Atypical presentation of cervical necrotizing fasciitis. Case report

Cervical necrotizing fasciitis (NF) is a soft tissue infection with a low incidence, characterized by rapid progression and high morbidity and mortality. The purpose of this report is to communicate the case of a patient diagnosed with cervical NF and its successful management. A 54-year-old male consulted after suffering from the condition for seven days. It was characterized by bilateral submandibular swelling, accompanied by fever, dysphagia, odynophagia, which were severely affecting the patient’s generalhealth. Physical examination revealed a painful, erythematous cervical swelling. A cervical computed tomography scan was performed, revealing a gaseous collection in the left mucosal pharyngeal space, extending to the glottis, associated with significant deep plane soft tissue emphysema onon the left side of the neck and with possible involvement of the danger space; pertinent lab findings include 19,190/uL leukocytes and 219mg/LCRP. Broad-spectrum antibiotic therapy was initiated with ceftriaxoneand clindamycin. Exploratory surgery, lavage and drainage of the collected material were performed. Streptococcus anginosus was isolated by culture. The patient recovered appropriately showing improvement in clinical as well as in inflammatory parameters, being discharged on the ninth day. He iscurrently receiving periodical checkups in the surgery polyclinic

Glial βii spectrin contributes to paranode formation and maintenance

Action potential conduction along myelinated axons depends on high densities of voltage-gated Na channels at the nodes of Ranvier. Flanking each node, paranodal junctions (paranodes) are formed between axons and Schwann cells in the peripheral nervous system (PNS) or oligodendrocytes intheCNS. Paranodal junctions contribute to both no deassembly and maintenance. Despitetheir importance, the molecular mechanisms responsible for paranode assembly and maintenance remain poorly understood. βII spectrin is expressed in diverse cells and is an essential part of the submembranous cytoskeleton. Here, we show that Schwann cell βII spectrin is highly enriched at paranodes. To elucidate the roles of glial βII spectrin, we generated mutant mice lacking βII spectrin in myelinating glial cells by crossing mice with a floxed allele of Sptbn1 with Cnp-Cre mice, and analyzed both male and female mice. Juvenile (4 weeks) and middle-aged (60 weeks) mutant mice showed reduced grip strength and sciatic nerve conduction slowing, whereas no phenotype was observed between 8 and 24 weeks of age. Consistent with these findings, immunofluorescence microscopy revealed disorganized paranodes in the PNS and CNS of both postnatal day 13 and middle-aged mutant mice, but not in young adult mutant mice. Electron microscopy confirmed partial loss of transverse bands at the paranodal axoglial junction in the middle-aged mutant mice in both the PNS and CNS. These findings demonstrate that a spectrin-based cytoskeleton in myelinating glia contributes to formation and maintenance of paranodal junctions.Fil: Susuki, Keiichiro. Baylor College of Medicine; Estados UnidosFil: Zollinger, Daniel R.. Baylor College of Medicine; Estados UnidosFil: Chang, Kae Jiun. Baylor College of Medicine; Estados UnidosFil: Zhang, Chuansheng. Baylor College of Medicine; Estados UnidosFil: Huang, Claire Yu Mei. Baylor College of Medicine; Estados UnidosFil: Tsai, Chang Ru. Baylor College of Medicine; Estados UnidosFil: Galiano, Mauricio Raul. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Centro de Investigaciones en Química Biológica de Córdoba. Universidad Nacional de Córdoba. Facultad de Ciencias Químicas. Centro de Investigaciones en Química Biológica de Córdoba; Argentina. Baylor College of Medicine; Estados UnidosFil: Liu, Yanhong. Baylor College of Medicine; Estados UnidosFil: Benusa, Savannah D.. Virginia Commonwealth University; Estados UnidosFil: Yermakov, Leonid M.. Wright State University; Estados UnidosFil: Griggs, Ryan B.. Wright State University; Estados UnidosFil: Dupree, Jeffrey L.. Virginia Commonwealth University; Estados UnidosFil: Rasband, Matthew N.. Baylor College of Medicine; Estados Unido

Understanding the pathways from biodiversity to agro-ecological outcomes : a new, interactive approach

The adoption of agro-ecological practices in agricultural systems worldwide can contribute to increased food production without compromising future food security, especially under the current biodiversity loss and climate change scenarios. Despite the increase in publications on agro-ecological research and practices during the last 35 years, a weak link between that knowledge and changed farmer practices has led to few examples of agro-ecological protocols and effective delivery systems to agriculturalists. In an attempt to reduce this gap, we synthesised the main concepts related to biodiversity and its functions by creating a web-based interactive spiral (www.biodiversityfunction.com). This tool explains and describes a pathway for achieving agro-ecological outcomes, starting from the basic principle of biodiversity and its functions to enhanced biodiversity on farms. Within this pathway, 11 key steps are identified and sequentially presented on a web platform through which key players (farmers, farmer networks, policy makers, scientists and other stakeholders) can navigate and learn. Because in many areas of the world the necessary knowledge needed for achieving the adoption of particular agro-ecological techniques is not available, the spiral approach can provide the necessary conceptual steps needed for obtaining and understanding such knowledge by navigating through the interactive pathway. This novel approach aims to improve our understanding of the sequence from the concept of biodiversity to harnessing its power to improve prospects for ‘sustainable intensification’ of agricultural systems worldwide. © 2020 The Authors. **Please note that there are multiple authors for this article therefore only the name of the first 5 including Federation University Australia affiliate “Harpinder Sandhu” is provided in this record*

