Bilateral Nature Research Articles

Challenges in Pediatric Foreign Body Aspiration: A Case Report on Persistent Bronchial Obstruction and Aspiration Pneumonia

Foreign body aspiration is a common and potentially dangerous event in young children, often leading to emergency department visits. Our case study presents a 2-year-old boy who aspirated multiple nuts, leading to choking and respiratory distress. The child initially experienced cyanosis and was later found to have decreased air entry on the right side of the chest, prompting the need for bronchoscopy. The initial tolerance for the procedure was low, with frequent loss of saturation, and despite multiple attempts, the bilateral and deep nature of the foreign body resulted in the child being intubated and admitted to the Pediatric Intensive Care Unit (PICU). Over the following days, the child underwent multiple combined bronchoscopies, utilizing flexible and rigid and a staged approach to clear the lungs. This was a combined treatment alongside antibiotics and dexamethasone for inflammation and infection prevention. The child experienced behavioral changes post-extubation, managed with psychiatric support and physiotherapy. This case emphasizes the need for early intervention, the importance of an interventional toolkit, and, at times, multidisciplinary or combined approaches to ensure complete recovery from foreign body aspiration incidents in children.

Formation of patriotic values as a predictor of psychological and moral stability of young men of conscription age

Introduction. In the conditions of confronting external threats and the need to respond to numerous challenges of modernity, the problem of identifying the predictors of psychological and moral stability of an individual is characterised by special relevance and significance. The aim of the research is to study the extent of formation of patriotic values as a predictor of psychological and moral stability in young people of conscription age. Materials and methods. The research was carried out in four Russian Federation entities: Arkhangelsk-, Kaliningrad-, Murmansk- and Leningrad regions. The total number of respondents was 1,050 – young men aged 16 to 20 (conscription age). The following techniques were used in the research: theoretical methods (analysis of the research subject through investigating statutory documents, psychological and pedagogical literature; synthesis, generalisation, comparison and systematisation of the obtained data), and empirical methods (questioning, testing and interviewing). To achieve the set targets, the following diagnostic tools were used: the Constructive patriotism questionnaire; the Values materialism questionnaire; the Scale of psychological well-being by C. Ryff; the “Behaviour self-regulation style – SSP-98” questionnaire by V.I. Morosanova. Results. It was found that the number of respondents with the formed constructive patriotism prevails twice as much among young people of conscription age. At the same time, it is worth noting that in fact, one in three young men of conscription age who took part in the survey (31.8%) have formed blind patriotism (pseudo-patriotism, patriotism of obedience, ignorance and intolerance). Young people of conscription age with pronounced constructive patriotism, compared to the group of young people with blind patriotism, have more expressed significant basic values: “Independence”; “Power”; “Achievements”; “Traditions”; “Safety”; “Universalism”; “Benevolence”. Meanwhile, the group of young people of conscription age with pronounced blind patriotism demonstrate mostly two basic values: “Stimulation”; “Conformism”. Young people of conscription age with expressed constructive patriotism have statistically significant differences on the scale “Personal growth”. It was also revealed that they have a significantly higher overall level of self-regulation and the levels of individual self-control of various regulatory processes and personal regulation properties according to five indicators (“Modelling”, “Programming”, “Evaluation of results”, “Flexibility”, “Independence”), compared to the group of respondents with the formed blind patriotism. Conclusion. The study provides important data on the extent of the formation of patriotic values serving as a predictor of psychological and moral stability in young people of conscription age. The obtained results are in demand, being relevant since they make it possible to design the personality education and development processes with regard for the bilateral nature of interconditionality of patriotism relative to a person’s psychological and moral stability

Complexity in the diagnosis of endocrine ophthalmopathy with a carotid-cavernous fistula. A clinical case

