Sexual dysfunction following traumatic pelvic fracture

BACKGROUND

While sexual dysfunction (SD) in men following traumatic pelvic fracture is common, little is known of how men experience changes in their sexual health after injury. The aims of the present study were to explore the personal and interpersonal impacts of SD in men after pelvic injury and to understood how interactions with the health care system can be optimized to improve patient-centered trauma survivorship care.

METHODS

Fifteen semistructured interviews were conducted with men who had a history of traumatic pelvic fracture and self-reported SD. Interviews were audio recorded, transcribed, and uploaded to a web-based qualitative analysis platform. A codebook was developed, and intercoder reliability was verified. Inductive thematic analysis was performed to identify notable themes related to patient postinjury sexual health experiences.

RESULTS

Median age of interviewees was 46 years (interquartile range, 44-54 years), with a median time since injury of 41 months (interquartile range, 22-55 months). Five primary themes were identified from the analysis: (1) effects on self-image and romantic relationships, (2) unknown care pathways and lack of communication, (3) inconsistencies with health care provider priorities, (4) provision of sexual health information and resources, and (5) the importance of setting expectations. Interviewees suggested that improved communication, provision of information related to possible adverse effects of their injuries, and expectation setting would improve posttrauma experiences.

CONCLUSION

Men's experiences with SD after pelvic trauma can be heavily influenced by their interactions with health care providers and the value that is placed on sexual health as a component of survivorship. Incorporating these findings into a patient-centered trauma survivorship program may improve patient experiences.

LEVEL OF EVIDENCE

Therapeutic, level V.

A role for TENM1 mutations in congenital general anosmia

Congenital general anosmia (CGA) is a neurological disorder entailing a complete innate inability to sense odors. While the mechanisms underlying vertebrate olfaction have been studied in detail, there are still gaps in our understanding of the molecular genetic basis of innate olfactory disorders. Applying whole-exome sequencing to a family multiply affected with CGA, we identified three members with a rare X-linked missense mutation in the TENM1 (teneurin 1) gene (ENST00000422452:c.C4829T). In Drosophila melanogaster, TENM1 functions in synaptic-partner-matching between axons of olfactory sensory neurons and target projection neurons and is involved in synapse organization in the olfactory system. We used CRISPR-Cas9 system to generate a Tenm1 disrupted mouse model. Tenm1(-/-) and point-mutated Tenm1(A) (/A) adult mice were shown to have an altered ability to locate a buried food pellet. Tenm1(A) (/A) mice also displayed an altered ability to sense aversive odors. Results of our study, that describes a new Tenm1 mouse, agree with the hypothesis that TENM1 has a role in olfaction. However, additional studies should be done in larger CGA cohorts, to provide statistical evidence that loss-of-function mutations in TENM1 can solely cause the disease in our and other CGA cases.

Connexin 26: required for normal auditory function

A single base deletion mutation, 35delG, in the gene (GJB2/DFNB1)(OMIM 121011/220290) encoding the gap junction protein, connexin 26 is the most important single cause of genetic hearing loss in European and American populations. It is the cause of one of the most common human genetic disorders with a frequency similar to cystic fibrosis. Mutations in this connexin are associated with skin disorders.

Parental hopes for therapy outcomes: children with sensory modulation disorders

OBJECTIVE

Understanding parents' hopes for therapy outcomes is essential to family-centered care. This qualitative study explored parents' points of view regarding their hopes for the outcomes of occupational therapy using a sensory integration treatment approach.

METHOD

Data were collected as part of a larger research project on the effectiveness of rehabilitating children who have sensory modulation disorders. Five interviews were randomly selected from 17 parent interviews conducted in the larger study. Data were analyzed using grounded theory methods.

FINDINGS

Three themes pertinent to the occupations of children and two themes related to the occupations of parenting and sustaining family life emerged. Child-focused outcomes include social participation, self-regulation, and perceived competence. Parent-focused outcomes include learning strategies to support children and obtaining personal validation.

DISCUSSION

Interventions are proposed that relate to children's participation in contexts in which they live, learn, and play, as well as the support of parents in the occupations of parenting.

