Why do startups fail? A core competency deficit model.

A growing body of work aims to explore the reasons behind startup failures. However, there is a need for integrative approaches organized around conceptual frameworks to avoid fragmented and perplexing knowledge about these reasons. To our knowledge, no previous research has systematically investigated the role of competency deficits in startup failures, a crucial element of these failures. In our study, we adapted Spencer's behavioral competence model specifically for startups to identify the competencies within startup teams that, according to their Chief Executive Officers, contributed to their downfall. Three coders meticulously analyzed 50 online accounts of startup failures using a modified Critical Incident Technique. This analysis revealed two prominent competency deficits as pivotal determinants of these startups' outcomes: information-seeking and customer service orientation. Additionally, deficits in technical expertise, analytical thinking, and flexibility emerged as significant factors contributing to these failures. The competency deficits identified in this study offer focal points for evaluating and enhancing startup teams, thereby helping to prevent failure.

Elevated level of serum human epididymis protein 4 (HE4) predicts disease severity and mortality in COVID-19 pneumonia.

BACKGROUND: We retrospectively analyzed serum level of human epididymis protein 4 (HE4) as a pulmonary inflammatory biomarker in patients with COVID-19 pneumonia in association with disease severity and outcome. METHODS: Ninety-nine (40 critically ill, 40 severe and 19 mild) COVID-19 patients and as controls 25 age- and sex-matched non-COVID-19 bacterial sepsis subjects were included. Serum HE4 was measured by an immunoassay (Architect® i1000SR, Abbott) in the baseline samples of all study participants obtained at intensive care unit (ICU) admission or during outpatient clinic visit and follow-up sera were available in case of 30 COVID-19 subjects with life-threating conditions. Associations were studied between serum HE4, routinely available laboratory parameters, clinical characteristics, and disease progression. RESULTS: Baseline HE4 level was significantly higher (P < 0.0001) in critically ill (524.7 [300.1-1153.0] pmol/L) than severe COVID-19 subjects (157.4 [85.2-336.9] pmol/L) and in mild SARS-CoV-2 infection (46.7 [39.1-57.2] pmol/L). Similarly increased HE4 concentrations were found in bacterial sepsis (1118.0 [418.3-1953.0] pmol/L, P = 0.056) compared to critically ill COVID-19 individuals. Serum HE4 levels significantly correlated with age, SOFA-score, inflammation-dependent biomarkers, and the degree of lung manifestation evaluated by chest CT examination in ICU COVID-19 individuals. Based on ROC-AUC curve analysis, baseline HE4 independently indicated the severity of COVID-19 with an AUC value of 0.816 (95% CI [0.723-0.908]; P < 0.0001), while binary logistic regression test found HE4 as an independent prognostic parameter for death (OR: 10.618 [2.331-48.354]; P = 0.002). Furthermore, COVID-19 non-survivors showed much higher baseline HE4 levels without a substantial change under treatment vs. survivors (P < 0.0001). Finally, pre-treatment HE4 level of ≥ 331.7 pmol/L effectively predicted a larger risk for mortality (Log-Rank P < 0.0001) due to severe COVID-19 pneumonia. CONCLUSION: Elevated serum HE4 level at ICU admission highly correlates with COVID-19 severity and predicts disease outcome.

Chronic postoperative pain after non-intubated uniportal VATS lobectomy.

Introduction: Patients undergoing thoracic surgery are at increased risk of developing, long-lasting pain. Beyond the non-surgical factors, the type of operation, including the number of incisions, and the anesthetic assessment seemed to be important factors, although some studies are controversial. The aim of our study was to examine the presence of chronic postoperative pain after non-intubated uniportal VATS lobectomy. We examined the difference between the intubated, relaxed and non-intubated spontaneous ventilation surgical approaches in patients who underwent video-assisted thoracoscopic (VATS) uniportal lobectomy. Methods: Demographic and postoperative data were retrospectively collected and analyzed, focusing on the use of pain medications, in 67 patients of the 140 patients selected by propensity score matching who underwent intubated (iVATS) or non-intubated (NITS) uniportal VATS lobectomy. This study focused on the use of analgesic medications 3, 6, and 12 months after surgery. Results: Thirty-five intubated and 32 non-intubated patients were compared. Although the analgesic consumption was nearly 2% higher among the iVATS patients during the follow-up period, there were no statistically significant differences at 3 months (15.6 vs. 17.1%) (p = 0.868), at 6 months (9.4 vs. 12.4%) (p = 0.785), and at 12 months (3.3 vs. 5.9%) (p = 0.633) between the NITS and iVATS groups, respectively. More female than male patients reported chronic pain, but the difference was not statistically significant (p = 0.616). Diabetes mellitus was a statistically significant cofactor associated with chronic pain (p = 0.03), while cardiac disease (p = 0.6), perioperative morbidity (p = 0.228), prolonged air leak (p = 0.057), and repeat drainage (p = 0.626) were not. Conclusion: Our study suggests that after non-intubation VATS lobectomies, the postoperative pain was less at 3, 6, and 12 months in NITS patients compared to iVATS patients. The 2% difference was not significant, so it may not be appropriate to claim the advantages of NITS in terms of postoperative pain.

