Head Region Research Articles

COMMUNITY PARTICIPATION IN THE 2022 REGIONAL ELECTIONS IN BANDAR SETIA VILLAGE, PERCUT SEI TUAN DISTRICT, DELI SERDANG REGENCY, NORTH SUMATRA PROVINCE

The election of regional heads in Indonesia is a direct mandate of the reform movement in 1998. The election of regional heads is part of local democracy, which to realize good democracy, the implementation that can be carried out is the election of regional heads. This aims to channel the aspirations of the community to exercise their voting rights. The election of Regional Heads that is carried out directly can increase the participation of the community. However, it is not uncommon for many people to not care about the election of regional heads. Most of them are apathetic and do not find out about the future leader they will choose. This can happen because the prospective leaders promise a lot of things that can attract the attention of the public but are not implemented correctly. So that the community is disappointed and does not want to know anymore about how the leader will lead them in the future. This analysis is to find out the participation of the community in carrying out local democracy through the election of regional heads. This study uses a qualitative descriptive method. Qualitative research is an approach used to understand the phenomena experienced by the research subject, for example motivation, perception, action, and so on.

Trend change analysis of postural balance in Parkinson’s disease discriminates between medication state

BackgroundMaintaining static balance is relevant and common in everyday life and it depends on a correct intersegmental coordination. A change or reduction in postural capacity has been linked to increased risk of falls. People with Parkinson’s disease (pwPD) experience motor symptoms affecting the maintenance of a stable posture. The aim of the study is to understand the intersegmental changes in postural sway and to apply a trend change analysis to uncover different movement strategies between pwPD and healthy adults.MethodsIn total, 61 healthy participants, 40 young (YO), 21 old participants (OP), and 29 pwPD (13 during medication off, PDoff; 23 during medication on, PDon) were included. Participants stood quietly for 10 s as part of the Short Physical Performance Battery. Inertial measurement units (IMU) at the head, sternum, and lumbar region were used to extract postural parameters and a trend change analysis (TCA) was performed to compare between groups.ObjectiveThis study aims to explore the potential application of TCA for the assessment of postural stability using IMUs, and secondly, to employ this analysis within the context of neurological diseases, specifically Parkinson’s disease.ResultsComparison of sensors locations revealed significant differences between head, sternum and pelvis for almost all parameters and cohorts. When comparing PDon and PDoff, the TCA revealed differences that were not seen by any other parameter.ConclusionsWhile all parameters could differentiate between sensor locations, no group differences could be uncovered except for the TCA that allowed to distinguish between the PD on/off. The potential of the TCA to assess disease progression, response to treatment or even the prodromal PD phase should be explored in future studies.Trial registrationThe research procedure was approved by the ethical committee of the Medical Faculty of Kiel University (D438/18). The study is registered in the German Clinical Trials Register (DRKS00022998).

Impact of Upadacitinib on Atopic Keratoconjunctivitis Exacerbated by Dupilumab Treatment in Atopic Dermatitis Patients: A Prospective Dermatological and Ophthalmological Clinical Evaluation in Common Clinical Practice.

Introduction: Atopic dermatitis (AD) is a prevalent chronic inflammatory skin condition with a substantial impact on patients, particularly due to ocular involvement known as atopic keratoconjunctivitis (AKC). Current therapeutic approaches, such as dupilumab, often lead to conjunctivitis, prompting exploration of alternative treatments like upadacitinib. Methods: We collected dermatological and ophthalmological prospective clinical evaluations of six adults with moderate-to-severe AD, undergoing treatment with upadacitinib after discontinuation of dupilumab due to the onset of AKC during therapy and the worsening of dermatitis in particular in the head and neck region. Clinical evaluations, including EASI scores, itch and sleep NRS, DLQI, and ocular parameters, were performed at baseline (during screening assessment before switching to upadacitinib) and then at week 12 and week 24. Clinical evaluation of AKC was performed by a team of ophthalmologists. Results: Upadacitinib not only improved atopic dermatitis in terms of EASI, itching, and sleep NRS, but also demonstrated a notable reduction in ocular signs and symptoms, as indicated by the Visual Analogue Scale (VAS), the Efron scale, and the Ocular Surface Disease Index Symptom Severity (OSDISS) scores. Discussion: Our observation of common clinical practice underscores the substantial impact of biological and small-molecule therapies on AD, emphasizing the limitation posed by dupilumab-associated conjunctivitis. Switching to upadacitinib significantly improved both clinical and functional ocular outcomes, suggesting its potential as an alternative therapeutic option for AD patients with ocular involvement. Conclusion: The presented data provides insights into the complex interplay between systemic therapies and ocular manifestations in AD. Upadacitinib emerges as a promising option to address dupilumab-associated conjunctivitis, offering improved quality of life for patients.