Tilling the soil: nurturing the seeds of patient and family education

Effective patient and family education has become most essential in today's changing health care environment. The importance of patient education is reflected in the organizational performance standards of the Joint Commission on Accreditation of Healthcare Organizations. To keep abreast of these rapid changes, we decided to evaluate and enhance our existing cardiac education program. This article presents our analysis that effective patient and family education must be a coordinated effort across the cardiac continuum. New teaching tools were established to assist in increasing the patients' knowledge base, and consequently empower patients to make better decisions regarding their care.

Fluctuating sensorineural hearing loss associated with enlarged vestibular aqueduct maps to 7q31, the region containing the Pendred gene

The most common form of inner ear abnormality, enlarged vestibular aqueduct (EVA), is of particular interest because it is associated with characteristic clinical findings, including fluctuating and sometimes progressive sensorineural hearing loss and disequilibrium symptoms. Although EVA has been reported to be inherited in a recessive manner, nothing else is known about the genetic basis of this hearing loss. Here we report on the localization of the gene responsible for sensorineural hearing loss associated with EVA to chromosomal region 7q31, with maximum multipoint LOD score of 3.647. The EVA candidate gene region lies in a 1.7-cM interval between the flanking markers D7S501 and D7S2425. Interestingly, this region overlaps the region containing the gene responsible for Pendred syndrome, called PDS, which was identified recently. However, the present subjects did not fulfill the criteria for Pendred syndrome. It is hypothesized that different mutations within the PDS gene may cause different phenotypes ranging from EVA to the Mondini deformity seen in Pendred syndrome.

A Collagenolytic Fungus, Cunninghamella elegans, for Biological Control of Plant-parasitic Nematodes

The root-galling index of tomatoes inoculated with Meloidogyne javanica was decreased 70% when collagen was used as a soil amendment (0.1% w/w) and 90% when the amendment was supplemented with the collagenolytic fungus Cunninghamella elegans. The root-galling index was reduced 80% when the fungus was homogenized in collagen culture medium and added to soil without collagen supplement. Culture filtrates of the fungus C. elegans, grown on collagen as a single source of carbon and nitrogen, immobilized M. javanica second-stage juveniles and inhibited egg hatch. Root galling was reduced when tomato plants were inoculated with filtrate-treated juveniles. Culture filtrates reduced the motility of Rotylenchulus reniformis and Xiphinema index, but they had less effect on Anguina tritici and almost no effect on Ditylenchus dipsaci. Cunninghamella elegans had collagenolytic, elastolytic, keratinolytic, and nonspecific proteolytic activities when grown on collagen media, but only chitinolytic activity when grown on chitin media.

[A case of sirenomelia]

The case of a 37-year-old woman, dressmaker, with congenital lower limb amelia is presented. The specific and complementary investigations revealed the absence of the left half of sacrum, coccyx, together with the left iliac bone, ischium and pubis. Urography demonstrated the absence of left kidney. Ultrasonography revealed the presence of the spleen. The data in the literature are reviewed and some comments are made.

Use of Chitin for Controlling Heterodera avenae and Tylenchulus semipenetrans

The nematicidal effect of chitin, relative to other pesticides, was evaluated against two plant-parasitic nematodes, Heterodera avenae and Tylenchulus semipenetrans. Wheat seedlings, grown in soils artificially or naturally infested with H. avenae, were treated with 0.4% (w/w) ClandoSan (CLA) prepared from crustacean chitin, aldicarb (Temik 15G), or ethylene dibromide (EDB 90EC). The CLA treatment significantly increased wheat straw, ear, and average grain dry weights of nematode-infected plants, compared with the other two treatments. In an experiment covering two consecutive seasons, all three treatments reduced the number of cysts in the soil by 60%. In a one-season experiment, CLA reduced the number of cysts by 51% and aldicarb or EDB reduced cyst number by about 40%. A reduction of 50-90% in T. semipenetrans population densities on roots of two citrus rootstocks was recorded following an application of 0.2% (w/w) CLA to the soil.

Observations on the Mode of Parasitism and Histopathology of Meloidodera floridensis and Verutus volvingentis (Heteroderidae)

Some aspects of the host-parasite relationships of two heteroderid nematodes are described. Meloidodera floridensis induced formation of single uninucleate giant cells in the stelar parenchyma tissue of sand pine (Pinus clausa) roots. Wrinkling and yellowing of the cuticle were associated with maturation of the adult female (cystoid stage). The mode of parasitism of different life stages of Verutus volvingentis on buttonweed (Diodia virginiana) is described. The nematode caused extensive necrosis during penetration and the formation of a large feeding site consisting of nonhypertrophied parenchyma cells with enlarged nuclei and thickened cell walls in the cortex. Walls between cells within the feeding site degenerated, resulting in the formation of a syncytium. Two citrus rootstocks, rough lemon (Citrus lirnon) and trifoliate orange (Poncirus trifoliata), were not hosts of V. volvingentis.