Jungian personality type preferences of female and male Hungarian leaders.

In this study, we investigated the personality type preferences of female and male Hungarian non-managerial individual contributors, middle managers, and executives. We aimed to investigate the preferences among successful females and males (i.e., executives) compared to non-executives. The preference distinctions between successful females and males were also analyzed. We conducted a cross-sectional analysis using the Jungian-based Golden Profiler of Personality (GPOP) questionnaire (N = 5,376; 2,678 females, 2,698 males; average age 35.98 with an SD = 8.977). Executives scored higher in extraversion, intuition, thinking, perceiving, and calm preferences compared to middle managers and individual contributors while scoring lower in sensing and tense preferences. Extraversion, intuition, and feeling preferences were more prevalent among female executives than both male executives and women in general. Our findings suggest that Hungarian female executives' personality preferences align with either stereotypically feminine traits (intuitive and feeling) or male executive-like preferences (extraverted, sensing, thinking, and judging combination). We also discussed the influence of cultural norms and expectations on the personality preferences of female and male executives. Our results are in line with prior research conducted in the Western context, however, the gender differences are more striking. We concluded that men have a reasonable chance of success across a spectrum of personality preferences as they ascend the hierarchy, while women need to exhibit specific preferences to be successful on the same journey. The self-descriptive and cross-sectional nature of our data spell limitations, therefore we suggest conducting future longitudinal studies, including explanatory and contingency variables (e.g. perceived cultural norms).

Spontaneous Ventilation Combined with Double-Lumen Tube Intubation during Thoracic Surgery: A New Anesthesiologic Method Based on 141 Cases over Three Years.

BACKGROUND: Non-intubated thoracic surgery has not achieved widespread acceptance despite its potential to improve postoperative outcomes. To ensure airway safety, our institute has developed a technique combining spontaneous ventilation with double-lumen tube intubation (SVI). This study aimed to verify the feasibility and limitations of this SVI technique. METHODS: For the SVI method, anesthesia induction involves fentanyl and propofol target-controlled infusion, with mivacurium administration. Bispectral index monitoring was used to ensure the optimal depth of anesthesia. Short-term muscle relaxation facilitated double-lumen tube intubation and early surgical steps. Chest opening preceded local infiltration, followed by a vagal nerve blockade to prevent the cough reflex and a paravertebral blockade for pain relief. Subsequently, the muscle relaxant was ceased. The patient underwent spontaneous breathing without coughing during surgical manipulation. RESULTS: Between 10 March 2020 and 28 October 2022, 141 SVI surgeries were performed. Spontaneous respiration with positive end-expiratory pressure was sufficient in 65.96% (93/141) of cases, whereas 31.21% (44/141) required pressure support ventilation. Only 2.84% (4/141) of cases reversed to conventional anesthetic management, owing to technical or surgical difficulties. Results of the 141 cases: The mean maximal carbon dioxide pressure was 59.01 (34.4-92.9) mmHg, and the mean lowest oxygen saturation was 93.96% (81-100%). The mean one-lung, mechanical and spontaneous one-lung ventilation time was 74.88 (20-140), 17.55 (0-115) and 57.73 (0-130) min, respectively. CONCLUSIONS: Spontaneous ventilation with double-lumen tube intubation is safe and feasible for thoracic surgery. The mechanical one-lung ventilation time was reduced by 76.5%, and the rate of anesthetic conversion to relaxation was low (2.8%).

