Chlorfenapyr poisoning:mechanisms,clinical presentations,and treatment strategies

BACKGROUND:Chlorfenapyr is used to kill insects that are resistant to organophosphorus insecticides.Chlorfenapyr poisoning has a high mortality rate and is difficult to treat.This article aims to review the mechanisms,clinical presentations,and treatment strategies for chlorfenapyr poisoning.DATA RESOURCES:We conducted a review of the literature using PubMed,Web of Science,and SpringerLink from their beginnings to the end of October 2023.The inclusion criteria were systematic reviews,clinical guidelines,retrospective studies,and case reports on chlorfenapyr poisoning that focused on its mechanisms,clinical presentations,and treatment strategies.The references in the included studies were also examined to identify additional sources.RESULTS:We included 57 studies in this review.Chlorfenapyr can be degraded into tralopyril,which is more toxic and reduces energy production by inhibiting the conversion of adenosine diphosphate to adenosine triphosphate.High fever and altered mental status are characteristic clinical presentations of chlorfenapyr poisoning.Once it occurs,respiratory failure occurs immediately,ultimately leading to cardiac arrest and death.Chlorfenapyr poisoning is diflcult to treat,and there is no specific antidote.CONCLUSION:Chlorfenapyr is a new pyrrole pesticide.Although it has been identified as a moderately toxic pesticide by the World Health Organization(WHO),the mortality rate of poisoned patients is extremely high.There is no specific antidote for chlorfenapyr poisoning.Therefore,based on the literature review,future efforts to explore rapid and effective detoxification methods,reconstitute intracellular oxidative phosphorylation couplings,identify early biomarkers of chlorfenapyr poisoning,and block the conversion of chlorfenapyr to tralopyril may be helpful for emergency physicians in the diagnosis and treatment of this disease.

Recent Advances for Global Perspectives on Etiology, Pathophysiology, Clinical Presentations, and Management of Moyamoya Disease

Moyamoya disease (MMD) is a condition characterized by the gradual narrowing and blockage of blood vessels in the brain, specifically those in the circle of Willis and the arteries that supply it. This results in reduced blood flow and oxygen to the brain, leading to progressive symptoms and potential complications. The underlying pathophysiological mechanism remains elucidated. However, recent studies have highlighted numerous etiologic factors: abnormal immune complex responses, susceptibility genes, branched-chain amino acids, antibodies, heritable diseases, and acquired diseases, which may be the great potential triggers for the development of moyamoya disease. Its clinical presentation has varying degrees from transient asymptomatic events to significant neurological deficits. Moyamoya disease (MMD) shows different patterns in children and adults. Children with MMD are more susceptible to ischemic events due to decreased blood flow to the brain. Conversely, adults with MMD are more prone to hemorrhagic events involving brain bleeding. Children with MMD may experience a range of symptoms including motor impairments, sensory issues, seizures, headaches, dizziness, cognitive delays, or ongoing neurological problems. Although adults may present with similar clinical symptoms as children, they are more prone to experiencing sudden onset intraventricular, subarachnoid, or intracerebral hemorrhages. One of the challenges in moyamoya disease is the potential for misdiagnosis or delayed diagnosis, particularly when physicians fail to consider MMD as a possible cause in stroke patients. This review aims to provide a comprehensive overview of recent global studies on the pathophysiology of MMD, along with advancements in its management. Additionally, the review will delve into various surgical treatment options for MMD, as well as its rare occurrence alongside atrioventricular malformations. Exciting prospects include the use of autologous bone marrow transplant and the potential role of Connexin 43 protein treatment in the development of moyamoya disease.

