PERAN PETUGAS KOLEKTOR DESA DALAM MENINGKATKAN KEPATUHAN WAJIB PAJAK DALAM MEMBAYAR PAJAK BUMI DAN BANGUNAN (PBB-P2) DI KABUPATEN SUBANG

This research is motivated by the level of taxpayer compliance in paying Land and Building Tax, the lack of coordination between village collector officers and the Regional Revenue Agency, and the low performance in collecting Land and Building Taxes. The method in this study uses qualitative research. Primary data sources are 10 people. Data collection techniques in this study using interviews, observation and documentation. The data analysis technique uses data reduction, data presentation and drawing conclusions or verification. Test the validity of the data in this study using prolonged observation of increased persistence and triangulation. The results obtained in this study, the role of village collector officers in improving taxpayer compliance in paying PBB taxes in Subang District, Jalancagak District and Subang District has been implemented but not maximized. Not maximized based on the obstacles that occur, both internal and external obstacles. Internal obstacles include the lack of awareness of taxpayers in paying land and building taxes, lack of understanding of land and building taxes, lack of understanding of the main duties and functions of village collector officers and the economic condition of taxpayers. Meanwhile, external constraints include, where the tax subject is not known to the officer, the contents of the data are not in accordance with the tax object owned, multiple tax returns (SPPT) and regional expansion. The strategic efforts carried out are by providing counseling or socialization, increasing the level of land and building tax services and providing sanctions so that the achievement of the target of land and building tax revenue can be achieved.

Acute Exposure to European Viper Bite in Children: Advocating for a Pediatric Approach

Background: Viper bite is an uncommon but serious cause of envenoming in Europe, especially in children. Our study aim is to better describe and analyze the clinical course and treatment of viper bite envenoming in a pediatric population. Methods: We retrospectively reviewed 24 cases of pediatric viper bites that were admitted to the Pediatric Emergency Department and the Pediatric Intensive Care Unit of the Bambino Gesù Children Hospital in Rome between 2000 and 2020. Epidemiological characteristics of the children, localization of the bite, clinical and laboratory findings, and treatment approaches were evaluated. Results: The median age of the patients was 4.2 years, with male predominance. Most cases of viper bite occurred in the late summer. Most patients required admission to the ward for prolonged observation. The most common presenting signs were pain, local oedema, and swelling. Patients with a high severity score also had a significantly higher white blood cell count and an increase of INR, LDH, and CRP levels. No fatality was reported. Conclusions: Viper bite envenomation is a rare pediatric medical emergency in Italy but may sometimes be severe. A new pediatric severity score may be implemented in the screening of children with viper bites to favor a selective and prompt administration of antivenom.

Lung ultrasound assessment for pneumothorax following transbronchial lung cryobiopsy

BackgroundIatrogenic pneumothorax is a common and clinically important transbronchial cryobiopsy (TBCB) complication. A study was conducted to assess the diagnostic accuracy and clinical impact of immediate postprocedure lung ultrasound for diagnosing iatrogenic pneumothorax in patients suspected of interstitial lung disease (ILD) undergoing TBCB.Study design and methodsIn patients undergoing TBCB due to suspected ILD, LUS of the anterior surface of the chest was performed immediately after the TBCB procedure prior to extubation. Presence of lung point was used as a definite sign of pneumothorax. Chest X-ray (CXR) performed routinely 2 h after TBCB was used as reference standard.ResultsA total of 141 consecutive patients were included. Postprocedure LUS identified definite pneumothorax in 5 patients (3.6%)(95%CI: 1.5–8.3%). 2-hour CXR identified 19 patients (13.5%)(95%CI: 8.7–20.2%) with pneumothorax following TBCB. The diagnostic accuracy of LUS for diagnosing pneumothorax was: sensitivity 21.1% (95% CI: 6.1–45.6%), specificity 99.2% (95% CI: 95.5–100.0%), positive predictive value 80.0% (95%CI: 28.4–99.5%), and negative predictive value 89.0% (95%CI: 82.5–93.7%). Postprocedure LUS had a clinical impact in 5 patients (3.6%) (95%CI: 1.5–8.3), in which 4 had pleural drain inserted prior to extubation and 1 patient had prolonged observation prior to extubation.InterpretationLUS performed immediately following TBCB have a clinical impact by identifying patients with pneumothorax in need of immediate treatment prior to extubation, and to monitor pneumothorax size during in the operating room. Supplementary imaging prior to patient discharge is however still needed since the majority of pneumothoraxes develop later in the postprocedure period.