[Pancreatic cancer with liver metastases: is it possible to improve survival by resection of oligopersistent primary tumor following neoadjuvant chemotherapy?] / Májáttétes pancreasrák: meghosszabbítható-e a túlélés az oligoperzisztens primer daganat neoadjuváns kemoterápiát követo reszekciójával?

The prognosis of pancreatic cancer is one of the worst of all cancers. Though the routine use of modern targeted and immunotherapy is still pending, the recently applied new chemotherapy combinations resulted in obvious improvement in the clinical management of pancreatic cancer. Adjuvant treatment followed by radical operation can increase the survival of the patients, moreover, neoadjuvant therapy for locally advanced tumors is associated with higher resectability rate. However, in metastatic disease only palliative chemotherapy could be indicated due to the dismal prognosis. The introduction of new chemotherapy combinations produced a major evolution by extending the median survival time of these patients. According to recent publications, even complete remission of the metastases can be achieved by the palliative chemotherapy, justifying a radical operation. This approach can be more advantageous, compared to patients treated with chemotherapy only. Reporting our two primary metastatic cases, we also endorse this new approach. The clinical significance of complex management is justified in the case of oligopersistence which is traditionally treated only with palliative systemic therapy. Orv Hetil. 2023; 164(43): 1712-1718.

Pancreatic SABR using peritumoral fiducials, triggered imaging and breath-hold.

Background: We aim to present our linear accelerator-based workflow for pancreatic stereotactic ablative radiotherapy (SABR) in order to address the following issues: intrafractional organ motion management, Cone Beam CT (CBCT) image quality, residual errors with dosimetric consequences, treatment time, and clinical results. Methods: Between 2016 and 2021, 14 patients with locally advanced pancreatic cancer were treated with induction chemotherapy and SABR using volumetric modulated arc therapy (VMAT). Internal target volume (ITV) concept (5), phase-gated (4), or breath hold (5) techniques were used. Treatment was verified by CBCT before and after irradiation, while tumor motion was monitored and controlled by kV triggered imaging and beam hold using peritumoral surgical clips. Beam interruptions and treatment time were recorded. The CBCT image quality was scored and supplemented by an agreement analysis (Krippendorff's-α) of breath-hold CBCT images to determine the position of OARs relative to the planning risk volumes (PRV). Residual errors and their dosimetry impact were also calculated. Progression free (PFS) and overall survival (OS) were assessed by the Kaplan-Meier analysis with acute and late toxicity reporting (CTCAEv4). Results: On average, beams were interrupted once (range: 0-3) per treatment session on triggered imaging. The total median treatment time was 16.7 ± 10.8 min, significantly less for breath-hold vs. phase-gated sessions (18.8 ± 6.2 vs. 26.5 ± 13.4, p < 0.001). The best image quality was achieved by breath hold CBCT. The Krippendorff's-α test showed a strong agreement among five radiation therapists (mean K-α value: 0.8 (97.5%). The mean residual errors were <0.2 cm in each direction resulting in an average difference of <2% in dosimetry for OAR and target volume. Two patients received offline adaptation. The median OS/PFS after induction chemotherapy and SABR was 20/12 months and 15/8 months. No Gr. ≥2 acute/late RT-related toxicity was noted. Conclusion: Linear accelerator based pancreatic SABR with the combination of CBCT and triggered imaging + beam hold is feasible. Peritumoral fiducials improve utility while breath-hold CBCT provides the best image quality at a reasonable treatment time with offline adaptation possibilities. In well-selected cases, it can be an effective alternative in clinics where CBCT/MRI-guided online adaptive workflow is not available.

Anesthetic (r)evolution from the conventional concept to the minimally invasive techniques in thoracic surgery-narrative review.

