An interesting case of reruptured endovascularly coiled aneurysm managed with clipping

Endovascular treatment has proven to be effective in the management of intracranial aneurysm, and can achieve permanent occlusion in up to 85% of cases, reducing the bleeding or rebleeding rate. A paradigm shift from microsurgical clipping to endovascular intervention has been observed since the publication of the International Subarachnoid Aneurysm Trial. Aneurysm recurrence after coil embolization remains both a major shortcoming of endovascular treatment and a daunting challenge for neurosurgeons without optimal management strategies.: We present a case report of a patient with history of previously endovascularly coiled and presenting with aneurysmal bleed. Microsurgical clipping is an effective intervention for managing reruptured previously coiled intracranial aneurysm.

Raiders of the Lost Canal: Review of Underrecognized Skull Base Canals, Fissures, and Foramina

The anatomy of the skull base is complex and poses a daunting challenge to many radiologists and trainees. In addition to knowing major skull base passages, there are several underrecognized skull base canals, foramina, and fissures that are critical to avoid misdiagnosis, understand the spread of disease, and guide surgical management. A review of the current literature on these forgotten structures yielded numerous original articles and a few review articles, none of which were comprehensive. This article aimed to fill that void. We provide a comprehensive review of underrecognized skull base anatomic structures and their content and discuss their clinical implications.Learning Objective: Recognize uncommon skull base structures, their content, and their clinical implications

Culture-specific Items from Ukrainian and Russian Fairy Tales: A Daunting Challenge for Translators

Translation studies of children’s literature deserve meticulous attention today not only in the wake of active global publishing activity of books for children but due to the culture-specific information the latter may contain. Fairy tales are usually the first narratives children are introduced to and often these stories with a long-reproduction history reveal some features of national culture that form a child’s worldview. From this perspective, the research is set out to identify culture-specific items in fairy tales that originated from oral tradition and to determine what translation procedures should be used and what factors may influence the choice of the translation method. The corpus of the research includes the titles of East Slavic fairy tales limited by culture-specific items and their translations into English and German. Despite the period when translations were made and gender of translators, findings of our research show that in both languages source language-oriented translation procedures prevail in rendering proper names with denotative meaning, and target language-oriented translation methods are dominant for culture-specific common expressions and descriptive elements of proper names. The current research has allowed us to distinguish the factors that may influence the choice of a translation procedure. To this end, a scale of source language- and target language-oriented translation strategies of culture-specific items from fairy tales with the account of target reader’s age and genre has been provided for the translators to reveal the efficiency of certain translation procedures. Given the above, the study of culture-specific items in fairy tales requires a greater focus and thus further lines of inquiry are suggested in this paper.

Diagnosis and Management of Chronic Anastomotic Leak

Chronic anastomotic leaks present a daunting challenge to colorectal surgeons. Unfortunately, anastomotic leaks are common, and a significant number of leaks are diagnosed in a delayed fashion. The clinical presentation of these chronic leaks can be silent or have low grade, indolent symptoms. Operative options can be quite formidable and highly complex. Leaks are typically diagnosed by radiographic and endoscopic imaging during the preoperative assessment prior to defunctioning stoma reversal. The operative strategy depends on the location of the anastomosis and the specific features of the anastomotic dehiscence. Low colorectal anastomosis (i.e. following low anterior resection) may require a transanal approach, transabdominal approach, or a combination of the two. While restoration of bowel continuity is encouraged, it is not infrequent for a permanent ostomy to be required to maximize patient quality of life.

The outcome of telemedicine services for COVID-19 patients in “Al-Anbar” province west of Iraq

