Academic literature on the topic 'Man-in-the-Room Attack'

This report describes a complication of symptoms consistent with transient ischemic attack following administration of physician-compounded foam sclerotherapy created with room air. After intravenous administration of 8 cc of foam sclerosant prepared with room air and polidocanol using the Tessari method, an otherwise healthy man experienced transient neurologic changes. Immediately following injection of foam, a dense hemiplegia consistent with interruption of the middle cerebral arterial circulation was observed. The patient’s symptoms resolved completely over approximately 30 min with interventions including Trendelenburg positioning and supplemental oxygen via nasal cannula. PCP foam sclerotherapy with room air administered in typical concentrations, preparations, and volumes may result in severe neurologic events in otherwise healthy individuals. Continued investigation into the potential role of product, gas, volume and technique to identify optimal approaches may further refine the consistency and safety of foam sclerotherapy.

ABSTRACT Bite injuries tend to be among the most typical forms of trauma to which man is exposed. Contamination is actually the most frequent problem in animal attack injuries. The surgical approach regarding facial bite injuries continues to be debatable. The controversy persists in the ideal time to do the wound debridement together with initial wound suturing as well as the use of antibiotic prophylaxis. On the contrary, human attacks are likely to be unnoticed with regard to making an evaluation within any casualty room. They can be especially notorious owing to the polymicrobial character associated with human saliva inoculated within the injury as well as the threat that they will present with for transmission of contagious health conditions. Prompt treatment plan, most appropriate prophylaxis in addition to precise evaluation are definitely critical for attaining desired results. In this article, we have presented two animal bite cases and 1 human bite case that presented to our department and our management protocol. How to cite this article Dhupar V, Akkara F, Roy I, Louis A. Management of Animal Bites in Maxillofacial Surgery. World J Dent 2014;5(4):243-246.

IntroductionThe terms catastrophe and disaster have been frequently heard worldwide due to situations like earthquakes, floods and events provoked by man as the September 11th and Anthrax attack. Catastrophe means all situations where material and human resources available in a healthcare facility are not enough to assist a large number of victims admitted at the same time. Accreditation requires having a plan to manage effectively those situations, assessing safely as much victims as possible.ObjectiveTo describe the catastrophe plan and its management in a private hospital.MethodologyHospital Albert Einstein is located close to a huge soccer game stadium and near to the State Government Hall. This was the reason to have a plan focusing on casualties with a large number of victims. The literature was revised to choose the triage methodology. Triage to identify the priority of patients' assessment based on their condition, possibility of treatment and determining discharge for those without visible risk. Simulation was implemented, followed by debriefing to register lessons learned.ResultsAn algorithm was developed with a crisis center and defining care and support areas in the organizations to manage the victims at Emergency Room and triage field. The plan was effectively deflagrated twice: 47 victims from a bus accident and 25 from a policeman strike. Debriefing was done in all opportunities and communication is the main issue; 15 simulations have been done for training purpose, with specific goals.ConclusionHospital is a high risk environment itself for an internal or external incident depending on its localization. A disaster plan is necessary to improve everyone safety, to organize resources, to respond effectively to such situations and take the organization back to regular operation as soon as possible. Simulations are essential to guarantee staff competency and organization support and response to adverse situations.

Background:Behçet’s disease (BD) or “Silk Road” disease is a rare multisystemic inflammatory disease of unknown etiology.Vascular involvement manifested as thrombosis, arterial aneurysm, and occlusion can carry a high mortality risk. BD can be a diagnostic conundrum with its broad array of clinical presentations.Objectives:Identifying vasculo-Behçet’s disease and its management.Methods:A 25-year-old man born in Malaysia and known for cirrhosis due to idiopathic Budd Chiari syndrome presented to the emergency room with a transient ischemic attack. An inferior vena cava (IVC) occlusive thrombus and a patent foramen ovale (PFO) were discovered. Thrombolysis, angioplasty, PFO closure, and a transjugular intrahepatic portosystemic shunt (TIPS) procedure were performed. The following year, the patient experienced numerous IVC and TIPS-associated thromboses as well as a right atrial thrombus attached to his PFO closure device, all of which were refractory to anticoagulation. A few months later, the patient suffered from an acute right anterior cerebral artery stroke, with no etiology uncovered at the time. It was later determined that the patient had experienced years of recurrent oral and genital aphthae, thereby prompting a strong clinical suspicion of BD. Six months later, after only one appointment at the rheumatology clinic during which he was prescribed colchicine, the patient presented to the hospital with hemoptysis. A computed tomography (CT) pulmonary angiogram revealed a right lower lobar pulmonary arterial aneurysm with a peripheral thrombus, a right bronchial artery dilatation, and pulmonary emboli. The patient declined anticoagulation and was sent home. Two months later, he returned to the hospital, this time with hematemesis. A repeat CT pulmonary angiogram was performed and showed an increasing pulmonary emboli burden and an enlarging aneurysm. A thrombophilia workup was negative.Results:A diagnosis of BD with pulmonary aneurysms was made and treatment was initiated with methylprednisolone pulses and monthly intravenous cyclophosphamide as recommended by the European League Against Rheumatism. A month later, there was radiological evidence of significant improvement in the burden of pulmonary emboli, an interval decrease in the aneurysm’s diameter, and resolution of the right atrial thrombus.Conclusion:BD with vascular involvement or vasculo-Behçet’s disease can affect small, medium, and large vessels of both the venous and arterial vasculatures and is thought to originate from vessel wall inflammation.Thrombi in vasculo-Behçet’s disease are typically quite adherent to the vessel walls and tend not to embolize. In this case, pulmonary arterial thrombosis burden was significantly decreased after immunosuppression alone, favoring a diagnosis of in situ thrombosis rather then thromboembolism. Moreover, pulmonary artery aneurysm, Budd-Chiari syndrome, and vena cava thrombosis, which are quite uncommon and carry the highest mortality risk in vasculo-Behçet’s, were all present in this case. Early recognition can be life-saving as immunosuppression is the first-line therapy rather than anticoagulation, which carries a significant risk of pulmonary hemorrhage in the presence of a pulmonary artery aneurysm.References:[1]Seyahi, E., Behcet’s disease: How to diagnose and treat vascular involvement. Best Pract Res Clin Rheumatol, 2016. 30(2): p. 279-295.[2]Hamuryudan, V., et al., Pulmonary artery aneurysms in Behcet syndrome. Am J Med, 2004. 117(11): p. 867-70.[3]Kobayashi, M., et al., Neutrophil and endothelial cell activation in the vasa vasorum in vasculo-Behcet disease. Histopathology, 2000. 36(4): p. 362-71.[4]Seyahi, E. and S. Yurdakul, Behcet’s Syndrome and Thrombosis. Mediterr J Hematol Infect Dis, 2011. 3(1): p. e2011026.[5]Hatemi, G., et al., 2018 update of the EULAR recommendations for the management of Behcet’s syndrome. Ann Rheum Dis, 2018. 77(6): p. 808-818Disclosure of Interests:None declared

Electric Injury is a very aggressive burn injury with severe functional and aesthetic consequences caused by progressive and prolonged tissue necrosis. Necrosis that attacks the skeletal muscle can lead to rhabdomyolysis which results in complications if not treated properly. A complicated case of electric injury in Dr. Soebandi Jember General Hospital, a 26 years old man came to the emergency room with complaints of severe shortness of breath and urinary disorders. The patient had a history of having an electric shock in his right hand when turning on the fan a week prior of admission. The examination showed that the patient had bilateral pulmonary effusion, generalized edema and acute tubular necrosis (ATN) which was characterized by oliguria and even anuria accompanied by hematuria. Other symptoms experienced by patients are anterior uveitis, subconjunctival hemorrhage, and hematemesis.