Background and Objective: Thanks to the growing experience with the non-intubated anesthetic and surgical techniques, most pulmonary resections can now be performed by using minimally invasive techniques. The conventional method, i.e., surgery on the intubated, ventilated patient under general anesthesia with one-lung ventilation (OLV) was considered necessary for the major thoracoscopic lung resections for all patients. An adequate analgesic approach (regional or epidural anesthesia) allows video-assisted thoracoscopy (VATS) to be performed in anesthetized patients and thus the potential adverse effects related to general anesthesia and mechanical OLV can be minimized. Methods: Multiple medical literature databases (PubMed, Google Scholar, Scopus) were searched, using the terms [(non-intubated) OR (nonintubated) OR (tubeless) OR (awake)] AND [(thoracoscopic surgery)] from 2004 to December 2021. Thirty hundred and six scientific papers were collected. The editorials, commentaries, letters, and papers were excluded, that focus on other than the non-intubated (aka awake or tubeless) VATS technique, as well as the full text scientific papers available in languages other than English. Key Content and Findings: After reviewing the literature, we identified "schools" with different techniques but with very similar results. Most of the differences were in the anesthetic technique, oxygenation and analgesia, however, the immunological results, and the qualitative parameters (inpatient hospital care days, complication rate, mortality) of the perioperative period showed great similarity, in addition, all three schools identified the same risk factors (hypoxia, hypercapnia, airway safety). The combination of spontaneous ventilation with double lumen tube intubation, called VATS-spontaneous ventilation with intubation (SVI) method seems to be suitable for reducing these risk factors, which may serve as an alternative for patients not suitable for the non-intubated technique in the near future. Conclusions: Based on the results, non-intubated thoracic surgery appears to be an increasingly widespread, safe procedure, that will be available to a wider range of patients as experience expands and by the implication of the constantly evolving new processes.

Near-infrared fluorescence guided surgery: State of the evidence from a health technology assessment perspective.

Different applications of near-infrared fluorescence-guided surgery are very promising, and techniques that help surgeons in intraoperative guidance have been developed, thereby bridging the gap between preoperative imaging and intraoperative visualization and palpation. Thus, these techniques are advantageous in terms of being faster, safer, less invasive, and cheaper. There are a few fluorescent dyes available, but the most commonly used dye is indocyanine green. It can be used in its natural form, but different nanocapsulated and targeted modifications are possible, making this dye more stable and specific. A new active tumor-targeting strategy is the conjugation of indocyanine green nanoparticles with antibodies, making this dye targeted and highly selective to various tumor proteins. In this mini-review, we discuss the application of near-infrared fluorescence-guided techniques in thoracic surgery. During lung surgery, it can help find small, non-palpable, or additional tumor nodules, it is also useful for finding the sentinel lymph node and identifying the proper intersegmental plane for segmentectomies. Furthermore, it can help visualize the thoracic duct, smaller bullae of the lung, phrenic nerve, or pleural nodules. We summarize current applications and provide a framework for future applications and development.

Putrescine Intensifies Glu/GABA Exchange Mechanism and Promotes Early Termination of Seizures.

Endogenous anticonvulsant mechanisms represent a reliable and currently underdeveloped strategy against recurrent seizures and may recall novel original therapeutics. Here, we investigated whether the intensification of the astroglial Glu-GABA exchange mechanism by application of the GABA precursor putrescine (PUT) may be effective against convulsive and non-convulsive seizures. We explored the potential of PUT to inhibit spontaneous spike-and-wave discharges (SWDs) in WAG/Rij rats, a genetic model of absence epilepsy. Significant shortening of SWDs in response to intraperitoneally applied PUT has been observed, which could be antagonized by blocking GAT-2/3-mediated astrocytic GABA release with the specific inhibitor SNAP-5114. Direct application of exogenous GABA also reduced SWD duration, suggesting that PUT-triggered astroglial GABA release through GAT-2/3 may be a critical step in limiting seizure duration. PUT application also dose-dependently shortened seizure-like events (SLEs) in the low-[Mg2+] in vitro model of temporal lobe epilepsy. SNAP-5114 reversed the antiepileptic effect of PUT in the in vitro model as well, further confirming that PUT reduces seizure duration by triggering glial GABA release. In accordance, we observed that PUT specifically reduces the frequency of excitatory synaptic potentials, suggesting that it specifically acts at excitatory synapses. We also identified that PUT specifically eliminated the tonic depolarization-induced desynchronization of SLEs. Since PUT is an important source of glial GABA and we previously showed significant GABA release, it is suggested that the astroglial Glu-GABA exchange mechanism plays a key role in limiting ictal discharges, potentially opening up novel pathways to control seizure propagation and generalization.

