Deep Recession Research Articles

The laterally closed coronally advanced flap: A case study

AbstractBackgroundSeveral methods have been described for treating deep Cairo Class RT1 recessions. Most involve relieving incisions, which cause scar tissue formation or use a tunneled approach. This report introduces a modified technique for treating a single deep recession beyond the mucogingival margin. The approach uses a laterally closed coronally advanced flap (LCAF) without relieving incisions, combined with a subepithelial connective tissue graft and enamel matrix derivative.MethodsA 28‐year‐old woman was referred to our periodontal practice for the treatment of a progressive deep Cairo Class I recession with hypersensitivity and limited access to hygiene measures. The root coverage procedure was performed using a modified LCAF, combined with a connective tissue graft from the palate and enamel matrix derivative. The case was followed for 6 months.ResultsThe healing process was uneventful. Six months after surgery, the root surfaces remained completely covered. Hypersensitivity resolved entirely, and there was only a slight formation of visible scar tissue.ConclusionsThis modified technique of an LCAF is a feasible and effective method for treating single deep RT1 recessions. By avoiding visible relieving incisions, scar tissue formation is minimized. The preparation of an LCAF allows for adequate coronal advancement.Key points As far as our knowledge, this is the first description of a laterally closed coronally advanced flap (LCAF) combining the advantage of a minimalized scarring root coverage with a simplified coronally advancement for recessions exceeding the mucogingival junction. This modified technique combines the advantages of a lateral closing with a CAF for covering deep class RT1 recessions. Meticulous handling of the delicate pedicles combined with a coronal advancement of at least 2 mm beyond the cemento‐enamel junction is the key factor for the successful adaption of this technique. Plain language summaryDeep gum recessions originating from traumatic hygiene measures can cause hypersensitivity and limit patients´ access to oral hygiene. Especially in deep recessions, the common surgical techniques have shortcomings due to a post‐surgical lack of keratinized gingiva or visible scar tissue formation. This case study shows the treatment of a 28‐year‐old woman´s deep recession on a mandibular front tooth introducing a modified surgical technique for covering deep gum recessions exceeding the area of the keratinized gingiva (so‐called deep Cairo RT1 recessions). This new technique uses a “laterally closed coronally advanced flap” (LCAF), which combines a curtain‐similar lateral closing of the flap pedicles with a coronal advancement to cover the recession without making cuts that can lead to scars. It is combined with a tissue graft from the patient's palate and a special protein to regenerate the periodontium. Six months after surgery, complete root coverage was achieved without remaining hypersensitivity and with restored access for oral hygiene measures. Minimal visible scar tissue formed. This case study demonstrates that the LCAF is a feasible technique for covering single deep gum recessions exceeding the keratinized area of the gingiva.

Papilla Access Tunnel Combined With the Laterally Closed Tunnel: A Technique for Treatment of Deep Gingival Recession in the Anterior Mandible.

Treatment of gingival recession in the anterior mandible is more complex due to unique anatomic features including excessive tension due to frenal and muscle attachments, thin tissue, shallow vestibule, and narrow interdental space. These features are particularly limiting in the presence of deep recession and negatively impact the success most routine soft tissue grafting procedures. The recently proposed laterally closed tunnel combined the benefit of tension management from tunneling rather than incising papillae with lateral closure of deep recession to minimize the need for coronal advancement. This is an effective, although technically demanding procedure. This report presents a method of facilitating tunnel preparation by utilizing superficial papillary access incisions bilaterally in the papilla between the lateral incisor and canine. This papilla has the least tension and most robust interdental volume and blood supply. This incision creates a mini flap that facilitates tunnel dissection and graft placement. Because the mini flap is used for graft insertion, the suturing for lateral closure can be performed before graft insertion. The result is reduced technical difficulty.

