Is “Unconsummated Marriage” still an appropriate term? A snapshot of reality

The most shared definition of Unconsummated Marriage (UM) refers to “the failure to perform successful sexual intercourse at the beginning of the marriage. UM usually occurs in the first few nights of marriage and so it is frequently referred to as “honeymoon impotence” or “wedding night impotence”. In the Middle-Eastern (MES) and Western (WS) societies, sexuality follows different patterns in terms of meaning and rules. Moreover the evolution of societies all around the world created new contexts and kinds of relationship. This could hamper a correct taxonomy of such sexual dysfunction where a social variable seems crucial. Aim: To analyze and review data on UM all around the world, to understand if in different societies it refers to the same situation. Method: A review of published literature on UM from 1970 to date, was conducted. Results: Substantial difference emerged from MES to WS. In MES, sexuality is allowable only in marriage, while in WS sexuality and relationship are not strongly linked. This could suggest that the term “marriage” is unable to cover the phenomenon in such different countries. Moreover, the average time before the consultation, causal attribution and prevalence are very different in Western and Middle Eastern countries. Conclusion: We found that the term “first attempts dysfunction” could be better used to describe male, female or both difficulties related to ignorance about sexuality or state/performance anxiety. On the other hand over the individual category of sexual dysfunctions, we suggest a new term as “Unconsummated relationship”, where individual difficulties toward sexuality are involved creating a couple’s dysfunction. Keywords: Unconsummated marriage; Honeymoon impotence; White marriage; Vaginismus; Infertilit

An epistatic mini-circuitry between the transcription factors Snail and HNF4a controls liver stem cell and hepatocyte features exhorting opposite regulation on stemness-inhibiting microRNAs

Preservation of the epithelial state involves the stable repression of EMT program while maintenance of the stem compartment requires the inhibition of differentiation processes. A simple and direct molecular mini-circuitry between master elements of these biological processes, may provide the best device to keep balanced such complex phenomena. In this work, we show that in hepatic stem cell Snail, a transcriptional repressor of the hepatocyte differentiation master gene HNF4, directly represses the expression of the epithelial microRNAs-200c and -34a, which in turn target several stem cell genes. Notably, in differentiated hepatocytes HNF4, previously identified as a transcriptional repressor of Snail, induces the microRNAs-34a and -200a, b, c that, when silenced, causes epithelial dedifferentiation and reacquisition of stem traits. Altogether these data unveiled Snail, HNF4 and microRNAs -200a, b, c and -34a as epistatic elements controlling hepatic stem cell maintenance/differentiation

Liver Disease and Hemostatic (Dys)function

Cirrhosis presents with decreased procoagulant factors as a consequence of the impaired synthetic capacity of the liver. This was taken as evidence to explain the abnormalities of the coagulation tests prothrombin time (PT) and activated partial thromboplastin time (aPTT) and the bleeding events that occur in these patients. It was for long time (and probably is still) common practice to test patients with the PT and to treat those with predefined (but arbitrary) cutoff values with plasma or prohemostatic agents to prevent or stop bleeding. However, anticoagulant factors that contrast the procoagulants are also decreased in cirrhosis. It was therefore postulated that the coagulation balance (i.e., the net result between the action of pro- and anticoagulants) is somewhat rebalanced. Subsequent studies supported this view showing that plasma from cirrhotic patients generates normal amounts of thrombin. In addition, primary hemostasis (i.e., platelet-vessel wall interaction) is rebalanced notwithstanding cirrhosis present with thrombocytopenia. It was shown that increased levels of the adhesive protein von Willebrand factor (a typical feature of cirrhosis) compensate for the low number (function) of platelets. The earlier considerations have been instrumental to help dismantle the old paradigms of cirrhosis as the epitome of the acquired hemorrhagic coagulopathies and the traditional coagulation tests PT and aPTT as suitable predictors of bleeding risk. The demise of the old paradigms and the rise of the new one may have important practical implications for the management of patients with cirrhosis and will be discussed in this chapter

Hemostasis in acute and chronic liver disease

Acute and chronic liver diseases have long been considered prototypes of acquired hemorrhagic diseases. Over the last decade, evidence stemming from the laboratory bench and clinical practice has indicated that hemostasis abnormalities, until recently considered as the cause of bleeding in these conditions, are rebalanced to normal despite the abnormal results of the hemostasis tests such as prothrombin time and platelet counts. Consequently, the commonly used therapeutic approach the infusion of plasma, platelets, or other prohemostatic agents are not biologically plausible and should be reconsidered. In this article, the author reviews the evidence supporting the changing paradigm