Introduction. Clinical cases featuring a combination of endocrine ophthalmopathy with a carotid-cavernous fistula are scarce, with only four cases documented in the literature, thus posing a diagnostic challenge due to overlapping clinical symptoms. A carotid-cavernous fistula with high blood flow typically presents a clear clinical picture. However, low-flow variants are challenging to timely diagnose. A history of head trauma can be an essential diagnostic clue, as carotid-cavernous anastomosis develops in 75% of cases post-trauma and in 25% spontaneously. Bilateral carotid-cavernous fistulas are particularly rare.Purpose: to present the clinical features and outcomes of bilateral endocrine ophthalmopathy associated with a non-traumatic carotid-cavernous fistula, based on the prospective observation of a patient treated in various city healthcare hospitals during 2021–2022.Case description. The patient first visited the ophthalmologist in October 2021, presenting with bilateral exophthalmos, edema, and eye redness. A positive test for antibodies to thyroid-stimulating hormone and enlargement of the eye muscles, confirmed by orbital ultrasound, led to a diagnosis of “Endocrine Ophthalmopathy”. The patient’s condition was managed jointly by an endocrinologist and an ophthalmologist. Over two months, a worsening of ocular symptoms was observed, prompting a neurosurgical consultation. Cerebral angiography conducted in a hospital setting confirmed a carotid-cavernous fistula. An endovascular procedure was performed five months after the initial ocular symptoms appeared to separate the carotid-cavernous anastomosis on the right using a non-adhesive composition. Ocular symptoms resolved within 2–3 weeks post-surgery.Conclusions. Clinical manifestations of carotid-cavernous fistulas can resemble those of endocrine ophthalmopathy. The absence of a traumatic head injury history, complaints of unilateral head noise synchronous with the pulse, and the bilateral nature of the symptoms complicated the diagnosis of this neurosurgical pathology in a patient with endocrine ophthalmopathy. It is crucial to include both conditions in the differential diagnosis and to employ a multidisciplinary approach for effective management.

The Power of Boilerplate: Bilateralism, Plurilateralism, and the International Tax System

How do states exercise power in complex, decentralized governance regimes? This article sheds light on this question by analyzing one of the pillars of the post-war economic order: the international tax regime. The taxation of multinational enterprises is governed by a system composed of thousands of Bilateral Tax Treaties signed between pairs of national governments. We argue that despite the bilateral nature of these treaties, their legal content is largely controlled by a small group of economically powerful governments. By drafting and promoting “boilerplate” legal language, and by leveraging network effects, OECD countries were able to build a coherent, encompassing, quasi-multilateral regime to govern the taxation of multinationals in most of the world. We test and find support for our arguments about the role of network effects and the power of boilerplate using inferential network analysis and an automated text analysis of a corpus of 3200 treaty texts.

National legislation as a source of the obligation to extradite or prosecute (aut dedere aut judicare)

The article, based on the study of doctrinal developments and the practice of states, reveals the issue of national legislation as a source of the obligation to extradite or prosecute (aut dedere aut judicare). The article highlights the position of the UN International Law Commission on the role of national legislation and state practice in implementing the obligation to extradite or prosecute; the practice of certain states (Finland, Estonia, Macedonia, Azerbaijan, Ukraine) regarding the legal establishment of the obligation to extradite or prosecute is considered; the measures that states should follow at the national level in order to effectively implement the principle of aut dedere aut judicare are defined.
 The article establishes that the determination of the legal nature and scope of the obligation aut dedere aut judicare is possible through the study of various types of sources in which this obligation is established (treaties, customs, international and national court decisions, national legislation of states). The obligation to extradite or prosecute has traditionally been established by international treaties of various types, the number of which is constantly increasing. The participation of many states in such international treaties (of a universal, regional or bilateral nature) is a reflection of the existing national practice of the states regarding the implementation of the principle of aut dedere aut judicare.
 It is substantiated that, along with treaties and customary (at least for the most serious international crimes) enshrining the principle of aut dedere aut judicare, national criminal law is an important source of the obligation to extradite or prosecute. The effective implementation of the principle of aut dedere aut judicare in each specific case will depend on the state’s fulfillment of both its international obligations and the implementation of the necessary measures (in particular, regarding the establishment of jurisdiction over offenders and criminal offenses) defined in national legislation with regard to extradition and prosecution.

Bilateral Dorsal Nail Curvature of the Thumb Distal Phalanx - A Case Report.