Clinical Presentation and Treatment Outcomes of Pregnancy-Related Acute Kidney Injury among Pregnant Women Admitted at the Benjamin Mkapa Hospital in Tanzania

Background: Globally, PRAKI is among the leading causes of death in pregnant women. The prevalence, causes and outcome of this condition vary among countries due to differences in environmental, socioeconomic, and health delivery systems. The common causes that have been reported in several studies are PIH, Haemorrhages and Sepsis while the outcomes may be either complete renal recovery, progression to CKD and hence dialysis dependency or death. This study aimed at determining clinical presentation and treatment outcomes of Pregnancy-Related Acute Kidney Injury in Pregnant women admitted at the Benjamin Mkapa Hospital, Dodoma, Tanzania. Results: Out of 4007 pregnant women who were admitted to the maternity ward 51 pregnant women were found to have PRAKI. Of those with PRAKI, 74.5% were between 21 to 25 years. The leading causes of PRAKI were PPH 12 (23.53%), Eclampsia 12 (23.53%), and pre-eclampsia 12 (23.5%). Hemodialysis therapy was provided to 22 (43.1%) patients, 15 (29.4%) individuals recovered spontaneously with medical management and 14 (27.5%) missed haemodialysis therapy due to various reasons. The mortality due to PRAKI was 17 (33.3%). Conclusion and Recommendation: Pre-eclampsia/eclampsia and post-partum haemorrhage were found to be the main causes of PRAKI. The mortality related to PRAKI is high and Hemodialysis therapy is vital help to prevent deaths for pregnant women with PRAKI. Pregnant women who develop acute kidney injury should be followed closely and a nephrologist should be consulted early. Early referral should be done by the lower level facilities for all at-risk pregnant women to a specialized multidisciplinary health facility.

The Alienation of Nature in Emily Dickinson’s Poems through the Prism of Taoism

In the poems created by the renowned American poet Emily Dickinson,those related to nature constitute a considerable proportion.However,Dickinson’s attitude toward nature is,in fact,contradictory.On the one hand,Dickinson perceives nature as gentle and kind,akin to a mother.Nature is regarded as“heaven”and embodies harmony.On the other hand,nature possesses its own operational principles and harbors inherent cruelty.According to Dickinson,humans should refrain from excessive interference in the natural order.This article attempts to analyze the similarities in attitude towards nature between Dickinson’s poetry and Taoist philosophy.

Problems and Development Suggestions of Nature Education in Jiangxi Province

The forest coverage rate of Jiangxi Province ranks second in China.It has rich natural resources,a long history of ancient color culture and rich red culture.In the development of nature education,Jiangxi Province has great potential and advantages.This paper introduces the development conditions of nature education in Jiangxi Province,summarizes the problems existing in the development of nature education in Jiangxi Province from the aspects of the types of nature education and the construction of nature education base,such as simple content and single form,imperfect infrastructure and lack of professionals,and puts forward some suggestions on the development of nature education in Jiangxi Province.

《Nature》子刊:苏佳琪等开发基于牛奶的水凝胶,用作酒精中毒的解毒剂

近日,苏黎世联邦理工学院Raffaele Mezzenga、苏佳琪等人在《Nature》子刊《Nature Nanotechnology》上发表的一篇研究显示,该研究开发了一种口服的、基于牛奶蛋白的水凝胶——FeSA@FibBLG,或可作为急性酒精中毒的有效解毒剂,能够稳定耐受胃酸消化且持续显著降低酒精中毒小鼠血液中的酒精水平,同时避免额外积累有毒的乙醛,还可增强肝脏保护,并显著减轻肠道损伤和生态失调,强调了其作为酒精相关疾病的新疗法的潜力。

真学习还是假参与?——Presentation在高校课堂教学应用中的问题与改进

Presentation是目前国内高校教学改革中常用的教学形式之一,在各类学科教学中均有不同程度的应用。这种以增强教学双主体互动为主要特征的教学形式,在实际教学中呈现出学生课堂参与深度不足、学习收获不系统、课堂汇报“一言堂”等问题。学生学习是为了完成任务而非获得知识、学生习惯于服从教师权威而非批判性思考、教师教学准备不足与指导环节缺失,以及教学评价的评价主体与形式单一是造成Presenta-tion应用效果不佳的重要因素。提高Presentation的应用效果,需要强化对教学过程的管理,保障Presentation规范实施;改革学业评价方式,促进学生主动思考与合作学习;拓展教学资源供给,为学生自主与合作学习提供更多支持;鼓励教师开展教学行动研究,不断提高教学专业化水平。

