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.

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。

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.

Cultivate Critical Thinking Ability via Students’ Presentations in College English Classes

In the new era when demands for flexible intellectual skills are increasing,strengthening the cultivation of critical thinking ability of students has become one of the key purposes of higher education.This paper intends to discuss how to cultivate students’critical thinking ability through English classroom presentations.It points out that during the whole process,teachers’guidance plays an indispensable role.Only when both teachers and students are aware that classroom presentations are a golden opportunity for the cultivation of students’critical thinking ability and carry this awareness into their English classes,can English presentations be brought into full play.

Research on Heterogeneous Information Network Link Prediction Based on Representation Learning

A heterogeneous information network,which is composed of various types of nodes and edges,has a complex structure and rich information content,and is widely used in social networks,academic networks,e-commerce,and other fields.Link prediction,as a key task to reveal the unobserved relationships in the network,is of great significance in heterogeneous information networks.This paper reviews the application of presentation-based learning methods in link prediction of heterogeneous information networks.This paper introduces the basic concepts of heterogeneous information networks,and the theoretical basis of representation learning,and discusses the specific application of the deep learning model in node embedding learning and link prediction in detail.The effectiveness and superiority of these methods on multiple real data sets are demonstrated by experimental verification.

基于Present算法的无线网络通信数据安全加密方法

为降低无线网络通信中数据传输节点的损失系数,引进Present算法,设计一种针对无线网络通信数据的安全加密方法。将贝叶斯定理作为参照,计算得到无线网络通信中数据处于安全状态的概率,推断得到数据通信的安全等级,实现对无线网络通信数据类别的划分;引进Present算法,生成无线网络通信数据轮密钥;根据窗口分割的结果,提取通信网络敏感数据,设定无线网络通信数据的时间序列,实现对无线网络通信数据中敏感数据的主动安全加密。实验结果表明:所提方法应用效果较好,可以将加密后节点损失系数控制在一个相对较低的水平,通过此种方式,降低节点在通信与传输信息时的损失。

PRESENT轻量级密码的中间相遇统计故障分析

PRESENT算法是于2007年在国际密码硬件与嵌入式系统会议提出的一种轻量级分组密码,2012年成为国际轻量级算法标准ISO/IEC-29192-2,适用于物联网中射频识别标签、网络传感器、智能卡等设备的数据保护.本文结合PRESENT密码的设计结构和实现特点,基于统计分析和中间相遇分析策略,提出了一种中间相遇统计故障分析方法,设计了皮尔逊相关系数-汉明重量、库尔贝克莱布勒散度-汉明重量区分器和杰卡德相似系数-汉明重量-极大似然估计等区分器,可以分别破译PRESENT密码全部版本的80比特和128比特原始密钥.该方法攻击轮数更深,故障数和耗时更少,有效地扩展了攻击范围,提升了攻击能力.结果表明,中间相遇统计故障分析对PRESENT密码构成了严重威胁.该研究为轻量级密码的实现安全研究提供了有价值的参考.

基于Present算法的通信网络自主防御数据安全加密方法

由于传统的通信网络数据加密方法受到攻击时节点损失系数较大,无法保证加密后的数据安全性,文章提出一种基于Present算法的通信网络自主防御数据安全加密方法。提取通信网络自主防御敏感数据,利用混沌条件量生成Present算法的轮密钥,实现敏感数据的加密。实验结果表明:经过此方法加密后的通信网络自主防御数据,受到攻击时节点损失系数仅有0.06,具有较好的加密性能。

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.

A Flexible Architecture for Cryptographic Applications: ECC and PRESENT

This work presents a flexible/unified hardware architecture of Elliptic-curve Cryptography(ECC)and PRESENT for cryptographic applications.The features of the proposed work are(i)computation of only the point multiplication operation of ECC over GF(2163)for a 163-bit key generation,(ii)execution of only the variant of an 80-bit PRESENT block cipher for data encryption&decryption and(iii)execution of point multiplication operation(ECC algorithm)along with the data encryption and decryption(PRESENT algorithm).To establish an area overhead for the flexible design,dedicated hardware architectures of ECC and PRESENT are implemented in the first step,and a sum of their hardware area is computed.Then,the implementation of the proposed flexible architecture for ECC and PRESENT algorithms is presented.Implementation results regarding the area,clock cycles,latency,clock frequency,and power after the place-and-route level on Xilinx Virtex-5,Virtex-6,and Virtex-7 FPGA devices are presented.Hence,the implementation results and comparisons show that the proposed architecture suits applications demanding flexible implementation of cryptographic applications.

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.

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.

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.