Congenital dorsal curvature of the distal phalanx has been previously described as 'reverse Kirner' or 'ski-jump' deformity. This report describes bilateral occurrence in the thumbs. A 13-year-old male presented with difficulty caring for his thumbnails and in picking up small objects. Examination showed dorsal curvature of the distal phalanges of both thumbs, with greater curvature of the right side. Radiographs showed wedge-shaped epiphyses and dorsal curvature without coronal plane deviation of the distal phalanges. There was objective and subjective decrease in function associated with lateral pinch and tripod grasp. The reported aetiopathogenesis for Kirner deformity cannot explain the observed dorsal curvature. The bilateral nature makes a secondary physeal cause unlikely and suggests an embryologic basis. Due to the noticeable deficits in function, operative intervention may be warranted. Level of Evidence: Level V (Therapeutic).

One State’s Rebel Is Another State’s Agent

Abstract In State Responsibility and Rebels, Kathryn Greenman explores the post-colonial history of state responsibility, the doctrine of international law that determines whether a state has breached its obligations and what, if anything, can be done about it. Today, the doctrine is one of the most frequently referenced ones of international law. Greenman shows that international arbitrators have applied the rules of state responsibility in order to support a global economic order that sustains Western investments and trade. Greenman also highlights the bilateral or transactional nature of the doctrine. The early practice of state responsibility has been a story of political concessions. Western states would often withhold their recognition of governments until the latter agreed to arbitrate international claims such as injuries to aliens during the rebellions. The resulting awards were often inchoate analyses of international law, in which arbitrators would attribute liability to states for conduct that was often out of their control. These findings are as interesting as they are relevant to today’s international practice. Indeed, says Greenman, imposing state responsibility for conduct that is outside of a state’s control is effectively sustaining the legacy of international law’s colonial past.

Five Years Without the INF Treaty: Lessons and Prospects

This article focuses on regional ground-launched missiles in the context of the Russia-U.S.-China strategic triangle. It studies the bilateral nature, limited scope, and asymmetric limits/ reductions of the INF Treaty; considers the military and symbolic significance of regional ground-launched missiles in comparison with their sea- and air-launched counterparts; and examines the reasons for the INF Treaty’s termination, future U.S. deployments, and Russian and Chinese responses. In conclusion it describes two possible U.S. deployment scenarios and analyzes possibilities for minimizing the unfolding arms race.

Sound production biomechanics in three-spined toadfish and potential functional consequences of swim bladder morphology in the Batrachoididaea).

The relationship between sound complexity and the underlying morphology and physiology of the vocal organ anatomy is a fundamental component in the evolution of acoustic communication, particularly for fishes. Among vertebrates, the mammalian larynx and avian syrinx are the best-studied vocal organs, and their ability to produce complex vocalizations has been modeled. The range and complexity of the sounds in mammalian lineages have been attributed, in part, to the bilateral nature of the vocal anatomy. Similarly, we hypothesize that the bipartite swim bladder of some species of toadfish (family Batrachoididae) is responsible for complex nonlinear characters of the multiple call types that they can produce, supported by nerve transection experiments. Here, we develop a low-dimensional coupled-oscillator model of the mechanics underlying sound production by the two halves of the swim bladder of the three-spined toadfish, Batrachomoeus trispinosus. Our model was able to replicate the nonlinear structure of both courtship and agonistic sounds. The results provide essential support for the hypothesis that fishes and tetrapods have converged in an evolutionary innovation for complex acoustic signaling, namely, a relatively simple bipartite mechanism dependent on sonic muscles contracting around a gas filled structure.

The Danish Rigsfællesskab

Abstract The Danish Realm or Rigsfællesskab is a decentralised state in which the Faroe Islands and Greenland each count with a home-rule, holding the executive and legislative power over transferred matters. The paper discusses several issues concerning this decentralised legal framework and its functioning. In spite of what is stated in the home-rule arrangements about equality between parties, there is a dominant position of Danish authorities and Danish law. ‘Danish central authorities’ (Rigsmyndigheder) do not exist strictly speaking since the Danish authorities act as authorities for both Denmark proper and the Danish Realm. The mechanism for solving conflicts of competences is also questioned as non-functional, potentially reinforcing inequality and uncertainty. A territorial limit to Greenlandic/Faroese laws is of little use when the criterion for application of the laws is personal, not territorial. Finally, it is argued that the bilateral nature of the home-rule arrangements is not suitable for a three-part decentralised state in which all involved laws are lex fori.