Rhabdomyolysis is defined as a skeletal muscle injury, with subsequent release of cellular constituents into the extracellular fluid and the circulation. Several conditions can lead to rhabdomyolysis, and new causes are constantly expanded with new case reports. The aim of this paper is to report on a case of acute kidney injury (AKI) induced by rhabdomyolysis due to alcohol abuse and physical agression. A 48-year-old man was admitted to the emergency room with dyspnea, lower limbs edema, weakness, oliguria and dark brown urine. Four days before admission he was physically attacked, after drinking almost 2.5 liters of beer. The diagnosis of AKI due to rhabdomyolysis was made through clinical and laboratory findings (creatine kinase 184,376 IU/l, serum urea 275 mg/dL, creatinine 14.6 mg/ dL, potassium 7.9 mEq/L). Urgency hemodyalisis was started due to anuria, refractory hiperkalemia and hypercatabolism. Recovery of renal function was recorded, after fourteen hemodialysis sessions. Patients with rhabdomyolysis are common in the emergency room. Initial therapy of fluid replacement is essential to prevent progression to renal failure. Once established, the dialysis is indicated early. The prognosis is good, when early supportive therapy is adequate. DOI: http://dx.doi.org/10.3329/jom.v13i2.12759 J Medicine 2012; 13 : 212-215

On Grundtvig’s Thought and Post-Lutheran PhilosophyAn introduction to Danevirke IIBy William MichelsenGrundtvig’s considerations on the life of man in his periodical Danevirke (1816- 19) are the result of his critical reading of the major works in modern philosophy and in protestant theology since 1517. His criticism of the works can be found in Prospect o f World Chronicle Especially in the Age o f Luther from 1817; his own comments are presented in Danevirke. Inevitably the criticism has affected the comments, making them difficult to read today in our altered circumstances. Yet all philosophy and theology since Luther has seen itself in relation to the same works, though in most cases reaching a different conclusion from Grundtvig’s. It is three hundred years of thought he is concerned with.Grundtvig denotes the fundamental concepts in his thought with the words: Sense, Knowledge, and Made in G od’s Image. By “sense” he means the faculties through which we apprehend existence, both the outer existence and the inner: sight, hearing, and feeling. With their aid man already in childhood builds up not only his environment but also his self-awareness. Here Grundtvig ascribes the fundamental sense to feeling. Sight, he says, is both the faculty through which we receive images of the outer world, but also as the inner sense the faculty through which we create imaginative pictures of what we cannot see directly with the outer eye. Such pictures may be true or false, that is, illusions. When Grundtvig had his visions, he regarded the true visions as brought about by God, and the false as produced by “the Father of Lies”, the Devil. Hearing, the sense through which we perceive words and thus learn to speak, is for Grundtvig the basis of human reason, which he considers a faculty developed later and which could therefore under no circumstances be the basis of the human psyche.The creation of man in God’s image, as both the Old and the New Testament relate it, means that man is made to resemble his Maker, though from the outset he is in no way a complete image of God. Rather, he finds himself in a slow development towards this goal; a development that is still marked by the Fall. Grundtvig has given his first exposition of his thinking on the subject in the unfinished second edition of Brief Prospect of World Chronicle, the first edition of which appeared in 1812. These pages from 1814 are reprinted at the front of this edition of Grundtvig Studies.Grundtvig’s understanding of the old Danish word, vidskab, (knowledge) is as the intellectual superstructure of the sciences through which we form our world-view. He demanded of himself that his ideas should be understandable to every thinking person, and that they should be expressed in pure Danish without the loan-words constructed by philosophers. Naturally they should also be in agreement with common sense as well as classical logic. He paid no heed to Kant’s Critique o f Pure Reason, which is a major reason why he has been attacked for being unable to understand what he read and unable to think sensibly himself. Søren Kierkegaard chose a different tactic in his criticism of contemporary thought, but Kierkegaard’s tactic in no way changed Grundtvig’s views. Understanding Grundtvig therefore requires that one begins from the same starting-point that he offered his readers, even though posterity has called it naive realism.Part of fundamental experience, says Grundtvig, is that every person is both body and spirit, and that the bodily and the spiritual cannot be separated in the living person. He calls this permanent link between body and spirit man’s Self or Soul.Since man’s life is limited in time and moves in only a limited space, Grundtvig believes that time and space are also limited, are not endless. Man is not master of time and space; but he can imagine beings living an endless existence which is called everlasting. From this comes the idea of an everlasting life.Such ideas come into being through the Word, by which Grundtvig does not mean constructed sound symbols but something that the child learns from the other people it trusts. In this way man comes to trust the super-human word too: God’s Word. It is from this Word of God that the world man lives in and man himself are created. This idea is not the experience of the individual, however, but something which belongs to mankind’s, i.e. all men’s common experience, which Grundtvig calls History. No man has experienced the creation of the world, but ideas of it have been transmitted from man to man through history. Grundtvig calls his view of man and the life of man a historical view of man. However, he does not regard this view as science (videnskab) but only knowledge (vidskab). He also avoids the word “philosophy” in his thought because his view goes against the conttemporary misuse of the word.Grundtvig’s thought rejects every philosophy which claims to explain man and his existence solely through human reason and without regard to man’s limitation in time and space. Instead