Early postoperative results of sublobal lung resections performed with spontaneous ventilation combined with double lumen tube intubation. A new surgical method / Intubálással biztosított spontán légzés módszerével elvégzett sublobaris tüdoreszekciók korai mutét utáni eredményei. Új mutéti eljárás

Introduction. Non-intubated spontaneous ventilated (NITS) minimally invasive surgery (video-assisted thoracic surgery VATS) is a widespread procedure, but there are some doubts regarding its safety. We developed a safe method, spontaneous ventilation with intubation (SVI) to resolve these concerns. In this study, the early postoperative results of the SVI sublobar resections are presented. Methods. Between 2020 May 25 and 2021 March 26, 20 SVI VATS sublobar resection was performed with a double lumen intratracheal tube. Results. Surgeries were performed for 9 females and 11 males with a mean age of 66.1. The mean BMI was 27.8, FEV1 was 89.1%, and Carlson Comorbidity score was 6.1. The mean surgical time was 61.5 min, drainage time was 1.85 days and hospital stay was 3.35 days. Morbidity was found to be 5%. Primer lung cancer was removed in 9 cases, we performed 6 metastasectomies and in 5 cases benign lesion was removed. Conclusion. According to the early postoperative results spontaneous ventilated VATS sublobar resections with double lumen intratracheal tube can be considered a safe thoracic surgical method.

Perioperative Systemic Inflammation in Lung Cancer Surgery.

Systemic inflammation (SI) is a response of the immune system to infectious or non-infectious injuries that defends the body homeostasis. Every surgical intervention triggers SI, the level of which depends on the extent of damage caused by the surgery. During the first few hours after the damage, the innate or natural immunity, involving neutrophils, macrophages, and natural killer cells, plays a main role in the defense mechanism, but thereafter the adaptive immune response ensues. The number of leukocytes is elevated, the levels of lymphocytes and natural killer cells are reduced, and the cytokines released after surgery correlate with surgical damage. Minimally invasive thoracic surgery procedures induce less inflammatory response and reduce the immune defense in patients to a more moderate level compared with the open surgery procedures; this immunosuppression can be further diminished in spontaneous ventilation cases. The normal functioning of the immune defense is important in controlling the perioperative circulatory tumor cells. Moreover, elevated levels of inflammatory cytokines before immune therapy have a negative impact on the response, and significantly shorten the progression-free survival. Clinically, the lower are the levels of cytokines released during lung surgery, the lesser is the postoperative morbidity, especially pneumonia and wound infection. The return to normal levels of lymphocytes and cytokines occurs faster after spontaneous ventilation surgery. The use of locoregional anesthesia can also reduce SI. Herein, we review the current knowledge on the effects of different operative factors on postoperative SI and defense mechanism in lung cancer surgery.

Elite Athletes' Perfectionistic Striving vs. Concerns as Opposing Predictors of Self-Handicapping With the Mediating Role of Attributional Style.

Self-handicapping is not only present among amateurs, but also even among the most elite athletes. The vast majority of the research investigates self-handicapping in academic context among students with mediocre performance. However, scientific examinations of predictors among top performers in the field of sports is terra incognita. Among the predictors of self-handicapping, perfectionistic strivings, and concerns as well as attributional style, were demonstrated as relevant ones among samples in prior studies. However, these links have never been examined among elite athletes who can be characterized by various aspects of perfectionism. In this study, the link between self-handicapping and perfectionistic striving and concerns was examined both directly and indirectly through the potential mediating effect of attributional style among elite athletes (N = 111) where more than half of the participants was competing at international level such as European and World Championships or Olympic Games. As it was expected, a positive relationship was found between perfectionistic concerns and self-handicapping, whereas the findings suggested a negative relationship between perfectionistic striving and self-handicapping. These connections were partially mediated by attributions for negative sport-related events. It appears that explanations for negative events are crucial in connection with protecting oneself through self-handicapping even among top athletes. The present work is a first step of a broader program in which the goal is reducing self-handicapping of top athletes through attributional retraining intervention.

Promoting a growth mindset decreases behavioral self-handicapping among students who are on the fixed side of the mindset continuum.

