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We present the case of a patient with bilateral vocal fold paralysis following extensive surgical repair of congenital cardiac abnormalities and the management of the subsequent airway compromise with primary endoscopic anterior–posterior cricoid split.
Methods
Review of our management of a patient with bilateral vocal fold paralysis using anterior–posterior cricoid split and literature search of alternative management options for patients with bilateral vocal fold paralysis.
Results
Our newborn patient developed stridor and respiratory failure following surgery for multiple cardiac malformations. Flexible fiberoptic laryngoscopy revealed bilateral vocal fold paralysis, and the patient was intubated for airway protection. We addressed the bilateral vocal fold paralysis with primary endoscopic anterior–posterior cricoid split to avoid tracheostomy, successfully extubating to room air 13 days later. The patient regained nearly total function of both folds and, at two-year follow-up, was asymptomatic from an airway, voice, sleep and swallowing perspective.
Conclusions
APCS was effective in managing bilateral vocal fold paralysis-associated respiratory failure and avoiding tracheostomy, with long-term follow-up demonstrating symptom resolution and bilateral recovery of laryngeal mobility.
We apply a synthesis review to revisit the concept, measurement, and operationalisation of social inclusion and exclusion in the context of comparative social policy, integrating the vast literature on the concepts, with the aim of elucidating a clearer understanding of the concepts for use by scholars and policymakers around the planet. In turn, we outline the conceptual development of the concepts, how they have been operationalised through social policy, and how they have been measured at the national and individual levels. Through our review, we identify limitations in extant conceptualisation and measurement approaches and suggest directions for refining conceptual and measurement frameworks to enhance their utility in social inclusion policy, emphasising the concepts’ multidimensional, multilevel, dynamic, and relational essence and highlighting their connection to related concepts such as social capital, social integration, and social citizenship.
We give a notion of boundary pair $(\mathcal{B}_-,\mathcal{B}_+)$ for measured groupoids which generalizes the one introduced by Bader and Furman [BF14] for locally compact groups. In the case of a semidirect groupoid $\mathcal{G}=\Gamma \ltimes X$ obtained by a probability measure preserving action $\Gamma \curvearrowright X$ of a locally compact group, we show that a boundary pair is exactly $(B_- \times X, B_+ \times X)$, where $(B_-,B_+)$ is a boundary pair for $\Gamma$. For any measured groupoid $(\mathcal{G},\nu )$, we prove that the Poisson boundaries associated to the Markov operators generated by a probability measure equivalent to $\nu$ provide other examples of our definition. Following Bader and Furman [BF], we define algebraic representability for an ergodic groupoid $(\mathcal{G},\nu )$. In this way, given any measurable representation $\rho \,:\,\mathcal{G} \rightarrow H$ into the $\kappa$-points of an algebraic $\kappa$-group $\mathbf{H}$, we obtain $\rho$-equivariant maps $\mathcal{B}_\pm \rightarrow H/L_\pm$, where $L_\pm =\mathbf{L}_\pm (\kappa )$ for some $\kappa$-subgroups $\mathbf{L}_\pm \lt \mathbf{H}$. In the particular case when $\kappa =\mathbb{R}$ and $\rho$ is Zariski dense, we show that $L_\pm$ must be minimal parabolic subgroups.
Executive dysfunction is prevalent in early stroke and can predict long-term outcomes. Impairments can be subtle and undetected in cognitive stroke screens. To better assess executive functions, this study introduced a novel sentence completion test, which assesses multiple executive processes in <5 minutes (Brief Executive Language Screen – Sentence Completion; BELS-SC). The aim was to determine construct, convergent and divergent validity, sensitivity and specificity of the BELS-SC, and to explore differences between left and right hemisphere stroke patients (LHS and RHS, respectively) on the BELS-SC and standard executive function tests.
Method:
Eighty-eight acute/early sub-acute stroke patients and 116 age-matched healthy controls were included.
