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Coronavirus|

Covid-19 Nasal Swab Test Led To Cerebrospinal Fluid Leak

Nina Shapiro

统计显示,截至2015年底,西藏约有59万农村贫困人口。
而伦敦预计今年将接待1888名游客。
菲亚特(Fiat)试图就投资克莱斯勒(Chrysler)条款重新谈判。
Additional reporting from Stefan Wagstyl in Berlin
demonstration
1. Peaceful Era
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7.《大白鲨》
如果你每周的周一到周五没有一天早晨醒来感到一种想要去工作的兴奋,那么这就是一个问题了。那意味着你没有能够享受你的工作并且你的工作正在破坏你的生活质量。如果你每天醒来,恐惧去上班,那么是时候辞掉你的工作了
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The Wizards need to surge ASAP if they want to stay in this. We saw what happened last year when they waited too long to get it together.
库克的缺乏表现欲,并不总被视为一种优点。
'Short Term 12' is one of those small indie features that stays with you in a big way. It's only 96 minutes long, a modest production set in a foster-care facility for troubled teens. Yet Destin Cretton's direction and Brie Larson's performance elevate the film to, well, one of the year's very best. Ms. Larson is almost a sure thing for not getting an Oscar-this year's competition is unusually fierce-but do catch up with her portrayal of Grace, a 20-something supervisor who is far from untroubled in her own life.
The People’s Bank of China has long intervened in foreign-exchange markets to hedge against excessive volatility. Since August, however, such intervention has expanded from the domestic spot market, which covers daily transactions, to include the offshore renminbi market in Hong Kong, as well as both onshore and offshore futures markets, traders say.
“如果30年前的改革是解决意识形态问题,现在则要解决利益问题。改革是调整既得利益,等于拿刀割自己的肉,很痛苦,需要下定决心、坚定信心。”

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.

如何保障老漂族权益?地方政府应担起相应责任

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The values of the citizenry are a democracy’s most important asset.

TextPride是一门不错的生意,就是规模太小。与此同时,短信应用市场正在爆炸式增长。Facebook公司斥资190亿美元并购了WhatsApp,这款产品的每月活跃用户现已达到7亿人。拥有2.5亿注册用户的应用Tango目前市值15亿美元。Kik拥有2亿注册用户。Snapchat价值100亿美元,拥有一亿用户。Kik赞助的一项新研究表明,美国用户现在花在短信应用上的平均时间要多于社交网络应用。不过唯一的问题是,这些短信应用需要找到赚钱的手段,目前广告主还没找到靠谱的方式插入朋友间的聊天之中。
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Female vocalist: Miranda Lambert
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