Nature’s Gift

NATURAL WONDERS IN CHINA AND AFRICA Qilian Mountains National Park Located in Northwest China’s Gansu and Qinghai provinces,Qilian Mountains National Park spans 50,200 square km,serving as a vital ecological security barrier and water source conservation area in west China.Established in 2017 to address ecosystem damage,intensive food chain protection and wildlife monitoring in the area began in early 2011.

Spatiotemporal Evolution of Ecological Quality in Alpine Freshwater Lake Nature Reserves in the Past 20 Years

The Caohai Nature Reserve is one of the three major plateau freshwater lakes in China.Since the 1950s,human activities such as land reclamation and population relocation have greatly damaged Caohai.A rapid evaluation of the spatiotemporal evolution trend of the ecological quality of the Caohai Nature Reserve is significant for the maintenance and construction of the ecosystem in this area.The research is based on the Google Earth Engine(GEE)remote sensing cloud computing platform.Landsat TM/OLI images from May to October in five time periods:2000-2002,2004-2006,2009-2011,2014-2016,and 2019-2021 were obtained to reconstruct the optimal cloud image set by averaging the images in each time period.By constructing four ecological indicators:Greenness(NDVI),Wetness(Wet),Hotness(LST),and Dryness(NDBSI),and using Principal Component Analysis(PCA)method to obtain the Remote Sensing Ecological Index(RSEI)for the corresponding years,the spatiotemporal variation of ecological quality in the Caohai Nature Reserve over 20 years was analyzed.The results indicate:①the mean value of RSEI increased from 0.460 in 2000-2002 to 0.772 in 2019-2021,a 67.83%increase,indicating a significant improvement in the ecological quality of the reserve over the 20 years;②from the perspective of functional zoning of the Caohai Nature Reserve,the ecological quality of the core area showed a degrading trend,while the ecological quality of the buffer zone and experimental zone significantly improved;③with the implementation of ecological restoration projects,the ecological quality of the reserve gradually recovered and improved from 2014 to 2021.The trend of RSEI value changes is well correlated with human interventions,indicating that the PCA-based RSEI model can be effectively used for ecological quality assessment in lake areas.

《Nature》:新开发的可穿戴超声贴片可连续、无创监测大脑血流

近日,一篇发表在《Nature》上的研究显示,研究人员开发出一种可穿戴超声贴片(wearable ultrasound patch),其可对大脑血流进行连续、无创的监测。该研究将贴片在36名健康志愿者身上进行了测试,以检验其测量脑部主要动脉血流速度(收缩期峰值、平均流速和舒张末期速度)的能力,发现测量结果与传统超声探头的测量结果非常吻合。

《Nature》:科学家发现能驱动患者狼疮发生的两种细胞缺陷

近日,一篇发表在《Nature》上的研究显示,研究发现了一种特殊的分子缺陷或会促进系统性红斑狼疮的病理性免疫反应,同时揭示了逆转这一缺陷或有望逆转疾病。该研究中,研究人员报道了驱动狼疮发生的新通路,研究者表示,患者体内血液中的多种分子都会发生疾病相关的改变,最终,这些变化会导致芳香烃受体(aryl hydrocarbon receptor,AHR)所控制的通路激活不足,AHR能调节细胞对环境污染物、细菌或代谢产物的反应。

“Eternal Motion” as a “Form of Movement of a Special Nature” and the Main Condition for the Creation of the Universe

