Results of Angioplasty With Double-Layer Mesh Stent and Protection Systems of the Extra- and Intracranial Dissection of Cephalic Arteries

Purpose: Although a majority of cervical artery dissections can be managed conservatively, patients presenting with cerebral embolization or significant stenosis require a more aggressive approach. However, complications associated with endovascular repair are quite frequent and optimal interventional technique still remains to be established. Materials and methods: The aim of this post hoc survey was to analyze results of endovascular treatments for symptomatic dissections of the internal carotid and vertebral arteries, which were performed under protection and with the use of double-layer mesh stents. During endovascular procedure catheters, stents and protection systems were tailored according to the angioarchitecture of dissection, particularly to its location, length and coexisting stenotic or aneurysmatic lesions. We evaluated retrospectively midterm and late results of endovascular treatment of 25 patients presenting with symptomatic dissection of cervical arteries, including 11 patients with dissections of intracranial segments of the internal carotid artery. Follow-ups were scheduled 1, 3 and 6 after the procedure, and then every 6 months. Control computed tomography (CT) or digital subtraction angiography (DSA) arteriographies were performed 1–6 months and 12 months after endovascular repair. Results: There were no periprocedural major adverse events. All patients completed the 12-month follow-up. There were neither fatalities nor new neurologic adverse events at the 30-day follow-up, and no such adverse events during long-term follow-up. At 12-month follow-up, in all patients, angiographies revealed patent stents, full coverage of lesions by stents and complete thrombotic closure of the pseudoaneurysms. Conclusions: A tailored endovascular management of symptomatic dissection of cervical arteries is safe and efficient, also in a long run.

Extending Uppsala Model with Springboard Perspective in Emerging Multinational’s Sequential Internationalisation—Evidence from a Construction Company’s Expansion in Africa

The Uppsala model explains the traditional internationalisation process of multinational enterprises (MNEs), which gradually begin to internationalise from countries with smaller psychic distances. However, in the turbulent global economy, an increasing number of MNEs from emerging markets (EMNEs) adopts a more radical and aggressive approach, strategically using international expansion as a springboard to enter an overseas market and radiate surrounding countries and regions. By combining the springboard perspective and the Uppsala model, we analyse a series of processes from EMNE’s first entry into an overseas market to the successful localisation and expansion of international business. This radical model of international expansion has not been thoroughly studied. This empirical study aims to address this research gap by using a qualitative method and an in-depth case study. This paper conducted a semi-structured interview with 16 expatriates, executives, and middle-level managers from the case company in 2016. As one of the few single case studies that systematically studies the internationalisation process of EMNEs and provides first-hand empirical evidence, it contributes to practice and provides a contextual reference for EMNEs.

Current Perspectives on Achieving Pronounced Enteric Methane Mitigation From Ruminant Production

Limiting global warming to 1.5°C above pre-industrial levels by 2050 requires achieving net zero emissions of greenhouse gases by 2050 and a strong decrease in methane (CH4) emissions. Our aim was to connect the global need for mitigation of the emissions of greenhouse gases and enteric CH4 from ruminant production to basic research on the biological consequences of inhibiting rumen methanogenesis in order to better design strategies for pronounced mitigation of enteric CH4 production without negative impacts on animal productivity or economic returns. Ruminant production worldwide has the challenge of decreasing its emissions of greenhouse gases while increasing the production of meat and milk to meet consumers demand. Production intensification decreases the emissions of greenhouse gases per unit of product, and in some instances has decreased total emissions, but in other instances has resulted in increased total emissions of greenhouse gases. We propose that decreasing total emission of greenhouse gases from ruminants in the next decades while simultaneously increasing meat and milk production will require strong inhibition of rumen methanogenesis. An aggressive approach to pronounced inhibition of enteric CH4 emissions is technically possible through the use of chemical compounds and/or bromoform-containing algae, but aspects such as safety, availability, government approval, consumer acceptance, and impacts on productivity and economic returns must be satisfactorily addressed. Feeding these additives will increase the cost of ruminant diets, which can discourage their adoption. On the other hand, inhibiting rumen methanogenesis potentially saves energy for the host animal and causes profound changes in rumen fermentation and post-absorptive metabolism. Understanding the biological consequences of methanogenesis inhibition could allow designing strategies to optimize the intervention. We conducted meta-regressions using published studies with at least one treatment with >50% inhibition of CH4 production to elucidate the responses of key rumen metabolites and animal variables to methanogenesis inhibition, and understand possible consequences on post-absorptive metabolism. We propose possible avenues, attainable through the understanding of biological consequences of the methanogenesis inhibition intervention, to increase animal productivity or decrease feed costs when inhibiting methanogenesis.