he maintains that we can only know human life through the experience of individual peoples and the whole human race, i.e. through History. This is the criticism he makes in the first of his “reflections”, which has the title On the Philosophical Century, a term that comprises the philosophy of the 18th century from Christian Wolf to Schelling.According to Grundtvig the task of philosophy and the sciences is to understand mankind. But when he contemplates man as an image of his Creator, he maintains that man knows what he is an image of, even though he cannot conceive it. He can only conceive himself. His task is to attain a true picture of himself - “to conceive oneself in Truth”. Grundtvig believes this means conceiving man as the inconceivable God has created him.In his criticism of the philosophy of the 18th century Grundtvig does not mention Leibniz. But in his World Chronicle from 1817 he does mention his Théodicée (1710). He admits that the defence of Christianity which Leibniz presents was built on the same logical foundation as his own view, namely the basic principle of contradiction. But he nevertheless claims that this foundation was an illusion. For Christianity exceeds all human reason, though it is not in conflict with it. And if one wishes to support Christianity with philosophical proof, one risks leading it to destruction: “Supports are ready to fall, and what rests on them wobbles when it is pushed. ” This was almost what happened when Leibniz’s pupil, Christian Wolf, built his system on Leibniz’s philosophy. And this is why Grundtvig’s criticism of 18th century philosophy begins with Christian Wolf.What is the core of Grundtvig’s criticism? What is the main purpose of this lengthy presentation, which appeared just as obscure to contemporary readers as it does to present-day readers, however willing they may be to follow him?Grundtvig’s criticism of “the philosophical century” is to the effect that man is attempting the impossible: to conceive who or what has created the world and man himself, God. This is impossible, if only because man is incapable of conceiving anything greater than himself and his existence, limited by time and space. He can imagine something greater but he cannot conceive it. He can believe in God and an everlasting life, but neither God nor everlasting life can he conceive philosophically.Man’s philosophical and scientific task is limited to understanding himself and his existence in time and space. And since he only knows his development up to the point at which he lives, he cannot achieve any systematic description or explanation of human life in its entirety, as that would require a development he does not know of.This is the core of Grundtvig’s thought and of his criticism of the philosophy of his time and of previous centuries. But it may well be difficult to perceive or deduce this from his first philosophical consideration in Danevirke, partly due to the polemical tone and the words and thoughts that are foreign to us, and partly because his way of thinking is disfigured by a terrible misprint in his criticism of this philosophy which was the basis of all contemporary thought. It is not especially Kant that Grundtvig singles out; he is attacking every philosophy which maintains that human reason can conceive a being which is created by itself, absolutely independent of anything else. He then continues: “... and what it cannot conceive it cannot itself be either, since reason is in no way outside (udenfor) as far as it conceives... - as if Grundtvig would argue against the idea that reason was “outside”. That is not his aim. The sentence only makes sense when the word udenfor is separated into its component parts: It then reads: “... since reason is not, unless it conceives; it is a concept, and in us a temporal concept which cannot possibly conceive anything eternal and unchangeable; and the self-dependent is eternal, the self-dependent living truth is unchangeable.”This was Grundtvig’s main assertion in the dispute over Schelling’s philosophy. It is extended here to cover the whole of “the philosophical century” and thus Kant’s philosophy too. God is and will remain inconceivable. One can believe in Him, but one cannot conceive Him. Religion can just as little be replaced as supported by philosophy. Grundtvig refuses to accept the philosophical artifice of turning time and space into categories of human thought (and thus in principle everlasting).Man cannot conceive eternal truth. But he can conceive that nothing can be true if it excludes man as he really is. For eternal truth has created man as he is.This is the use to which Grundtvig puts the basic principle of contradiction in his view of the relationship between reason and faith. He does not attempt to prove that God exists, or what faculties He has, or that He created the world and man. But he does maintain that whoever denies that God can create and has created the world contradicts himself. For man does exist, and has created neither himself nor the world - nor his own reason.Grundtvig goes no further in his application of the basic principle of contradiction in the essay. But he claims that he has the right to use it in his evaluation of men’s deeds throughout history; see also Henning H.irup's doctorate: Grundtvig’s View o f Faith and Knowledge (Copenhagen 1949).The purpose of this first consideration is not only to contradict contemporary philosophy but to make room for historical knowledge. Grundtvig elaborates his concepts in two other essays: On Historical Knowledge and On Developing the Chronicle in the same volume. His aim with all three articles - and with the periodical in general - was to marshal an alternative to the contemporary view that it was possible to adduce another ground for an understanding of human life than historical knowledge, that is, in a speculative natural philosophy. According to Grundtvig History shows that man is “a being in the process of developing himself’. He asserts that what is developing itself must already be present in man as “woven into” him. He himself cannot generate it, he must conceive it. God’s revelation as man does not mean that man has produced God, but that he is made in God’s image. So when Grundtvig speaks here of God’s “revelation in time”, he is not thinking of religious experiences but incontrovertible historical events.