EE543 The Impact of Different Utility Values on a Cost-Effectiveness Model in Diabetic Macular Edema

Building a cost-effectiveness model in the ophthalmology disease area is challenging due to the ambiguity of utility estimates that comes from the bilateral nature of the disease. With the availability of a recent study that provides utility estimates accounting for the bilateral nature of vision, we evaluated the impact of different utility values on a cost-effectiveness model in diabetic macular edema.

PCR186 Health State Utility and Quality of Life Measures for Neovascular Age-Related Macular Degeneration

Utility estimates for vision loss among patients with neovascular age-related macular degeneration (nAMD) often fail to capture disutility from intravitreal injection or the bilateral nature of the disease. Additionally, previous utility estimates have been criticized for failing to capture the full effects of vision loss and quality of life.

CASES OF SYNONYMY AND ANTONYMY IN THE LATIN MEDICAL TERMINOLOGICAL SYSTEM

One of the most significant traits of terminology is its consistency. Each term may be perceived as an entity with bilateral nature: 1. A unity of meaning and form; 2. An entity from the natural language subject to the same phenomena and processes, which are valid for all language units. Synonymy and antonymy result from the ambiguous relation between the form and meaning of the term; unfortunately, they cannot be avoided – even in specialized terminological systems. Since scientific terminology is intended for specific purposes, it is based on the convention regarding the structuring and usage of linguistic forms and their meanings more than any other lexical subsystem. The research object of the present text is the cases of synonymy and antonymy found in the Latin medical terminology as well as the reasons for their appearance. Such lexical relations are observed between lexemes, between a lexeme and a phraseological unit, and between phraseological units.The examples provided are called absolute antonyms and absolute synonyms (or lexical doublets) and they can be part only of the specialized terminological system. Those relations between terms may cause a problem in communication because they obstruct the possibility of a specific and identical nomination in the field of science. On the other hand, they facilitate the appearance of new different variants, and these different forms may also express different opinions about the same phenomenon.

Measuring competitive balance in sports leagues that award bonus points, with an application to rugby union

We examine within-season competitive balance measurement in sports leagues where points allocated in each match depend on bonus points awarded as well as the win/draw/loss outcome, as in rugby union. The bilateral nature of matches imposes constraints on the range of competitive balance measures, as teams cannot win matches in which they do not play. Application of normalized competitive balance indices requires knowing the maximum value the index can attain, representing the most unequal distribution of points among teams. However, evaluation of the points distribution consistent with maximum imbalance is non-trivial when the total points allocated are not known in advance, as when bonus points are awarded. We theoretically derive the corresponding perfectly unbalanced distribution of points, characterized as a ‘Double Cascade distribution’, and provide an Excel tool to obtain it for different parameter values. We apply our results to examine variation in within-season competitive balance in the Six Nations Championship in rugby. The degree of competitive balance, as measured by a normalized concentration index, has improved since the award of bonus points in 2017, primarily because the index's maximum value increases with bonus points. However, with limited available data on the bonus-points regime, it is not possible to establish or reject a causal link, due to induced behavioural changes by teams, between the raw concentration index and bonus points. A relatively high level of imbalance still exists compared to other sports leagues, which will be an important consideration in evaluating future developments of the competition.

How many nerve fibers innervate the human glans clitoris: a histomorphometric evaluation of the dorsal nerve of the clitoris.