Null-Flux Coils in Permanent Magnets Bearings

In this paper, the stability analysis of a new permanent magnets (PMs) bearings is presented and discussed. The suspension is assured by the repulsive force of properly shaped PMs placed on both the stator and the rotor. Then, exploiting currents induced on a system of null-flux coils attached to the stator, a stabilizing force for the translation of the center of mass of the rotor is obtained. The performance of the proposed bearing is investigated by a research code, previously developed at DESTEC and capable to simulate six degrees of freedom electromechanical devices

Bio-ethylene Production: from Reaction Kinetics to Plant Scale

Ethylene production from renewable bio-ethanol has been recently proposed as sustainable alternative to fossil sources. The possibility to exploit diluted bioethanol as less expensive feedstock was studied both experimentally, using different catalysts at lab-level, and through preliminary process design. In this work, a full-scale plant simulation is presented, built on a detailed reaction kinetics. Rate equations for the primary and side reactions are revised and implemented with a process simulation package, using a range of thermodynamic methods as best suited to the different process stages. The catalyst loading within the reactor can be effectively distributed according to the underlying kinetic, and the overall plant layout let foresee the best routes for the material recycles. The detailed reaction modeling and the choice of the thermodynamic models are essential to obtain reliable predictions. Setting a target yield of 105 t/year of polymer-grade ethylene, the reactive section must be fed with 76 t/h of diluted ethanol and operated at 400 \ub0C. 85% of the fed carbon mass is found as ethylene, 12% remains as ethanol and a 2% as longer olefins. Considering also the recycle of ethanol the carbon conversion and recovery increases to the value of 97.6%. The global ethylene recovery is 90.7%: most of the loss takes place in the last stage due to the non-condensable purification and to the adopted strategy of having low reflux ratio \u2013 and then a closed cryogenic balance \u2013 in the last purification column. Full heat integration of the process with upstream bioethanol production and purification sections allows process intensification and consistent energy savings. This newly designed process sets the sustainable ethylene production on a detailed and reassessed computational basis and has been assessed as for Capital and Operational Expenditures and Total Investment costs

Role of Insulin-Like Growth Factor Receptor 2 across Muscle Homeostasis: Implications for Treating Muscular Dystrophy

The insulin-like growth factor 2 receptor (IGF2R) plays a major role in binding and regulating the circulating and tissue levels of the mitogenic peptide insulin-like growth factor 2 (IGF2). IGF2/IGF2R interaction influences cell growth, survival, and migration in normal tissue development, and the deregulation of IGF2R expression has been associated with growth-related disease and cancer. IGF2R overexpression has been implicated in heart and muscle disease progression. Recent research findings suggest novel approaches to target IGF2R action. This review highlights recent advances in the understanding of the IGF2R structure and pathways related to muscle homeostasis

Different cut-off values of quantitative D-dimer methods to predict the risk of venous thromboembolism recurrence : a post-hoc analysis of the PROLONG study

Background: The PROLONG study showed that patients with venous thromboembolism who had qualitatively abnormal results in a D-dimer assay (Clearview Simplify D-dimer) after discontinuation of vitamin K antagonism benefit from resumption of treatment with vitamin K antagonism. The objective of this study was to evaluate the possible advantage of using quantitative D-dimer assays. Design and Methods: VIDAS D-dimer Exclusion (bioMerieux), Innovance D-DIMER (Dade Behring), HemosIL D-dimer HS (Instrumentation Laboratory) and STA Liatest D-dimer (Diagnostica Stago) assays were performed in plasma aliquots sampled 30\ub110 days after cessation of vitamin K antagonism in 321 patients enrolled in the PROLONG study. Results: During the follow-up without vitamin K antagonism, 25 patients had recurrent venous thromboembolism. The cut-off levels of the quantitative assays giving results most comparable with those of the qualitative test were: VIDAS = 800 ng/mL; Innovance = 800 ng/mL; HemosIL HS = 300 ng/mL; STA Liatest = 700 ng/mL. When the effect of the patients' age ( 6470 vs. >70 years) was analyzed, it was found that only in younger patients was the rate of recurrence of venous thromboembolism significantly higher in patients with abnormal D-dimer levels. However, using the quantitative assays and age-specific cut-off levels it was possible to determine statistically significant hazard ratios also in elderly patients (VIDAS = 600 and 1200 ng/mL, Innovance = 500 and 900 ng/mL, HemosIL HS = 250 and 450 ng/mL, STA Liatest = 700 and 1000 ng/mL, in patients aged 6470 and >70 years, respectively). Conclusions: Quantitative D-dimer assays may provide information useful for evaluating the individual risk of recurrent venous thromboembolism. They seem particularly advantageous since they allow the selection of different cut-off levels according to the age or other characteristics of the patients