Dear Editor, Foreign bodies in the paranasal sinuses are not so common, but are still possible. The structures most often involved are maxillary and the frontal sinuses.1 In our case, the sphenoid sinus, which is posterior and deep, was involved. Having a foreign body lodged in the sphenoid sinus, and considering how it got there, put the patient at great risk of possible involvement of the optic nerve and the carotid artery. Accessing the sphenoid sinus and removing the foreign body lodged in it would be a big challenge to any surgeon. We report one such case. Case Report A 22 year old man, was accidentaly shot in the face by a fellow criminology student while playing with a polyvinyl chloride (PVC) handmade gun two weeks prior to admission. The patient, who was conscious, coherent, and ambulatory at that time, was brought to a local government hospital where facial CT scans revealed a radio-opaque, well rounded foreign body, approximately measuring 1.5 cm x 1. 5 cm in diameter, lodged in the sphenoid sinus. (Figure 1 A, B) He was subsequently admitted on Penicillin G and was eventually discharged. On his fourth post-injury day, he had profuse epistaxis from the right nostril and consulted at the emergency room of our medical center. Anterior nasal packing did not control the bleeding, and was converted to a posterior nasal pack. A sutured wound with a scab on the left lateral nasal root was also noted. (Figure 2) The rhinology Service consultants advised endoscopic removal of the foreign body under general anesthesia. Intraoperatively, the nasal cavity was congested, with slight septal deviation to the right and a collapsed postero-superior septal wall. Behind the postero-superior 3rd segment of the middle meatus, sphenoethmoidal recess was appreciated. On further exploration, a 1.5 cm x 1.5 cm green marble was seen lodged in the sphenoid sinus. An initial attempt to remove the foreign body using a nasal foreign body extractor failed. An improvised large metallic paper clip, molded to the shape of a curved foreign body extractor was also unsuccessful. A cotton pledget tip dipped in cyanoacrylate (super glue) also failed to have the marble attach to it. Two angulated sharp foreign body extractors insinuated using the four hand technique yet again failed. The collapsed posterior end of the nasal septum was removed using a cutting forceps for better visualization and access, and on the last attempt, a bent spoon was used to scoop out marble out of the sphenoid sinus was successful. (Figure 3) Full extraction of the foreign body was achieved by dislodging the marble towards the nasopharynx and into the oral cavity, without compromising the optic nerve and the carotid artery. (Figure 4) Discussion It is very common to see a foreign body in the nasal cavity or in the external ear canal, but seeing it in unlikely places like the sphenoid sinus is such a surprise. Many factors need to be considered in the decision to extract it. One factor to consider is the approach to the sphenoid sinus. There are two different approaches to the sphenoid sinus, external and internal. The external, trans-ethmoidal approach involves subperiosteal elevation and ethmoidectomy.2 Internal approaches such as the trans-septal and trans-nasal are less-invasive ways to access the sphenoid sinus. Because of ease in access, minimal damage to surrounding mucosa, and good exposure, the trans-nasal approach was used. Whatever approach the surgeon chooses, it is important to be familiar with the surgical anatomy to prevent unwanted complications. Creativity also played a role in this procedure, and quick thinking was needed, since the foreign body was a round object and extracting it from such a limited space with utmost care, using makeshift instruments, was critically challenging. Alvin B. Javierto, MD Josefino G. Hernandez, MD Rodante A. Roldan, MD Rizal Medical Center Pasig Blvd., Pasig City 1600 Tel: 671-9740 Fax: 671-4216 Email: info@rizalmedicalcenter.gov.ph

Abstract Abstract 5009 Description: A 57 year-old Bangladeshi man presented to the emergency room with a 4-day history of shortness of breath, productive cough and sensation of choking. He had a history of recurrent dyspnea, chest pain and chronic bilateral pedal edema. He had recent admissions for similar complaints at different hospitals where he was diagnosed with low grade non-Hodgkin lymphoma not requiring treatment and was discharged with bronchodilators and anti-tussives. He was symptom-free between episodes. There was no fever, night sweats or weight loss and there was no history of asthma. Physical exam revealed moderate dyspnea with some stridor, cervical lymphadenopathy with many firm and mobile small lymph nodes. There was no hepato-splenomegaly, urticaria or rashes. Results of routine blood tests including CBC and C-reactive protein were normal. Chest X-ray showed mild pulmonary congestion and CT images of the chest and abdomen showed multiple lymph nodes of about 1–1.5 cm in size. X-rays of the hands showed multiple small lytic lesions. Laryngoscopy showed laryngeal edema. Bone marrow biopsy showed a few paratrabecular areas with increased numbers of small lymphocytes and a lymph node biopsy revealed low grade B-cell lymphoma with plasmacytic differentiation, which was positive for CD19, 20, 22, 38, and CD44. Serum viscosity was 1.6. Immunological studies showed a low C4 at 4 mg/dl (normal range 10–40 mg/dl), low C1q at <3.6 (normal range 5–8.6), C1 esterase inhibitor low-normal at 16 (normal range 11–26). Serum immunoglobulins showed IgM gammopathy with low IgA and normal IgG levels. Beta-2 microglubulin was also elevated at 4.93 mg/dl (normal range < 2.51). Serum protein electrophoresis showed a monoclonal IgM spike measuring 1.5 g/dl with immunofixation positive for a IgM kappa band. Total protein, alpha2- and beta-globulins were elevated and urine electrophoresis was positive for kappa light chains. A diagnosis of Waldenström's macroglobulinemia with angioneurotic edema was made. He was treated with 4 cycles of bortezomib (Velcade®), dexamethasone and rituximab. The patient's angioedema and respiratory symptoms improved dramatically. Follow-up serum electrophoresis showed a very good response to treatment, with a major decrease in total protein and the M-spike. Complement levels returned to normal. Discussion: C1 is the first protein of the classical and kinin pathways which is an arm of the innate immune system. Triggering factors activate the complement cascade and lead to activation of C1 which in turn cleaves C2, the product of which is an inflammatory mediator responsible for angioedema by causing increased capillary permeability and extravasations. In C1INH deficiency, this process occurs uninhibited, triggered by minimal stimulation. C1q esterase inhibitor deficiency is a rare manifestation of Waldenström's macroglobulinemia with very few reported cases in literature. Symptoms are non-allergic, non-pruritic and clinical presentation depends on parts of the anatomy affected and may be as mild as inconvenient skin blotching up to life-threatening laryngeal edema or shock. They vary widely, often self limiting and recurrent. Angioedema, acquired or inherited, is complement mediated, characterized by low levels of complement proteins during attacks. C1INH deficiency can be acquired due to increased consumption or/and inactivation by circulating autoantibodies or secondary to lymphoproliferative diseases that lead to increased catabolism. These are often associated with B-cell disorders but may be associated with other disease patterns. Symptomatology is variable and periods of remission and recurrence lead to easy misdiagnosis and incomplete treatment. Proper diagnosis is dependent on awareness and knowledge of the various clinical presentations, adequate and focused use of laboratory analyses and immunopathology studies. The key to treatment is first therapy of the acute stage (in our patient with the use of intravenous steroids) and then more specific treatment of the underlying disease entity (in our patient with bortezomib, dexamethasone and rituximab). Conclusion: Waldenstrom's macroglobulinemia presenting with angioedema is rare, often misdiagnosed and acquired C1 esterase inhibitor deficiency should be at least ruled out, as presentation is varied and could be potentially life-threatening. Disclosures: No relevant conflicts of interest to declare.

