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Covid-19 Nasal Swab Test Led To Cerebrospinal Fluid Leak

Nina Shapiro

How do you know if you need to drink more water? Well, there's a list of factors: dry lips, dizziness, headaches, low urine output and increased thirst. Yet, this smart bottle wants you to listen more to your phone than to your body.
“有个人把一杯咖啡摔在地上后就扬长而去。”
无论你相信与否,今年的搞笑文学奖被授予美国政府审计总署(GAO),以表彰他们发表的有关如何准备一份报告的报告的报告的报告……
但煽动家利用此类抱怨的做法威胁到了民主。
美国仍是最具价值品牌大国,2016年该国10强品牌的品牌价值增长10%,至1.3万亿美元。以沃达丰(Vodafone)为首的英国10强品牌的品牌价值缩水8%。以德国软件集团SAP为首的欧洲大陆10强品牌的品牌价值增长5%。最后,以腾讯(Tencent)、中国移动和阿里巴巴(Alibaba)为首的亚洲10强品牌的品牌价值达3600亿美元,仅比欧洲大陆和英国10强品牌的品牌价值总和低10%。
不会。华尔街策略师预测美国政府的10年期借贷成本将在未来一年攀升至3%以上,这话就像尴尬的办公室聚会一样是圣诞节那段时间的固定节目。鉴于美联储退出量化宽松和美国减税,今年的预测看起来更有可能实现。然而,压低通胀和长期债券收益率的长期重大因素依然存在,并且仍然被低估。2018年美联储将至少加息三次,但10年期收益率不会突破3%。
Many believe the population is no longer a major threat to China's resources and environment. Instead, China's population challenges have shifted to low birth rates, an aging society and a widening gender imbalance. China has already experienced a shortage of skilled workers in places like the Pearl River Delta, so it might not be long before we see major reforms.
The 12 US schools that appear in this ranking are the most gender balanced on average, with cohorts that are 48 per cent female.
尽管可以下载的课程具有较好前景,但在现实世界,得到官方承认的学历仍然基于课堂教学活动。初创公司采取了这样一种态度:如果他们无法以新的服务交付方式在高校的地盘上击败它们,那就应该与之建立合作伙伴关系。其结果是,他们忙着争取考试委员会核准他们的在线课程,使其可以算作学士或硕士学位资格的一部分。
在岛上海边的总督大楼,数万名支持群众等待罗塞略在宣誓就职典礼后的到来,手握着伞挡住炽热阳光。

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The improvements in education levels mirrored the development of China's education system. Independent research into China's education situation showed that overall education development was better than the world average last year, Yuan Guiren, minister of education, said in March.
Intel
Writing for a Comedy Series: Aziz Ansari and Alan Yang, “Master of None” (“Parents”)
Consider:
After months have passed without a culprit in her daughter's murder case, Mildred Hayesmakes a bold move, painting three signs leading into her town with a controversial message directed at William Willoughby, the town's revered chief of police. When his second-in-command Officer Dixon, an immature mother's boy with a penchant for violence, gets involved, the battle between Mildred and Ebbing's law enforcement is only exacerbated.

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.

楼市信贷终于拧紧 首付贷产品已经全部被取消

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体积大未必就是好的。
获奖者:布兰妮·斯皮尔斯

凸起那部分有个“涡卷饰品”——(古埃及碑上)在王和神的名字周围的椭圆形装饰。考古学家在上面发现有眼镜蛇一只眼的符号。
Will Emmanuel Macron secure a commitment from German chancellor Angela Merkel on a eurozone budget
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Sweden’s foreign minister, Margot Wallstrom, a proponent of a “feminist foreign policy,” opened up to Ellen Barry about her abuse at the hands of an old boyfriend when she was a young woman, something she had never said publicly before.
“有个家伙有一天跟所有同事说这是他最后一天了,结果却没让老板和人力资源部经理知道。”
Now the burden is on Noel to prove that he's capable of being more than the shell of a player he often looked like amidst the Sixers' disarray.
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This means war: Christopher Nolan's second film not set in the present (or future) is an epic tableau about the rescue of hundreds of thousands of troops from the French coast. Tom Hardy, Mark Rylance, Kenneth Branagh, Cillian Murphy and, er, Harry Styles, star. Think Saving Private Ryan, but saltier.
主机运营商HostGator.com公司的布兰迪o班奈特认为,在一家可靠的网站上坚持写博客,或者做一名志愿者,贡献出你的时间和技能。不要去告诉别人你是谁,而应该通过实际行动去展示你自己,这样做可以积累专业知识以及个人信誉。
The best bosses understand that there must be a balance between the company or client’s needs and the needs of his or her employees. The best bosses are willing to listen and talk about any issues an employee may be having because they understand that a happy employee is a more productive employee。
合作公寓和共管公寓
'Nebraska' gets to the heart of Bruce Dern's prickly old geezer, Woody Grant, by way of a road trip across Montana and Nebraska, shot in radiant black-and-white. (Here again one of the movie's stars is its cinematographer, Phedon Papamichael.) Alexander Payne directed, flawlessly, from Bob Nelson's stellar script, which is all about thwarted love, and reconciliation, between Woody and his son Will; he's played with painfully quiet eloquence by Will Forte. Here's the American heartland as it's seldom portrayed on screen, with humor and almost palpable fondness.
Feud: Bette and Joan
4.英国人似乎总是喜欢道歉,但道歉的意义并不相同。在英国,“对不起”实际可能表示这几种意思:(1)我没听清你说什么;(2)我没明白你的意思;(3)我听到了你说的,也明白你的意思,可我觉得你是个白痴。