The article hypothesizes that DE and DM (UCM) are a “Form of Motion of a Special Nature”, where “Form of Motion” means “Eternal Motion” as the power of dynamics of different levels and varying degrees of self-sufficiency, and by “Special Nature”, gravitational and two other properties of matter, “tied” to the “Eternal Movement” and completely dependent on it. Carriers of key properties of a “Special Nature” have been established: “0”-DE particles and “3”-DM particles (UDM). The unity of their inherent “motionally-gravitational” properties and the peculiarity of the relationship between “motion” and “gravity” are revealed: the higher the intensity of “Eternal Motion”, the stronger the gravitational properties of matter are manifested (and vice versa). The relationship of “time” with the “vibration frequency” and the “mass” of photons with the “degree of bonding and deformation properties of the field” is shown. The maximum level of gravity has been determined, which allows Nature to successfully create the Universe: such a landmark is the proximity to the property of the Primary Source—the “pure graviton” of the OSP space, the most powerful “motionally-gravitational” particle of the Universe. The reasons for the emergence of such an identity of the gravitational properties of particles with the indicators of a “pure graviton” are established: for “0”-DE particles, this is the acquisition of the function of “freedom of movement”;for “3”-DM particles (UDM), the creation of a special structure—a “double field” (“Main” and “Small”). The presence in the “double field” of specific “tools” for the creation of the worlds of the Universe—gravitational “waves” gives rise to impulses (shocks) of varying intensity and shape. A list of functions performed by “waves” in the “Main” and “Small” fields has been compiled. The specific conditions for the formation of “UDM Streams”, their transformation into a “Vortex” and, under the influence of a powerful Initial Impulse (push), sending them to the “place” of the creation of galaxies, are shown. It is suggested that there is a “Cycle of Matter in Nature” in the closed structure of our Universe due to the “work” of “waves” and the functioning of special “factories” in the form of exotic space objects—Black holes.

What to do when it is breech? A state-of-the-art review on management of breech presentation

Any non-cephalic presentation in a fetus is regarded as malpresentation.The most common malpresentation,breech,contributes to 3%-5%of term pregnancies and is a leading indication for cesarean delivery.Identification of risk factors and a proper physical examination are beneficial;however,ultrasound is the gold standard for the diagnosis of malpresentations.External cephalic version(ECV)refers to a procedure aimed to convert a non-cephalic presenting fetus to cephalic presentation.This procedure is performed manually through the mother’s abdomen by a trained health care provider,to reduce the likelihood of a cesarean section.Studies have reported a version success rate of above 50%by ECV.The main objective of this review is to present a broad perspective on fetal malpresentation,ECV,and delivery of a breech fetus.The focus is to elaborate all clinical scenarios of breech and to provide an evidence-based clinical approach for them.After discussing breech prevalence,risk factors,diagnosis,and management,an updated review of ECV is presented.Moreover,ECV indications/contraindications,alternatives,clinical techniques on how to perform ECV and breech vaginal delivery,and obstetrical considerations for the delivery of malpresentations are thoroughly discussed.

The Man Who Organized Nature: The Life of Linnaeus by Gunnar Broberg

GunnarBroberg(1942–2022),a professor of history ideas and sciences at the Lund University in Sweden,has assembled and summarized virtually all of the contemporary documents relating to the life of Carl Linnaeus(1707–1778).This is therefore a fact-laden and definitive personal biography of the founder of our systems of plant and animal taxonomy.Linnaeus’childhood included much time in nature that forever provided him an experience background for the huge amount of plant and animal species he would encounter.In his early days,his country was in an era of poverty where“hordes of starving,homeless people drifted along the roads in the years when the harvest failed.”Linnaeus himself“...could lie awake all night as he lacked the money for evening meals when he was a student.”He inserted paper into his shoes to cover the holes on which he walked.