Introduction Such symptoms as hard, complex, bodily or mental feelings, that turn our everyday life into a hell, at first, lead us to a doctor, and then - to a psychotherapist. A sick man is keen to get rid of a symptom. A doctor prescribes medication, that is ought to eliminate a symptom. A psychotherapist searches for a reason of the problem that needs to be removed. There is such an idea that a neurotic symptom, in particular, an anxiety - is a pathological (spare or extra) response of a body. It is generally believed that such anxiety doesn’t have some real, objective reasons and that it is the result of a nervous system disorder, or some disruption of a cognitive sphere etc. Meanwhile, it is known that in the majority of cases, medical examinations of anxious people show that they don’t have any organic damages, including nervous system. It often happens that patients even wish doctors have found at least any pathology and have begun its treatment. And yet - there is no pathology. All examinations indicate a high level of functionality of a body and great performance of the brain's work. Doctors throw their hands up, as they can't cure healthy people. One of my clients told me her story of such medical examinations (which I’ll tell you with her permission). She said that it was more than 10 years ago. So, when she told her doctor all of her symptoms - he seemed very interested in it. He placed a helmet with electrodes on her head and wore some special glasses, when, according to her words, he created some kind of stressful situation for her brain, as she was seeing some flashings of bright pictures in her eyes. She said that he had been bothered with her for quite a long time, and at the end of it he had told her that her brain had been performing the best results in all respects. He noted that he’d rarely got patients with such great health indicators. My client asked the doctor how rare that was. And he answered: “one client in two or three months.” At that moment my client didn’t know whether to be relieved, flattered or sad. But since then, when someone told her that anxiety was a certain sign of mental problems, or problems with the nervous system, or with a body in general, she answered that people who had anxiety usually had already got all the required medical examinations sufficiently, and gave them the advice to go through medical screening by themselves before saying something like that. Therefore, we see a paradoxical situation, when some experts point to a neurotic anxiety as if it is a kind of pathology, in other words - some result of a nervous system disorder. Other specialists in the same situation talk about cognitive impairments. And some, after all the examinations, are ready to send such patients into space Main text I don’t agree with the statement that any neurotic anxiety that happens is excessive and unfounded. It often happens that there is objective, specific and real causes for appearance of anxiety conditions. And these causes require solutions. And it’s not about some organic damages of the brain or nervous system. The precondition that may give a rise to anxiety disorder is the development of such a life story that at some stage becomes too toxic - when, on the one hand, a person interacts with the outside world in a way that destroys his or her personality, and, on the other hand, this person uses repression and accepts such situation as common and normal. Repression - is an essential condition for the development of a neurotic symptom. Sigmund Freud was the first who pointed this out. Repression is such a defense mechanism that helps people separate themselves from some unpleasant feelings of discomfort (pain) while having (external or internal) irritations. It is the situation when, despite the presence of irritations and painful feelings, a person, however, doesn't feel any of it and is not aware of them in his or her conscious mind. Repression creates the situation of so-called emotional anesthesia. As a result, a displacement takes place, so a body starts to signal about the existing toxic life situation via a symptom. Anxiety disorder is usually an appropriate response (symptom) of a healthy body to an unhealthy life situation, which is seen by a person as normal. And it’s common when such a person is surrounded by others (close people), who tend to benefit from such situation, and so they actively maintain this state of affairs, whether it is conscious for them or not. At the beginning of a psychotherapy almost all clients insist that everything is good in their lives, even great, as it is like in everyone else’s life. They say that they have only one problem, which is that goddamn symptom. So they focus all of their attention on that symptom. They are not interested in all the other aspects of their life, and they show their irritation when it comes to talking about it. People want to get rid of it, whatever it takes, but they often tend to keep their lives the way that it was. In such cases a psychotherapist is dealing with the resistance of clients, trying to turn their attention from a symptom to their everyday situation that includes their way of thinking, interactions with themselves and with others and with the external world in order to have the opportunity to see the real problem, to live it through, to rethink and to change the story of their lives. For better understanding about how it works I want to tell you three allegorical tales. The name of the first tale is “A frog in boiling water”. There is one scientific anecdote and an assumption (however, it is noted that such experiments were held in 19 century), that if we put a frog in a pot with warm water and start to slowly heat the water, then this frog get used to the temperature rise and stays in a hot water, the frog doesn’t fight the situation, slowly begins to lose its energy and at the last moment it couldn’t find enough strength and energy to get out of that pot. But if we throw a frog abruptly in hot water - it jumps out very quickly. It is likely that a frog, that is seating in boiling water, will have some responses of the body (symptoms). For example, the temperature of its body will rise, the same as the color of it, etc., that is an absolutely normal body response to the existing situation. But let us keep fantasizing further. Imagine a cartoon where such a frog is the magical cartoon hero, that comes to some magical cartoon doctor, shows its skin, that has changed the color, to the doctor, and asks to change the situation by removing this unpleasant symptom. So the doctor prescribes some medication to return the natural green color of the frog’s skin back. The frog gets back in its hot water. For some period of time this medication helps. But then, after a while, the frog’s body gets over the situation, and the redness of the frog's skin gets back. And the magical cartoon doctor states that the resistance of the body to this medication has increased, and each time prescribes some more and more strong drugs. In this example with the frog it is perfectly clear that the true solution of the problem requires the reduction of the water temperature in that pot. We could propose that magical cartoon frog to think and try to realize that: 1) the water in that pot is hot, and that is the reason why the skin is red; 2) the frog got used to this situation and that is why it is so unnoticeably for this frog; 3) if the temperature of the water in the pot still stay so hot, without any temperature drop, then all the medication works only temporarily; 4) if we lower the temperature in that pot - the redness disappears on its own, automatically and without any medication. Also this cartoon frog, that will go after the doctor to some cartoon physiotherapist, will face the necessity to give itself some answers for such questions as: 1) What is going on? Who has put this frog in that pot? Who is raising the temperature progressively? Who needs it? And what is the purpose or benefit for this person in that? Who benefits? 2) Why did the frog get into the pot? What are the benefits in it for the frog? Or why did the frog agree to that? 3) What does the frog lose when it gets out of this pot? What are the consequences of it for the frog? What does the frog have to face? What are the possible difficulties on the way? Who would be against the changes? With whom the frog may confront? 