Comprometimentos sexuais em homens com lesão medular: revisão sistemática

Introduction: Spinal cord injury poses multiple challenges to the subject and his / her relatives. Sensory-motor damage, autonomic and / or sphincteric dysfunction are some of the consequences, caused by spinal cord injuries, negatively affecting the quality of life. Objective: to know and describe the main sexual dysfunctions in patients with marrow sequelae; to explain new horizons from the physiotherapeutic point of view and the main methods of physiotherapeutic treatments available for this population. Methods: This is a systematic review of the literature that searched for articles in the Lilacs, PEDro, PuBmed and SciELO databases using the terms spinal cord injury, sexual dysfunction, physiotherapy, rehabilitation. Observational articles and clinical trials published between 2001 and 2017, in the languages of Portuguese, English and Spanish, which addressed sexual dysfunction in men who had some type of spinal cord injury were included. Articles that addressed the female audience, articles that associated physical therapy with another type of treatment and abstracts were excluded. Results: 11 studies were found that addressed sexual impairments in spinal cord injured persons. The reported dysfunctions were erectile dysfunction, followed by premature ejaculation or absence of ejaculation, with the aim of reducing sexual desire. Conclusion: Erectile dysfunction, specifically neurogenic, was the most common sexual dysfunction, followed by premature ejaculation or absence of ejaculation, with the aim of reducing sexual desire.Introdução: A lesão medular espinal impõe múltiplos desafios ao sujeito e seus familiares. Danos sensório-motores, disfunção autonômica e/ou esfincteriana são algumas das consequências, causadas por lesões da medula espinhal, impactando negativamente na qualidade de vida. Objetivo: conhecer e descrever as principais disfunções sexuais em pacientes com sequelas medulares; explanar novos horizontes do ponto de vista fisioterapêutico e os principais métodos de tratamentos fisioterapêuticos disponíveis para esta população. Métodos: Trata-se de uma revisão sistemática da literatura que buscou por artigos nas bases de dados do Lilacs, PEDro, PuBmed e SciELO utilizando os termos lesão medular, disfunção sexual, fisioterapia, reabilitação. Foram incluídos artigos observacionais e ensaios clínicos publicados entre 2001 e 2017, nos idiomas de português, inglês e espanhol, que abordassem a disfunção sexual em homens que tiveram algum tipo de lesão medular. Foram excluídos artigos que abordassem o público feminino, artigos que associassem fisioterapia com outro tipo de tratamento e abstracts Resultados: foram encontrados 11 estudos que abordaram os comprometimentos sexuais em lesados medulares. A disfunções relatadas foram a disfunção erétil, seguidas da ejaculação precoce ou ausência da ejaculação, tendo por fim a redução do desejo sexual. Conclusão: A disfunção erétil, especificamente a neurogênica, foi a disfunção sexual mais encontrada, seguidas da ejaculação precoce ou ausência da ejaculação, tendo por fim a redução do desejo sexual

Toxigenic Clostridium difficile colonization among hospitalised adults; risk factors and impact on survival

Objectives: To establish risk factors for Clostridium difficile colonization among hospitalized patients in England. Methods: Patients admitted to elderly medicine wards at three acute hospitals in England were recruited to a prospective observational study. Participants were asked to provide a stool sample as soon as possible after enrolment and then weekly during their hospital stay. Samples were cultured for C. difficile before ribotyping and toxin detection by PCR. A multivariable logistic regression model of risk factors for C. difficile colonization was fitted from univariable risk factors significant at the p < 0.05 level. Results: 410/727 participants submitted ≥1 stool sample and 40 (9.8%) carried toxigenic C. difficile in the first sample taken. Ribotype 106 was identified three times and seven other ribotypes twice. No ribotype 027 strains were identified. Independent predictors of colonization were previous C. difficile infection (OR 4.53 (95% C.I. 1.33–15.48) and malnutrition (MUST score ≥2) (OR 3.29 (95% C.I. 1.47–7.35)). Although C. difficile colonised patients experienced higher 90-day mortality, colonization was not an independent risk for death. Conclusions: In a non-epidemic setting patients who have previously had CDI and have a MUST score of ≥2 are at increased risk of C. difficile colonization and could be targeted for active surveillance to prevent C. difficile transmission

Early sympathy and social acceptance predict the development of sharing in children.

Sharing is a fascinating activity of the human species and an important basis for the development of fairness, care, and cooperation in human social interaction. Economic research has proposed that sharing, or the willingness to sacrifice own resources for others, has its roots in social emotions such as sympathy. However, only few cross-sectional experiments have investigated children's other-regarding preferences, and the question how social-emotional skills influence the willingness to share valuable resources has not been tested. In the present longitudinal-experimental study, a sample of 175 6-year-old children, their primary caregivers, and their teachers is examined over a 3-year period of time. Data are analyzed by means of growth curve modeling. The findings show that sharing valuable resources strongly increases in children from 6 to 9 years of age. Increases in sharing behavior are associated with the early-developing ability to sympathize with anonymous others. Sharing at 7 years of age is predicted by feelings of social acceptance at 6 years of age. These findings hold after controlling for children's IQ and SES. Girls share more equally than boys at 6 and 7 years of age, however, this gender difference disappears at the age of 9 years. These results indicate that human sharing strongly increases in middle childhood and, that this increase is associated with sympathy towards anonymous others and with feelings of social acceptance. Additionally, sharing develops earlier in girls than in boys. This developmental perspective contributes to new evidence on change in sharing and its social-emotional roots. A better understanding of the factors underlying differences in the development of sharing and pro-social orientations should also provide insights into the development of atypical, anti-social orientations which exhibit social-emotional differences such as aggression and bullying behavior