Clinical Presentation, Management and Materno-Fetal Outcome of Patients with HELLP Syndrome at the Yaoundé Gyneco-Obstetrics and Pediatric Hospital

Background: HELLP (Hemolysis, Elevated Liver enzymes and Low Platelets) syndrome is a common complication of severe preeclampsia, with a high maternal and perinatal mortality rate. Data on HELLP syndrome is scanty in our setting. We sought to study the clinical presentation, management, and materno-fetal outcome of patients with HELLP syndrome at the Yaoundé Gyneco-Obstetrics and Pediatric Hospital (YGOPH). Methods: This was a cross-sectional, analytical study with a retrospective data collection of patients, diagnosed with HELLP syndrome at the YGOPH between 1st January 2020 and 31st July 2021. Data were analyzed using the software R version 4.0.2. Results are presented as mean ± standard deviation, frequencies and percentages. P values < 0.05 were considered statistically significant. Results: Of 254 cases of severe preeclampsia, 17 developed HELLP syndrome, giving us a frequency of 6.7%. One patient who presented with hepatitis B was excluded. The mean age was 27.19 ± 6.44 years. Most patients (56.3%) had poor follow up during antenatal contacts. The most common symptom was headache (93.8%). Most cases (56.3%) were diagnosed during post-partum, prepartum (25.0%), and per partum (18.8%). Obstetrical management was done by cesarean section (62.5%) and vaginal delivery (37.5%). Post-partum management of HELLP syndrome consisted of antihypertensive medication, anticonvulsants, sedatives, transfusion of blood and blood products, and fluid resuscitation. Of the 50% of patients who presented with acute kidney injury, only 12.5% (1) were referred for dialysis. Over 50% of our study participants presented severe complications after delivery, but 43.8% recovered, while 56.2% finally died. The fetal outcome was: still birth (31.2%), intra-uterine growth restriction/low birth weight (12.5%), term delivery (≥37 weeks) (31.3%), and preterm deliveries (<37 weeks) (68.7%). Three (18.8%) of the neonates delivered alive presented with a poor Apgar score at the 5th minute. Conclusion: Although rare, HELLP syndrome exists in our setting. Proper management in appropriate centers is key to improving maternal and fetal outcomes.

The Significance of Constructing TCM Psychosomatic Medicine from the Holistic View of the Unity of Nature and Man

With the development of medical technology, the problem of fragmentation of medical research has become increasingly prominent, and a series of iatrogenic diseases, drug-induced diseases and drug toxicity and side effects have resulted in an increase in the number of diseases. In the face of these problems, the medical concept has been re-examined and re-thought. The concept of the holistic view of the unity of nature and man in traditional Chinese medicine has certain enlightenment for dealing with the problems in the current medical development. Based on the holistic view of the unity of nature and man, the overall connection between human’s heart and body and nature is explained, and the further construction of TCM psychosomatic medicine is conducive to guiding the diagnosis and treatment of clinical diseases, and providing new enlightenment for the current medical concept thinking and clinical disease research.

Unusual Presentation of a Large Multi-Septated Cystic Hygroma: A Case Report and Comprehensive Literature Review

Background: Cystic hygromas are primarily found in the cervicofacial, thoracic, and abdominal regions, with limited occurrences in other areas. Despite existing literature on this condition, comprehensive descriptions and MRI findings of cystic hygromas in the extremities are rare. Aim: This case report aims to present a unique instance of a cystic hygroma in the left thigh. The objective is to provide detailed insights into the characteristics of this atypical presentation. Case Presentation: The case involves a 2-year-10 month-old girl with a cystic hygroma in her left thigh. The report includes a comprehensive description of the lesion’s clinical features and diagnostic evaluation, emphasizing the MRI findings to enhance understanding of this rare occurrence. Conclusion: This case report highlights the rarity of cystic hygromas outside the cervicofacial, thoracic, and abdominal regions, explicitly focusing on the occurrence in the left thigh. By presenting detailed insights into the clinical features, MRI findings, histopathological findings, and the surgical approach employed, this report contributes to the existing knowledge on this condition in atypical locations and informs future treatment strategies.