COVID-19 and South Asia: an overview

The article explores the global impact of the COVID-19 pandemic, highlighting its severe effects on health systems, economies, and poverty levels. With an estimated 6.9 million deaths worldwide and the deepest recession since World War II, the pandemic had diverse regional impacts. South Asia, for example, experienced varying degrees of health and economic challenges; India faced over 500,000 deaths and a sharp economic downturn, while other nations in the region were less severely affected. The pandemic’s relatively brief duration, aided by global responses like lockdowns, social distancing, and rapid vaccine distribution, facilitated a quicker economic recovery, bolstered by unprecedented counter-cyclical policies. The article also examines South Asian case studies, including regional trade integration, the economic benefits of vaccination, and the socio-economic impacts on women in Bangladesh. It further discusses Pakistan’s response, Sri Lanka’s populist policies, and Indonesia’s monetary policy adjustments, offering valuable lessons for managing global health crises and economic downturns.

The myoarchitecture of the vertebrate cardiac ventricles: evolution and classification.

The ventricle of the vertebrate heart is the main segment of the cardiac outflow region. Compared with other cardiac components, it shows remarkable histomorphological variation among different animal groups. This variation is especially apparent in the myocardium, which is generally classified into three main types: trabeculated, compact and mixed. The trabeculated or 'spongy' myocardium is characterized by the existence of trabeculae and deep recesses or intertrabecular spaces, lined by the endocardium. The compact type is composed of condensed myocardial fibers, with almost no trabeculated layer. The mixed type consists of an outer compact layer and an inner trabeculated layer. Among vertebrates, fishes show a great diversity of myocardial types. On this basis, the ventricular myoarchitecture has been categorized into four groups of varying complexity. This classification is made according to (i) the proportion of the two types of myocardium, trabeculated versus compact, and (ii) the vascularization of the heart wall. Here, we review the morphogenetic mechanisms that give rise to the different ventricular myoarchitecture in gnathostomes (i.e. jawed vertebrates) with special emphasis on the diversity of the ventricular myocardium throughout the phylogeny of ancient actinopterygians and teleosts. Finally, we propose that the classification of the ventricular myoarchitecture should be reconsidered, given that the degrees of myocardial compactness on which the current classification system is based do not constitute discrete states, but an anatomical continuum.

Pathophysiological and Pedigree Analysis of Left Ventricular Noncompaction in Japanese Macaques (Macaca fuscata).

Left ventricular noncompaction (LVNC) involving genetic mutation is categorized as an unclassified cardiomyopathy, and its diagnostic criteria have not been standardized. This could be because precise animal models of LVNC have not been created in any laboratory animal species. This study aimed to analyze the pathophysiology and familial tendency of LVNC in Japanese macaques. Two Japanese macaques with LVNC, and their parents who were suspected of having cardiac disease, were examined. One macaque with LVNC was examined using chest radiography, echocardiography, cardiac biomarkers, cardiac MRI, and pathologic examination, and the other macaque was examined using chest radiography, echocardiography, and cardiac biomarkers. Their common father and the mother of one of the macaques with LVNC were tested for chest radiography and cardiac biomarkers. Echocardiography revealed a meshwork with trabeculation and deep intertrabecular recesses in all their left ventricular walls. The 2 macaques with LVNC demonstrated a layered appearance of the myocardium, consisting of noncompacted myocardium on the endocardial side and compacted myocardium on the epicardial side, with a noncompacted/compacted ratio of 6.0 and 5.8, respectively. One of the 2 macaques with LVNC (case 1) had elevated levels of troponin I, troponin T, atrial natriuretic peptide, and brain natriuretic peptide. The second macaque with LVNC (case 2) showed blood flow in the intertrabecular recesses on echocardiography. The common father (case 3) of the 2 macaques with LVNC and the mother (case 4) of one of the macaques with LVNC had elevated levels of troponin I and troponin T. In case 1, histopathologic examination revealed fibrous thickening of the endocardium, fibrosis of the myocardial interstitium, myocardial disarray, vacuolar degeneration, anisonucleosis, and necrosis of myocardial cells. This suggests that Japanese macaques could serve as a reliable animal model of human LVNC.

