Subacute Presentation of Central Cord Syndrome Resulting from Vertebral Osteomyelitis and Discitis: A Case Report

Introduction: Central cord syndrome (CCS) is a clinical syndrome of motor weakness and sensory changes. While CCS is most often associated with traumatic events. There have been few documented cases being caused by abscesses resulting from osteomyelitis.Case Report: A 56-year-old male presented to a regional trauma center complaining of excruciating neck and bilateral upper extremity pain. Computed tomography of the cervical and thoracic regions revealed severe discitis and osteomyelitis of the fourth and fifth cervical (C4-C5) with near-complete destruction of the C4 vertebral body, as well as anterolisthesis of C4 on C5 causing compression of the central canal. Empiric intravenous (IV) antibiotic therapy with ampicillin/sulbactam and vancomycin was initiated, and drainage of the abscess was scheduled. After the patient refused surgery, he was planned to be transferred to a skilled nursing facility to receive a six-week course of IV vancomycin therapy. A month later, patient returned to emergency department with the same complaint due to non-compliance with antibiotic therapy.Discussion: Delayed diagnosis and treatment of osteomyelitis can result in devastating neurological sequelae, and literature supports immediate surgical debridement. Although past evidence has suggested surgical intervention in similar patients with presence of abscesses, this case may suggest that antibiotic treatment may be an alternative approach to the management of CCS due to an infectious etiology. However, the patient had been non-compliant with medication, so it is unknown whether there was definite resolution of the condition.Conclusion: In patients presenting with non-traumatic central cord syndrome, it is vital to identify risk factors for infection in a thoroughly obtained patient history, as well as to maintain a low threshold for diagnostic imaging

Cannabinoids in the treatment of epilepsy: current status and future prospects

Cannabidiol (CBD) is one of the prominent phytocannabinoids found in Cannabis sativa, differentiating from Δ9-tetrahydrocannabinol (THC) for its non-intoxicating profile and its antianxiety/antipsychotic effects. CBD is a multi-target drug whose anti-convulsant properties are supposed to be independent of endocannabinoid receptor CB1 and might be related to several underlying mechanisms, such as antagonism on the orphan GPR55 receptor, regulation of adenosine tone, activation of 5HT1A receptors and modulation of calcium intracellular levels. CBD is a lipophilic compound with low oral bioavailability (6%) due to poor intestinal absorption and high first-pass metabolism. Its exposure parameters are greatly influenced by feeding status (ie, high fatcontaining meals). It is mainly metabolized by cytochrome P 450 (CYP) 3A4 and 2C19, which it strongly inhibits. A proprietary formulation of highly purified, plant-derived CBD has been recently licensed as an adjunctive treatment for Dravet syndrome (DS) and Lennox-Gastaut syndrome (LGS), while it is being currently investigated in tuberous sclerosis complex. The regulatory agencies’ approval was granted based on four pivotal double-blind, placebocontrolled, randomized clinical trials (RCTs) on overall 154 DS patients and 396 LGS ones, receiving CBD 10 or 20 mg/kg/day BID as active treatment. The primary endpoint (reduction in monthly seizure frequency) was met by both CBD doses. Most patients reported adverse events (AEs), generally from mild to moderate and transient, which mainly consisted of somnolence, sedation, decreased appetite, diarrhea and elevation in aminotransferase levels, the last being documented only in subjects on concomitant valproate therapy. The interaction between CBD and clobazam, likely due to CYP2C19 inhibition, might contribute to some AEs, especially somnolence, but also to CBD clinical effectiveness. Cannabidivarin (CBDV), the propyl analogue of CBD, showed anti-convulsant properties in pre-clinical studies, but a plant-derived, purified proprietary formulation of CBDV recently failed the Phase II RCT in patients with uncontrolled focal seizures

ASSESSING ECONOMIC AND TECHNICAL IMPACTS OF NON EXPECTED WEATHER EVENTS ON FRENCH SUCKLER COW FARMS DYNAMICS: A DYNAMIC RECURSIVE FARM MODEL

Weather variability can threaten French suckler cow farms which rely on rather extensive forage production. However, flexibility of the production system can help farmer to face crop production shocks. This study aims at assessing how crop yield shocks impact on farms outcomes when adaptive capacity is taken into account. Our objectives are to develop a dynamic model which enables us 1) to predict the optimal mix of production adjustments to face crop yield shocks, 2) to quantify how far the system moves from the equilibrium and how long it takes to return and 3) to measure impact of shocks on economic results when adaptive capacity is taken into account. An original dynamic recursive bio-economic farm model integrating detailed technical and biological constraints and coupled with biological sub-models has been built and calibrated to represent an average farm producing charolais finished animals. Crop yield shocks of intensities ranging between -60% and +60% of their average values are simulated in between average years. A preference for maintaining animal sales and animal live weight at the expense of crop products trade balance is found. Thought, when intensities of shocks get higher, forced sales and important variations of the area of pasture cut are observed. Essential of loss (or gain) of net profit is felt the year of the shock but can be remnant for several years. In addition, gains for good years do not totally compensate loss of symmetric bad ones. Consequently, farms capacity to face risk could be weaken over time. Minimum consumption needs, probability distribution of shocks and successions or combinations of shocks would have thought to be taken into account to assess real capacity of farms to maintain over time.livestock farm model, dynamic recursive model, crop yield variability, Livestock Production/Industries,

Effector memory differentiation increases detection of replication-competent HIV-l in resting CD4+ T cells from virally suppressed individuals.