It is frequently quoted in mainstream media that the clitoris has "8000 nerve endings." However, no study has yet quantified the number of nerve fibers (axons) innervating the human clitoris. The dorsal nerves of the clitoris (DNCs) are the primary source of sensation and somatic clitoral innervation. Therefore, reporting the number of axons in the DNCs is an important step in our understanding of clitoral innervation and sexual response with implications for many fields of medical practice. The purpose of this study is to quantify the mean number of axons in the human DNCs and to report the approximate mean number of nerve fibers that innervate the human glans clitoris. DNC samples were obtained from 7 transmasculine patients undergoing gender-affirming phalloplasty surgery. At the time of nerve coaptation, a small excess of the DNC (5 mm) was collected for analysis at the proximal level of the clitoral body, just distal of the emergence of the DNCs from underneath the pubic symphysis. Samples were placed into 3% glutaraldehyde fixative, postfixed in 1% osmium tetroxide, and serially dehydrated in ethanol and toluene. Samples were then embedded in araldite, sectioned on an ultramicrotome into 1-μm cross sections, and counterstained with 1% toluidine blue. Histomorphometric evaluation was performed at 1000x magnification with a Leitz Laborlux S microscope and image analysis software (Clemex Vision Professional) to obtain an axon counts. Descriptive statistics were performed to yield a mean and standard deviation of the number of axons in the DNCs. Assuming anatomic symmetry between bilateral DNCs, mean total number of somatic nerve fibers innervating the human glans clitoris was obtained by doubling the mean count of the DNCs. Seven sample DNCs were collected. Of those, 5 were analyzed as 2 did not have sufficient nerve tissue present. The mean number of nerve fibers in the human DNCs was 5140 (SD = 218.4). The mean number of myelinated nerve fibers innervating the human clitoris was 10,281 (SD = 436.8). This study is the first to report the number of axons in the human DNC, at a mean 5140. Given the bilateral nature of clitoral innervation and symmetry of anatomic structures, the approximate mean number of myelinated axons that innervate the human glans clitoris is 10,280. When the uncaptured unmyelinated fibers and contributions from the cavernosal innervation are accounted for, it is clear that far Moree than 8000 axons innervate the human clitoris.

SECTOR DISCOURSE/TEXT IN THE NOMINATIVE FIELD OF THE COMPLEX CONCEPT WORD / LANGUAGE / SPEECH

The article is dedicated to the study of the complex concept WORD / LANGUAGE / SPEECH and its medial zone in the naпve picture of the world within a framework of a new scientific direction — dual linguistics: scientific and naive interpretation of language in the English lexicography. The complex concept WORD / LANGUAGE / SPEECH, which is verbalized by nominative units extracted from English general lexicographic sources, is considered. The nuclear zone of the naпve picture of the world counts three lexemes (which together contain 42 sememes), among which 161 semes have been filtered by means of seme analysis method. The most common semanteme, present in all nuclear lexemes, is the idea of the bilateral nature of any communicative unit. All of the nuclear zone lexemes in the primary dictionary position contain the seme, which emphasizes the unity of content and form of the phenomena under consideration. The medial zone of the nominative field of the verbalized WORD / LANGUAGE / SPEECH complex concept is many times bigger and more variable in comparison with the nuclear zone. It includes more than 700 lexical units with semantic components language, speech, communication. According to the thematic principle, the collected material was divided into 6 sectors: communication; units of language, speech; discourse, text; phonetical, grammatical and stylistic phenomena; language / dialect / slang, speaker; linguistics. The given sector contains nominative units of the English vocabulary to indicate various types of institutionalized discourse, primarily means of written fixation of human communication in public and private spheres. The evolution of verbal communication between people from ancient times to the present is reflected in a diverse palette of nominations of communicative phenomena of religious, artistic, scientific, legal and business, mass media and even everyday communication.

The MLI May Preserve the Essentially Bilateral Nature of Tax Treaties and Embrace a Strong Anti-Avoidance Approach to the Application of Treaty Provisions

The MLI May Preserve the Essentially Bilateral Nature of Tax Treaties and Embrace a Strong Anti-Avoidance Approach to the Application of Treaty Provisions

Clinical, Pathophysiologic, Genetic, and Therapeutic Progress in Primary Bilateral Macronodular Adrenal Hyperplasia.

