Fournier gangrene with concurrent multifocal necrotizing fasciitis: a systematic review and case report

Purpose A patient presented to a regional surgical center with Fournier gangrene (FG) and concurrent multifocal necrotizing fasciitis (NF). Given the rarity, it was decided to undertake a systematic review to investigate the incidence and prevalence of FG with multifocal NF and consequently determine the treatment and approach to management of such presentation. Methods Firstly, the report of the 56-year-old male patient is discussed regarding his surgical management. Secondly, a systematic review was undertaken according to PRISMA guidelines using MEDLINE, Scopus, and Embase databases. Searches used the following MeSH terms: (“fournier’s gangrene”) AND ((necrotising fasciitis) OR (necrotising soft tissue infection)). Once the search results were obtained, duplicate articles were removed. Titles, abstracts, and articles were reviewed by 2 authors. Results The search strategy using the 3 databases revealed a total of 402 studies. Fifty-seven studies were removed due to duplication. A total of 345 records were screened via title and abstract, of which 115 were excluded. Two hundred and thirty studies were reviewed for eligibility. A total of all 230 studies were excluded; 169 were excluded as they included the incorrect patient population (patients suffered from FG or NF, but not both collectively), 60 studies were excluded due to incorrect study designs, and 1 report occurred in the wrong setting. Conclusion This highlights that while being a relatively known, uncommon infection both FG and NF are well documented separately within the literature. However, FG with concurrent multifocal NF has not been documented within the literature

Boussinesq modeling of a rip current system

In this study, we use a time domain numerical model based on the fully nonlinear extended Boussinesq equations [Wei et al., 1995] to investigate surface wave transformation and breaking-induced nearshore circulation. The energy dissipation due to wave breaking is modeled by introducing an eddy viscosity term into the momentum equations, with the viscosity strongly localized on the front face of the breaking waves. Wave run-up on the beach is simulated using a moving shoreline technique. We employ quasi fourth-order finite difference schemes to solve the governing equations. Satisfactory agreement is found between the numerical results and the laboratory measurements of Haller et al. [1997], including wave height, mean water level, and longshore and cross-shore velocity components. The model results reveal the temporal and spatial variability of the wave-induced nearshore circulation, and the instability of the rip current in agreement with the physical experiment. Insights into the vorticity associated with the rip current and wave diffraction by underlying vortices are obtained

Dynamic Regulation of Histone H3 Methylated at Lysine 79 within a Tissue-specific Chromatin Domain

Post-translational modifications of individual lysine residues of core histones can exert unique functional consequences. For example, methylation of histone H3 at lysine 79 (H3-meK79) has been implicated recently in gene silencing in Saccharomyces cerevisiae. However, the distribution and function of H3-meK79 in mammalian chromatin are not known. We found that H3-meK79 has a variable distribution within the murine beta-globin locus in adult erythroid cells, being preferentially enriched at the active betamajor gene. By contrast, acetylated H3 and H4 and H3 methylated at lysine 4 were enriched both at betamajor and at the upstream locus control region. H3-meK79 was also enriched at the active cad gene, whereas the transcriptionally inactive loci necdin and MyoD1 contained very little H3-meK79. As the pattern of H3-meK79 at the beta-globin locus differed between adult and embryonic erythroid cells, establishment and/or maintenance of H3-meK79 was developmentally dynamic. Genetic complementation analysis in null cells lacking the erythroid and megakaryocyte-specific transcription factor p45/NF-E2 showed that p45/NF-E2 preferentially establishes H3-meK79 at the betamajor promoter. These results support a model in which H3-meK79 is strongly enriched in mammalian chromatin at active genes but not uniformly throughout active chromatin domains. As H3-meK79 is highly regulated at the beta-globin locus, we propose that the murine ortholog of Disruptor of Telomeric Silencing-1-like (mDOT1L) methyltransferase, which synthesizes H3-meK79, regulates beta-globin transcription

Culture and Social Change in Mothers’ and Fathers’ Individualism, Collectivism and Parenting Attitudes

Cultures and families are not static over time but evolve in response to social transformations, such as changing gender roles, urbanization, globalization, and technology uptake. Historically, individualism and collectivism have been widely used heuristics guiding cross-cultural comparisons, yet these orientations may evolve over time, and individuals within cultures and cultures themselves can have both individualist and collectivist orientations. Historical shifts in parents’ attitudes also have occurred within families in several cultures. As a way of understanding mothers’ and fathers’ individualism, collectivism, and parenting attitudes at this point in history, we examined parents in nine countries that varied widely in country-level individualism rankings. Data included mothers’ and fathers’ reports (N = 1338 families) at three time points in China, Colombia, Italy, Jordan, Kenya, Philippines, Sweden, Thailand, and the United States. More variance was accounted for by within-culture than between-culture factors for parents’ individualism, collectivism, progressive parenting attitudes, and authoritarian parenting attitudes, which were predicted by a range of sociodemographic factors that were largely similar for mothers and fathers and across cultural groups. Social changes from the 20th to the 21st century may have contributed to some of the similarities between mothers and fathers and across the nine countries

