RESUMEN
Defense mechanisms are mental functions which facilitate coping when real or imagined events challenge personal wishes, needs, and feelings. Whether defense mechanisms have a specific neural basis is unknown. The present research tested the hypothesis that interhemispheric integration plays a critical role in defense mechanism development, by studying a unique sample of patients born without the corpus callosum (agenesis of the corpus callosum; AgCC). Adults with AgCC (N = 27) and matched healthy volunteers (N = 30) were compared on defense mechanism use across increasing levels of developmental maturity (denial, least; projection, intermediate; identification, most). Narratives generated in response to Thematic Apperception Test images were scored according to the Defense Mechanism Manual. Greater use of denial and less identification was found in persons with AgCC, compared to healthy comparisons. This difference emerged after age 18 when full maturation of defenses among healthy individuals was expected. The findings provide clinically important characterization of social and emotional processing in persons with AgCC. More broadly, the results support the hypothesis that functional integration across the hemispheres is important for the development of defense mechanisms.
RESUMEN
In chronic infections, the immune response fails to control virus, leading to persistent antigen stimulation and the progressive development of T cell exhaustion. T cell effector differentiation is poorly understood in the context of exhaustion, but targeting effector programs may provide new strategies for reinvigorating T cell function. We identified Tribbles pseudokinase 1 (Trib1) as a central regulator of antiviral T cell immunity, where loss of Trib1 led to a sustained enrichment of effector-like KLRG1+ T cells, enhanced function, and improved viral control. Single-cell profiling revealed that Trib1 restrains a population of KLRG1+ effector CD8 T cells that is transcriptionally distinct from exhausted cells. Mechanistically, we identified an interaction between Trib1 and the T cell receptor (TCR) signaling activator, MALT1, which disrupted MALT1 signaling complexes. These data identify Trib1 as a negative regulator of TCR signaling and downstream function, and reveal a link between Trib1 and effector versus exhausted T cell differentiation that can be targeted to improve antiviral immunity.
Asunto(s)
Diferenciación Celular , Péptidos y Proteínas de Señalización Intracelular/metabolismo , Coriomeningitis Linfocítica/inmunología , Coriomeningitis Linfocítica/virología , Proteínas Serina-Treonina Quinasas/antagonistas & inhibidores , Secuencia de Aminoácidos , Animales , Linfocitos T CD4-Positivos/inmunología , Linfocitos T CD8-positivos/inmunología , Línea Celular , Enfermedad Crónica , Humanos , Inmunidad , Péptidos y Proteínas de Señalización Intracelular/química , Péptidos y Proteínas de Señalización Intracelular/deficiencia , Activación de Linfocitos/inmunología , Subgrupos Linfocitarios/inmunología , Virus de la Coriomeningitis Linfocítica/inmunología , Ratones Endogámicos C57BL , Ratones Noqueados , Proteína 1 de la Translocación del Linfoma del Tejido Linfático Asociado a Mucosas/metabolismo , Fenotipo , Unión Proteica , Proteínas Serina-Treonina Quinasas/química , Proteínas Serina-Treonina Quinasas/deficiencia , Proteínas Serina-Treonina Quinasas/metabolismo , Linfocitos T/citología , Linfocitos T/inmunología , Transcripción Genética , Carga ViralRESUMEN
BACKGROUND: Diabetic foot infection (DFI) is a serious, difficult-to-treat infection, especially when caused by methicillin-resistant Staphylococcus aureus (MRSA). Vancomycin has been the standard treatment for MRSA infection, but lower response rates in MRSA skin infections have been reported. This analysis assessed the outcome and safety of daptomycin therapy in patients with a DFI caused by MRSA. METHODS: Using the Cubicin Outcomes Registry and Experience and the European Cubicin Outcomes Registry and Experience (2006-2009), 79 patients with MRSA DFI were identified and included in this analysis. RESULTS: In the 74 evaluable patients, daptomycin was administered at a median dose of 4.8 mg/kg primarily every 24 hours (85.1%) and for a median of 15.0 days. Overall, 77.0% of the patients (57 of 74) received initial therapy with activity against MRSA; however, of patients receiving daptomycin as second-line therapy (n = 31), only 45.2% were treated with an antibiotic agent active against MRSA. The overall clinical success and treatment failure rates were 89.2% and 10.8%, respectively. Success with daptomycin therapy was higher in patients who had surgery and in those whose initial therapy was daptomycin. Eleven patients had 14 adverse events, two of which were possibly related to daptomycin use and led to discontinuation. CONCLUSIONS: In a large real-world cohort of patients with MRSA DFI, daptomycin therapy was shown to be generally well tolerated and effective. The use of an anti-MRSA antibiotic agent should be considered when implementing first-line antibiotic drug therapy for DFI in countries where MRSA is common to avoid inappropriate empirical treatment and potential negative effects on outcomes.