Parasitic Habits of Trophotylenchulus floridensis (Tylenchulidae) and its Taxonomic Relationship to Tylenchulus semipenetrans and Allied Species

Parasitism by Trophotylenchulus floridensis Raski, 1957 was studied on roots of sand pine (Pinus clausa [Chapm.] Vasey). Different life stages of the nematode were observed to be covered by dark, spherical, brittle, capsule-like structures which protruded from the root surface. The mature capsule enveloped a single sedentary female with a gelatinous matrix containing an average of 76 (44-117) eggs. The capsule was composed of a single layer of cells which appeared to be of plant origin. The anterior end of the nematode was embedded superficially in the root tissue where it created a feeding site comprised of a small number of discrete stelar parenchyma cells with dense cytoplasm and enlarged nuclei and nucleoli. The nematode also infected slash pine, Pinus elliottii, loblolly pine, P. taeda, red oak, Quercus falcata, post oak, Q. stellada, and sweet gum, Liquidambar styraciflua, in four different locations in central Florida. The taxonomic relationship between Tr. floridensis and Tylenchulus spp. is discussed. Based on differences in the tail and lip regions, position of the excretory pore, type of obesity and especially in the mode of plant parasitism, the genus Trophotylenchulus Raski, 1957 is upheld, and the transfer of Tylenchulus clavicaudatus Colbran, 1966, Ty. rnangenoti Luc, 1957, and Ty. obscurus Colbran, 1961 to Trophotylenchulus is proposed.

Influence of Potassium and Nitrogen Fertilization on Parasitism by the Root-knot Nematode Meloidogyne javanica

The influence of various c oncentrations of K, nitrogen sources, and inoculation with root-knot nematode Meloidogyne javanica were evaluated in tomato plants. Increased potassium concentration increased top and root fresh weights of intact plants and fresh weights of excised roots. Nitrate-fertilized plants weighed more than plants receiving ammonium independent of the K level in the medium. Nematode counts on roots were not affected by nutritional differences in intact or excised roots. In intact roots a high percentage of males was recorded at low K levels, whereas in excised roots the proportion of males in the population rose as the K levels increased. Inoculated intact roots accumulated K when the level of potassium supply was low; infected excised roots contained less K than did nematode-free roots.

Characterization of sialyl and galactosyl residues on the body wall of different plant parasitic nematodes

The plant parasitic nematodes Helicotylenchus multicinctus, Meloidogyne javanica, Tylenchulus semipenetrans, and Xiphinema index, differing in their host specificity and parasitic habits, were analyzed as to their cuticle surface sialyl, galaclosyl, and/or N-acetylgalactosaminyl residues. The procedure involved the selective oxidation of sialic acid and galactose/N-acetylgal-actosamine residues using periodate and galactose oxidase, respectively, to form reactive aldehyde groups. These functional groups were coupled directly with a new hydrazide-containing compound, the fluorescent reagent lissamine rhodamine-beta-alanine hydrazide, or they were utilized to introduce DPN-groups to the nematode cuticle. The distribution of the DNP-tagged glycoconjugates was visualized by treating the nematodes with rabbit anti-DNP antibody and staining with fluorescein isothiocyanate (FITC)-labeled goat antirabbit IgG. Sialo residues were observed along the entire outer body wall of the first three aforementioned nematodes, but there were some differences in reaction among the various life stages within the species. In X. index, sialo residues were sited in the tail and head areas, mainly on the lips, oral opening, amphid apertures and stylet. Galactose oxidase treatments revealed galactose on N-acytylgalactosamine residues on T. sentipenetrans and X. index, but there were no indications that their presence was dependent on the developmental stage. Trypsin, pronase, and neuraminidase pretreatment completely abolished the fluorescence in T. semipenetrans but did not alter the sialo residue binding reaction in H. multicinctus or M. javanica, indicating possible differences in the outer body wall saccharide structure and composition between these nematodes. The existence and nature of sugar residues on the cuticle surface of nematodes could contribute to an understanding of the specific recognition by phytophagous nematodes of their host, and perhaps also of the virus transmission mechanism in those nematodes which serve as vectors.