Results:
Principal Component Analysis (PCA) suggested four to five factors of the BELS-SC: Initiation, Selection, Inhibition (with strategy loading on Inhibition), Inhibition Response Time, and Semantic Retrieval Response Time. The BELS-SC had good sensitivity (.84) but poorer specificity (.66) differentiating controls and stroke, and good sensitivity (.83) and specificity (.80) differentiating executive function impaired versus executive function intact groups. BELS-SC Initiation and Inhibition subtests demonstrated convergent and divergent validity with corresponding Hayling subtests. LHS and RHS showed impairment across initiation, selection, inhibition and strategy; however, greatest deficits were shown by RHS on Inhibition items requiring suppression of one dominant response. More patients were impaired on BELS-SC than other executive function tests.
Conclusions:
The BELS-SC demonstrated convergent, divergent, and construct validity, good sensitivity and specificity, taps multiple executive processes, and provides insight into strategy. Use in early stroke may aid in targeted and timely cognitive rehabilitation.
Neurodegenerative diseases (NDDs) are a group of complex disorders marked by pathophysiological mechanisms involving protein aggregation, mitochondrial dysfunction, oxidative stress and neuroinflammation. Irrespective of extensive research advances, NDDs have become a serious global concern and persist as a major therapeutic challenge. In recent years, microRNAs (miRNAs), a class of small non-coding RNAs, have established a pivotal role in combating NDDs. The altered expression of miRNAs is reported to be associated with the progression of various NDDs. This review aims to discuss miRNA biogenesis; dysregulation in NDDs, specifically Alzheimer’s disease, Parkinson’s disease (PD) and amyotrophic lateral sclerosis; their potential as biomarkers; and promising therapeutic targets. Additionally, there are various emerging technologies discussed that are advanced approaches to enhance miRNA-based diagnostics and therapeutics.
Let $A\ \mathrm{and}\ B$ be subsets of $(\mathbb {Z}/p^r\mathbb {Z})^2$. In this note, we provide conditions on the densities of A and B such that $|gA-B|\gg p^{2r}$ for a positive proportion of $g\in SO_2(\mathbb {Z}/p^r\mathbb {Z})$. The conditions are sharp up to constant factors in the unbalanced case, and the proof makes use of tools from discrete Fourier analysis and results in restriction/extension theory.
Highlights from the International Symposium on Twins, held at the University of Crete on May 23−24, 2025, are summarized. The symposium, organized by Dr Maria Markodimitraki, Professor in the Department of Preschool Education at the University of Crete, attracted scholars and practitioners from Greece and around the world. Meetings with a pair of reunited monozygotic female twins, and a female twin in search of her sister, also from Greece, are described. This review is followed by summaries of twin research on neonatal outcomes, growth discordance and restriction, and romantic partners and alcohol use. Human interest stories include a book documenting the extraordinary lives of identical twins Celia and Mamaine Paget, a museum wing honoring the lost Rockefeller twin, a remarkable conjoined twinning case in India, the death of an Australian sports icon, and a most unusual triplet birth.
Effective performance of oil-based drilling fluids (OBFs) in demanding high-temperature environments hinges on the stability of their rheological properties. However, conventional organoclays (OCs) utilized to control these properties often exhibit thermal degradation at elevated temperatures, necessitating the development of more robust alternatives. Therefore, the present study aimed to develop a high-temperature-resistant OC to enhance OBF rheological stability. To address the thermal instability issues of conventional quaternary organo-montmorillonites (OMts), which manifest as interlayer structural collapse and particle aggregation, an innovative dual modification strategy was developed through the synergistic combination of quaternary ammonium intercalation and silane grafting. Montmorillonite (Mnt) was modified with dioctadecyl dimethyl ammonium chloride (1821) and stearyl dimethyl benzyl ammonium chloride (1827) at a mass ratio of 2:1 to yield 1821+1827-OMt, which was subsequently further modified with dodecyl trimethoxy silane (DTMS) to form 1821+1827+DTMS-OMt. Comparison of the properties of 1821+1827-OMt and 1821+1827+DTMS-OMt after high temperatures revealed the following. (1) Thermogravimetric (TG) and derivative thermogravimetric (DTG) analysis and gel volume tests demonstrated that the Si–O–Si bonds in 1821+1827+DTMS-OMt were thermally stable up to ~440°C, and the gel volume of the 1821+1827+DTMS-OMt suspension remained stable at 100 mL following high-temperature aging treatments. (2) X-ray diffraction and elemental analysis revealed that 1821+1827+DTMS-OMt exhibited a larger basal spacing and larger nitrogen content compared with ungrafted 1821+1827-OMt. (3) The suspension containing 1821+1827+DTMS-OMt demonstrated enhanced thermal stability at 260°C, evidenced by its narrower rheological parameter ranges of apparent viscosity (6–12 mPa s), plastic viscosity (5–9 mPa s), and yield point (1–3 Pa), compared with those of the suspension containing 1821+1827-OMt. (4) Optical microscopy demonstrated that 1821+1827+DTMS-OMt exhibited greater resistance to agglomeration at high temperatures than 1821+1827-OMt. The high-temperature-resistant OC developed in this study overcomes the thermal instability of traditional OCs, providing a robust approach for enhancing the efficiency and reliability of oil-based drilling fluids in high-temperature drilling applications.