4) Is the frog ready to take control over its own pot in its own hands and start to regulate the temperature of the water by itself, so to make this temperature comfortable for itself? Is this frog ready to influence by itself on its own living space, to take the responsibility for it to itself? The example “A frog in boiling water” is often used as a metaphorical portrayal of the inability of people to respond (or fight back) to significant changes that slowly happen in their lives. Also this tale shows that a body, while trying to adjust to unfavorable living conditions, will react with a symptom. And it is very important to understand this symptom. Symptom - is the response of a body, it’s a way a body adjusts to some unfriendly environment. Symptom, on the one hand, informs about the existence of a problem, and from the other hand - tries to regulate this problem, at least in some way (like, to remove or reduce), at the level on which it can do it. The process is similar to those when, for example, in a body, while it suffers from some infectious disease, the temperature rises. Thus, on the one hand, the temperature informs about the existence of some infection. On the other hand, the temperature increase creates in a body the situation that is damaging for the infection. So, it would be good to think about in what way does an anxiety symptom help a body that is surrounded by some toxic life situation. And this is a good topic for another article. Here I want to emphasize that all the attempts to remove a symptom without a removal of a problem, without changing the everyday life story, may lead to strengthening of the symptom in the body. Even though the removal of a symptom without elimination of its cause has shown success, it only means that the situation was changed into the condition of asymptomatic existence of a problem. And it is, in its essence, a worse situation. For example, it can cause an occurrence of cancer. The tale “A frog in boiling water” is about the tendency of people to treat a symptom, instead of seeing their real problems, as its cause, and trying to solve it. People don’t want to see their problems, but it doesn’t mean that the problem doesn’t exist. The problem does exist and it continues to destroy a person, unnoticeably for him or her. A person with panic disorder could show us anxiety that is out of control (fear, panic), which, by its essence, seems to exist without any logical reason. Meanwhile the body of such a person could be in such processes that are similar to those that occur in the conditions of some real dangers, when the instinct for self-preservation is triggered and an automatic response of a body to fight or flight implements for its full potential. We can see or feel signs of this response, for example, in cases when some person tries to avoid some real or imaginary danger via attempts to escape (the feeling of fear), or tries to handle the situation by some attempts to fight (the feeling of anger). As I mentioned before, many doctors believe that such fear is pathological, as there is no real reason for such intense anxiety. They may see the cause of the problem in worrisome temper, so they try to remove specifically anxiety rather than help such patients to understand specific reason of their anxiety, they use special psychotherapeutic methods that are designed to help clients to develop logical thinking, so it must help them to realize the groundlessness of their anxiety. In my point of view, such anxiety often has specific, real reasons, when this response of a body, fight or flight, is absolutely appropriate, but not excessive or pathological. Inadequacy, in fact, is in the unconsciousness, but not in the reactions of a body. For a better understanding of the role of anxiety in some toxic environment, that isn’t realized, I want to tell you another allegorical tale called “The wolf and the hare”. Let us imagine that two cages were brought together in one room. The wolf was inside one cage and the hare was in another. The cages were divided by some kind of curtain that makes it impossible for them to see each other. At this point a question arises whether the animals react to each other in some way in such a situation, or not? I think that yes, they will. Since there are a lot of other receptors that participate in the receiving and processing of the sensory information. As well as sight and hearing, we have of course a range of other senses. For example, animals have a strong sense of smell. It is well known that people, along with verbal methods of communicating information, like language and speaking, also have other means of transmitting information - non-verbal, such as tone of voice, intonation, look, gestures, body language, facial expressions etc., that gives us the opportunity to receive additional information from each other. The lie detector works by using this principle: due to detecting non-verbal signals, it distinguishes the level of the accuracy of information that is transmitted. It is assumed, that about 30% of information, that we receive from the environment, comes through words, vision, hearing, touches etc. This is the information that we are aware of in our consciousness, so we could consciously (logically) use it to be guided by. And approximately 70% of everyday information about the reality around us we receive non-verbally, and this information in the majority of cases could remain in us without any recognition. It is the situation when we’ve already known something, and we even have already started to respond to it via our body, but we still don’t know logically and consciously that we know it. We can observe the responses of our own body without understanding what are the reasons for such responses. We can recognize this unconscious information through certain pictures, associations, dreams, or with the help of psychoanalysis. Psychoanalysis is a great tool that can help to recognize the information from the unconscious mind, so that it can be logically processed further on, in other words, a person then receives the opportunity to indicate the real problems and to make right decisions. But let us return to the tale where the hare and the wolf stay in one room and don’t see each other, and, maybe, don’t hear, though - feel. These feelings (in other words - non-verbal information that the hare receives) activate a certain response in the hare’s body. And it reacts properly and adequately to the situation, for instance, the body starts to produce adrenaline and runs the response “fight or flight”. So the hare starts to behave accordingly and we could see the following symptoms: the hare is running around his cage, fussing, having some tremor and an increased heart rate, etc.. And now let us imagine this tale in some cartoon. The hare stays in its house, and the wolf wanders about this house. But the hare doesn’t see the wolf. Though the body of the hare gives some appropriate responses. And then that cartoon hare goes to a cartoon doctor and asks that doctor to give it some pill from its tremor and the increased heart rate. And in general asks to treat in some way this incomprehensible, confusing, totally unreasonable severe anxiety. If we try to replace the situation from this fairy-tale to a life story, we could see that it fits well to the script of interdependent relationships, where there are a couple “a victim and an aggressor”, and where such common for our traditional families’ occurrences as a domestic family violence, psychological and physical abuse take place. Only in 2019 a law was passed that follows the European norms and gives a legislative definition of such concepts as psychological domestic abuse, sexual abuse, physical abuse, bullying, that criminalizes all of these occurrences, establishes the punishment and directly points to people that could be a potential abuser. Among them are: a husband towards his wife, parents towards their children, a wife towards her husband, a superior towards a subordinate, a teacher towards his or her students, children towards each other etc.. When it comes to recognition of something as unacceptable, it seems more easy to put to that category such occurrences as physical and sexual abuse, as we could see here some obvious events. For example, beating or sexual harassment. Our society is ready to respond to these incidents in more or less adequate way, and to recognize them as a crime. But it is harder to deal with the recognition of psychological abuse as an offence. Psychological abuse in our families is common. Psychological abuse occurs through such situations, when one person, while using different psychological manipulations, such as violation of psychological borders, imposition of feeling of guilty or shame, etc., force another person to give up his or her needs and desires, and so in such a way make this person live another’s life. Such actions have