Short-term antibody response and tolerability after one dose of BNT162b2 vaccine in patients receiving hemodialysis: A report from the Quebec Renal Network COVID-19 study

ABSTRACTBackgroundPatients receiving in-center hemodialysis (HD) are at high risk of exposure to SARS-CoV-2 with high mortality, and response to vaccination is uncertain.MethodsWe obtained serial plasma from 58 HD patients and 32 health-care workers (HCW) before and after vaccination with one dose of the BNT162b2 mRNA vaccine; as well as convalescent plasma from 11 HD patients who survived COVID-19. Anti-RBD (region binding domain of the SARS-CoV-2 Spike protein) IgG and IgM levels were measured by ELISA. Groups were stratified by evidence of prior SARS-CoV-2 infection.ResultsIn HD patients without prior SARS-CoV-2, antiRBD levels were significantly lower at 4 and 8 weeks after vaccination, compared to in HCWs after 3 weeks (p<0.001), and to convalescent plasma (p=0.002). Anti-RBD IgG was non-detectable in 29/46 (63%) of HD, compared to 1/16 (6%) of HCWs (p<0.0001). No patient with non-detectable levels at 4 weeks developed antiRBD by 8 weeks. In HD patients with prior SARS-CoV-2, mean 8-week anti-RBD IgG levels were similar to controls at 3 weeks (p=0.16), and to convalescent plasma (p=0.45). No patients reported symptoms 7 days after vaccination on a standardized questionnaire.InterpretationWhile the BNT162b2 vaccine was well-tolerated in hemodialysis patients, a single dose failed to elicit a humoral immune response in the majority of SARS-CoV-2 naïve patients even after prolonged observation. In those with prior SARS-CoV-2 infection, the humoral response after vaccination was delayed. Whether HD patients develop T-cell responses requires further study. Until then, we advise the second dose be administered to all HD patients at the recommended 3-week time interval, and that rigorous SARS-CoV-2 infection prevention and control measures be continued in dialysis units until vaccine efficacy is proven.

About changes in temperature in case of progressive paralysis of the obsessed

Observations of temperature in patients with progressive paralysis began by me from the beginning of 1901. In the course of almost three years, only about 40 cases have been investigated, but for more or less a long time, continuously, systematically, daily in the morning and in the evening, it was possible to conduct research in 25 cases. Out of them, for the following presentation, I choose only those cases, in the number 24, which belong to the purest forms of progressive paralysis, so to speak with the classic course, avoiding various mixed forms. Diagnosis in each individual case was established after more or less prolonged observation in the hospital, under the direct guidance of the deeply respected Professor N.M. Popov.

CREEP OF A THICKWALLED QUASILINEAR VISCOELASTIC TUBE UNDER A CONSTANT EXTERNAL AND INTERNAL PRESSURE

We consider the creep problem for a quasilinear viscoelastic model of a thickwalled tube, loaded with constant internal and external pressure; the material is supposed to be incompressible. An exact solution to this problem was received by one of the authors in previous papers, assuming the state of a tube to be plain deformation; hereby we study properties of this solution for arbitrary material functions of quasilinear viscoelasticity constitutive relation. A criterion of stress stationarity is derived; the stress field of a thickwalled tube under a constant pressure evolves in time in the case of unbounded creep function and arbitrary nonlinearity function, except some particular types. The monotonicity of stress field components is studied: the radial stress monotonicity depends only on internal and external pressure values (for internal pressure, greater than an external one, it is negative and increases in radii). For other stress components, there are derived sufficient conditions of monotonicity. For an exponential nonlinearity function and unbounded creep function, a creep curve is determined to be concave up at the initial moment, and concave down during prolonged observation; the creep curve of a bipower nonlinearity function model may change its convexity. The stressstrain state of a model with a bounded creep function is proved to be bounded.