In March 1933, the United States Congress declared beer up to 3.2 percent alcohol by weight to be “non-intoxicating,” thus allowing it to be produced and sold while the nation was still under the 18th Amendment’s ban of intoxicating liquors. Brewers had long argued that beer was a temperance beverage that should be regulated with a lighter touch than harder liquor. In fact, the declaration that 3.2 beer was non-intoxicating opened several markets that would otherwise have been closed to brewers. In the decades that followed Repeal, 3.2 beer continued to be treated differently than stronger alcohol with respect to who, when, where, and how it was legally available. This paper explores the important—and continuing—role that 3.2 beer has played in the post-Prohibition United States.
In this paper we study the optimal multiple stopping problem with weak regularity for the reward, where the reward is given by a set of random variables indexed by stopping times. When the reward family is upper semicontinuous in expectation along stopping times, we construct the optimal multiple stopping strategy using the auxiliary optimal single stopping problems. We also obtain the corresponding results when the reward is given by a progressively measurable process.
World-historical analyses often view the “Asian” empires that survived into the twentieth century (the Russian, Qing, and Ottoman empires) as anomalies: sovereign “archaic” formations that remained external to the capitalist system. They posit an antagonistic relationship between state and capital and assume that modern capitalism failed to emerge in these empires because local merchants could not take over their states, as they did in Europe. Ottoman economic actors, and specifically the sarraf as state financier, have accordingly been portrayed as premodern intermediaries serving a “predatory” fiscal state, and thus, as external to capitalist development. This article challenges these narratives by uncovering the central role of Ottoman sarrafs, tax-farmers, and other merchant-financiers in the expanding credit economy of the mid-nineteenth century, focusing on their investment in the treasury bonds of Damascus. I show how fiscal change and new laws on interest facilitated the expansion of credit markets while attempting to regulate them by distinguishing between legitimate interest and usury. I also discuss Ottoman efforts to mitigate peasant indebtedness and the abuse of public debt by foreigners, amid the treasury bonds’ growing popularity. In this analysis, global capitalism was forged in the encounter between Ottoman imperial structures, geo-political concerns, and diverse, interacting traditions of credit, while the boundaries between public and private finance were being negotiated and redefined. Ultimately, Ottoman economic policies aimed to retain imperial sovereignty against European attempts to dominate regional credit markets—efforts often recast by the latter as “fanatical” Muslim resistance.
The Takeuchi procedure remains an important surgical option for treating anomalous origin of the left coronary artery from the pulmonary artery, particularly in cases where direct coronary reimplantation is not feasible. However, long-term outcome data in paediatric patients are limited.
Methods:
We retrospectively reviewed 18 paediatric patients who underwent Takeuchi repair between 2007 and 2023. Clinical characteristics, echocardiographic data, and outcomes—including survival, ventricular function, mitral regurgitation, and reintervention—were analysed. Kaplan–Meier analysis was used to assess survival and freedom from reintervention, and paired comparisons were evaluated using the Wilcoxon signed-rank test.
Results:
The median age at surgery was 6 months (range: 25 days to 12 years). Preoperative left ventricular ejection fraction was significantly depressed (median 23.5%), and mitral regurgitation was present in all patients. There were two early deaths (11.1%), both in patients with severe heart failure. No late mortality was observed during a maximum follow-up of 10.9 years. All survivors achieved New York Heart Association class I status. Left ventricular ejection fraction improved significantly postoperatively (p < 0.0001), and mitral regurgitation grade also decreased significantly (p < 0.001), with 94.4% showing only mild residual mitral regurgitation. Reintervention occurred in three patients (16.7%) for pulmonary artery stenosis or baffle leak. Freedom from reintervention at 10.9 years was 66.7%.