A CASE OF LEFT VENTRICULAR NON COMPACTION CARDIOMYOPATHY WITH ATRIAL SEPTAL DEFECT

Left ventricular non-compaction (LVNC) is a rare form of cardiomyopathy characterized by abnormal myocardial trabeculations and deep recesses within the left ventricle. It is often associated with other congenital heart defects, such as atrial septal defects (ASD). This report discusses the case of a 5-year-old female with both LVNC and ASD, highlighting the clinical presentation, diagnostic challenges, and management strategies. The case emphasizes the importance of early detection and a multidisciplinary approach to optimize patient outcomes. Recent literature is reviewed to provide updated insights into the pathophysiology, diagnosis, and treatment of this rare condition.

Left Ventricular Non-Compaction: Evolving Concepts

Left ventricular non-compaction (LVNC) is a rare heart muscle disease defined by the presence of prominent left ventricular trabeculation, deep intertrabecular recesses, and a thin compact layer. Several hypotheses have been proposed regarding its pathogenesis, with the most recently accepted one being that compact layer and trabeculated layers develop independently according to an “allometric growth”. The current gold-standard diagnostic criteria (in particular, the Petersen index non-compaction/compaction ratio > 2.3) reflect an excess of myocardial trabeculation, which is not a specific morpho-functional feature of LVNC cardiomyopathy but merely a “phenotypic trait”, even described in association with other myocardial disease and over-loading conditions. Accordingly, the European Society of Cardiology (ESC) guidelines have definitively abolished the term ‘LVNC cardiomyopathy’. Recently, evolving perspectives led to the restoration of LVNC cardiomyopathy by distinguishing “hypertrabeculation phenotype” and “non-compaction phenotype”. It has been proposed that the disease-specific pathophysiologic mechanism is a congenitally underdevelopment of the compact layer accounting for an impairment of the left ventricular systolic function. Future prospective research should focus on the clinical and prognostic relevance of compact layer thinning rather than excessive trabeculation, which could significantly influence the management of patients with LVNC. The review aims to update current knowledge on the pathogenesis, genetics, and diagnostic criteria of LVNC, offering modern insights for future perspectives.

What charge-off rates are predictable by macroeconomic latent factors?

Charge-offs provide critical insights into the risk level of loan portfolios within the banking system, signaling potential systemic risks that could lead to deep recessions. Utilizing consolidated financial statements, we have compiled the net charge-off rate (COR) data from the 10 largest U.S. bank holding companies (BHCs) for disaggregated loans, including business loans, real estate loans, and consumer loans, as well as the average COR for each loan category among these top 10 banks. We propose factor-augmented forecasting models for CORs that incorporate latent common factor estimates, including targeted factors, via an array of data dimensionality reduction methods for a large panel of macroeconomic predictors. Our models have demonstrated superior performance compared with benchmark forecasting models, particularly well for business loan and real estate loan CORs, while predicting consumer loan CORs remains challenging especially at short horizons. Notably, real activity factors improve the out-of-sample predictability over the benchmarks for business loan CORs even when financial sector factors are excluded.

The role of immigration in a deep recession

This paper studies the impact of pre-Great Recession immigrant inflows on the labour market during a recession. It develops a random search model of the labour market featuring vacancy persistence, endogenous return migration, and wage rigidity. Consistent with the Spanish data, some immigrants in the model leave the country during the recession, freeing up jobs for natives. Yet, differences in match-quality draws between immigrants and natives also impact firms’ job creation decisions. The return-migration channel positively affects natives, while job creation effects are negative in the calibrated Spanish economy. I find that immigrants mitigate the impact of the recession and enhance natives’ welfare. During the recession, the native unemployment rate would have been 2 percentage points higher in the absence of the pre-crisis immigration boom. Return migration plays a key role, with short- and medium-run impacts on the native unemployment rate 6 times larger than all other channels combined.