An Incidental Finding and Unusual Presentation of Atypical Coccidioidomycosis in a 72-Year-Old Man: A Case Report

This case report presents an unusual and challenging diagnostic scenario involving a 72-year-old man who recently returned from a trip to Maui, Hawaii. While in Maui, the patient presented with a fever and fatigue that resolved spontaneously. However, he had an observable rash on his head and was given a steroid injection to resolve the rash. Later on his trip, the patient experienced a dry, nonproductive cough which resolved with a five-day course of prednisone. While visiting Michigan, the patient began to experience neck pain and visited Troy Beaumont Hospital for further treatment. Meningitis tests were negative. Vancomycin was given due to the detection of gram positive coccidioidomycosis in the culture, but this was later proven to be a contaminant. Coccidiomycosis does not initially have specific symptoms. Despite negative coccidioidomycosis antigen tests, the patient exhibited features more consistent with blastomycosis and cryptococcus, highlighting the complexities of diagnosing fungal infections with atypical presentations. The case emphasizes the importance of considering alternative fungal pathogens native to endemic regions and pursuing comprehensive diagnostic measures to establish an accurate diagnosis. Lastly, the discussion about recommendations for antifungal therapy and preventative measures for individuals at risk of respiratory fungal infections is critically important for the advancement of early detection of fungal infections.

PRESENT密码代数故障攻击

提出了一种新的PRESENT密码故障分析方法——代数故障攻击。将代数攻击和故障攻击相结合,首先利用代数攻击方法建立密码算法等效布尔代数方程组;然后通过故障攻击手段获取错误密文信息,并将故障差分和密文差分转化为额外的布尔代数方程组;最后使用CryptoMiniSAT解析器求解方程组恢复密钥。结果表明:在PRESENT-80的第29轮注入宽度为4的故障,故障位置和值未知时,2次故障注入可在50s内恢复64bit后期白化密钥,将PRESENT-80密钥搜索空间降低为216,经1min暴力破解恢复完整主密钥;和现有PRESENT故障攻击相比,该攻击所需样本量是最小的;此外该代数故障分析方法也可为其他分组密码故障分析提供一定思路。

PRESENT密码硬件语言实现及其优化研究

PRESENT密码算法是2007年提出来的一种轻量级分组密码算法,适合于物联网环境下的安全加密.研究了PRESENT密码算法结构,在原算法结构基础上优化了密钥扩展的实现方法,把密钥扩展不在原算法图的右边实现,而是放入轮运算中.在硬件实现上,31轮重复运算只实现一次,采用31次调用完成,从而可以大幅节约PRESENT密码实现面积.最后,对PRESENT密码的各核心模块进行了Verilog HDL实现,并分模块进行了测试数据验证.经FPGA综合下载后,实验结果表明优化的PRESENT密码硬件语言实现正确,面积相对原始算法更少.

缩减轮数PRESENT算法的Biclique分析

轻量级分组密码算法PRESENT由于其出色的硬件实现性能和简洁的轮函数设计,一经提出便引起了工业界与学术界的广泛关注.文中作者基于Biclique分析方法,首次提出针对21轮PRESENT-80算法的Biclique密钥恢复攻击方法.该攻击方法需要278.9的计算复杂度和264的数据复杂度.此外,针对PRESENT-80的Biclique攻击也可推广到相同轮数的PRESENT-128和DM-PRESENT压缩函数的安全性分析.与其它已公开密码学安全性分析结果相比,作者提出的Biclique攻击在内存复杂度上具有一定的优势.

基于PRESENT算法的RFID安全认证协议

物联网中RFID技术的应用非常广泛,但是RFID系统的安全性却存在着很大隐患。在RFID系统中标签与读写器间的通信信道是最易受到攻击,传输数据的完整性与保密性得不到保障,因而需要加强RFID系统通信的安全机制。考虑到RFID系统的硬件条件与成本限制,需要建立一个适合RFID系统的安全认证协议,来解决在RFID系统中信息传输所遇到的安全问题。PRESENT算法是轻量级的分组加密算法,将PRESENT结合到RFID系统的安全认证协议中,形成了新的RFID安全认证协议PRSA(PRESENT based RFID security authentication)。此协议可以增强RFID系统的安全性而又不会占用过多的硬件资源,从而能够适用于低成本的RFID系统的通信安全。

基于汉明重的PRESENT密码代数旁路攻击

研究了分组密码代数旁路攻击原理及模型、非线性布尔方程组转化为SAT问题的方法,提出了一种基于汉明重的PRESENT密码代数旁路攻击方法,降低了求解非线性多元方程组的复杂度,减少了旁路攻击所需样本量,并通过实验对理论正确性进行了验证。结果表明,在已知明文条件下,利用一个样本前3轮的S盒输入、输出汉明重在0.63s内即可恢复80bit PRESENT完整密钥;在未知明密文和S盒输入、输出汉明重随机选取条件下,也可恢复PRESENT完整密钥。