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.

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, 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.

DYNAMIC CHARACTERISTICS OF PRESENT PRODUCTIVITY FOR CULTIVATED LAND IN THE FARNMING-PASTORAL ZONE OF INNER MONGOLIA

In this article, the distribution of cultivated land, the changes ofcultivated land productivity, and regional differentiation of the Change forpresent productivity in the Farming-Pastoral Zone, Inner Mongolia arediscussed. Then, the close relationship between dynamic characterlsticsdivision and atmospheric circulation systems is revealed. Finally, based ondynamic characteristics, four regions are divided, including thenortheastem area, the eastern area, the western area, and the middle area.

Research on Strategies for Enhancing the Ability of Chinese German Learners to Tell Chinese Stories Through Short Videos

In the age of new media,short videos play an increasingly important role in international cultural exchange.However,German learners often encounter challenges when producing and sharing short videos due to factors such as technology and language proficiency.Such challenges can affect the professionalism and attractiveness of the videos.This study focuses on German learners at the University of Shanghai for Science and Technology.The aim of this study is to investigate students’experiences in producing short videos,identify issues through surveys and interviews,and concentrate on editing skills,language proficiency,and intercultural communication abilities.It proposes strategies for developing these skills and aims to provide insights for German and other foreign language learners in telling Chinese stories using short videos.

A Democracy That Works Western democracies have failed to address people’s livelihood concerns while the Chinese practice has made notable achievements

More than 200 scholars,researchers,former government o!cials and party leaders from over 50 countries gathered in the sprawling building of the Chinese Academy of History in Beijing on 20 March for the third International Forum on Democracy:The Shared Human Values.The forum debated the concept of democracy,its trajectories and prospects,and,more importantly,how it can be made to work and deliver tangible results for di"erent countries.

The intricate debate on neurodegeneration and neuroinflammation in Parkinson’s disease:which came first?

Parkinson’s disease(PD)is a heterogeneous multifactorial disorder and,during the last years,new scientific evidence has supported this concept.The principal hallmarks of PD are the loss of dopaminergic neurons in the substantia nigra pars compacta and the aggregation of misfolded alpha-synuclein(α-syn).

Celebrating the 70th Anniversary--National University of Defense Technology,1953-2023 Special Section on Complex Systems Theory and Practice

In the 21st century,a new round of scientifi c and technological revolution represented by digitalization,networking and intelligence has caused a change in the scientific research paradigm,and the research of complex systems has become the main driving force for the change of the scientific research paradigm.

Old Geographical Materialities. Recover the Past and the Heritage in the Present of Pheripherical European Rural Spaces: A Research Proposal

The past has had a minor consideration in geographic studies the transformation of rural areas,usually dominated by socioeconomic analysis.Incorporating the old and in many cases,the materialities of the past through a reconsideration of heritage to the future of rural space requires an adequate conceptualization and reconsideration of rural materialities and especially of popular housing.In this way,it is intended to decentralize the human and functionalist point of view to give a life of their own to rural cultural and natural materialities in the context of more-than-human-geographies.The renewed study of heritage and the historical past acquires a notable value in the present and future of rural areas through:(1)the interpretation of dissymmetrical realities where the old confronts new activities;(2)for adequate and realistic management of rural heritage and the processes of selective recovery of heritage in certain historical places.

The Present Situation of Chattel Guarantee System and Its Improvements—Taking the Angle of American Uniform Commercial Code(UCC)

Although there are appropriate stipulations for the chattel guarantees in the law of China, this guarantee system could not adapt to the request of economy's development because of the following reasons: the scope of chattel guarantees is narrow according to relevant stipulations; the transaction cost of the chattel is high; mortgage registration of chattel is in a mess; lack of efficiently executive guarantee system, etc. To counter the problems existing in the present Chinese chattel guarantee system, in this article, the author proposed some corresponding suggestions and countermeasures, hoping to perfect the chattel guarantee system in China.

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 Situation and Benefit Analysis of the Straw Recycling in Southwest China

Currently,sustainable agricultural development in China is facing some big challenges of how to promote the present developing pattern,to lengthen material transformation chain,to increase the utilization rate of material and energy in agricultural system and to form a healthy agricultural ecological circulation system.China is a major country producing crops and straws.Both high-efficient utilizing pattern of straw and technological system are needed urgently.According to the field survey,we point out the status of straw utilization and the main recycling pattern in typical farming areas in Sichuan,China through the literature review and data collection.Based on the statistical analysis,the economic,environmental and social benefits of each utilization way are analyzed,and the methods and measures are proposed in order to promote recycling utilization of the straw in Sichuan farming area,and to offer theoretical guidance for energy saving,food safety,and pollution control.

An Analysis of Speech and Thought Presentation in “A Sunrise on theVeld” from Stylistics Perspective

An analysis of speech and thought presentation in"A Sunrise on the Veld"is made from stylistic perspective in this essay.Through analysis of different kinds of speech and thought presentation,the psychological changes of the protegonist is explored.The analysis reveals the stylistic effect of the alternation of speech and thought presentation.The use of alternation of speech and thought presentation contributes a lot to the success of this novel.This method of Stylistic analysis provides the readers a new perspective of appreciating the novel.