Evaluation of the effectiveness and performance of environmental impact assessment studies in Greece

As environmental management is becoming increasingly complex, adequate assessment techniques must be utilized to forecast environmental impact trends. The current study aims to investigate the effectiveness of the evaluation system in Greece regarding environmental impact assessment (EIA) concerning projects. Data were extracted from literature and a questionnaire, which was distributed electronically on a Pan-Hellenic scale. Results indicated that the EIA system in Greece has solid foundations with a weak point regarding implementation. Strengths, weaknesses, and threats of EIA institution were analyzed through SWOT-AHP (Strength, Weaknesses, Opportunities, Threats and Analytical Hierarchy Process) analysis. A dominant criterion in the analysis due to the dynamic of the deep economic recession was found to be the economic crisis.

Демография и развитие: исторический опыт и актуальные проблемы Кабардино-Балкарской Республики

The demographic characteristics of society act at any given moment as factors determining the possibilities and limitations of socio-economic development, but over long historical stages, they themselves change under the influence of socio-economic changes. This relationship should be considered when setting goals and objectives for both economic and demographic policies at the national and regional levels. This paper provides a review of the leading trends and results of the economic and socio-demographic evolution of Kabardino-Balkaria during the Soviet era and the main features of the current demographic situation in the context of the region’s transition to an innovative path of socio-economic development. The socio-economic modernization of the Soviet period was accompanied by demographic modernization. The population of Kabardino-Balkaria grew rapidly and acquired a new sociocultural appearance, becoming more diverse in ethnic com-position, urban in settlement structure and way of life. By the end of the Soviet era, the demo-graphic transition was completed, the level of education of the population of the republic was comparable to all-Russian parameters, its socio-professional structure acquired a diversified and generally modern character. However, the transition from the Soviet to the post-Soviet social and state system was accompanied not just by a deep economic recession, but by the phenomena of structural deindustrialization and demodernization. A reflection of these socio-economic condi-tions is the ambivalence of the demographic situation – a significant slowdown in natural growth, the aging of the population, a shift in the age distribution of marriage and birth rate towards older ages, a change in the vector of migration processes from inflow to outflow, a decrease in the share of the urban population, a reduction in industrial employment, a decline in the Russian population, reaching a plateau in dynamics and a deterioration in comparative indicators of the level of educa-tion. Meanwhile, qualitatively new tasks have appeared on the agenda, placing increased demands on the quality of human potential of modern development.

A case report of autosomal recessive polycystic kidney disease with noncompaction of ventricular myocardium: coincidence or different manifestations of ciliopathy?

BackgroundAutosomal recessive polycystic kidney disease (ARPKD) is a rare inherited cystic disease characterized by bilateral renal cyst formation and congenital liver fibrosis. Cardiovascular disorders such as noncompaction of ventricular myocardium (NVM) have not been reported with ARPKD.Case presentationA 5-month-old girl was examined after presenting with a fever and turbid urine for one day and was diagnosed as urinary tract infection. Urinary ultrasound showed multiple round, small cysts varying in size in both kidneys. Genetic testing revealed two heterozygous mutations and one exon deletion in the polycystic kidney and hepatic disease 1 gene, indicating a diagnosis of ARPKD. During hospitalization, she was found to have chronic heart failure after respiratory tract infection, with an ejection fraction of 29% and fraction shortening of 13%. When the patient was 15 months old, it was found that she had prominent trabeculations and deep intertrabecular recesses with the appearance of blood flow from the ventricular cavity into the intertrabecular recesses by echocardiography. The noncompaction myocardium was 0.716 cm and compaction myocardium was 0.221 cm (N/C = 3.27), indicating a diagnosis of NVM. Liver and kidney function remained normal during four-year follow-up.ConclusionsThis is the first report of NVM in a patient with ARPKD. It is unsure if the coexistence of NVM and ARPKD is a coincidence or they are different manifestations of ciliary dysfunction in the heart and kidneys.