Sistema tributario municipal: un análisis de su obsolescencia sobre la recaudación tributaria en los gobiernos locales; caso de la municipalidad distrital de Cayma, provincia y departamento de Arequipa, 2015 – 2018

El análisis de la obsolescencia del sistema tributario municipal de los gobiernos locales, es el principal objetivo de nuestra investigación, habiendo estudiado el caso de la Municipalidad Distrital de Cayma, dentro del período 2015 – 2018. Los gobiernos locales en la actualidad tienen serias deficiencias y limitaciones en cuanto al fortalecimiento institucional, siendo instituciones débiles que dependen de normas nacionales y como resultado, para nuestro caso, tienen una recaudación del impuesto predial no importante, no solo desde una óptica de la cantidad de ingresos, sino también desde la motivación y previsión sostenible de sus recursos económicos necesarios para solventar los servicios públicos, mantenimientos e infraestructura básica local; respecto a ello, los gobiernos locales subsisten de las transferencias del gobierno central, que este concentra por los conceptos de canon minero y regalías mineras. Para esto, adicionalmente de la revisión bibliográfica plasmada y analizada dentro del marco teórico y estado de la cuestión, hemos podido desarrollar conceptos básicos y necesarios para poder contextualizar, entender y distinguir los niveles de gobierno; dentro de ellos, sus responsabilidades en lo que refiere a la recaudación tributaria, poniendo en evidencia las limitaciones que no les permite, en autonomía, resolver sus problemas económicos dentro del ámbito local. Hemos realizado entrevistas a los principales funcionarios de la municipalidad materia de estudio, como también hemos trabajado y revisado la estadística comparada y descriptiva de las instituciones, como la del Ministerio de Economía y Finanzas, logrando observar los distintos escenarios que la Municipalidad Distrital de Cayma tiene, pudiendo notar un peligro financiero, en su responsabilidad de absolver sus gastos e inversión pública básica local. El resultado final es que hemos puesto en evidencia cualitativa y cuantitativa, mediante una estadística descriptiva, la obsolescencia del actual sistema tributario municipal, que tiene dentro de su manejo el impuesto predial; todo esto, mediante un soporte de información y fuentes oficiales como la del Ministerio de Economía y Finanzas, como a su vez la información propia de la Municipalidad Distrital de Cayma. Es necesario que las instituciones responsables, como conclusión, puedan realizar una reevaluación y actualización del sistema tributario municipal, permitiendo a los gobiernos locales puedan sustentar económicamente sus propias necesidades básicas locales, sin depender coyunturalmente y necesariamente de ingresos transferidos por parte del gobierno central.Tesi

Cosmological expansion governed by a scalar field from a 5D vacuum

We consider a single field governed expansion of the universe from a five dimensional (5D) vacuum state. Under an appropiate change of variables the universe can be viewed in a effective manner as expanding in 4D with an effective equation of state which describes different epochs of its evolution. In the example here worked the universe fistly describes an inflationary phase, followed by a decelerated expansion. Thereafter, the universe is accelerated and describes a quintessential expansion to finally, in the future, be vacuum dominated.Comment: version accepted in Phys. Lett.

Budget impact analysis of robotic exoskeleton use for locomotor training following spinal cord injury in four SCI Model Systems

Background We know little about the budget impact of integrating robotic exoskeleton over-ground training into therapy services for locomotor training. The purpose of this study was to estimate the budget impact of adding robotic exoskeleton over-ground training to existing locomotor training strategies in the rehabilitation of people with spinal cord injury. Methods A Budget Impact Analysis (BIA) was conducted using data provided by four Spinal Cord Injury (SCI) Model Systems rehabilitation hospitals. Hospitals provided estimates of therapy utilization and costs about people with spinal cord injury who participated in locomotor training in the calendar year 2017. Interventions were standard of care walking training including body-weight supported treadmill training, overground training, stationary robotic systems (i.e., treadmill-based robotic gait orthoses), and overground robotic exoskeleton training. The main outcome measures included device costs, training costs for personnel to use the device, human capital costs of locomotor training, device demand, and the number of training sessions per person with SCI. Results Robotic exoskeletons for over-ground training decreased hospital costs associated with delivering locomotor training in the base case analysis. This analysis assumed no difference in intervention effectiveness across locomotor training strategies. Providing robotic exoskeleton overground training for 10% of locomotor training sessions over the course of the year (range 226–397 sessions) results in decreased annual locomotor training costs (i.e., net savings) between $1114 to$4784 per annum. The base case shows small savings that are sensitive to parameters of the BIA model which were tested in one-way sensitivity analyses, scenarios analyses, and probability sensitivity analyses. The base case scenario was more sensitive to clinical utilization parameters (e.g., how often devices sit idle and the substitution of high cost training) than device-specific parameters (e.g., robotic exoskeleton device cost or device life). Probabilistic sensitivity analysis simultaneously considered human capital cost, device cost, and locomotor device substitution. With probabilistic sensitivity analysis, the introduction of a robotic exoskeleton only remained cost saving for one facility. Conclusions Providing robotic exoskeleton for over-ground training was associated with lower costs for the locomotor training of people with SCI in the base case analyses. The analysis was sensitive to parameter assumptions