Establishment of an LMBV-infection model in zebrafish larvae and its application in studying virus-host interactions

Largemouth bass virus (LMBV) causes high transmission efficiency and mortality in freshwater aquaculture industry. However, the host responses to LMBV infection, particularly the molecular mechanisms involved in vivo, remain largely uncertain. Zebrafish has been developed as a powerful model organism for the study of host inflammation and immune response upon pathogen infections. Here, we evaluated the susceptibility of LMBV to zebrafish larvae and investigated the host response upon virus infection using transcriptomic analysis. LMBV replicated well in larvae by inoculation with LMBV via the brain and the duct of Cuvier, but the later showed more severe systemic infection, evidenced by the cumulative mortality, the increased transcriptions of viral core genes, and the presence of mcp positive signal in infected larvae. After inoculation with LMBV via the duct of Cuvier, we observed numerous viral particles in the head and tail regions of infected larvae. Moreover, ROS and TUNEL positive signaling also significantly increased in LMBV infected larvae. Of note, a great deal of neutrophils migrated towards the virus infected sites during LMBV infection. Transcriptomic analysis showed that a total of 1263 genes were up-regulated and 1039 genes were down-regulated in response to LMBV infection. Enrichment analysis indicated that the majority of the enriched KEGG pathways were associated with metabolism, cell death and immune regulation, such as fatty acid metabolism, steroid hormone biosynthesis, PPAR signaling, apoptosis, necroptosis, phagosome, cytokine-cytokine receptor pathway, NOD-like receptor signaling, and toll-like receptor pathway. For instance, cell death related signaling molecules including casp9,fas,tnfα and sqstm1 were significantly up-regulated, while camk2a,sept4b and akt1 were down-regulated in response to LMBV infection. Thus, our data firstly established LMBV-infected model in zebrafish larvae which could provide an alternative means for investigation of LMBV-host interaction in vivo, and application for high throughput drug screening in the future.

Assessment by the Population of the Effectiveness of Digital Communication of the Heads of Regions in the Internet Dialogue “Power ‒ Societyˮ

Assessment by the Population of the Effectiveness of Digital Communication of the Heads of Regions in the Internet Dialogue “Power ‒ Societyˮ

Clinico-epidemiological characteristics and long-term surgical outcome of basal cell carcinoma treated with standard excision in patients of skin of colour: A retrospective study from Northern India.

Background There is scant data on basal cell carcinoma (BCC) in Indian patients. This retrospective study was conducted to explore epidemiology, risk factors, clinical and pathological aspects, and long-term treatment outcomes of BCC in a cohort of North Indian patients. Methods Data about patients registered in the dermatosurgery clinic between 01 January 2017 and 31 December 2022 with a confirmed diagnosis of BCC was collected. Results Among the 83 patients, 56.6% were females, and the median age was 62 years (6-85 years). Most patients (81.9%) had a single BCC lesion, resulting in a total of 126 assessed lesions. The median size of BCC at presentation was 1.90 cm, with nodular BCC being the most common histopathological subtype (39.7%). Head and neck region involvement was observed in 82.5% of patients, with the malar region, nose, and periorbital region being the most commonly affected sites. Pigmentation was clinically evident in 45.2% of cases. Surgical excision was the primary treatment modality (71.1% of patients). The median follow-up duration was 40 months (6-57 months). Recurrence occurred in five patients, with a longer disease-free survival period observed in the surgically treated group (55.58 ± 0.98 months) compared to patients treated with medical or destructive therapies (43.6 ± 3.482 months) (p = 0.003). Conclusion The data from this hospital-based study indicated a slight predilection for females among North Indian patients with BCC, with most cases occurring during their seventh decade of life. The condition commonly occurred on sun-exposed areas such as the malar region and nose, with a high percentage of pigmented lesions. Recurrence following surgical excision was rare, and overall treatment outcomes were favourable.