Post-COVID inflation and the monetary policy dilemma: an agent-based scenario analysis

AbstractThe economic shocks that followed the COVID-19 pandemic have brought to light the difficulty, both for academics and policy makers, of describing and predicting the dynamics of inflation. This paper offers an alternative modelling approach. We study the 2020–2023 period within the well-studied Mark-0 Agent-Based Model, in which economic agents act and react according to plausible behavioural rules. We include a mechanism through which trust of economic agents in the Central Bank can de-anchor. We investigate the influence of regulatory policies on inflationary dynamics resulting from three exogenous shocks, calibrated on those that followed the COVID-19 pandemic: a production/consumption shock due to COVID-related lockdowns, a supply chain shock, and an energy price shock exacerbated by the Russian invasion of Ukraine. By exploring the impact of these shocks under different assumptions about monetary policy efficacy and transmission channels, we review various explanations for the resurgence of inflation in the USA, including demand-pull, cost-push, and profit-driven factors. Our main results are fourfold: (i) without appropriate fiscal policy, the shocked economy can take years to recover, or even tip over into a deep recession; (ii) the success of monetary policy in curbing inflation is primarily due to expectation anchoring, rather than to the direct economic impact of interest rate hikes; (iii) however, perhaps paradoxically, strong inflation anchoring is detrimental to consumption and unemployment, leading to a narrow window of “optimal” policy responses due to the trade-off between inflation and unemployment; (iv) the two most sensitive model parameters are those describing wage and price indexation. The results of our study have implications for Central Bank decision-making, and offer an easy-to-use tool that may help anticipate the consequences of different monetary and fiscal policies.

Impact of Otoendoscopy in Cholesteatoma Surgery.

To study the Impact of Otoendoscopy at the end of apparent microscopic clearance of disease during primary Cholesteatoma surgery in detecting the residual cholesteatoma. A prospective, interventional, non randomized and non comparative study was conducted at the ESIC Medical College and PGIMSR. All patients of chronic otitis media of squamosal type undergoing modified radical mastoidectomy were included in the study. Otoendoscopy was performed after apparent clearance of cholesteatoma under microscope. If any residual cholesteatoma detected during otoendocsopy was recorded. Total of 63 cases were included in the study. Residual cholesteatoma was seen in 14% of the cases. Commonest site of residual cholesteatoma was sinus tympani. Otoendoscopy helps in visualizing the deep recesses of the middle ear cleft for residual cholesteatoma after apparent clearance under the operating microscope. It also helps in clearing the cholesteatoma from these deep recesses there by it helps in reducing the recurrence rate of cholesteatoma.

Isolated left ventricular non-compaction: clinical characterisation of a teenage male

Isolated Left Ventricular Non-compaction (LVNC) is a type of cardiomyopathy that usually has a genetic origin. Its diagnosis is based on findings such as deep intertrabecular recesses or sinusoids and ventricular trabeculations communicating with the left ventricular cavity. LVNC was first clinically recognised almost four decades back, yet its diagnostic and management challenges persist. In this report, we present the case of an 18-year-old boy, who presented at the National Institute of Cardiovascular Diseases, Karachi, in March 2023, with complaints of dizziness, pedal oedema, and shortness of breath. Echocardiography revealed signs suggestive of LVNC, which were confirmed conclusively on Cardiovascular Magnetic Resonance (CMR) (NC/C ratio>2.4). The patient underwent implantable cardioverter defibrillator (ICD) placement, was discharged after a smooth post-procedure recovery, and is doing well on follow-ups. ---Continue

Economic resilience: Why some countries recover more robustly than others from shocks

Economic resilience – the tendency of economies to bounce back from negative shocks – has never been more important, given the growing prevalence and frequency of such shocks. The existing literature on its determinants are inconclusive. We therefore reanalyze those determinants for a large sample of countries, first collectively and then separately for advanced countries and emerging markets. Deeper recessions are followed by stronger recoveries, consistent with Friedman's plucking model of the business cycle. In contrast, longer recessions are associated with weaker recoveries, as if more extensive destruction of human capital and other hysteresis effects limit resilience. Trade openness and exchange rate flexibility, which facilitate the substitution of external demand when domestic demand is weak, are positively associated with resilience, as are a strong current account balance and ample foreign reserves. Financial openness and rapid private credit growth in the preceding expansion contribute negatively, reflecting their legacy of financial problems.