Background: The rapid spread of COVID-19 disease in Iraq has been a daunting challenge. Given the overwhelmed Iraqi healthcare system, healthcare directors struggled to manage this unprecedented crisis. The role of telemedicine during the coronavirus pandemic has evolved to allow for social distancing while providing appropriate health care to the community at large. Telemedicine emerged as a reasonable solution to deliver appropriate care to COVID-19 and non-COVID-19 patients in the era of the COVID-19 pandemic. Objectives: This study explores the role of telemedicine using the “WhatsApp” application between doctors and patients at home in the “Al-Anbar” province west of Iraq. Patients and Methods: All patients diagnosed with COVID-19 disease who were managed by a group of physicians willing to offer telemedicine service in many cities of the ”Al-Anbar” province west of Iraq were included in this study. Patients’ demographics included age, gender, disease severity, and mortality rate. All patients were followed until they were declared cured of the disease or otherwise. The telemedicine service was provided using the “WhatsApp” platform. The data were entered into a digital database for final analysis. Results: from April through July 2020, at the beginning of the disease in Iraq, 716 patients were managed inclusive of diagnosis, treatment, and follow-up using telemedicine services. Of these, 414 (57.8%) were male, and 302 (42.2%) were female. Of the males, 12 patients succumbed to the disease, resulting in a survival rate of 97.10%, whereas of the females, nine patients succumbed to the disease, resulting in a survival rate of 97.02%. Most COVID-19 patients contracted mild-to-moderate disease with a reported mortality rate of 1.2%. Those with severe disease had a higher mortality rate of 17.5%. There was a statistically significant association between the mortality rate and increasing age and COVID-19 disease severity. Conclusions: We believe that our experience using telemedicine in its most basic form proved effective in managing COVID-19 patients in areas where resources are scarce. It provided essential health care while minimizing the risk of disease spread among healthcare workers, patients, and their families.

Describing and Classifying Shock: Recent Insights

Cardiogenic shock continues to present a daunting challenge to clinicians, despite an increasing array of percutaneous mechanical circulatory support devices. Mortality for cardiogenic shock has not changed meaningfully in more than 20 years. There have been many attempts to generate risk scores or frameworks to evaluate cardiogenic shock and optimize the use of resources and assist with prognostication. These include the Intra-Aortic Balloon Pump in Cardiogenic Shock (IABP-SHOCK) II risk score, the CardShock score and the new CLIP biomarker score. This article reviews the Society for Cardiac Angiography and Interventions (SCAI) classification of cardiogenic shock and subsequent validation studies. The SCAI classification is simple for clinicians to use as it is based on readily available information and can be adapted depending on the data set that can be accessed. The authors consider the future of the field. Underlying all these efforts is the hope that a better understanding and classification of shock will lead to meaningful improvements in mortality rates.

The HIF1α-PDGFD-PDGFRα axis controls glioblastoma growth at normoxia/mild-hypoxia and confers sensitivity to targeted therapy by echinomycin

Background Glioblastoma multiforme (GBM), a lethal brain tumor, remains the most daunting challenge in cancer therapy. Overexpression and constitutive activation of PDGFs and PDGFRα are observed in most GBM; however, available inhibitors targeting isolated signaling pathways are minimally effective. Therefore, better understanding of crucial mechanisms underlying GBM is needed for developing more effective targeted therapies. Methods Target genes controlled by HIF1α in GBM were identified by analysis of TCGA database and by RNA-sequencing of GBM cells with HIF1α knockout by sgRNA-Cas9 method. Functional roles of HIF1α, PDGFs and PDGFRs were elucidated by loss- or gain-of-function assays or chemical inhibitors, and compared in response to oxygen tension. Pharmacological efficacy and gene expression in mice with intracranial xenografts of primary GBM were analyzed by bioluminescence imaging and immunofluorescence. Results HIF1α binds the PDGFD proximal promoter and PDGFRA intron enhancers in GBM cells under normoxia or mild-hypoxia to induce their expression and maintain constitutive activation of AKT signaling, which in turn increases HIF1α protein level and activity. Paradoxically, severe hypoxia abrogates PDGFRα expression despite enhancing HIF1α accumulation and corresponding PDGF-D expression. Knockout of HIF1A, PDGFD or PDGFRA in U251 cells inhibits cell growth and invasion in vitro and eradicates tumor growth in vivo. HIF1A knockdown in primary GBM extends survival of xenograft mice, whereas PDGFD overexpression in GL261 shortens survival. HIF1α inhibitor Echinomycin induces GBM cell apoptosis and effectively inhibits growth of GBM in vivo by simultaneously targeting HIF1α-PDGFD/PDGFRα-AKT feedforward pathway. Conclusions HIF1α orchestrates expression of PDGF-D and PDGFRα for constitutive activation of AKT pathway and is crucial for GBM malignancy. Therefore, therapies targeting HIF1α should provide an effective treatment for GBM.

