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Covid-19 Nasal Swab Test Led To Cerebrospinal Fluid Leak

Nina Shapiro

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The world's second-largest economy is catching up to traditional innovation front-runners, who were led again this year by Switzerland, Sweden, Britain and the United States, said the annual report by the U.N.'s World Intellectual Property Organization (WIPO), INSEAD Business School and Cornell University.

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这些新数据是由一个叫做全球碳计划(Global Carbon Project)的追踪项目提交的,发表在了期刊《自然·地球科学》(Nature Geoscience)上。数据公布之际,正是联合国(United Nations)一次峰会召开前夕。此次峰会意在激发新的政治愿望来解决气候变化问题。科学家说,这些数据表明,如果要把长期的全球变暖问题控制在可以承受的范围内,还需要做出极大的努力。
该报告指出,代理商和投资机构的涌入导致世界第二大经济体的增长方式和平台发生了额外的变化。小米科技公司的投资人和创始人雷军、360董事长周鸿祎、中国首富王健林等众多互联网大咖都大力支持流媒体的网络直播,这强烈表明了投资网红经济的巨大利润。
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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.

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当发生问题时,库克会迅速而无情地采取行动。2012年底,苹果过早推出了有缺陷的苹果地图(Apple Maps)应用之后,库克解雇了乔布斯的亲密盟友、领导开发iOS的斯科特?福斯托(Scott Forstall),以及前Dixons首席执行官、掌管苹果零售部门不到一年的约翰?布劳伊特(John Browett)。此举传递出一条信息:库克不会容忍业绩不佳或内部政治。
与此同时,布拉德福德大学管理学院(Bradford University School of Management)和爱丁堡大学商学院(University of Edinburgh Business School)的排名均上升16位,分别排在第42名和第55名。剑桥大学(University of Cambridge)佳奇管理学院(Judge Business School)的排名上升15位,排在第14名。

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