TCAD Simulation of Novel Recess Gate Common Drain Dual Channel AlGaN/GaN HEMT for Small Signal Performance

In this paper, DC and RF characteristics of Recess Gate Common Drain Dual Channel (CDDC) AlGaN/GaN HEMT have been investigated. The performance of the device in terms of the various figures of merits including gate-source capacitance, drain current, transconductance, and channel conductance has been studied for different recess depths. The threshold voltage is found to decrease by shifting right with increasing recess depth, even though with deeper recess, transconductance increases. It has also been observed that the device operates in enhancement mode with a minimum gate recess depth of 15 nm or more. With increasing recess depth, the drain current starts decreasing due to an increase in channel resistance. Use of recess technology with Al graded barrier layer enhances the performance in terms of gm, ft, and fmax which are 0.003 S, 23, and 46 GHz, respectively, but utilizing gate recess technology alone in CDDC HEMT further enhances device performance and the maximum gm, ft, and fmax are 0.0442 S, 28.43, and 59.21 GHz. The CDDC HEMT retain its advantage for specific applications including PA, LNA, and RF switch with optimized gate recess and graded barrier layer parameters.

Left Ventricular Noncompaction: Often Forgotten Cause of Heart Failure

Left ventricular (LV) noncompaction is a form of genetic cardiomyopathy characterized by hypertrabeculations with deep intertrabecular recesses of the LV myocardium. The diagnosis can be confirmed by echocardiography and magnetic resonance imaging. These patients can be asymptomatic or may present with heart failure, arrhythmias, or thromboembolic episodes. The management is guideline directed. When associated with congenital heart defects or correctable valvular lesions, surgical management should be advised. Familial screening and counseling of first-degree relatives are essential. In this review, an attempt has been made to give an overview of this condition.

Employment trends in the world and a reference perspective for university graduates in Vietnam in of the period before and after the COVID-19 pandemic

The COVID-19 pandemic has caused a global economic crisis, endangering the health, jobs and income of millions of people around the world. The strict containment measures adopted by many countries to contain the increase in infections have created a significant drag on most economic and social activities. The decline in total hours worked and the decline in workforce participation are unprecedented in peacetime. There are signs that many economies around the world are in sharp and deep recession and have reached the bottom. Ensuring that the recovery is swift and sustainable and rebuilding a more resilient and inclusive labor market remain significant challenges for us. In this context, the Vietnam case study has demonstrated that unemployment rates and workers receiving wages below the minimum wage have increased, while temporary layoffs and job quality have increased, and wages fell again. The goal of this article, the authors will learn and research the following issues: Overview of the employment situation in the world during and after the COVID-19 pandemic; Reference perspective on the trend of working with university graduates in Vietnam after the COVID-19 pandemic; and some conclusions & recommendations for Vietnam related to the research issue.

Al‐Rich AlGaN Transistors with Regrown p‐AlGaN Gate Layers and Ohmic Contacts

AbstractEpitaxial regrowth processes are presented for achieving Al‐rich aluminum gallium nitride (AlGaN) high electron mobility transistor (HEMTs) with p‐type gates with large, positive threshold voltage for enhancement mode operation and low resistance Ohmic contacts. Utilizing a deep gate recess etch into the channel and an epitaxial regrown p‐AlGaN gate structure, an Al0.85Ga0.15N barrier/Al0.50Ga0.50N channel HEMT with a large positive threshold voltage (VTH = +3.5 V) and negligible gate leakage is demonstrated. Epitaxial regrowth of AlGaN avoids the use of gate insulators which can suffer from charge trapping effects observed in typical dielectric layers deposited on AlGaN. Low resistance Ohmic contacts (minimum specific contact resistance = 4 × 10−6 Ω cm2, average = 1.8 × 10−4 Ω cm2) are demonstrated in an Al0.85Ga0.15N barrier/Al0.68Ga0.32N channel HEMT by employing epitaxial regrowth of a heavily doped, n‐type, reverse compositionally graded epitaxial structure. The combination of low‐leakage, large positive threshold p‐gates and low resistance Ohmic contacts by the described regrowth processes provide a pathway to realizing high‐current, enhancement‐mode, Al‐rich AlGaN‐based ultra‐wide bandgap transistors.