The Effects of ML385 on Head and Neck Squamous Cell Carcinoma: Implications for NRF2 Inhibition as a Therapeutic Strategy.

Head and neck squamous cell carcinoma (HNSCC) affects squamous cells in the head and neck region and is currently ranked as the sixth most common cancer worldwide. NF-E2-related factor 2 (NRF2) plays a crucial role in cellular protection and defence mechanisms and NRF2 over-expression has been linked to various cancers; however, its role in the response of HNSCC cells remains elusive. We investigated the effects of ML385, a selective NRF2 inhibitor, on HNSCC to understand the underlying molecular mechanisms, and to assess the potential of ML385 as a therapeutic agent. We treated HNSCC cell lines with ML385 and observed a significant reduction in the expression of NRF2 and its downstream target, heme oxygenase-1 (HO-1), using Western blotting. We evaluated its effects on various cellular processes, including cell proliferation, cloning, migration, and wound healing, in HNSCC cell lines. ML385 treatment substantially reduced NRF2 expression, promoting a decrease in the investigated cellular activities. Additionally, we examined changes in the expression of cell-cycle-related proteins and found that ML385 induced cell cycle arrest at the G1/S phase in HNSCC cell lines. Our findings suggest that ML385 can regulate cell cycle progression, inhibit HNSCC growth, and have potential as a therapeutic agent for HNSCC.

Extraosseous osteosarcoma of the larynx: an unusual tumor managed with radical surgery – case report

Introduction and importance: Extraosseous osteosarcoma (EOO) is a malignant tumor that arises in soft tissue without affecting bone or periosteum but produces osteoid, osseous, or chondroid material. It is a very rare malignancy that accounts for approximately less than 1% of all tissue sarcomas and ~2–4% of all osteosarcomas. EOO in the head and neck region is extremely rare; however, in the larynx, it is exceptional, with only one case reported worldwide in the literature to date. Case presentation: A 72-year-old male with no personal history of interest in the current condition presented with dysphonia, hoarseness, and dyspnea for 6 months. A flexible nasofibrolaryngoscopy (FNFL) and computed tomography (CT) scan exhibited a glottic tumor with a lumen obstruction of 90%. An endoscopic resection was performed, reporting an EOO, osteoblastic, and ulcerated type. During follow-up, tumoral persistence was detected, leading to the decision to perform a definitive radical treatment with a total laryngectomy. Clinical discussion: Its presentation in the head and neck region is exceptional, with only a few isolated cases reported in the literature. Available data on treatment recommendations have emphasized the importance of timely surgical intervention with adjuvant radiation therapy if necessary for the head and neck. Conclusion: Extraosseous osteoblastoma of the larynx is an extremely rare and infrequent disease. Correct diagnosis and oncological surgical management of this disease are essential for optimal and even curative treatment of the patient.

Clinical Value of Fine Needle Aspiration Cytology and Core Needle Biopsy in Head and Neck Pathology - A Nationwide Survey in Germany.

Fine-needle aspiration cytology (FNA) and core needle biopsy (CNB) of the thyroid gland, salivary glands, and lymph nodes are considered simple and rapid methods for minimally invasive tissue collection. We performed a postal survey to analyse the diagnostic value and complication rate of FNA and CNB in Germany. A questionnaire comprising 11 questions was sent to all 161 German ENT departments in September 2015. The response rate was 45%. In 33 of the 73 responding clinics neither FNA nor CNB were carried out. Of the 26 clinics that provided detailed reasons, the majority (n=18) cited a lack of expertise among the collaborating pathologists. Overall, FNA was used more often, regardless of the anatomical region investigated. The study was based on a total of 36,684 FNAs and 9,624 CNBs. The rate of estimated meaningful and correct findings was 63% (10%-90%) for FNA, and 83% (50%-100%) for CNB. In eight cases (<0.001%) a potential tumor cell spread was reported. This is the first nationwide survey in Germany to investigate the utility of FNA and CNB across different localizations in the head and neck region. This study revealed comparable results to the literature regarding the diagnostic value of FNA and CNB. Cell spreading was only observed in individual cases. The appraisal of needle biopsies in the head and neck area seems to be rather inhomogeneous in Germany.

