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.

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.

H7N9 influenza-the laboratory presentations: A letter to editor

To the editor,1.Introduction to new H7N9 bird flu Influenza virus infection is an important group of respiratory infectious disease.Several groups of influenza viruses can cause human infections.However,in the recent years,there are many newly emerging influenza infections,which have never been previously seen in human.Crossing species from animal to human lead

Unusual presentations of cutaneous leishmaniasis in clinical practice and potential challenges in diagnosis:a comprehensive analysis of literature reviews

Cutaneous leishmaniasis is regarded as a re-emerging disease due to its increase in spread and rate of transmission over the past decade due to a proportionate increase in global human movements.This study was therefore carried out to review epidemiology,laboratory diagnosis and treatment with in-depth discussion on some of the rare clinical presentations of the disease capable of influencing its control.The study was based on literature review on clinical and laboratory features of cutaneous leishmaniasis from original research articles,review articles, short communications,letters to editor and case reports on the disease for the past 10 years(April 2000 to April 2010).The results were analysed using simple descriptive methods.The rarest presentations of leishmaniasis encountered were peritibial ulcerations,hard painful nipple in a male,swollen upper lip,dermatofibro sarcoma protuberans,sternal proliferative growth,turban tumour,post operative granuloma,chalazion-like 0.00%,and cutaneous sterile pyogranuloma with asymmetrical alopecia 0.00%each.Others include infected sebaceous cysts 0.45%,syphilis 0.19%,yaws 0.13%,thrombotic ulcerations 0.40%,mycetoma 0.90%,sarcoidosis 0.67%,painless nasal solitary nodule 0.00%,tuberculous lymphadenopathy 0.25%and unilateral erythema nodosum 0.28%.Physicians practicing in cutaneous leishmaniasis endemic,but most especially in the non-endemic areas should bear in mind that the disease may not be that rare in the context of the present global village phenomenon:and that,the next case could just be that of cutaneous leishmaniasis,the clinical picture of the patient notwithstanding.

Primary localized gastric amyloidosis:A scoping review of the literature from clinical presentations to prognosis

Localized gastric amyloidosis(LGA)is a rare disease characterized by abnormal extracellular deposition of amyloid protein restricted to the stomach and it is confirmed by positive results of Congo red staining.Over decades,only a few cases have been reported and studies or research focusing on it are few.Although LGA has a low incidence,patients may suffer a lot from it and require proper diagnosis and management.However,the pathology of LGA remains unknown and no overall review of LGA from its presentations to its prognosis has been published.Patients with LGA are often asymptomatic or manifest atypical symptoms,making it difficult to differentiate from other gastrointestinal diseases.Here,we report the case of a 70-year-old woman with LGA and provide an overview of case reports of LGA available to us.Based on that,we conclude current concepts of clinical manifestations,diagnosis,treatment,and prognosis of LGA,aiming at providing a detailed diagnostic procedure for clinicians and promoting the guidelines of LGA.In addition,a few advanced technologies applied in amyloidosis are also discussed in this review,aiming at providing clinicians with a reference of diagnostic process.With this review,we hope to raise awareness of LGA among the public and clinicians.

Presentations 3.0 for Windows帮你完善演讲制作的效果

你需要准备演示用的幻灯片吗?现在的大多数产品可以制作出乍一看不错的幻灯片。但是,为了使老板满意,为了在竞争中获胜,你必须特别注意演示内容。此时就需要有一个能帮你整理思路的产品,该产品还应该能够针对不同的演示内容和演示对象提出有关最佳方案建议。

Characteristics and clinical presentations of pediatric 0retinoblastoma in North-western Iran

·AIM:To report the characteristics and clinical presentations of retinoblastoma in a series of pediatric patients from Iran. ·METHODS:In this retrospective study, profiles of pediatric patients with retinoblastoma archived in a referral eye hospital in north-west of Iran during 7 years (n =40 patients with 57 eyes) were reviewed. Demographics, as well as the laterality, clinical manifestations and the types of treatment were the major endpoints. The Student’s t test, Mann-Whitney U -test, Chi-square or Fishers’ Exact test was used for analysis where appropriate. ·RESULTS:There were 23 cases (57.7%) with unilateral and 17 cases (42.5%) with bilateral involvement. The male to female ratio was 1 to 1.4 with a mean admitting age of 24.0±11.3 (range:5-62) months. The mean diagnosis delay was (7.4±9.6) months (range:10 days to 13 months). The most common presenting sign was leukocoria (97.5%) followed by proptosis (7.5%), strabismus (7.5%), hyphema (5%), orbital cellulitis (5%) and glaucoma (2.5%). Enucleation was performed in 95.7% of the cases with unilateral involvement and at least one eye of the patients with bilateral disease. A second enucleation was performed in other 3 patients (17.6%) of the latter group. ·CONCLUSION:This is the first study evaluating a series of Iranian children with retinoblastoma.