Asunto(s)
Antibacterianos/uso terapéutico , Daptomicina/uso terapéutico , Pie Diabético/tratamiento farmacológico , Pie Diabético/microbiología , Staphylococcus aureus Resistente a Meticilina , Infecciones Estafilocócicas/tratamiento farmacológico , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del Tratamiento , Estados UnidosRESUMEN
This article reports the first known study on dogs in Port-au-Prince. Interviews with 1,290 residents provided information on 1,804 dogs. More than 57.7% of homes kept dogs. Not all the dogs received vaccinations for rabies (41.6%), even though 28.2% of households had had a household member bitten by a dog. Although the "owned" dog population had decreased as a result of the earthquake in January 2010, the number of roaming dogs appeared to have been uninfluenced by the disaster. Given that 64.8% of dogs probably had access to the street and only 6.0% of the females were spayed, to humanely contain the dog population will require both confinement and neutering. Although roaming dogs were considered a nuisance by 63.3% of respondents, 42.6% of households fed dogs they did not own.
Asunto(s)
Bienestar del Animal , Perros , Mascotas , Bienestar del Animal/estadística & datos numéricos , Animales , Actitud , Mordeduras y Picaduras/epidemiología , Recolección de Datos , Desastres , Terremotos , Femenino , Haití , Masculino , Rabia/prevención & control , Rabia/veterinariaRESUMEN
Apesar da sensibilidade para ouvir pacientes, analistas não obtiveram bom desempenho ao ouvir e falar com colegas de maneira realmente aberta. Fatores importantes são destacados nesta interação entre forças direcionadas do narcisismo em si próprio e forças externalizadas de curiosidade. Algumas limitações de comunicação inerentes à mente humana foram incluídos no exame de problemas de comunicação entre colegas de profissão. Limitações como a necessidade de abstrair aspectos da experiência para focar atenção e a tendência mental de pensar por categorias. Outras limitações são derivadas da psicologia individual (como a vulnerabilidade da autoestima) e aquelas relacionadas a dinâmicas de grupo (como a adaptação às novas ideias e os problemas que elas causam, paroquialismo e o desenvolvimento de escolas radicais e a competitividade entre as escolas). A contribuição das influências culturais e da multiplicação do uso de determinada linguagem também foi ressaltada. O sentido principal da pequenez na estranheza do universo e a presença de outros em uma corrente natural.(AU)
Mismo con la sensibilidad par escuchar nos pacientes, los analistas no obtuvieran una buena performance cuando escuchan y hablan con otros colegas de forma abierta. Algunos factores importantes son destacados en esta interacción entre fuerzas diseccionadas del narcisismo propio y las fuerzas externalizadas de la curiosidad. Algunas limitaciones de comunicación, naturales de la mente humana, fueran incluyeras en el análisis de problemas de comunicación entre colegas de profesión. Limitaciones como la necesidad de abstraer aspectos de la experiencia para centrar la atención y la tendencia mental de piensas en dos categorías distintas. Otras limitaciones son originadas de la psicología individual (coma la vulnerabilidad y la auto-estima) y aquellas con relación a las dinámicas grupales (como la adaptación a nuevas ideas y los problemas que son causados, el parroquialismo y lo el desarrollo de las escuelas radicales y la competencia entre escuelas). La contribución de las influencias culturales y da la multiplicación del uso de un lenguaje especifico también fue destacada. El sentido principal de ser pequeño en este universo raro y la presencia de otras es una acontecimiento natural.(AU)