Laryngeal leiomyoma: A case report and review of literature

BACKGROUND Leiomyomas (LMs) are mesenchymal tumors that arise from smooth muscle cells. LMs most commonly arise in organs with an abundance of smooth muscle such as the uterus and gastrointestinal tract. Conversely, LMs are rarely detected in the head and neck region. In this study, we report a rare case of laryngeal LM (LLM) and summarized the clinical characteristics of reported LLMs to help clinicians better understand this rare disease and improve its diagnosis, treatment, and postoperative course. CASE SUMMARY A 49-year-old man was admitted to our ENT outpatient clinic with a chief complaint of pharynx discomfort for 2 months. Laryngoscopy performed under topical anesthesia revealed a solitary, pink mass at the tubercle of epiglottis. Surgery via laryngeal endoscopy was performed under general anesthesia, and the lesion was excised easily. Positive immunohistochemical staining for desmin and smooth-muscle actin indicated a smooth muscle origin and the diagnosis was laryngeal leiomyoma. After surgery, the patient’s condition was stable, and he was discharged 2 d after surgery. During the 1-year postoperative period, the patient’s condition remained stable without evidence of recurrence. CONCLUSION Surgical resection is the preferred treatment for LLMs, its early diagnosis and differential diagnosis have important clinical significance.

Retinal microglial cells increase expression and release of IL-1β when exposed to ATP.

Cytokine IL-1β is an early component of inflammatory cascades, with both priming and activation steps required before IL-1β release. Here, the P2X7 receptor (P2X7R) for ATP was shown to both prime and release IL-1β from retinal microglial cells. Isolated retinal microglial cells increased expression of Il1b when stimulated with endogenous receptor agonist extracellular ATP; ATP also rapidly downregulated expression of microglial markers Tmem119 and Cd206. Changes to all three genes were reduced by specific P2X7R antagonist A839977, implicating the P2X7R. Microglial cells expressed the P2X7R on ramifications and responded to receptor agonist BzATP with robust and rapid rises in intracellular Ca 2+ . BzATP increased expression of IL-1β protein colocalizing with CX3CR1-GFP in retinal wholemounts consistent with microglial cells. ATP also triggered release of IL-1β from isolated retinal microglia into the bath; release was inhibited by A839977 and induced by BzATP, supporting a role for the P2X7R in release as well as priming. The IL-1β release triggered by ATP was substantially greater from microglial cells compared to astrocytes from the optic nerve head region. Il1b expression was increased by a transient rise in intraocular pressure and Il1b levels remained elevated 10 days after a single IOP elevation. In summary, this study suggests the P2X7 receptor can both prime IL-1β levels in microglial cells and trigger its release. The P2Y12R was previously identified as a chemoattractant for retinal microglia, suggesting the recruitment of the cells towards the source of released extracellular ATP could position microglia for P2X7R receptor, enabling both priming and release of IL-1β.

Myofibroma with Atypical Features can Mimic Low-Grade Myofibroblastic Sarcoma: Two Paediatric Cases.

Myofibroma is a rare benign mesenchymal tumor that frequently affects the pediatric population with a predilection for the head and neck region. About 10% of myofibroma cases, presenting atypical features, can be misinterpreted as low-grade myofibroblastic sarcoma (LGMS), with therapeutic and prognostic impact. Here, we report two pediatric cases of benign myofibroblastic tumors, one of them showing typical characteristics of myofibroma, the other was an atypical myofibroma, which initially mimicked low-grade myofibroblastic sarcoma. Atypical myofibromas, despite its distinctive characteristics, follow a benign course, similar with typical myofibroma. It is necessary to distinguish atypical myofibroma from low-grade myofibroblastic sarcoma and avoid unnecessary invasive therapy.

Acquired High Flow Arteriovenous Malformation of the Lower Lip Induced by Hormonal Variation- Report of a Rare Case and Review

Arteriovenous malformations (AVMs) are uncommon vascular lesions. AVMs are the most serious type of vascular malformations, causing substantial deformity and functional disability. AVMs of the acquired type are rarely confronted in the head and neck region. They may present as a medical emergency while performing dental procedures due to their potential for uncontrollable haemorrhage. Dental professionals should be aware of their potentially fatal complications and management. Accurate diagnosis of AVMs is critical and their management remains challenging. Vascular anomalies involving the lips can negatively impact the functionality and facial appearance. In this article, we discuss a very rare case of acquired AVM of the lower lip triggered by hormonal variation occurring during menopause in a female patient, 58 years of age. There are no reported cases of acquired AVM of the lip with hormonal variation occurring during menopause as the trigger for proliferation of the lesion. An overview of the clinical, etiological, diagnostic and management aspects of head and neck region-acquired AVMs is also presented in this paper.