Patients with primary bilateral macronodular adrenal hyperplasia (PBMAH) usually present bilateral benign adrenocortical macronodules at imaging and variable levels of cortisol excess. PBMAH is a rare cause of primary overt Cushing's syndrome but may represent up to one-third of bilateral adrenal incidentalomas with evidence of cortisol excess. The increased steroidogenesis in PBMAH is often regulated by various G protein-coupled receptors (GPCRs) aberrantly expressed in PBMAH tissues; some receptor ligands are ectopically produced in PBMAH tissues, creating aberrant autocrine/paracrine regulation of steroidogenesis. The bilateral nature of PBMAH and familial aggregation led to the identification of germline heterozygous inactivating mutations of the ARMC5 gene, in 20% to 25% of the apparent sporadic cases and more frequently in familial cases; ARMC5 mutations/pathogenic variants can be associated with meningiomas. More recently, combined germline mutations/pathogenic variants and somatic events inactivating the KDM1A gene were specifically identified in patients affected by glucose-dependent insulinotropic peptide (GIP)-dependent PBMAH. Functional studies demonstrated that inactivation of KDM1A leads to GIP-receptor (GIPR) overexpression and over- or downregulation of other GPCRs. Genetic analysis is now available for early detection of family members of index cases with PBMAH carrying identified germline pathogenic variants. Detailed biochemical, imaging, and comorbidity assessment of the nature and severity of PBMAH is essential for its management. Treatment is reserved for patients with overt or mild cortisol/aldosterone or other steroid excesses, taking in account comorbidities. It previously relied on bilateral adrenalectomy; however, recent studies tend to favor unilateral adrenalectomy or, less frequently, medical treatment with cortisol synthesis inhibitors or specific blockers of aberrant GPCR.

Nature of pathological changes on magnetic resonance imaging of the CNS in patients with focal forms of acute tick-borne encephalitis

Introduction. Tick-borne encephalitis (TBE) is a widespread natural focal viral neuroinfection in Russia and the Sverdlovsk region. The high level of morbidity, leading to disability, and the annual registration of focal forms and lethal cases determine the relevance of the search for early differential diagnostic criteria for acute tickborne encephalitis (TBE). A promising direction in the early diagnosis of TBE is acquired by magnetic resonance imaging (MRI).The aim of the study was to study the features of the MRI picture in patients with focal forms of TBE.Material and methods. The study included 38 patients with focal forms of OKE who were treated in the neurological department of Sverdlonsk regional clinical hospital № 1 since 2009 to 2019.Results. In the acute period of focal forms of TBE, pathological changes of an inflammatory nature during MRI of the CNS were more often detected in the cerebral hemispheres (mainly in the white matter) in 40.4 % and subcortical structures in 36.8 %, in the brainstem in 16.7 %, less often in 6.1 % – in the region of the cerebellum and spinal cord. Bilateral nature and combined lesions of the CNS structures were detected 2 times more often. Discussion A detailed analysis of the localization and nature of MRI changes in the CNS in patients with severe focal forms of the disease, in contrast to single descriptions of the MRI picture of TBE according to the literature, made it possible to identify combined lesions of the frontal and parietal lobes characteristic of TBE in combination with pathological changes in the region of the thalamus and basal ganglia.Conclusion. Identification of typical MRI changes in the CNS in patients with a clinical picture of viral encephalitis in the spring-summer period contributes to the early diagnosis of a severe course of TBE.

Visiting migrants: An introduction

AbstractThis paper offers an overview of the origins and dynamics of the concept of migrant visits and introduces the key contributions of the special issue. We highlight the significance of visits that criss‐cross many forms of migration and centre on these visits’ bilateral and multilateral nature. Furthermore, we emphasize emotional, sensory and bodily implications, which almost always shape encounters between migrants and others in such visits. The papers of this special issue contribute to a broad interdisciplinary agenda highlighting familial ties, networks and transnational spaces at the core of migration and mobility scholarship. Together, we offer new perspectives on the multidirectionality of visits and the role of relationships which drive, connect and diversify forms of migration and are facilitated by broader developments in technology, tourism and diasporic practices.