PERORAL ENDOSCOPIC MYOTOMY IN TREATMENT OF THE ESOPHAGEAL ACHALASIA AT CHILDREN

Etiological treatment of esophageal achalasia are absent. None of the currently available treatment methods can restore normal esophageal peristalsis and the functionality of the lower esophageal sphincter, thereby alleviating dysphagia and other symptoms of achalasia. Therapeutic procedures currently used for the effective treatment of achalasia of the esophagus are represented by laparoscopic Heller's myotomy and endoscopic balloon dilatation of the esophagus. According to the literature, Heller's myotomy is considered as a method of choice in children, since it provides more reliable results in comparison with pneumatic expansion during prolonged observation. Peroral endoscopic myotomy (POEM) is a new endoscopic method for the treatment of esophageal achalasia, first reported by P. Pasricha in experiment, and then H. Inoue performed this operation in adult patients. There are only a few studies on the use of POEM in children and adolescents. Existing studies have demonstrated the feasibility of this procedure in children, low level of complications and excellent results with short-term observation. Several studies have reported high efficacy in the use of POEM in children, ranging from 90% to 100%. Reports of the occurrence of complications after POEM in children are sporadic and are represented by the formation of subcutaneous emphysema, carboperitoneum, retroperitoneum and mediastinal emphysema. Obviously, detailed studies with longer observation are required before the role of POEM in the treatment of esophageal achalasia in children can be established. If preliminary results are confirmed, POEM can be a real alternative to Heller's myotomy in pediatric patients. This study is intended to explore the potential and safety of the use of POEM for the treatment of achalasia in children based on a review of existing data in the scientific literature.

Gangliocytic Paraganglioma of the Filum Terminale. A Rare Entity

Paragangliomas are rare, benign and slow-growing neuroendocrine tumors that can arise from the adrenal medulla (85–90%) or from the extra-adrenal paraganglia.In the central nervous system (CNS), they can be found at several sites, but more often at the cauda equina and filum terminale region, where they account for between 2.5 and 3.8% of total tumor cases of that region. There are only 8 cases described in the literature that mention the presence of the gangliocytic variant of this entity at the filum terminale.We present the case of a 41-year-old man with chronic lumbar pain refractory to medical treatment, without any associated neurological deficits. Magnetic resonance imaging (MRI) revealed an intradural, extramedullar oval lesion with regular contours and homogeneous caption of contrast at L1 level.He was submitted to surgical treatment, with complete resection of the lesion. The histological analysis revealed a gangliocytic paraganglioma of the filum terminale. At 5 years of follow-up, he remains asymptomatic and without any signs of relapse.These are lesions with an overall good prognosis with gross total resection. Although the recurrence rate is extremely low, prolonged observation is recommended due to the slow-growing nature of the tumor, being estimated that between 1 and 4% can recur even after gross total removal.

Zebrafish Oxr1a Knockout Reveals Its Role in Regulating Antioxidant Defenses and Aging

Oxidation resistance gene 1 (OXR1) is essential for protection against oxidative stress in mammals, but its functions in non-mammalian vertebrates, especially in fish, remain uncertain. Here, we created a homozygous oxr1a-knockout zebrafish via the CRISPR/Cas9 (Clustered Regularly Interspaced Short Palindromic Repeats/CRISPR associated protein 9) system. Compared with wild-type (WT) zebrafish, oxr1a−/− mutants exhibited higher mortality and more apoptotic cells under oxidative stress, and multiple antioxidant genes (i.e., gpx1b, gpx4a, gpx7 and sod3a) involved in detoxifying cellular reactive oxygen species were downregulated significantly. Based on these observations, we conducted a comparative transcriptome analysis of early oxidative stress response. The results show that oxr1a mutation caused more extensive changes in transcriptional networks compared to WT zebrafish, and several stress response and pro-inflammatory pathways in oxr1a−/− mutant zebrafish were strongly induced. More importantly, we only observed the activation of the p53 signaling and apoptosis pathway in oxr1a−/− mutant zebrafish, revealing an important role of oxr1a in regulating apoptosis via the p53 signaling pathway. Additionally, we found that oxr1a mutation displayed a shortened lifespan and premature ovarian failure in prolonged observation, which may be caused by the loss of oxr1a impaired antioxidant defenses, thereby increasing pro-apoptotic events. Altogether, our findings demonstrate that oxr1a is vital for antioxidant defenses and anti-aging in zebrafish.