an extremely negative effect on the mental health of these people, just as much as physical abuse. It can destroy a person from the inside, ruin self-esteem and a feeling of self-worth, create the situation of absolute dependence such victim from an abuser, including financial dependence etc.. It often happens that psychological abuse takes place against the backdrop of demonstrations of care and love. So you've got this story about the wolf and the hare, that are right next to each other, and the shield between two of them is a repression - a psychological defense mechanism, when a person turns a blind eye to such offences, that take place in his or her own life and towards him or her. And this person considers this as normal, doesn't realize, doesn't have a resource to realize, that it is a crime. Most importantly - doesn’t feel anything, as a repression takes place. But a body responds in a right way - from a certain point of the existence of such a toxic situation the response “fight or flight” is launched in a body at full, in other words - the fear and anxiety with the associated symptoms. The third allegorical tale I called “Defective suit”, which I read in the book of Clarissa Pinkola Estés with the name “Running With the Wolves". “Once one man came to a tailor and started to try on a suit. When he was standing in front of a mirror, he saw that the costume had uneven edges. - Don’t worry, - said the tailor. - If you hold the short edge of the suit by your left hand - nobody notices it. But then the man saw that a lapel of a jacket folded up a little bit. - It's nothing. You only need to turn your head and to nail it by your chin. The customer obeyed, but when he put on trousers, he saw that they were pulling. - All right, so just hold your trousers like this by your right hand - and everything will be fine, - the tailor comforts him. The client agreed with him and took the suit. The next day he put on his new suit and went for a walk, while doing everything exactly in the way that the tailor told him to. He waddled in a park, while holding the lapel by his chin, and holding the short edge of the suit by his left hand, and holding his trousers by his right hand. Two old men, who were playing checkers, left the game and started to watch him. - Oh, God! - said one of them. - Look at that poor cripple. - Oh, yes - the limp - is a disaster. But I'm wondering, where did he get such a nice suit?” Clarissa wrote: “The commentary of the second old man reflects the common response of the society to a woman, who built a great reputation for herself, but turned into a cripple, while trying to save it. “Yes, she is a cripple, but look how great her life is and how lovely she looks.” When the “skin” that we put on ourselves towards society is small, we become cripples, but try to hide it. While fading away, we try to waddle perky, so everyone could see that we are doing really well, everything is great, everything is fine”. As for me, this tale is also about the process of forming a symptom in a situation when one person tries very hard to match to another one, whether it is a husband, a wife or parents. It’s about a situation when such a person always tries to support the other one, while giving up his or her own needs and causing oneself harm in such a way by feeling a tension every day, that becomes an inner normality. And so this person doesn’t give oneself a possibility to relax, to be herself (or himself), to be spontaneous, free. As a result, in this situation the person, who was supported, looks perfect from the outside, but those who tried to match, arises some visible defect, like a limp - a symptom. And so this person lives like a cripple, under everyday stress and tension, trying to handle it, while sacrificing herself (or himself) and trying to maintain this situation, so not to lose the general picture of a beautiful family and to avoid shame. The tailor, who made this defective suit and tells how to wear the suit properly, in order to keep things going as they are going, often is a mother who raised a problematic child and then tells another person how to deal with her child in the right way. It is the situation when a mother-in-law tells her daughter-in-law how to treat her son properly. In other words, how to support him, when to keep silent, to handle, how to fit in, so that her problematic son and this relationship in general looks perfect. Or vice versa, when a mother-in-law tells her son-in-law how to support her problematic daughter, how to fit in etc.. When, for example, a woman acts like this in her marriage and with her husband, with these excessive efforts to fit in - then after a while everybody will talk like: “Look at this lovely man: he lives with his sick wife, and their family seems perfect!”. But when such a woman becomes brave enough to relax and to just let the whole thing go, everybody will see that the relationship in her marriage isn’t perfect, and it is the other one who has problems. Each time when someone tries excessively to match up to another one, while turning oneself in some kind of a cripple, - he or she, on the one hand, supports the comfort of that person, to whom he or she tries to match up, and on the other hand - such a situation always arises in that person such conditions as a continuous tension, anxiety, fear to act spontaneously. A symptom - is like a visible defect, that shows itself through the body (and may look like some kind of injury). It is the result of a hidden inner prison. As a result of evolution, a pain tells us about a problem that is needed to be solved. When we repress our pain we can’t see our needs and our problems at full. And then a body starts to talk to us via a symptom. Psychotherapy aims for providing a movement from a symptom to a resumption of sensitivity to feelings, a resumption of the ability to feel your psychological pain, so you can realize your own toxic story. In this perspective another fairy-tale looks interesting to analyze - it is Andersen's fairytale “Princess and the Pea”. In the tale a prince wanted to find a princess to marry. There was one requirement for women candidates, so the prince could select her among commoner - high level of sensitivity, as the real princess would feel a pea through the mountain of mattresses, and so she could have the ability to feel discomfort, to be in a good contact with her body, to tell about her discomfort without such feeling as shame and guilt, and to refuse that discomfort, so to have the readiness to solve her problems and to demand from others the respect for her needs. It is common for our culture that the expression “a princess on a pea” very often uses for a negative meaning. So people who are in good contact with their body and who can demand comfort for themselves are often called capricious. At the same time the heroes who are ready to suffer and to tolerate their pain, who are able to repress (stop to feel) their pain represents a good example to be followed in our society. So, we may see the next algorithm in cases of various anxiety disorders: the existence of some toxic situation that brings some danger to a person. And we need not to be confused: a danger exists not for a body, but for a personality. A toxic live situation as well as having a panic attack is not a threat for the health of a body (that is what medical examinations show), and vice versa - it’s like every day intensive sport training, that could be good for your health only to some degree. A toxic situation destroys a person as a personality, who longs for one self’s expression; the existence of such a defense mechanism as repression - it’s a life with closed eyes, in pink glasses, when there is inability (or the absence of the desire) to see its own toxic story; 3.the presence of a symptom - a healthy response of a body “fight or flight” to some toxic situation; displacement - it’s replacement of the attention from the situation to a symptom, when a person starts to see and search for the problem in some other place, not where it really is. A symptom takes as some spare, pathological reaction that we need to get rid of. The readiness to fight the symptom arises, and that is the goal of such methods of therapy as pharmacological therapy, CBT and many others; the absence of adequate actions that are directed towards the change of a toxic situation itself. The absence of the readiness to show aggression when it comes to protect its space. All of it is a mechanism of formation of primary anxiety and preparation for launch of secondary anxiety. A complete anxiety disorder is the interaction between a primary and a secondary anxiety.