The present study examined the interplay between chronic intelligence beliefs, manipulated intelligence beliefs and self-handicapping processes. Prior studies showed that holding more of a fixed intelligence theory makes one vulnerable to resorting to self-protective mechanisms such as self-handicapping, while growth intelligence mindset can serve as a protective factor for self-handicapping. However, no prior studies have examined the potential interaction between pre-experimental intelligence beliefs, the manipulation of intelligence mindsets and behavioral self-handicapping. Although in our student sample (N = 101) there was no main effect of the mindset manipulations, participants with more of an initial fixed mindset benefited a lot from a brief growth mindset manipulation and displayed the lowest levels of behavioral self-handicapping. The mindset manipulation had less effect on self-handicapping of originally more of a growth-mindset individuals. These laboratory results demonstrate the benefits of growth mindset triggers which can be especially beneficial to reduce self-handicapping of young adults with more of a fixed mindset in educational settings.

Evolution of predictive and prognostic biomarkers in the treatment of advanced gastric cancer.

Despite new therapeutic options, advanced gastric cancer remains associated with a poor prognosis compared with other cancers. Recent gains in the treatment of gastric cancer were accompanied by the identification of novel biomarkers associated with various cellular pathways and corresponding diagnostic technologies. It is expected that the standardization of clinical workflow and technological refinements in biomarker assessment will support greater personalization and further improve treatment outcomes. In this article, we review the current state of prognostic and predictive biomarkers in gastric cancer.

Pathophysiological Advantages of Spontaneous Ventilation.

Surgical procedures cause stress, which can induce an inflammatory response and reduce immune function. Following video-assisted thoracoscopic surgery (VATS), non-intubated thoracic surgery (NITS) was developed to further reduce surgical stress in thoracic surgical procedures. This article reviews the pathophysiology of the NITS procedure and its potential for reducing the negative effects of mechanical one-lung ventilation (mOLV). In NITS with spontaneous ventilation, the negative side effects of mOLV are prevented or reduced, including volutrauma, biotrauma, systemic inflammatory immune responses, and compensatory anti-inflammatory immune responses. The pro-inflammatory and anti-inflammatory cytokines released from accumulated macrophages and neutrophils result in injury to the alveoli during mOLV. The inflammatory response is lower in NITS than in relaxed-surgery cases, causing a less-negative effect on immune function. The increase in leukocyte number and decrease in lymphocyte number are more moderate in NITS than in relaxed-surgery cases. The ventilation/perfusion match is better in spontaneous one-lung ventilation than in mOLV, resulting in better oxygenation and cardiac output. The direct effect of relaxant drugs on the acetylcholine receptors of macrophages can cause cytokine release, which is lower in NITS. The locoregional anesthesia in NITS is associated with a reduced cytokine release, contributing to a more physiological postoperative immune function.

Better intraoperative cardiopulmonary stability and similar postoperative results of spontaneous ventilation combined with intubation than non-intubated thoracic surgery.

OBJECTIVES: Non-intubated spontaneous ventilation video-assisted thoracic surgery lobectomy is a well-known procedure, but there are doubts regarding its safety. To solve this problem, we developed a safe procedure for spontaneous ventilation thoracic surgery (spontaneous ventilation with intubation). This study analyzed the intraoperative parameters and postoperative results of spontaneous ventilation with intubation. METHODS: Between March 11, 2020 and March 26, 2021, 38 spontaneous ventilation with intubation video-assisted thoracic surgery lobectomies were performed. We chose the first 38 non-intubated spontaneous ventilation video-assisted thoracic surgery lobectomy cases with a laryngeal mask performed in 2017 for comparison. RESULTS: There were no significant differences between the non-intubated spontaneous ventilation and spontaneous ventilation with intubation groups in postoperative surgical results (surgical time: 98,7 vs. 88,1 min (p = 0.067); drainage time: 3.5 vs. 2.7 days (p = 0.194); prolonged air leak 15.7% vs. 10.5% (p = 0.5); conversion rate to relaxation: 5.2% vs. 13.1% (p = 0.237); failure of the spontaneous ventilation rate: 10.5% vs. 13.1% (p = 0.724); and morbidity: 21% vs. 13.1% (p = 0.364)) and oncological outcomes. Significantly lower lowest systolic and diastolic blood pressure (systolic, 83.1 vs 132.3 mmHg, p = 0.001; diastolic 47.8 vs. 73.4 mmHg, p = 0.0001), lowest oxygen saturation (90.3% vs 94.9%, p = 0.026), and higher maximum pCO2 level (62.5 vs 54.8 kPa, p = 0.009) were found in the non-intubated spontaneous ventilation group than in the spontaneous ventilation with intubation group. CONCLUSIONS: Spontaneous ventilation with intubation is a more physiological procedure than non-intubated spontaneous ventilation in terms of intraoperative blood pressure stability and gas exchange. The surgical results were similar in the two groups.

