-effects or intoxication, electrolyte disturbances, cardiac disease, severe anemia, carbon monoxide poisoning, endocrine disorders and others. Other non-stroke neurological disorders may also present with AVS or episodic vertigo/dizziness, including demyelinating CNS diseases, posterior fossa mass lesions, acute thiamine deficiency and vestibular migraine. Furthermore, acute physiological abnormalities (e.g., hypotension, fever, severe anemia) may unmask previous vestibular impairments that had been well-compensated. Here, we review the diagnostic approach to patients with acute-onset dizziness in the emergency room and discuss the most important differential diagnoses beyond stroke and acute unilateral vestibulopathy. Full article

Background: The phenomenon of pink teeth represents a notable observation in forensic science, although its interpretation remains complex and not directly attributable to a specific cause of death. Methods: This systematic review provides an updated and comprehensive overview of the morphological and histological mechanisms associated with this finding, with a focus on hemoglobin diffusion and pigment accumulation during putrefaction rather than on detailed biochemical pathways. Results: Environmental conditions, especially high humidity and moderate temperatures, are identified as key facilitators. The synthesis of the available evidence, including case reports, observational series, and experimental studies, confirms that pink discoloration is primarily linked to postmortem hemoglobin diffusion following erythrocyte breakdown and release of heme groups into dentinal structures. This process occurs more frequently under conditions that preserve hemoglobin and facilitate its migration into dental tissues. Importantly, pink teeth have been documented across a wide spectrum of postmortem scenarios, such as hanging, drowning, carbon monoxide poisoning, and prolonged exposure to humid environments, indicating that their presence is neither pathognomonic nor exclusively associated with a specific cause of death. Assessment methods include semi-quantitative visual scoring systems (e.g., SPTC and SPTR), spectrophotometric assays, and histochemical analyses for hemoglobin derivatives. Recent advances in digital forensics, particularly micro-computed tomography and artificial intelligence–based segmentation, may further support the objective evaluation of chromatic dental changes. Conclusions: This review underscores the need for standardized approaches to the identification, classification, and analysis, both qualitative and quantitative, of pink teeth in medico-legal practice. Although not diagnostic in isolation, their systematic study enhances our understanding of decomposition processes and contributes supplementary interpretive data in forensic investigations. Full article

Background: Hyperbaric oxygen therapy (HBOT) is the standard treatment for moderate to severe carbon monoxide (CO) poisoning, but middle ear barotrauma (MEB) remains a common complication. This study identified risk factors associated with MEB in patients undergoing monoplace HBOT. Methods: This retrospective cohort study included patients treated for CO poisoning with monoplace HBOT at a tertiary academic hospital between May 2021 and December 2023. MEB severity was assessed before and after treatment using video otoscopy and graded according to the modified O’Neill Grading System. Results: MEB occurred predominantly at lower severity grades according to the O’Neill scale. In univariate analysis, significant risk factors for MEB included altered mental status at presentation (OR: 3.16, 95% CI: 1.35–7.40, p = 0.008), serum albumin > 4.3 g/dL (OR: 0.22, 95% CI: 0.10–0.65, p = 0.004), and magnesium levels (OR: 0.21, 95% CI: 0.05–0.98, p = 0.046). Multivariate analysis confirmed altered mental status (OR: 3.16, 95% CI: 1.05–9.52, p = 0.041), albumin > 4.3 g/dL (OR: 0.26, 95% CI: 0.10–0.65, p = 0.004), and magnesium level (OR: 0.21, 95% CI: 0.05–0.88, p = 0.033) as independent predictors of MEB. Patients with higher albumin and magnesium levels showed lower risk. Conclusions: Altered mental status, lower albumin, and lower magnesium levels predicted middle ear barotrauma in patients undergoing monoplace HBOT for CO poisoning. These findings highlight the importance of careful pre-treatment evaluation and close monitoring during therapy to reduce the incidence of MEB. Full article