Virtuální realita je v současné době využívána nejen pro zábavu, ale i pro práci a sociální interakci, kde má soukromí a důvěrnost informací vysokou prioritu. Avšak bohužel, bezpečnostní opatření uplatňovaná dodavateli softwaru často nejsou dostačující. Tato práce přináší rozsáhlou bezpečnostní analýzu populární aplikace Bigscreen pro virtuální realitu, která má více než 500 000 uživatelů. Byly využity techniky analýzy síťového provozu, penetračního testování, reverzního inženýrství a dokonce i metody pro application crippling. Výzkum vedl k odhalení kritických zranitelností, které přímo narušovaly soukromí uživatelů a umožnily útočníkovi plně převzít kontrolu nad počítačem oběti. Nalezené bezpečnostní chyby umožnily distribuci škodlivého softwaru a vytvoření botnetu pomocí počítačového červa šířícího se ve virtuálních prostředích. Byl vytvořen nový kybernetický útok ve virtální realitě nazvaný Man-in-the-Room. Dále byla objevena bezpečnostní chyba v Unity engine. Zodpovědné nahlášení objevených chyb pomohlo zmírnit rizika pro více než půl milionu uživatelů aplikace Bigscreen a uživatele všech dotčených aplikací v Unity po celém světě.

In 1912, Edwin Ray Lankester (1847–1929), a well-regarded zoologist, was introducing some interesting and ancient flints to the academic world at a Royal Society soirée when he spotted Dawkins in the room. The two men started to quarrel over the stones. Soon afterwards, Lankester described the incident to a friend, explaining ‘Dawkins was there and I made him go over them with me’. Dawkins, though now elderly, was still outspoken. He proceeded to attack Lankester’s view that the flints in question were very early tools, arguing that they had not been flaked by human hands. Lankester recalled that Dawkins had ‘idiotically said that such conchoidal fractures as they showcould be produced by pressure’ and had placed the burden of proof on Lankester’s shoulders: ‘Well, unless you can show that these flints could not possibly be produced by natural agencies, I shall refuse to attribute them to man.’ Lankester had responded that this was ‘a preposterous & unscientific attitude’ and further informed Dawkins: ‘neither I nor any one who had studied the subject, attached any importance to his opinion!’ The kind of stones displayed by Lankester in 1912 aroused enthusiasm and irritation in Britain during the late nineteenth and early twentieth centuries. They were claimed as the artefacts of tool-makers who had lived before the Palaeolithic period, in Eolithic times (from the Greek eos: dawn and lithos: stone). Lankester’s flints, which came from East Anglia, belonged to the second major group of eoliths to be discovered in Britain; the first group had been reported from Kent in the 1880s and 1890s. His arguments with Dawkins in the rooms of the Royal Society encapsulate the character of the British eolith debates. Lankester was trying to describe what he thought was an important new Stone-Age industry and was irritated by the suggestion that he should prove they were not produced by natural agencies. Dawkins could see only natural chipping in these stones; neither was convinced by the case of the other and the discussion grew heated. Nowadays, both groups of eoliths are usually regarded as the natural products of geological forces; in these chapters, though, the eoliths will occasionally be described as artefacts to retain the atmosphere of the arguments.

As challenging as I often found living in Kathmandu, my home base as I explored South Asia, I felt as if I had left a safe retreat and entered a maelstrom when I flew down to Delhi. By January of 2010 I had visited several times and had learned to negotiate the immense city to some extent. Still, the morning after I arrived, just the process of obtaining a SIM card for my phone sapped my energy. The tall man at the tiny general store near my guesthouse was quite pleasant. He apologized several times for all the forms I had to fill out to purchase a prepaid SIM card: the government was requiring even more documentation since the 2008 attacks in Mumbai. I had to go back to my room for a photo, then find a shop to make photocopies of my passport and visa. Then the store owner had to call the guesthouse owner, whom he knew, to vouch for me. I made a small mistake on one of the forms and had to start over. Yet this was only part of what taxed my equanimity. As I stood on the sidewalk at the shop counter negotiating the details, the store owner dexterously handled a couple of dozen other customers who crowded up on both sides and behind me to demand soap, toothpaste, recharge cards for their cell phones, potato chips, or little plastic pouches of milk. The man yelled for one of the boys who worked for him to bring a desired item from a shelf in back and bag it; he fanned through little stacks of recharge cards to find the right one for a customer; he took money and made change and still kept the process of my SIM card moving along, however slowly. Most of the other customers were yelling too, some of them quite close to my ear. I don’t understand much Hindi, but these were not angry exchanges. It was just business, just the pace of Delhi.

In 2007, on the occasion of my 70th birthday, Bassam Shakhashiri organized a symposium for me at the Boston meeting of the American Chemical Society. The session was entitled “Roald Hoffmann at 70: A Craftsman of Understanding.” I began my talk with thanks to many. That section has been shifted to the end of this chapter. I was born in a happy young Jewish family in unlucky times, 1937. In that war, most of us perished, 3800 of the 4000 Jews of Złoczów, now Zolochiv in Ukraine. Among those who were killed were my father, three of four grandparents, three aunts, and so on. I just want to show you three photos which relate to that time, one old and two recent. The last 15 months of the war we were hidden by a good Ukrainian man–Mikola Dyuk, the schoolteacher in the small village of Univ. The first year we were in an attic of the schoolhouse, the second year in a storeroom with no windows, maybe 6 x 10 feet, on the ground floor. Here are two photos from 2006, when my sister, my son, and I visited Univ. Here is the attic in which we were hidden, with its one window. The storeroom, a passageway, another ground floor room are gone, rebuilt into a new classroom of Univ’s school. It’s a chemistry classroom. Such is fate. Under the plank floor we dug a bunker to sit in if the police came to the house. I was five and a half when we went in. And nearly seven when we went out. Here’s a photo of me, a few months after we came out. We survived. Some of us. Good people helped us, I tell their story. I am also the speaker for the dead—the three million Polish Jews who were killed do not have good stories to tell, or photos to show. We built a new life, in refugee camps where I read of Marie Curie and George Washington Carver, and then came to America in 1949.