Studies have demonstrated that intensive ART alone is not capable of eradicating HIV-1, as the virus rebounds within a few weeks upon treatment interruption. Viral rebound may be induced from several cellular subsets; however, the majority of proviral DNA has been found in antigen experienced resting CD4+ T cells. To achieve a cure for HIV-1, eradication strategies depend upon both understanding mechanisms that drive HIV-1 persistence as well as sensitive assays to measure the frequency of infected cells after therapeutic interventions. Assays such as the quantitative viral outgrowth assay (QVOA) measure HIV-1 persistence during ART by ex vivo activation of resting CD4+ T cells to induce latency reversal; however, recent studies have shown that only a fraction of replication-competent viruses are inducible by primary mitogen stimulation. Previous studies have shown a correlation between the acquisition of effector memory phenotype and HIV-1 latency reversal in quiescent CD4+ T cell subsets that harbor the reservoir. Here, we apply our mechanistic understanding that differentiation into effector memory CD4+ T cells more effectively promotes HIV-1 latency reversal to significantly improve proviral measurements in the QVOA, termed differentiation QVOA (dQVOA), which reveals a significantly higher frequency of the inducible HIV-1 replication-competent reservoir in resting CD4+ T cells

FOOD SELF-SUFFICIENCY AND FARM ECONOMICS IN FRENCH ORGANIC SUCKLER CATTLE FARMS

The organic Charolais suckler farmers of the French Massif Central sell most of their animals on the conventional market. The high cost of the inputs, and in particular the concentrates, is an incentive for these suckler farmers to seek a high degree of food self-sufficiency on their farms. This self-sufficiency is reached through good management of grass and especially through cereal crops for animal feeding. The strong limitation of the inputs does not affect the numerical productivity or the health of the herd, but it entails lower meat productivity per animal and per hectare. However, the operational cost savings make it possible to maintain income per hectare at the same level as that of conventional farms

"Du läsa denna!" -en fallstudie av hur bilderboken används på två förskoleavdelningar

Syfte Syftet med vår fallstudie är att ta reda på när och hur man på två förskoleavdelningar arbetar med bilderböcker. Då ur ett sociokulturellt perspektiv där dialog och samspel är centrala begrepp. Vi är intresserade av att undersöka hur barnen samspelar med varandra respektive samspelet mellan barn och pedagog. Frågeställningar: · När och hur används bilderböcker i förskolans verksamhet? · Hur ser samspelet kring bilderböcker ut mellan barn och barn i förskolan? · Hur ser samspelet kring bilderböcker ut mellan barn och vuxen i förskolan? Metod En kvalitativ fallstudie genomfördes i form av observationer på två förskoleavdelningar med barn i åldrarna 1- 5 år, under 3 dagar på respektive avdelning. Till grund för de observationerna gjordes en pilotstudie vid ett tillfälle på de berörda avdelningarna. Resultat Resultatet av vår undersökning visar att arbetet med bilderböcker förekommer i olika former på de två undersökta förskoleavdelningarna. Vi fann att det inte alltid är så självklart att verklighetens bild stämmer överens med den pedagogiska litteraturens bild av arbete med bilderböcker. Vi såg dock goda möjligheter till samspel mellan de undersökta parterna. Betydelse för läraryrket Arbete med bilderböcker i förskolan är av stor vikt för såväl kommunikation som samspel och social utveckling. I denna undersökning framkom att samspel ofta står i fokus då det gäller arbete med litteratur. Genom samspel skapas lärosituationer som ligger till grund för det livslånga lärandet

Impacts possibles de la réforme de la PAC de juin 2003 et de ses différentes options d'application sur des exploitations d'élevages bovins allaitants

La dernière réforme de la PAC poursuit celle de 1992, elle-même confirmée par l'Agenda 2000, dans le découplage des soutiens directs à la production. Afin de voir les adaptations des exploitations d'élevage bovin allaitant, des simulations de différentes options d'application de la réforme ont été faites pour les principaux cas d'exploitations, plus ou moins intensives, naisseurs ou naisseurs-engraisseurs de taurillons ou de boeufs, avec plus ou moins de cultures, situées dans les 3 régions charolaise, limousine et Pays de Loire. Les tendances qui se dégagent, après adaptations à prix stables, soutiens globalement maintenus et à superficie constante, sont la faible incidence sur le résultat économique, la réduction des cultures au profit des prairies et du cheptel, l'augmentation du nombre de vaches après diminution dans la situation de référence, le maintien de la finition des femelles avec les rapports de prix entre catégories de 1998, et l'engraissement des mâles plus difficile mais maintenu dans certaines options dans les systèmes naisseurs-engraisseurs étudiés.