Take Presentations into the EFL Classroom

Presentations are activities in which people show,describe,or explain something to a group of people.They are often used in American school classrooms.On the base of the author’s referring to literature,observing classes and co-teaching practice,presentations are suggested to be applied to EFL classrooms to help students improve their speaking levels and integrate their language skills efficiently.In point of ways of organizing,presentations can be divided into three types:controlled,guided and free ones.While in point of ways of applying,they can be divided into five types:interactive,role-plays,interview,note-taking,and discourse analysis ones.Thus different types of presentations should be adopted according to EFL students’different levels and different communication purposes.Topics relating to EFL students’study,life and interest are practical for presentations.Important aspects of presentations include:posture and presence,eye contact with the audience,volume and voice projection,rate of speech,use of audiovisual aids,vitality,adherence to the topic,keeping track of time,natural delivery,fluency and accuracy,the quantity of information presented,the way the topic was handled and how the questions are handled in the post-presentation session and so on.Presentation evaluations can be done by the teacher or together with student peers.

Amniotic Fluid Embolism (AFE): A Review of the Literature Orientated on Two Clinical Presentations--Typical and Atypical

Background/Aim: Recently, a comparative study on the incidence of AFE has highlighted rather confusing results, showing that the complication is more than three times higher in North America than that in some European countries. In this paper, we put forward the hypothesis that this discrepancy is due to inaccurate diagnosis of non-classical form of AFE (atypical AFE). We also provide an outline of symptoms that characterize this type of AFE based on the analysis of all available case reports. Material and Methods: We searched Medline from 1969 (its inception) to 2011, using the key words “amniotic fluid embolism”. The search produced 1127 articles, including 208 case reports of AFE and other publications identified as eligible for our study (11 review articles and 6 population-based studies of the last few years). Moreover, we looked through the articles from the period before “inception of Medline” to find 178 earlier case reports. Full texts were analyzed. Results and Conclusions: (i) Worldwide, 447 cases of AFE have been reported, including 70 cases of atypical AFE (15.7%). (ii) Typical AFE is characterized by three clinical phases (cardiopulmonary collapse, clotting disorders and hemorrhages, multiorgan disturbances), whereas the atypical one shows lack of cardiopulmonary collapse as the initial presentation—the first to appear is obstetric hemorrhage and/or pulmonary and renal dysfunction. (iii) Four subclasses of atypical AFE were distinguished on the basis of case reports: uterine hemorrhage-type of AFE, ARDS as the only presentation of atypical AFE, paradoxical AFE, and cesarean section-related atypical AFEs.

Atypical presentations of propionic acidemia

One of the most common recessively inherited organic acidemias is the Propionic Acidosis (PA) which results from Propionyle-CoA Carboxylase (PCC) enzyme deficiency that is necessary for the catabolism of the branched chain Amino Acids and other metabolites. Classically this disease presented with high anion gap metabolic acidosis with its clinical consequences. We report 4 patients who presented to our facility with sepsis like picture and no metabolic acidosis. All of them were found to have high ammonia level. Diagnosis was confirmed by tandem MS/MS and urine Gas Chromatography/ Mass Spectrometry (GC/MS). All of them were treated supportively and by supplementation of adequate calories and PA formula. The different presentations may be very well attributed to the PCC molecular defects heterogeneity. Mutations in both genes PCCA and PCCB can cause PA with more frequent heterogeneity of PCCA gene. In spite of the fact that PCCB gene is responsible for the most of the oriental cases, our first patient condition was attributed to PCCA gene with a rare mutation which was not described in the literatures.

Epidemiology, Clinical Presentations and In-Hospital Mortality of Venous Thromboembolism at the Douala General Hospital: A Cross-Sectional Study in Cameroon, Sub-Saharan Africa