Conclusion:
The Takeuchi procedure offers excellent survival and functional recovery in paediatric anomalous origin of the left coronary artery from the pulmonary artery patients when coronary translocation is not feasible. Although late complications such as pulmonary artery stenosis or baffle leak can occur, outcomes remain favourable with appropriate follow-up.
The cerebellar cognitive affective syndrome (CCAS) scale has been developed to screen for possible cognitive and affective impairments in cerebellar patients, but previous studies stressed concerns regarding insufficient specificity of the scale. Also, direct comparisons of CCAS scale performance between cerebellar patients with and without CCAS are currently lacking. The aim of this study was to evaluate the validity of the CCAS scale in cerebellar patients.
Method:
In this study, cerebellar patients with CCAS (n = 49), without CCAS (n = 30), and healthy controls (n = 32) were included. The Dutch/Flemish version of the CCAS scale was evaluated in terms of validity and reliability using an extensive neuropsychological assessment as the gold standard for CCAS. Correlations were examined between the CCAS scale and possible confounding factors. Additionally, a correction for dysarthria was applied to timed neuropsychological tests to explore the influence of dysarthria on test outcomes.
Results:
Cerebellar patients with CCAS performed significantly worse on the CCAS scale compared to cerebellar controls. Sensitivity was acceptable, but specificity was insufficient due to high false-positive rates. Correlations were found between outcomes of the scale and both education and age. Although dysarthria did not affect the validity of the CCAS scale, it may influence timed neuropsychological test outcomes.
Conclusions:
Evaluation of the CCAS scale revealed insufficient specificity. Our findings call for age- and education-dependent reference values, which may improve the validity and usability of the scale. Dysarthria might be a confounding factor in timed test items and should be considered to prevent misclassification.
Beryl crystals from hydrothermal veins in the Colombian emerald mining district, were examined to understand their growth and dissolution processes. Chemical analysis reveals minor substitution of Al by Na, Mg and the colouring elements V, Cr and Fe. Growth features include characteristic indentations on (0001) and a ridge-and-valley structure on the second-order prism, which is also observed on rare conical growth faces. Zoning is the primary internal growth feature, investigated in cross sections parallel to the main growth directions, the a- and c-axes of beryl. All crystals show sector zoning, with enrichment of Na and Mg in the c-sector, whereas Al and most of the trace elements measured are concentrated in the a-sector. H2O and CO2 molecules in the crystal structure were identified by infrared spectroscopy. Two types of H2O are present, with the H–H vector aligned (type I) and perpendicular (type II) to the c-axis, with H2O II predominant in the c-sector. CO2 is present in both sectors, decreasing from core to rim, and is higher in the a-sector. Variable sector boundaries suggest irregular changes in the growth rate in the two growth directions. The substitution (VIMg+channelNa)c-sector = (VIAl+channel□)a-sector creates a pattern of stripes, originating at the steps of the sector boundaries. Etch pits as a result of dissolution are arranged in chains, typically forming etching channels, but the overall amount of dissolution is minor. The arrangement of the etch pits indicates that they formed on dislocation bundles, which originate at the sector boundaries. The observations indicate rapid crystallisation with skeletal growth in [0001] is responsible for the distribution of elements in sectors, and are consistent with a closed-system behaviour in the veins.
The aim of this study is to systematically review and analyse the literature regarding clinical application of picrotoxin for vertigo caused by peripheral vestibular disorders.
Methods
We conducted a search in PubMed/MEDLINE and Google Scholar in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analyses recommendations. The primary selection included all studies exploring the effect of this phytopharmacological substance on the vestibular system and vertigo. The secondary selection included only reports on its clinical use for treatment of Ménière’s disease and other peripheral vestibular disorders.
Results
From the 398 identified studies, 18 were included from the primary selection and 6 from the secondary selection. In total, 203 patients received picrotoxin; 85 of them were treated for vertigo with 1-mg picrotoxin suppositories. In this subgroup vertigo was reduced in 74.9 per cent.
Conclusion
Picrotoxin is a non-invasive treatment option worth considering, especially in cochlear-implanted patients with recurring disabling vertigo.