Surgery and Catheter Ablation for Atrial Fibrillation: History, Current Practice, and Future Directions

Atrial fibrillation (AF) is the most common of all cardiac arrhythmias, affecting roughly 1% of the general population in the Western world. The incidence of AF is predicted to double by 2050. Most patients with AF are treated with oral medications and only approximately 4% of AF patients are treated with interventional techniques, including catheter ablation and surgical ablation. The increasing prevalence and the morbidity/mortality associated with AF warrants a more aggressive approach to its treatment. It is the purpose of this invited editorial to describe the past, present, and anticipated future directions of the interventional therapy of AF, and to crystallize the problems that remain.

Bentall–De Bono procedure for aortic regurgitation and intraoperative rupture of moderately dilated ascending aorta: A case report

<p>We herein present a clinical case of root and ascending aortic replacement in a patient with borderline enlargement of the ascending aorta and aortic valve insufficiency. A 65-year-old man was admitted to our clinic with signs of heart failure. Subsequent echocardiography and contrast-enhanced computed tomography revealed hemodynamically significant aortic insufficiency, as well as expansion of the ascending aorta. Diameter at the levels of the sinuses of Valsalva, sinotubular junction and tubular portion of the ascending aorta were 48, 47 and 44 mm, respectively. Based on the aforementioned data, indications for isolated aortic valve replacement were determined. Although the main portion of the surgery was unremarkable, at its final stage, a rupture of a section of the ascending aorta occurred. The results of intraoperative express histological examination of the enlarged aorta revealed connective tissue dysplasia and cystic median necrosis. Replacement of the ascending aorta was performed using the modified Bentall–De Bono technique. This case demonstrated that a borderline aortic dilatation of 40–50 mm at the ascending aorta was associated with pathological changes in its wall, which can cause fatal complications (rupture and dissection) and may require a more aggressive approach during surgical correction. Intraoperative express histological examination of the wall of the ascending aorta in ambiguous situations can help determine the scope of the intervention.</p><p>Received 16 March 2021. Revised 14 September 2021. Accepted 15 September 2021.</p><p><strong>Funding:</strong> The study did not have sponsorship.</p><p><strong>Conflict of interest:</strong> The authors declare no conflict of interest.</p><p><strong>Contribution of the authors<br /> </strong>Literature review: S.Yu. Boldyrev, M.A. Marukyan<br /> Drafting the article: S.Yu. Boldyrev, M.A. Marukyan, V.N. Suslova<br /> Critical revision of the article: S.Yu. Boldyrev, V.A. Porkhanov<br /> Surgical treatment: S.Yu. Boldyrev, M.A. Marukyan<br /> Final approval of the version to be published: S.Yu. Boldyrev, M.A. Marukyan, V.N. Suslova, K.O. Barbukhatti, V.A. Porkhanov</p>

Post-Sensationalism: Catastrophism and Fight Paradigm in Romanian On-Line Media

In traditional journalism, sensationalism was a characteristic of tabloid press. The main instruments used in sensationalistic headlines were bombastic epithets (awesome, amazing, greatest etc), and exaggerations used to increase the impact by curiosity. In the last decade, transformation with society and online media consumption behaviour have triggered a change of paradigm: we believe that we are facing a post-sensationalism media narrative, defined by catastrophism and the fight paradigm. In the context of a huge news feed overloaded with information, in the purpose of increasing the number of views of online media, the journalistic discourse has transformed radically and switched from informative to a more aggressive approach. The study shows that in Romania, the pursuit for clicks has generated a new discursive paradigm, a sort of post-sensationalism era, which we referred to as catastrophism and fight paradigm. This conclusion is based on quantitative and qualitative research that analysed Romanian online press headlines and content in approximately the same period of time both in 2018 and 2019. The research followed the frequency and context of usage of a few hashtags and keywords connected with our main concepts of concern: sensationalism, catastrophism, fight paradigm. In other words, we selected a few words that are, in our opinion, the most representative for the aforementioned concepts, and, with the use of professional instruments of press monitoring, we analysed their frequency and dynamics.

