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Covid-19 Nasal Swab Test Led To Cerebrospinal Fluid Leak

Nina Shapiro

立场:呼吁进行移民改革
据国家新闻出版广电总局介绍,自2003年以来,中国这一世界第二大电影市场的票房总额平均逐年增长35%。仅仅在2015年,这一数字就猛增了48.7%。
想知道2013年的最差工作是哪些吗?报社记者以其令人尴尬的特质,取代伐木工人成为今年的最差工作。
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《生活大爆炸》中绝不缺少天才。不只是因为这部剧向观众展示了很多绝顶聪明的科学家,同时,演员玛伊姆·比亚利克还拥有神经学博士学位。因此,演员们想要在剧中展示他们的聪明才智,并将整部剧做到精益求精,这也不足为奇。剧中谢尔顿和莱纳德的公寓里有一块很大的白板,这对铁哥们几乎在处理任何事时都会用到它,从完成从学校带回来的工作,到决定是否等到看完最新一部《蜘蛛侠》再吃饭,都离不开这块白板。
The Cassini spacecraft has been sending home images of Saturn, its rings and its moons since arriving at the gas giant in 2004. The mission ended in September with a planned fiery crash into Saturn’s atmosphere. While it studied the planet, Cassini explored moons — Titan and Enceladus — that could be home to extraterrestrial life. The probe also gave us great insight into our solar system, and will continue to do so for years as scientists pore over the data it collected.
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然后,新班子的第一个举动——用路易斯-威廉姆斯从火箭那里换来一个一轮签——是一个明确的信号,他们意识到必须不惜一切代价保证六月抽签时自己的选秀权能在前三。
Matt Damon was named best actor in a comedy or musical motion picture for his role as a stranded astronaut in The Martian.
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sc=scene(n 风景),roll(n 卷)-卷着风景的画卷

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.

2017年陶瓷行业面临的三大挑战

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In other words, we’ve just had a false dawn on the climate change front.

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May the coming New Year bring you joy, love and peace.
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