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Background: Pediatric ingestion of toxic substances is a complicated cause of morbidity. Currently, there is limited literature on toxic ingestions resulting in pediatric intensive care unit (PICU) admissions., Methods: A retrospective study was conducted to quantify the number and financial costs of admissions for toxic ingestion. Secondary objectives were to determine common types of ingestions and interventions as well as examine the relationship between intentional ingestion status and patient age. Data were obtained from a retrospective review of records from April 2016 through August 2018 from a PICU located in the Midwestern USA., Results: There were 360 unique patient encounters used in primary analyses. Intentional ingestion and suicidal ideation documented in 72% and 54% of patients, respectively.Patients younger than nine had an 87% (95% confidence interval: 80%, 92%) lower risk for intentional ingestion. The median lengths of stay were 1.0 (interquartile range [IQR]: 1.0, 1.0) days with a median cost of $2498 (IQR: $1870, $3592) USD. There was no patient mortality identified in the sample., Conclusion: The types of ingestions appeared to match those of the National Poison Control Database. Lengths of stay were short and had a non-nominal cost. A greater age was associated with an increased risk of intentional ingestions., (© The Author(s) 2021. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: High-flow nasal cannula (HFNC) is an option for respiratory support in patients with acute hypoxic respiratory failure. To improve patient outcomes, reduce ICU-associated costs, and ease ICU bed availability, a multi-phased, comprehensive strategy was implemented to make HFNC available outside the ICU under the supervision of pulmonology or trauma providers in cooperation with a dedicated respiratory therapy team. The purpose of this study was to describe the education and implementation process for initiating HFNC therapy outside the ICU and to convey key patient demographics and outcomes from the implementation period., Methods: HFNC therapy was implemented at a tertiary hospital in the Midwest, with systematic roll-out to all in-patient floors over a 9-month period. Utilization of the therapy and patient outcomes were tracked to ensure safety and efficacy of the effort., Results: During the implementation period, 346 unique subjects met study inclusion criteria. Median (interquartile range) hospital length of stay was 8 d (4-12), and median duration of HFNC therapy was 44 h (18-90). Two thirds of subjects ( n = 238) received the entire course of HFNC therapy outside the ICU, and more than half of subjects ( n = 184) avoided the ICU for their entire hospitalization. Moreover, 6% of subjects in the study group escalated from HFNC to noninvasive ventilation, and 5% of subjects escalated from HFNC to mechanical ventilation., Conclusions: A comprehensive implementation process and a robust therapy protocol were integral to initiating and managing HFNC in all hospital locations. Study findings indicate that patients with acute hypoxic respiratory failure can safely receive HFNC therapy outside the ICU with appropriate patient selection and staff education., Competing Interests: Fisher & Paykel Healthcare provided grant support and donated disposables to UnityPoint Health to support nurse and physician education during the implementation phase of the study. Ms Jackson and Dr Trump have disclosed relationships with Fisher & Paykel HealthCare. The other authors have disclosed no conflicts of interest., (Copyright © 2021 by Daedalus Enterprises.)

Veratridine (VTD), an alkaloid derived from the Liliaceae plant shows anti-tumor effects; however, its molecular targets have not been thoroughly studied. Using a high-throughput drug screen, we found that VTD enhances transactivation of UBXN2A, resulting in upregulation of UBXN2A in the cytoplasm, where UBXN2A binds and inhibits the oncoprotein mortalin-2 (mot-2). VTD-treated cancer cells undergo cell death in UBXN2A- and mot-2-dependent manners. The cytotoxic function of VTD is grade-dependent, and the combined treatment with a sub-optimal dose of the standard chemotherapy, 5-Fluorouracil (5-FU) and etoposide, demonstrated a synergistic effect, resulting in higher therapeutic efficacy. VTD influences the CD44+ stem cells, possibly through UBXN2A-dependent inhibition of mot-2. The VTD-dependent expression of UBXN2A is a potential candidate for designing novel strategies for colon cancer treatment because: 1) In 50% of colon cancer patients, UBXN2A protein levels in tumor tissues are significantly lower than those in the adjacent normal tissues. 2) Cytoplasmic expression of the mot-2 protein is very low in non-cancerous cells; thus, VTD can produce tumor-specific toxicity while normal cells remain intact. 3) Finally, VTD or its modified analogs offer a valuable adjuvant chemotherapy strategy to improve the efficacy of 5-FU-based chemotherapy for colon cancer patients harboring WT-p53.