Narrative strategies of visualizing in the public pages the heads of regions (the VKontakte's case)

The article examines the main narrative communication strategies of Russian regional politicians in visual storelling. The research methods are discourse analysis in the interpretation of N. Fairclough and the approach of P. Sztompka. The sample of the research was composed of publications with visual materials: the 15 most popular blogs of the heads of regions of Russia on the VKontakte. Chronological framework: the period from March 1, 2023 to November 1, 2023. The results of the research allow to identify four key narrative strategies of visual storytelling. They are "hero’s path", "stability", "friend or foe" and "future plans". It is concluded that each of these narratives is involved in one way or another in each of the reviewed blogs. The most popular is the "hero’s path". The presentation of each strategy in the visual storytelling is different in the cases considered. This allows to suggest that the demonstration of a particular strategy depends both on the target audience of the public (in this case, residents of the region) and on the personal characteristics of politicians.

The role of electrochemotherapy in the treatment of locally advanced or recurrent eyelid-periocular basal cell carcinoma: long-term results.

While electrochemotherapy (ECT) is increasingly utilized as a highly effective method in the treatment of tumors in the head and neck region, there is significantly less data available for eyelid-periocular skin tumors. Our group reported the first extensive case series of eyelid-periocular basal cell carcinoma (BCC) patients with short-term follow-up treatment with ECT. The present study aims to report our long-term results of eyelid-periocular BCC cases treated with ECT. The treatments were performed according to the ESOPE (European Standard Operating Procedures on Electrochemotherapy) guidelines using the Cliniporator™ device. All patients received bleomycin-based ECT, administered intratumorally or intravenously. Tumor response was evaluated using the RECIST 1.1 criteria. The results of 19 patients treated with ECT are presented. Four patients had locally advanced primary tumors, while 15 patients had recurrent tumors. Bleomycin was administered intratumorally in four patients and intravenously in 15 patients. The overall response was 100%, while the complete response rate proved to be 95%. In three cases (15.8%), recurrence was observed during the mean follow-up period of 78.9 months. ECT can effectively treat locally advanced or recurrent BCC in the eyelid-periocular skin region. Excellent tumor control can be achieved with good functional and cosmetic results without systemic adverse events with long interval follow-up.

Analisis Yuridis Potensi Perubahan Nomenklatur Serta Bentuk Hukum Bank Pembangunan Daerah Kalimantan Barat Literature Review: Juridical Analysis Of Potential Changes In The Nomenclature And Legal Form Of The West Kalimantan Regional Development Bank

Perseroda West Kalimantan Regional Development Bank or "Perseroda Bank" is a Regional Company Company, West Kalimantan Regional Development Bank which will be formed based on the provisions of this PERDA Regional Companies are all companies whose capital is wholly or partially constituted as excluded regional assets, unless otherwise determined by or based on law. The aim of Regional Companies is to participate in implementing Regional development, especially in national economic development, to meet the needs of the people by prioritizing peace and enjoyment of work within the company, towards a just and prosperous society. Management of Regional Companies is in the hands of Regional Company administrators who are responsible to the Regional Head, the responsibility of the Regional Head is as owner and manager.

Optimizing Village Wealth Through the Transition to BUMDes in Indonesia

This research examines the regulation of transitioning village assets to Village-Owned Enterprises (BUMDes) based on Village Law, highlighting shifts in dispute resolution methods. Using a normative method with statutory and historical approaches, the study identifies challenges in optimizing village head authority and effective supervision by regional heads. Key findings show the transition process involves initiation and agreements between BUMDes and village government, with tailored dispute resolution methods including mediation and litigation. Effective regulations and collaboration between officials and asset managers can enhance BUMDes' self-sufficiency, benefiting local economies and village welfare while ensuring transparency and community participation.Highlight: Transition Process: Village assets to BUMDes via initiation and agreements. Dispute Resolution: Methods include mediation, village discussions, and litigation. Regulatory Challenges: Enhance village head authority and regional supervision. Keywoard: Village assets, BUMDes, Village Law, Dispute resolution, Normative method