Background: Venous thromboembolism (VTE) is a major cause of morbidity and mortality worldwide. It is also the most common complication in hospitalized patients. Aims:?To?study the in-hospital prevalence of VTE, describe the socio-demographic characteristics of patients, determine the frequency of risk factors, describe the clinical presentations, and determine the short term outcome of VTE in hospitalized patients in a low-income tertiary hospital setting.?Methods: We carried out a cross-sectional descriptive retrospective study over a period of 6 years and 4 months (January 2008 to April 2014) in the Douala General Hospital—Cameroon. Patients were cases of confirmed venous thromboembolic disease (VTE).?Results: A total of 78 case files were retained for this study, giving an in-hospital prevalence of 4.4 per 1000 admissions. There were 42 (53.8%) males and 36 (46.1%) females. Their ages ranged from 18 to 89 years (median: 53 years, [IQR: 40?-?61]).?There were 37 (47.4%) cases of Deep Vein Thrombosis (DVT), 31 (39.7%) cases of Pulmonary Embolism (PE), and 10 (12.8%) cases of PE associated with DVT (12.8%). The main risk factors were obesity (44.9%), hypertension (37.2%), immobility (20.5%), and long-haul travel (17.9%). The most frequent clinical presentations in PE were dyspnea (80.5%) and chest pain (65.9%). There were 8 (10%) in-hospital deaths. Conclusion: About twelve cases of VTE are seen yearly at the DGH, with an in-hospital mortality of ten percent. Obesity and hypertension were the main risk factors, with dyspnea and chest pain being the main clinical manifestations in PE, and lower limb swelling the main symptom in DVT.

Atypical Presentations of COVID-19

Coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2, emerged in Wuhan, China in December 2019. It has now spread to all parts of the world and as of 26th July 2020, more than 16 million cases and over 600,000 deaths have been reported. The commonest presentation is respiratory in nature with non-productive cough, fever and shortness of breath. Some COVID-19 patients have had atypical or unusual presentations involving the neurological, metabolic, gastrointestinal, renal, haematological, cutaneous and cardiovascular systems. In this mini-review, we have outlined the main atypical or unusual clinical presentations of COVID-19.

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.

“主题陈述+应用实践”模式在“社会学概论”课程教学中的运用——以H高校社会工作专业为例

文章通过对H高校“社会学概论”课程传统教学模式进行诊析,发现存在教学内容上重知识传授、轻立德树人;教学设计上重理论灌输、轻实践教学;教学方法上重教师主导、轻学生参与等问题。因此,课程教学团队以建构主义学习理论为指导,秉持“为学习者设计教学”的理念,创新性地提出以“主题陈述+应用实践”(Presentation+Practice)为核心的教学模式。该模式在理论教学部分增设“悦读经典”新环节,与学生共同选择高质量文献进行研讨,培养学生的研究能力与表达能力;在实践教学部分,创造性地移植并导入工科专业的“课程设计”环节,要求学生选择研究主题进行社会实践、撰写研究报告,帮助学生初步形成了运用专业理论知识和技术解决相关工作中实际问题的本领,提升了学生的能力。这一教学模式的创新契合“00后”大学生的学情特点,取得了显著的教学成效。

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.

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.

Fournier’s Gangrene: 13-Year Experience in a Tertiary Center, North Eastern Nigeria

Background: Fournier’s gangrene is a fulminant infection of the genitourinary tract characterized by progressive necrosis of the skin and subcutaneous tissue of the external genitalia. Initially mainly seen involving the scrotum of elderly men with different moods of occurrence each unpleasantly lethal. With varying types of presentation only one thing has remained constant;the poor prognosis of this condition. Purpose/Aim: Thus, it’s important to study the trends of the presentation of this condition laying emphasis on the challenges in the management of these patients;both the negative and positive prognostic factors. Materials and Methods: Urology ward record books, clinic record books and operating theater records were used to identify patients managed for Fournier gangrene in ATBUTH Bauchi. A retrospective study of the medical files of all the patients managed from January 2011 to January 2024 was done. Data was analyzed using SPSS version 29. Results: Data from 47 patients seen during the period of study were carefully collected and analyzed. The age range is 2 weeks to 97 years. There were two neonates, one at 2nd week of life and the other at 3rd week. Mortality rate is 36%. The average time duration before presentation for patients that died was two weeks, a minimum of 9 days prior to presentation and a maximum of 21 days, about 10 of which came in septic shock and the remaining presented with fever and very extensive necrotizing fasciitis of the perineum. All the patients that died had diabetes mellitus as a comorbidity except the neonate. All the patients that survived were much younger, all were below 60 years of age (2 weeks - 53 years). Conclusion: Here, we share our experience managing patients with Fournier’s gangrene in our facility in the past 13-year period from January 2011 to January 2024. .

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.

Graph Properties and Stratified Presentations of Partially Ordered Sets

In this paper, we introduce some new definitions such as the U＊L＊ condition to describe the zero-divisor graph G = F（P） of a poser P, and give a new and quick proof to a main result in [2, 4]. By deleting a typical vertex with least degree, we provide an algorithm for finding a maximum clique of a finite graph G. We study some properties of the zero-divisor graphs of posets concerning diameters and girths. We also provide stratified presentations of posets.