Positive Youth Development: Parental Warmth, Values, and Prosocial Behavior in 11 Cultural Groups

The current cross-cultural study aimed to extend research on parenting and children’s prosocial behavior by examining relations among parental warmth, values related to family obligations (i.e., children’s support to and respect for their parents, siblings, and extended family), and prosocial behavior during the transition to adolescence (from ages 9 to 12). Mothers, fathers, and their children (N = 1107 families) from 8 countries including 11 cultural groups (Colombia; Rome and Naples, Italy; Jordan; Kenya; the Philippines; Sweden; Thailand; and African Americans, European Americans, and Latin Americans in the United States) provided data over 3 years in 3 waves (Mage of child in wave 1 = 9.34 years, SD = 0.75; 50.5% female). Overall, across all 11 cultural groups, multivariate change score analysis revealed positive associations among the change rates of parental warmth, values related to family obligations, and prosocial behavior during late childhood (from age 9 to 10) and early-adolescence (from age 10 to 12). In most cultural groups, more parental warmth at ages 9 and 10 predicted steeper mean-level increases in prosocial behavior in subsequent years. The findings highlight the prominent role of positive family context, characterized by warm relationships and shared prosocial values, in fostering children’s positive development in the transition to adolescence. The practical implications of these findings are discussed

Unanesthetized Auditory Cortex Exhibits Multiple Codes for Gaps in Cochlear Implant Pulse Trains

Cochlear implant listeners receive auditory stimulation through amplitude-modulated electric pulse trains. Auditory nerve studies in animals demonstrate qualitatively different patterns of firing elicited by low versus high pulse rates, suggesting that stimulus pulse rate might influence the transmission of temporal information through the auditory pathway. We tested in awake guinea pigs the temporal acuity of auditory cortical neurons for gaps in cochlear implant pulse trains. Consistent with results using anesthetized conditions, temporal acuity improved with increasing pulse rates. Unlike the anesthetized condition, however, cortical neurons responded in the awake state to multiple distinct features of the gap-containing pulse trains, with the dominant features varying with stimulus pulse rate. Responses to the onset of the trailing pulse train (Trail-ON) provided the most sensitive gap detection at 1,017 and 4,069 pulse-per-second (pps) rates, particularly for short (25 ms) leading pulse trains. In contrast, under conditions of 254 pps rate and long (200 ms) leading pulse trains, a sizeable fraction of units demonstrated greater temporal acuity in the form of robust responses to the offsets of the leading pulse train (Lead-OFF). Finally, TONIC responses exhibited decrements in firing rate during gaps, but were rarely the most sensitive feature. Unlike results from anesthetized conditions, temporal acuity of the most sensitive units was nearly as sharp for brief as for long leading bursts. The differences in stimulus coding across pulse rates likely originate from pulse rate-dependent variations in adaptation in the auditory nerve. Two marked differences from responses to acoustic stimulation were: first, Trail-ON responses to 4,069 pps trains encoded substantially shorter gaps than have been observed with acoustic stimuli; and second, the Lead-OFF gap coding seen for <15 ms gaps in 254 pps stimuli is not seen in responses to sounds. The current results may help to explain why moderate pulse rates around 1,000 pps are favored by many cochlear implant listeners

Measurement of the Bottom-Strange Meson Mixing Phase in the Full CDF Data Set

We report a measurement of the bottom-strange meson mixing phase \beta_s using the time evolution of B0_s -> J/\psi (->\mu+\mu-) \phi (-> K+ K-) decays in which the quark-flavor content of the bottom-strange meson is identified at production. This measurement uses the full data set of proton-antiproton collisions at sqrt(s)= 1.96 TeV collected by the Collider Detector experiment at the Fermilab Tevatron, corresponding to 9.6 fb-1 of integrated luminosity. We report confidence regions in the two-dimensional space of \beta_s and the B0_s decay-width difference \Delta\Gamma_s, and measure \beta_s in [-\pi/2, -1.51] U [-0.06, 0.30] U [1.26, \pi/2] at the 68% confidence level, in agreement with the standard model expectation. Assuming the standard model value of \beta_s, we also determine \Delta\Gamma_s = 0.068 +- 0.026 (stat) +- 0.009 (syst) ps-1 and the mean B0_s lifetime, \tau_s = 1.528 +- 0.019 (stat) +- 0.009 (syst) ps, which are consistent and competitive with determinations by other experiments.Comment: 8 pages, 2 figures, Phys. Rev. Lett 109, 171802 (2012