Games theory and strategic alliances: applications to British Russian partnership

PurposeThis conceptual paper examines the need for viable theoretical models of international learning alliances in the light of cooperative games and complexity in two distinguished educational settings. Game theory is used to demonstrate the need for the top managerial executives to acquire a detailed understanding of decision makers' behaviours and trigger the deployment of complex analytical methods. The paper scrutinizes Russia's pursued aggressive approach using shock therapy, also suggest the critical need to reform policy.Design/methodology/approachCombining the critical analysis of (1) cooperative games and (2) adaptive systems structures, a dependable model is derived, which sets the baseline for determining the role of costs and gains. The analysis is supported using a real-world example of an alliance between British University (the X and Y alliance) and Russian University. It also emphasizes the importance of both internal and external pressure variables closely connected with the cooperative games, adaptive system and shock therapy.FindingsTwo features of alliances have been emphasized. The first is the importance of informal relationships in the evolution of partnerships and of cooperation. This is a well-known factor in the success of any relationship. Especially in international partnerships, empathy at the individual level is perhaps necessary to bypass the influence of historical and cultural differences that are barriers at the macro level, preconditions rather than consequences of successful policies and contractual arrangements at the level of organizations and governments. The second feature is interdependence at the cost–benefit level and in the domain of decisions. The cooperation of both partners is required to realize payoffs.Practical implicationsThe implication of this paper is a guideline for regulators and policymakers designing worldwide alliances in higher education. In addition, this paper covers an interesting domain that could be of interest to organizations involved in forming strategic alliances, developing and re-engineering policies for strategic coalitions and setting future profitable payoff relationships within the contextual limitations of X and Y.Originality/valueThis paper creates new knowledge by concisely examining the meaning of strategic alliances in the context of the global education industry.

Short of Suspension: How Suspension Warnings Can Reduce Hate Speech on Twitter

Debates around the effectiveness of high-profile Twitter account suspensions and similar bans on abusive users across social media platforms abound. Yet we know little about the effectiveness of warning a user about the possibility of suspending their account as opposed to outright suspensions in reducing hate speech. With a pre-registered experiment, we provide causal evidence that a warning message can reduce the use of hateful language on Twitter, at least in the short term. We design our messages based on the literature on deterrence, and test versions that emphasize the legitimacy of the sender, the credibility of the message, and the costliness of being suspended. We find that the act of warning a user of the potential consequences of their behavior can significantly reduce their hateful language for one week. We also find that warning messages that aim to appear legitimate in the eyes of the target user seem to be the most effective. In light of these findings, we consider the policy implications of platforms adopting a more aggressive approach to warning users that their accounts may be suspended as a tool for reducing hateful speech online.

Security in South East Asia: How Are South East Asian Countries Ensuring Their Security in an Uncertain Asian Security Environment Due to the Rise of China as a Regional and Global Power?

<p>The countries of Malaysia, Viet Nam and Indonesia are using a hedging strategy to ensure their security. The Philippines is pursuing a dual policy of hedging and balancing with the US. Singapore is following a policy of hedging but is verging on bandwagoning with the US. All countries are leveraging off ASEAN and its associated fora as their first line of defence. While ASEAN and its fora are adequate for dialogue they are not effective in solving disputes among ASEAN countries or between ASEAN countries and China. The uncertain military rise of China and territorial and maritime disputes with China are causing South East Asian countries to feel insecure. While China professes a policy of “Peaceful Development” its actions in 2009 and 2010 indicated a more aggressive approach to its claims over the entire South China Sea that it now states is an area of “core Interest” to China along with Taiwan. South East Asian countries are expanding or have plans to expand their defence force capability. The US is considered an important actor in guaranteeing South East Asian security and keeping China’s territorial ambitions in check in the immediate future. The countries of Malaysia, Viet Nam, Indonesia, Philippines and Singapore are developing strong economic links with China but are keeping their military links at arms length while forging closer defence links with the US.</p>