A Review on Capturing Twin Nucleation in Crystal Plasticity for Hexagonal Metals

Owing to its ability to incorporate Schmid’s law at each integration point, crystal plasticity has proven a powerful tool to simulate and predict the slip behavior at the grain level and the ensuing heterogeneous stress/strain localization and texture evolution at the macroscopic level. Unfortunately, notwithstanding substantial efforts during the last three decades, this remarkable capability has not been replicated for materials where twinning becomes a noticeable deformation mechanism, namely in the case of low-stacking fault energy cubic, orthorhombic, and hexagonal close-packed structures. The culprit lies in the widely adopted unphysical pseudo-slip approach for capturing twin formation. While the slip is diffuse, twinning is a localized event that occurs as a drastic burst of a confined number of partial twinning dislocations establishing an interface that pursues growth through a thread of perfect twinning dislocations in the sense of bicrystallography. Moreover, at earlier stages, twin nucleation may require atomic diffusion (Shuffling) and faceting, generally demanding higher stress levels not necessarily on the twin shear plane, while triaxiality at adequate sites might be needed or preferred such as lower grain boundary misorientations or other twin boundaries. Identifying a mathematical framework in the constitutive equations for capturing these twin formation sensitivities has been a daunting challenge for crystal plasticity modelers, which has stalled ameliorating the design of key hexagonal materials for futuristic climate change-related industries. This paper reviews existing approaches to incorporating twinning in crystal plasticity models, discusses their capabilities, addresses their limitations, and suggests prospective views to fill gaps. The incorporation of a new physics-based twin nucleation criterion in crystal plasticity models holds groundbreaking potential for substantial progress in the field of computational material science.

Intimate Borders and the Sense of Never-Quite-Being: A Dystopic (Non-)Fiction

Today’s academy is a dystopia. Many scholars of color and international scholars face the daunting challenge of navigating neoliberal state institutions that are often built on legacies of racism, colonialism, and classism. This essay brings attention to the feelings of despair, anxiety, and paranoia felt by many scholars of color in the fields of humanities and social sciences, but whose narratives too often become ones of abrupt exit from the Ministry of Knowledge (and) Entrepreneurship (MKE). The essay relies on a discussion of Anzaldúa’s intimate terrorism, the composition of today’s academy, and the sense of never-quite-being. These themes emerge out of a dialogue with Anzaldúa, Deleuze, and Harney and Moten, who each have something to say about navigating institutions of power from a position of in-betweenness. Then, I assemble themes from contemporary popular dystopia films to develop a performative fiction—a narrative of never-quite-being that embodies the critical theory and dystopic themes woven through the experiences of a border-body in the academy. The essay ends with a discussion of what being intimate looks like for someone that never-quite-is, informed by Anzaldúa’s concept of mestizaje and Deleuze’s nomad thought.

Strategy in the time of pandemics, climate change and the Kurzweil Singularity

PurposeThe business environment is increasingly fraught with societal disruptions—caused by factors such as pandemics, climate change and the probability of sentient machines—that are fundamentally different than the industry disruptions that firms have experienced and determined how to overcome. Societal disruptions create chaotic ambiguity and unknowable futures. This paper offers an approach to strategic management in the context of societal disruptions, employing purpose-driven “smart power” to harmonize the organization and the environment and promote both economic and social sustainability.Design/methodology/approachThe paper integrates the construct of smart power that blends hard and soft power, the concepts of purpose and identity that define what is core, aspirational, enduring and distinctive about the organization and the techniques of taming wicked problems in order to design processes and structures that can function in the context of social disruptions.FindingsThe paper offers a strategic management approach that employs purpose-driven smart power to overcome the challenge and thrive in the context of chaotic ambiguity.Practical implicationsThe approach offers practical guidelines for designing processes and structures that can guide strategic decision making in organizations challenged by societal disruptions.Originality/valueThe distinctive and daunting challenge posed by societal disruptions is delineated, and constructs and frameworks from multiple disciplines are uniquely integrated to potentially tame the chaotic ambiguity and unknowable futures created by these disruptions.