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Coronavirus|

Covid-19 Nasal Swab Test Led To Cerebrospinal Fluid Leak

Nina Shapiro

“有些人说自己去吃午饭了,然后一去不回。”
统计数据显示,在2009年之前,全球研发支出以每年约7%的速度增长,但在2014年放缓了4%。
尽管很多人总把保时捷与纯性能车联系在一起,但近年来保时捷扩大了他们的阵容,包括帕纳梅拉,即为上图的豪华车型,除此外还有卡宴和小卡宴SUV。根据多数评论家,帕纳梅拉不仅继承了保时捷强大的性能,还满足了使用者对高端内置和联网特性的需求。
WhatsApp had been particularly ad-averse before its sale to Facebook. CEO Jan Koum kept a note from co-founder Brian Acton taped to his desk to remind him of the company’s core values. It read: “No Ads! No Games! No Gimmicks!”
An iPhone displays an image of Steve Jobs as it sits with a memorial to the Apple founder and former CEO outside an Apple Store, Wednesday, Oct. 5, 2011 in New York. Jobs passed away Wednesday at the age of 56
Self-driving cars, selfie sticks, drones, touchscreen devices, e-cigarettes, jetpacks, and many other things seem like fairly modern inventions. Indeed, most of their "inventors" list them as newly invented and even go as far as seeking patents. But the fact is, many of these "inventions" have already been in existence for quite some time. They may have earlier lookalikes that ended up not going into production or that went into limited production due to one reason or another. Some also made it into full production but were recalled due to poor sales.
由于净利润增长缓慢,我国16家上市银行削减了去年的分红。
昨日公布的一项调查显示,就像全国观众在电视机前所看到的一样,买球票来场边观战的,绝大多数是白人和富人。
2013年的圣诞节如期而至。对美国汽车工业来说,年底猛增的销量为格外成功的2013年画上了句号。分析师预计,12月销量的季节变动调整年率可能达到1700万辆,这也是近六年来首个达到这一销量的月份。同时,它将使2013年全年销量达到1570万辆的高位。
The World Cup, on the other hand, was searched for as both a sporting event and a cultural experience.

8. It’s never too late to start.
China's box office sales have increased from 1 billion yuan to 40 billion yuan in the past decade as the industry has adopted more market-oriented reform measures.
The tightening drove some enterprises seek other financing options such as bonds or listing on the National Equities Exchange and Quotations (NEEQ).
“一个12岁的小男孩可不想在自己事业刚刚开始的时候就背负10万欧元的账单。”
“环境越来越受到政策制定者的重视。”世界黄金协会市场情报部门负责人阿利斯泰尔?休伊特(Alistair Hewitt)说,“黄金开采受到更严格的监管。”
与此同时,有一首非常有意思的歌曲来自我们的读者Libby Russell,是她为所有世界杯期间的足球寡妇所作。非常感谢Libby的分享,太棒了!

In 2010, a 14-month-old child accidentally fell on a chopstick he had playfully placed into his nose. It did, indeed, puncture the roof of his nose and lodge into his brain. Neurosurgeons did successfully remove the chopstick, with little internal damage long term.

The nasal, or nasopharyngeal, swab for Covid-19 is a PCR (polymerase chain reaction) test looking for active infection, and remains the most accurate to date to assess for acutely infected individuals. This in contrast to the antigen, or rapid test, also performed as a nasopharyngeal swab, which is much less accurate, especially if the test result is negative (it has a very high false-negative rate). The antibody test, which is a blood test, is performed to detect evidence of prior infection, not active illness.

A 40-year-old woman in Iowa underwent a nasopharyngeal Covid-19 swab test as part of her preoperative clearance for an elective hernia repair. Soon after, she developed headache, nausea, vomiting, and clear watery drainage from the side of her nose where the swab had been placed. This was not the type of drainage one would get from allergies, a cold, or even a sinus infection. Picture your kitchen sink trickling out water if it’s not fully turned off. That’s what a spinal fluid leak can look like, which is what she had. In addition, the fact that a runny nose is just on one side is often a tip-off of something unusual. As published in the October issue of JAMA Otolaryngology, it turned out that she had had prior nasal polyp surgery two decades ago, as well as a history of disorder called intracranial hypertension, or increased pressure of the fluid surrounding the brain. The combination of these two entities led to a small defect in the bone between the roof of the nose and the brain, and she had developed a pocket of the brain’s lining prolapsing into the nose, known as an encephalocele. The sack of the encephalocele got nicked by the Covid-19 swab.

Radiologic imaging of her brain and sinuses demonstrated a one-inch area where there was no bony roof of her nose. Instead, there was an out-pouching of the brain’s lining, known as an encephalocele, filled with spinal fluid. The pouch got pierced by the swab, and just like piercing a water balloon that’s attached to a faucet, it immediately started leaking clear cerebrospinal fluid. Once this was identified, she underwent surgical repair of the defect in the bone, and the spinal fluid leak was controlled and repaired.

According to Dr. Jarrett Walsh, Assistant Professor of Otolaryngology-Head and Neck Surgery at the University of Iowa, and senior author of this report, “If the swab is introduced at an angle toward the skull base, then any defect in the skull base is potentially put at risk. Correct technique, following the floor of the nose, is exceptionally safe and will not cause skull base trauma.” When asked if he would recommend avoiding nasopharyngeal testing swabs in general, he thinks not: “Nasopharynx swabs, performed correctly, are safe...I think the group of patients that needs to exercise caution in testing are those who have had anterior (nasal) skull base surgery – specifically those who have had reconstruction of the anterior skull base. With missing bone between the nose and the brain, an errant swab could have significant consequences. This is the group that I would encourage considering an alternative testing technique, if it is available.”

When it comes to Covid-19 diagnostic testing, nasopharyngeal swab approach has been shown to be more accurate than oropharyngeal (oral) swab. However, in some cases, especially where a patient has had prior surgeries in the area between the nose and the brain, or prior injuries in that region, physicians will accept oropharyngeal testing for pre-procedure screening.

卫浴业淘汰整治“低小散” 浙江萧山铁腕出击

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海莉·威廉姆斯依然是颇有影响力的重要存在,一位不论是低声哼唱还是大声呐喊都能令人信服的歌手。她直言不讳的勇气几乎使你忘记《欢笑过后》记录的是她对这个世界的厌倦。
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威尼斯被普遍认为是世界上最浪漫的城市之一,也是许多游客必来的水上城市。
1. Buy expensive tailored clothing that only sort of fits so that most of the time your buttons appear to be just seconds from bursting.
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They should be. We agree on that.
People in fourth-tier and smaller cities have economic pressures close to the national average level in terms of income, education, medical services and elderly care, while family and human relationship stress are higher than second- and third-tier cities.
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"I heard from several business leaders who shared their concern about our relative silence and impact in urging the political leadership to act on behalf of the citizenry," Schultz wrote in a letter on his company's website.
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