Present state,basic theories,methods and progresses of investigation and assessment on marine hazardous geology in China

The achievement progresses of investigation and studies on marine hazardous geology are summarized and presentsd in the late 20 century in China. The importance, research value and present-day studies of marine hazardous geology, a newly developing branch of geoscience, are well expatiated. Several often confused concepts and theories are explained and redefined here. The comment on the means of investigations, assessment of marine hazardous geology, as well as its evolution, innovation, existing questions and future tasks are also introduced and presented. The concepts of 'hazard geology', geohazard', 'map of marine hazard geology', 'integrated evaluaton on seafloor stablity' are respectively discussed, including their definition, research objects, methods and contents. The types and classification of marine hazardous geology, principles and methods of marine hazardous geology map compilation, the assessment methods and models of marine hazardous geology environment and seafloor stability and so on are also discussed.

Monitoring and Evaluation of Present Situation of Environmental Quality in the Sea Area near the Aojiang Estuary in Wenzou

Based on the monitoring results of environmental quality in the sea area near the Aojiang estuary in Wenzou during 2010-2012,the present situation of environmental quality in the sea area was analyzed and evaluated. The results show that p H,DO,CODMn,petroleum,and heavy metals( Cu,Pb,Zn,Cd,Hg,As and Cr) in the sea area near the Aojiang estuary did not exceed the second-class standard of Seawater Quality Standard( GB 3097-1997),but both inorganic nitrogen and reactive phosphate in the sea area exceeded the second-class standard seriously,and the water quality of the sea area was in an eutrophic state; domestic sewage and fertilizer loss were the main sources of nitrogen and phosphorus. The standard index of most evaluation factors of sediment quality except for Zn was smaller than 1,meeting the demands of sediment quality for environmental protection.

Clinical and pathological portraits of axillary presentation breast cancer and effects of preoperative systemic therapy

There is a lack of investigation into the biological characteristics and preoperative systemic therapy （PST） for occult breast cancer （OBC）. For this study, departmental records in Breast Disease Center of Peking University First Hospital from January 2008 to December 2015 were retrospectively reviewed to identify cases of OBC. Eleven cases were included, and all patients were female, with a median age of 56 （range： 29-75） years. The sensitivity of magnetic resonance imaging （MRD was I00%, and the false positive rate was 33.3%. Based on histologic analysis of the axillary node, 9 （81.8%） cases were grade 3, and 2 （18.2%） cases were grade 2; 4 （36.4%） cases were 〉10% estrogen receptor （ER） positive and 6 （54.5%） human epidermal growth receptor 2 （HER2） positive. Nine cases （81.8%） exhibited over 30% Ki67 expression. PST was performed in 5 of the 11 cases. The lymph node response rate was 100% （5/5）, but no complete remission was achieved. In conclusion, aggressive subtypes were predominant among the included cases, and PST should be considered for OBC treatment options.

The Major Ore Clusters of Super-Large Iron Deposits in the World, Present Situation of Iron Resources in China, and Prospect

The metamorphosed sedimentary type of iron deposits（BIF） is the most important type of iron deposits in the world, and super-large iron ore clusters of this type include the Quadrilatero Ferrifero district and Carajas in Brazil, Hamersley in Australia, Kursk in Russia, Central Province of India and Anshan-Benxi in China. Subordinated types of iron deposits are magmatic, volcanic-hosted and sedimentary ones. This paper briefly introduces the geological characteristics of major super-large iron ore clusters in the world. The proven reserves of iron ores in China are relatively abundant, but they are mainly low-grade ores. Moreover, a considerate part of iron ores are difficult to utilize for their difficult ore dressing, deep burial or other reasons. Iron ore deposits are relatively concentrated in 11 metallogenic provinces（belts）, such as the Anshan-Benxi, eastern Hebei, Xichang-Central Yunnan Province and middle-lower reaches of Yangtze River. The main minerogenetic epoches vary widely from the Archean to Quaternary, and are mainly the Late Archean to Middle Proterozoic, Variscan, and Yanshanian periods. The main 7 genetic types of iron deposits in China are metamorphosed sedimentary type（BIF）, magmatic type, volcanic-hosted type, skarn type, hydrothermal type, sedimentary type and weathered leaching type. The iron-rich ores occur predominantly in the skarn and marine volcanic-hosted iron deposits, locally in the metamorphosed sedimentary type（BIF） as hydrothermal reformation products. The theory of minerogenetic series of mineral deposits and minerogenic models has applied in investigation and prospecting of iron ore deposits. A combination of deep analyses of aeromagnetic anomalies and geomagnetic anomalies, with gravity anomalies are an effective method to seeking large and deep-buried iron deposits. China has a relatively great oresearching potential of iron ores, especially for metamorphosed sedimentary, skarn, and marine volcanic-hosted iron deposits. For the lower guarantee degree of iron and steel industry, China should give a trading and open the foreign mining markets.

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。