Management of everolimus-associated adverse events in patients with tuberous sclerosis complex: a practical guide

Tuberous sclerosis complex (TSC) is a genetic disorder characterised by highly variable comorbid dysfunction and subsequent morbidity. The mTOR inhibitor everolimus is indicated for the treatment of adult TSC patients with renal angiomyolipomas (AMLs) and for subependymal giant astrocytoma (SEGA) in both adults and children, based on data from the EXIST-1 and EXIST-2 trials. However, due to the historical predominance of everolimus in the oncology setting, some physicians who treat TSC patients may be unfamiliar with everolimus-associated adverse events (AEs) and appropriate management strategies. This article aims to serve as a resource for specialists including nephrologists, paediatricians, neurologists and geneticists who require practical guidance on the management of events such as non-infectious pneumonitis, rash, stomatitis, infections, and renal AEs. Additional consideration is given to drug interactions, hepatic impairment, fertility, and sexual maturation. Since patients with TSC receive clinical benefit from continued therapy, it is important that everolimus-related events are dealt with appropriately through strategies such as dose modification, interruption, the provision of supportive care, regular monitoring, and patient education

Predictors of seizure outcomes in children with tuberous sclerosis complex and intractable epilepsy undergoing resective epilepsy surgery: an individual participant data meta-analysis.

ObjectiveTo perform a systematic review and individual participant data meta-analysis to identify preoperative factors associated with a good seizure outcome in children with Tuberous Sclerosis Complex undergoing resective epilepsy surgery.Data sourcesElectronic databases (MEDLINE, EMBASE, CINAHL and Web of Science), archives of major epilepsy and neurosurgery meetings, and bibliographies of relevant articles, with no language or date restrictions.Study selectionWe included case-control or cohort studies of consecutive participants undergoing resective epilepsy surgery that reported seizure outcomes. We performed title and abstract and full text screening independently and in duplicate. We resolved disagreements through discussion.Data extractionOne author performed data extraction which was verified by a second author using predefined data fields including study quality assessment using a risk of bias instrument we developed. We recorded all preoperative factors that may plausibly predict seizure outcomes.Data synthesisTo identify predictors of a good seizure outcome (i.e. Engel Class I or II) we used logistic regression adjusting for length of follow-up for each preoperative variable.ResultsOf 9863 citations, 20 articles reporting on 181 participants were eligible. Good seizure outcomes were observed in 126 (69%) participants (Engel Class I: 102(56%); Engel class II: 24(13%)). In univariable analyses, absence of generalized seizure semiology (OR = 3.1, 95%CI = 1.2-8.2, p = 0.022), no or mild developmental delay (OR = 7.3, 95%CI = 2.1-24.7, p = 0.001), unifocal ictal scalp electroencephalographic (EEG) abnormality (OR = 3.2, 95%CI = 1.4-7.6, p = 0.008) and EEG/Magnetic resonance imaging concordance (OR = 4.9, 95%CI = 1.8-13.5, p = 0.002) were associated with a good postoperative seizure outcome.ConclusionsSmall retrospective cohort studies are inherently prone to bias, some of which are overcome using individual participant data. The best available evidence suggests four preoperative factors predictive of good seizure outcomes following resective epilepsy surgery. Large long-term prospective multicenter observational studies are required to further evaluate the risk factors identified in this review

On-farm weather risk management in suckler cow farms: A recursive discrete stochastic programming approach

Currently France wants to introduce a weather risk management framework into its agricultural policy for livestock farming. The aim of this paper is to better understand how on-farm risk reducing strategies modify the production system and profit distribution of French suckler cow enterprises. We present in this paper an original bioeconomic model that takes into account both risk anticipation and risk adjustments and that details biotechnical relationships between the different components of the beef cattle production system and their dynamics. On-farm risk management strategies are endogeneized under weather uncertainty and tested on real observed weather sequences. We simulate four scenarios characterized by different risk aversions and feed prices. Results emphasized that production adjustments, particularly the adjustments of area of grassland harvested and the possibility to purchase substitutes to on-farm forage production, improve farmers profit under weather variability. However, limiting the amplitude of these adjustments helps decreasing profit variability. All simulated long term decisions associated to risk reducing strategies encompass a reduction of long term stocking rate and the constitution of feed stocks. The impact of hay feed price on the market has similar effects on the long term strategy.Livestock Production/Industries, Risk and Uncertainty,