[Effectiveness of repeated antibiotic or chemotherapeutic treatments on Shigella carrier states]

A group of 39 former dysentery patients, who continued to excrete Shigella bacteria after a first cure of antibiotics when full clinical recovery was obtained, were treated differentially under bacteriological control. The carrier state was still extent in 7% of the cases after three antibiotic or chemotherapeutical cures. No direct relation was found between the sensitivity of Shigella to chemotherapeutics and the level of the carrier state. Although treated already in the acute stage with adequate antibiotics, resistance to a second therapeutical attempt was recorded in a proportion of 33%. It is considered useless to repeat the antibiotic or chemotherapeutical cures in the treatment of convalescent carriers because of the low efficiency and the biological and economical disadvantages.

A contribution to the taxonomy of the genus xiphinema cobb, 1913

In a comparative study of different populations of Xiphinema, the significance of the female gonad structure in species determination is stressed, and monodelphic, pseudomonodelphic, and didelphic forms in the genus are defined. X. chambersi is redescribed and illustrated, X. ensiculiferum and X. krugi are redefined, and X. ensiculiferoides n.sp. and X. orthotenum n.sp. are described. Proposed new synonymies are: X. itanhaense = X. brasiliense; X. bulgariensis and X. conurum = X. italiae; X. ifacolum = X. basiri; X. macrostylum = X. ensiculiferum; X. truncatum = X. elongatum; and X. vulgare = X. setariae. X. yapoense is considered species inquirenda and X. obtusum a nomen dubium. The following eight subgenera of the genus Xiphinema are proposed: Radiphinema n. subg., Krugiphinema n. subg., Xiphinema n. subg., Elongiphinema n. subg., Halliphinema n. subg., Basiphinema n. subg., Rotundiphinema n. subg., and Diversiphinema n. subg. A key to the subgenera of Xiphinema is presented, plus a list of 50 species in the genus, their synonyms, and 10 species inquirendae.

Biochemical Changes in Terminal Root Galls Caused by an Ectoparasitic Nematode, Longidorus africanus: Amino Acids

The amino acids of terminal root galls caused by Longidorus africanus on bur marigold (Bidens tripartita L.) and grapevine (Vitis vinifera L.) were studied. The galled roots of bur marigold contained 73% more cell-wall protein and 184% more free amino acids. The main changes among the free amino acids of the galled tissue were a large increase (1900%) in proline and a decrease in aspartic acid (56%) compared with the respective check tissue. Hydroxyproline decreased in the wall protein fraction from 5.6% in the healthy tissue to 3.6% in the infected tissue.Percent of hydroxyproline in total amino acids of the wall protein fraction of grapevine roots decreased from 0.7% in the healthy tissue to 0.3% in the galled tissue, and total proteins of this fraction decreased from 9.5 mg to 4.5 rag, respectively. Total protein in the protoplasmic fraction also decreased from 3.0 mg in healthy to 1.0 mg in infected roots. No change was noticed in total proteins in the free amino acids fraction but free proline decreased 40% in the infected roots.The relationship of these differences to the specific reactions of the hosts to nematode feeding is discussed.

Observations on the feeding and symptomatology of xiphinema and longidorus on selected host roots

In vitro feeding of Xiphinema brevicolle, X. index and Longidorus africanus on roots of host seedlings is described. Both Xiphinema spp. fed mainly along roots rather than at tips and up to several days at a single site. Feeding of L. africanus was confined to root tips and lasted up to 15 min. No visible short term reaction of roots parasitized by the Xiphinema spp. could be discerned, but both swelling and cessation of growth of root tips were observed within 20 hr after feeding by L. africanus. Long-term (12-month) symptoms on roots of several host plants caused by cultured populations of X. brevicolle, X. index, X. italiae, L. africanus and L. brevicaudatus are described. All the Xiphinema spp. caused a thinning and distinct darkening of root systems and, at some sites, a breakdown of the cortex. Both species of Longidorus caused stubby and swollen root tips. Root symptom severity was in proportion to nematode population levels.