Pressure-Reducing Design of 3D-Printed Diabetic Shoe Midsole Utilizing Auxetic Lattice Structure

With the global rise in the prevalence of diabetes, diabetic patients need innovative footwear designs to reduce the risk of foot ulcers. This study examined the mechanical properties of diabetic shoe midsoles featuring auxetic lattice structures. Through the construction of finite element models and simulation, this research compared the biomechanical parameter differences in the plantar regions of the metatarsal head, midfoot, and hindfoot when wearing two types of auxetic midsoles with internal angles of 60° and 75° and a non-auxetic midsole with an internal angle of 90° under both walking and running conditions. Compared to the non-auxetic midsole, the auxetic midsoles significantly reduced the peak plantar pressure and optimized the pressure distribution across various plantar regions. Notably, the auxetic 60° midsole reduced the peak plantar pressure by 19.68–55.25% and 16.19–54.39% compared to the non-auxetic 90° midsole during walking and running, respectively. This study also verified that the auxetic midsoles exhibited greater adaptability and compliance to the plantar foot shape, contributing to reductions in plantar pressure in comparisons of deformation values and plantar contact areas across the different midsoles. Auxetic midsoles manufactured using 3D printing technology have significant potential to prevent diabetic foot ulcers and maintain human foot health. This research integrates insights and techniques from materials science and ergonomics, offering a new direction for footwear design.

Correlation of Narrow Band Imaging Patterns with Histopathology Reports in Head and Neck Lesions.

Head and neck malignancies are associated with poor prognosis and poor quality-of-life if detected late. Narrow-Band-Imaging(NBI) is one of the important tools, which helps in detecting these lesions earlier. By using narrow-wavelength(400-550nm) it enhances the mucosal and submucosal vascularity against the pale mucosal background which helps us detecting benign, pre-malignant and malignant lesions. The objective of this study was to evaluate the accuracy of NBI in the diagnosis of various mucosal lesions of head and neck region and its correlation with the histopathology reports. This was a prospective diagnostic study conducted between June 2020 - June 2022 where 118 patients(oral cavity-28, laryngeal-87,and hypopharyngeal-3) who fulfilled the inclusion and exclusion criteria were recruited. All-118-patients underwent NBI endoscopy under local/general anaesthesia followed by biopsies from the most suspicious-areas. Type of vascular-pattern noted from NBI and their respective histopathological reports were correlated. The mean age was 53.28 ± 1.24 years ranging from 16 to 88 years. The sensitivity, specificity, Positive-Predictive-Value(PPV) and Negative-Predictive-Value(NPV) in detecting benign lesions were 100%, 90%, 74% and 100% respectively. The sensitivity, specificity, PPV and NPV in detecting premalignant lesions were 70%, 92%, 56% and 96% respectively. The sensitivity, specificity, PPV and NPV in detecting malignant lesions were 83%,97.5%, 98.5% and 97.5% respectively. NBI has a strong association with the histopathological reports, which is statistically significant(p-value < 0.001). NBI has high specificity and negative predictive value in detecting and classifying various mucosal lesions of head-neck region. Its findings had a strong correlation with histopathological reports.

Bureaucratic Politicization in the Process of Changing Bureaucratic Positions After the Vacancy of the Deputy Regent of Dharmasraya Regency in 2022

Bureaucratic politicization refers to introducing bureaucratic reform in the management of regional government. The regional head and deputy regional head posts are political roles that oversee administrative positions within a region, so political influence is inherently intertwined with the bureaucracy. Dharmasraya Regency exhibits signs of bureaucratic politics, as seen by a vacancy in the position of deputy regent. This vacancy has resulted in numerous examples of non-job ASN inside the government of Dharmasraya Regency. This thesis seeks to analyze the political dynamics involved in the transition of bureaucratic positions in Dharmasraya Regency, particularly after the vacancy of the deputy regent position. This study employs a qualitative research methodology utilizing a case study approach. This thesis uses the theory of bureaucratic politicization pioneered by Barbara Geddes. The findings of this study suggest that there are indicators of the techniques employed by the regent in his role as PPK to determine bureaucratic positions. The regent also has a vested interest in the bureaucracy, as he desires a loyal and efficient bureaucratic system to ensure continued control until the end of his term. The regent's politicization of the bureaucracy is seen in the ambiguous enforcement of heavy sanctions against ASN.