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When the Islamic State in Iraq and Syria displaced Christian Assyrians from the Nineveh Plain in 2014, several militias were founded in response. These small groups aimed from the beginning to establish a presence on the ground after the defeat of their enemy, with the long-term goal to remain as security providers in their historical heartland. Lacking material resources or political power of their own, most militias tied themselves to a single ally affiliated with the Government of Iraq or the Kurdistan Regional Government — but others obtained support from several actors, or none. Considering the marginality of the political parties and political entrepreneurs behind the militias, those displaying loyalty to a single powerful ally could be expected to prevail against rival groups. Instead, a militia with weak ties to several actors established the strongest presence on the ground, and became the main security provider in the largest Assyrian town. To explain this puzzling outcome, the study provides a detailed account of how the militias formed, built their capacity, and deployed to the Nineveh Plain. The empirical data originates mainly from observations and interviews conducted in Iraq, as well as news and social media. With an inductive and iterative approach, the external relations of the militias emerged as the central explanation to address the research puzzle, but other factors are discussed as well. The study concludes that the most successful militia prevailed over its rivals by engaging multiple external actors with pragmatism and diplomatic skill, while tenaciously building a capable organisation. The findings demonstrate the potential of very small militias to exercise agency and assert themselves in an ongoing civil war.

Facial blushing is one of the cardinal symptoms of social phobia and has a strong negative impact on the quality of life. Traditional therapeutic options are psychotherapy and pharmacological treatment. The results of these treatments on facial blushing are poorly documented. To investigate whether endoscopic bilateral transection of the upper thoracic sympathetic chain is efficient in the treatment of facial blushing, 244 consecutive patients were treated with bilateral endoscopic transthoracic sympathicotomy (ETS). The results were evaluated by questionnaire and symptoms assessed with visual analogue scales (0–10). There was no mortality nor conversion to open surgery. No Horner's syndrome occurred. Two patients with postoperative pneumothorax were treated with intercostal drainage and one small pulmonary embolus was detected. The questionnaire was answered by 219 patients (90%) a mean (± SEM) of 8 months (± 9 days) after surgery. Facial blushing (mean ± SEM) was reduced from 8.7 ± 0.1 to 2.2 ± 0.2, P

The heart is not spared from the catabolic effects of undernutrition, but is subject to the same degree of weight loss as skeletal muscle. Pumping performance, however, is not reduced in proportion to myocardial wasting and thus functional protection prevents failure of the hypotrophic heart. In animal experiments, no major qualitative changes in myocardial composition apart from reduced myosin ATPase activity have been found. This reduction in ATPase activity might be associated with down-regulation of thyroid hormones and the development of insulin resistance and serve as an energy saving adaptation. Increased cardiac sensitivity to adrenergic stimulation may also constitute a means to increase heart performance in situations with augmented circulatory demands. On the other hand, increased sensitivity and maximum response to adrenergic stimulation might render the heart more susceptible to arrhythmia, and thus explain sudden unexpected death following rapid weight loss.

This study evaluated whether altered insulin metabolism is a key factor behind weight loss during sarcoma growth in nongrowing mice (C57BL/6J). Fasted sarcoma-bearing mice had decreased blood glucose concentrations but unchanged levels of insulin, compared with those in pair-weighed and freely fed controls. During refeeding, insulin levels were inappropriately low for the degree of glycemia in sarcoma-bearing mice compared with those of pair-weighed and freely fed controls. Injections ip of glucose to tumor-bearing animals resulted in insulin levels comparable to postabsorptive values in healthy control animals, indicating that hypoinsulinemia in freely eating tumor-bearing animals was due to a reduced glycemic sensitivity for pancreatic insulin release. Insulin supplementation at doses [4 IU/100 g (body wt)] that increase body fat in normal animals could not protect the tumor-bearing host from progressive loss of body fat or lean tissues. Exogenous insulin in excess of endogenous insulin production did not stimulate tumor growth. Nitrogen and RNA-DNA content were significantly decreased in the quadriceps muscle of tumor-bearing mice. This reduction was independent of altered insulin levels and could not be prevented by exogenous insulin. The depressed capacity of protein synthesis in extensor digitorum longus (EDL) muscle could be entirely attributed to the state of malnutrition in tumor-bearing animals. The sensitivity and responsiveness of protein synthesis in EDL muscles to insulin were normal in tumor-bearing mice, regardless of whether exogenous insulin exerted its effect in vivo or in vitro. This study confirms insulin resistance for glucose metabolism in an experimental sarcoma animal model. Such changes are concluded to be secondary to anorexia and necessary to counteract hypoglycemia. In non-growing sarcoma-bearing mice, malnutrition and anorexia account entirely for depressed muscle protein synthesis, which is not explained by insulin resistance at the translational level. Insulin metabolism is not a key factor behind progression of wasting in sarcoma-bearing mice, but anorexia is.

The efficacy of total parenteral nutrition (TPN) in the protection of body composition, when given as an adjuvant to CVB (cisplatin-vinblastine-bleomycin) treatment to patients with testicular teratocarcinoma, was investigated. Twenty-three patients without previous malnutrition were randomized to receive either TPN or spontaneous oral intake only during their hospital stay, in the course of a total treatment period of 10 weeks. The patients spent weeks 1, 4, 7, and 10 in the hospital to undergo chemotherapy. Energy and nitrogen intakes were profoundly decreased in the spontaneous oral-intake group, whereas the intakes decreased in the TPN group only at home when they relied on oral intake. In spite of the cytotoxic drugs, the TPN group remained in nitrogen balance when undergoing TPN at the hospital. However, they lost substantial body weight and body nitrogen over 10 weeks when compared with the oral-intake group. This loss in body mass was mainly a result of the prolonged anorexia that all the patients had after weekly termination of chemotherapy. This study demonstrates that well-nourished patients can use intravenous nutrition even while receiving cytocidal and cytostatic drug administration. However, intermittent periods of adequate nutrition in the hospital had only a marginal impact, since the positive effects of nutrition were offset by the pronounced anorexia that occurred in all patients outside the hospital for a considerable time after cytostatic treatment.

Endoscopic thoracic sympathectomy (ETS) has gained increasing popularity due to its minimally invasive character. Despite the simplicity of the procedure, non-surgical options should always be considered as the first line of treatment. The complication risk of ETS is low but side effects, primarily compensatory sweating (CS) of mainly the trunk, may be severe enough to cause regret of the procedure. The risk/benefit ratio should always be discussed with the patient. Severe palmar hyperhidrosis and facial blushing respond very well to ETS with a high patient satisfaction rate. Facial hyperhidrosis is effectively treated with ETS, but is associated with a high risk for severe CS. Axillary hyperhidrosis is best treated by means other than ETS. The use of ETS for pain syndromes, vascular insufficiency and angina pectoris is not well supported by scientific evidence, making careful patient selection mandatory.