Exploration of Nature Education Path for Teenagers:A Case Study of Yancheng Wetland Nature Education Based on the World Natural Heritage Site

Nature education is the trend of the current social development.By gradually improving the awareness of ecological civilization among the whole people,the achievements in ecological civilization are jointly built and shared by the whole people.Yancheng Yellow Sea Wetland is a characteristic natural resource and the name card of Yancheng City,and also an important part of the natural education of teenagers in Yancheng.As one of the main resources of nature education in Yancheng,the Yellow Sea Wetland World Natural Heritage resources play a more important role in the cultivation of youth ecological civilization values and legal awareness of environmental protection.Based on the protection and utilization of the Yellow Sea Wetland World Natural Heritage resources,this paper explores the methods and approaches of nature education for teenagers in Yancheng.

Late presentation of dural tears:Two case reports and review of literature

BACKGROUND The late presentation of dural tears(LPDT)has a low incidence rate and hidden symptoms and is easily ignored in clinical practice.If the disease is not treated in time,a series of complications may occur,including low intracranial pressure headache,infection,pseudodural cyst formation,and sinus formation.Here,we describe two cases of LPDT.CASE SUMMARY Two patients had sudden fever 1 wk after lumbar surgery.Physical examination showed obvious tenderness in the operation area.The patients were confirmed as having LPDT by lumbar magnetic resonance imaging and surgical exploration.One case was caused by continuous negative pressure suction and malnutrition,and the other was caused by decreased dural ductility and low postoperative nutritional status.The first symptom of both patients was fever,with occasional headache.Both patients underwent secondary surgery to treat the LPDT.Dural defects were observed and dural sealants were used to seal the dural defects,then drainage tubes were retained for drainage.After the operation,the patients were treated with antibiotics and the patients’surgical incisions healed well,without fever or incision tenderness.Both recovered and were discharged 1 wk after the operation.CONCLUSION LPDT is a rare complication of spinal surgery or neurosurgery that has hidden symptoms and can easily be overlooked.Since it may cause a series of complic-ations,LPDT needs to be actively addressed in clinical practice.

From landslide characterization to nature reserve management:The“Scialimata Grande di Torre Alfina”landslide Geosite(Central Apennines,Italy)

Italy is characterized by widespread geomorphological instability,among which landslides leave impressive marks on the landscape.Nevertheless,landslide bodies may represent key sites for thematic and educational itineraries,especially in protected areas,where their management becomes an important issue.Our study focuses on the"Monte Rufeno Nature Reserve"(Central Apennines,Italy),where iconic landslides are present.Here,the"Scialimata Grande di Torre Alfina"landslide(SGTA)is listed in the regional Geosite database.This work aims to propose a multiscale procedure for landslide analysis,in terms of both hazard sources but also educational and geoheritage enhancement opportunities in natural reserves.After performing a Landslide Susceptibility conditional Analysis(LSA)for the reserve territory,attention was focused on the SGTA,to define properly its features and morphodynamics.A multi-disciplinary approach was adopted,by applying both remote sensing(UAV structure from motion,Photointerpretation)and field survey(geomorphological and GPS monitoring).From the LSA,based on drainage density,curvature,and slope triggering factors,the road and trail susceptibility maps were derived,as base tools for future risk assessments and trail paths management within the reserve.At the SGTA scale,the monitoring showed a displacement of up to 23 m during the time interval between 2015 and 2018.The landslide dynamics seem to be driven by alternating dry and extremely wet periods;moreover,leaks from the aqueduct in the detachment area and piping effects through clays may have also decreased the substrate cohesion.The SGTA complex influence on the Paglia River valley geometry was also hypothesized,underlining the action of landslide through different spatial scales(on-site and off-site)and on different environment features(sediment connectivity,hydrology).Finally,the SGTA appears highly representative of the geomorphic dynamics within the Nature Reserve(i.e.,scientific value)and it could be classified as an active geosite.Since the site was featured by a tourist trail,adequate management strategies must be adopted,considering the educational value and safety issues.