Two GCC boxes and AP2/ERF-domain transcription factor ORA59 in jasmonate/ethylene-mediated activation of the PDF1.2 promoter in Arabidopsis

Plant defense against microbial pathogens depends on the action of several endogenously produced hormones, including jasmonic acid (JA) and ethylene (ET). In defense against necrotrophic pathogens, the JA and ET signaling pathways synergize to activate a specific set of defense genes including PLANT DEFENSIN1.2 (PDF1.2). The APETALA2/Ethylene Response Factor (AP2/ERF)-domain transcription factor ORA59 acts as the integrator of the JA and ET signaling pathways and is the key regulator of JA- and ET-responsive PDF1.2 expression. The present study was aimed at the identification of elements in the PDF1.2 promoter conferring the synergistic response to JA/ET and interacting with ORA59. We show that the PDF1.2 promoter was activated synergistically by JA and the ET-releasing agent ethephon due to the activity of two GCC boxes. ORA59 bound in vitro to these GCC boxes and trans-activated the PDF1.2 promoter in transient assays via these two boxes. Using the chromatin immunoprecipitation technique we were able to show that ORA59 bound the PDF1.2 promoter in vivo. Finally, we show that a tetramer of a single GCC box conferred JA/ethephon-responsive expression, demonstrating that the JA and ET signaling pathways converge to a single type of GCC box. Therefore ORA59 and two functionally equivalent GCC box binding sites form the module that enables the PDF1.2 gene to respond synergistically to simultaneous activation of the JA and ET signaling pathways

Large scale multifactorial likelihood quantitative analysis of BRCA1 and BRCA2 variants: An ENIGMA resource to support clinical variant classification

The multifactorial likelihood analysis method has demonstrated utility for quantitative assessment of variant pathogenicity for multiple cancer syndrome genes. Independent data types currently incorporated in the model for assessing BRCA1 and BRCA2 variants include clinically calibrated prior probability of pathogenicity based on variant location and bioinformatic prediction of variant effect, co-segregation, family cancer history profile, co-occurrence with a pathogenic variant in the same gene, breast tumor pathology, and case-control information. Research and clinical data for multifactorial likelihood analysis were collated for 1,395 BRCA1/2 predominantly intronic and missense variants, enabling classification based on posterior probability of pathogenicity for 734 variants: 447 variants were classified as (likely) benign, and 94 as (likely) pathogenic; and 248 classifications were new or considerably altered relative to ClinVar submissions. Classifications were compared with information not yet included in the likelihood model, and evidence strengths aligned to those recommended for ACMG/AMP classification codes. Altered mRNA splicing or function relative to known nonpathogenic variant controls were moderately to strongly predictive of variant pathogenicity. Variant absence in population datasets provided supporting evidence for variant pathogenicity. These findings have direct relevance for BRCA1 and BRCA2 variant evaluation, and justify the need for gene-specific calibration of evidence types used for variant classification

Large scale multifactorial likelihood quantitative analysis of BRCA1 and BRCA2 variants: An ENIGMA resource to support clinical variant classification

Abstract The multifactorial likelihood analysis method has demonstrated utility for quantitative assessment of variant pathogenicity for multiple cancer syndrome genes. Independent data types currently incorporated in the model for assessing BRCA1 and BRCA2 variants include clinically calibrated prior probability of pathogenicity based on variant location and bioinformatic prediction of variant effect, co-segregation, family cancer history profile, co-occurrence with a pathogenic variant in the same gene, breast tumor pathology, and case-control information. Research and clinical data for multifactorial likelihood analysis were collated for 1395 BRCA1/2 predominantly intronic and missense variants, enabling classification based on posterior probability of pathogenicity for 734 variants: 447 variants were classified as (likely) benign, and 94 as (likely) pathogenic; 248 classifications were new or considerably altered relative to ClinVar submissions. Classifications were compared to information not yet included in the likelihood model, and evidence strengths aligned to those recommended for ACMG/AMP classification codes. Altered mRNA splicing or function relative to known non-pathogenic variant controls were moderately to strongly predictive of variant pathogenicity. Variant absence in population datasets provided supporting evidence for variant pathogenicity. These findings have direct relevance for BRCA1 and BRCA2 variant evaluation, and justify the need for gene-specific calibration of evidence types used for variant classification. This article is protected by copyright. All rights reserved.Peer reviewe

DYNAST AND DEFENDER: FERDINAND I OF AUSTRIA, 1522-1532

Abstract not availabl