Open, prospective, multicenter study on postoperative intranasal phototherapy in nasal polyposis.

BACKGROUND: The therapeutic effect of ultraviolet (UV) light is generally attributed to its immunosuppressive and immunomodulatory effects. Since chronic inflammation is the major factor in the development of nasal polyposis, we have previously used mixed ultraviolet-visible light (mUV-VIS, Rhinolight®) phototherapy for the treatment of nasal polyps. AIMS: In the present open, multicenter study, our aim was to delineate whether mUV-VIS applied postoperatively in vivo together with intranasal steroid treatment could reduce the recurrence of nasal polyps. METHODS: After functional endoscopic sinus surgery, one group of patients received mUV-VIS light together with standard intranasal steroid (mometason furoate 2 × 200 µg) application for a 12-week treatment period, whereas the other patient group obtained only intranasal steroid for the same duration. We recorded nasal endoscopy images and obtained demographical and clinical data, total nasal score (TNS), and nasal obstruction symptom evaluation (NOSE). We performed acoustic rhinometry and measured nasal inspiratory peak flow. Follow-up was 12 months. RESULTS: We found that the recurrence of nasal polyps was significantly diminished, and based on video-endoscopic measurements, the size and grade of recurrent polyps were significantly smaller in the phototherapy-receiving group. Nasal obstruction values and NOSE were significantly better throughout the follow-up period in the mUV-VIS light-treated group than in the intranasal steroid monotreatment group. CONCLUSIONS: Rhinophototherapy together with standard nasal steroid application may have a supportive role in the treatment of recurrent bilateral nasal polyps.

The Relationship Between Income Inequality and the Palliative Function of Meritocracy Belief: The Micro- and the Macro-Levels Both Count.

In the current paper, we report the analysis of the relationship between meritocracy belief and subjective well-being using two large international databases, the European Social Survey Program (N = 44,387) and the European Values Study Program (N = 51,752), involving data gathered from 36 countries in total. We investigated whether low status individuals are more likely to psychologically benefit from endorsing meritocratic beliefs, and the same benefits are more pronounced in more unequal societies. Since meritocracy belief can function as a justification for income differences, we assumed that the harsher the objective reality is, the higher level of subjective well-being can be maintained by justifying this harsh reality. Therefore, we hypothesized that the palliative function of meritocracy belief is stronger for both low social status (low income) individuals, and for those living in an unequal social environment (in countries with larger income differences). Our multilevel models showed a positive relationship between meritocracy belief and subjective well-being, which relationship was moderated by both individual-level income status and country-level income differences in both studies. Based on these results, we concluded that the emotional payoff of justifying income inequalities is larger if one is more strongly affected by these inequalities.

"The New State That We Are Building": Authoritarianism and System-Justification in an Illiberal Democracy.

The authoritarian personality is characterized by unquestionining obedience and respect to authority. System justification theory (SJT) argues that people are motivated to defend, bolster, and justify aspects of existing social, economic, and political systems. Commitment to the status quo is also a key characteristic of the authoritarian personality. It can be argued that the social context matters for how an underlying latent authoritarian character is expressed. This means that authoritarian regimes could be expected to lead to increased authoritarianism and stronger system-justification. We investigated this hypothesis in two representative samples of Hungarians, collected before (2010) and after (2018) 8 years of Fidesz' rule (N = 1,000 in both samples). Moreover, the strong version of SJT argues that members of disadvantaged groups are likely to experience the most cognitive dissonance and that the need to reduce this dissonance makes them the most supportive of the status quo. This argument dovetails nicely with claims made by the political opposition to Fidesz, according to which Fidesz is especially popular among low-status members of society. We found that measures assessing authoritarian tendencies did not change between 2010 and 2018. However, more specific beliefs and attitudes did change, and these effects were especially pronounced among Fidesz supporters. Their belief in a just world and a just system has grown stronger, while their attitudes toward migrants had hardened. Low status was associated with lower levels of system-justifying ideologies. However, low status Fidesz voters justified the system more than high status opposition voters in 2018, lending some support for the strong version of SJT. Our results suggest that beliefs and attitudes of Hungarians have changed between 2010 and 2018, and that political leadership played a crucial role in this.