Despite clinical sensitivity when listening to patients, analysts have not fared well in hearing and talking to each other with respectful open-mindedness. Underlying factors are considered with particular focus on the interplay between self-aimed forces of narcissism and outward aimed forces of curiosity. Included in examination of problems of collegial communication are limitations structurally inherent to the human mind (such as the need to abstract aspects of experience in order to focus attention plus the mind's tendency to categorical thinking), those derived from individual psychology (such as vulnerability of self esteem), and those related to group dynamics (such as the problems attendant to new ideas and the allegiances they stir, parochialism and the development of radical schools, the competitiveness between schools). The contribution of cultural influences and the multiply determined uses of language are also highlighted. The core sense of smallness in the strangeness of the universe and in the presence of others is seen as a common thread.(AU)
Asunto(s)
Humanos , Masculino , Femenino , Psicoanálisis/métodos , Narcisismo , Lenguaje , Conducta ExploratoriaRESUMEN
Apesar da sensibilidade para ouvir pacientes, analistas não obtiveram bom desempenho ao ouvir e falar com colegas de maneira realmente aberta. Fatores importantes são destacados nesta interação entre forças direcionadas do narcisismo em si próprio e forças externalizadas de curiosidade. Algumas limitações de comunicação inerentes à mente humana foram incluídos no exame de problemas de comunicação entre colegas de profissão. Limitações como a necessidade de abstrair aspectos da experiência para focar atenção e a tendência mental de pensar por categorias. Outras limitações são derivadas da psicologia individual (como a vulnerabilidade da autoestima) e aquelas relacionadas a dinâmicas de grupo (como a adaptação às novas ideias e os problemas que elas causam, paroquialismo e o desenvolvimento de escolas radicais e a competitividade entre as escolas). A contribuição das influências culturais e da multiplicação do uso de determinada linguagem também foi ressaltada. O sentido principal da pequenez na estranheza do universo e a presença de outros em uma corrente natural.
Mismo con la sensibilidad par escuchar nos pacientes, los analistas no obtuvieran una buena performance cuando escuchan y hablan con otros colegas de forma abierta. Algunos factores importantes son destacados en esta interacción entre fuerzas diseccionadas del narcisismo propio y las fuerzas externalizadas de la curiosidad. Algunas limitaciones de comunicación, naturales de la mente humana, fueran incluyeras en el análisis de problemas de comunicación entre colegas de profesión. Limitaciones como la necesidad de abstraer aspectos de la experiencia para centrar la atención y la tendencia mental de piensas en dos categorías distintas. Otras limitaciones son originadas de la psicología individual (coma la vulnerabilidad y la auto-estima) y aquellas con relación a las dinámicas grupales (como la adaptación a nuevas ideas y los problemas que son causados, el parroquialismo y lo el desarrollo de las escuelas radicales y la competencia entre escuelas). La contribución de las influencias culturales y da la multiplicación del uso de un lenguaje especifico también fue destacada. El sentido principal de ser pequeño en este universo raro y la presencia de otras es una acontecimiento natural.
Despite clinical sensitivity when listening to patients, analysts have not fared well in hearing and talking to each other with respectful open-mindedness. Underlying factors are considered with particular focus on the interplay between self-aimed forces of narcissism and outward aimed forces of curiosity. Included in examination of problems of collegial communication are limitations structurally inherent to the human mind (such as the need to abstract aspects of experience in order to focus attention plus the mind's tendency to categorical thinking), those derived from individual psychology (such as vulnerability of self esteem), and those related to group dynamics (such as the problems attendant to new ideas and the allegiances they stir, parochialism and the development of radical schools, the competitiveness between schools). The contribution of cultural influences and the multiply determined uses of language are also highlighted. The core sense of smallness in the strangeness of the universe and in the presence of others is seen as a common thread.
Asunto(s)
Humanos , Masculino , Femenino , Conducta Exploratoria , Lenguaje , Narcisismo , Psicoanálisis/métodosRESUMEN
Pese a la sensibilidad clínica que evidencian los psicoanalistas cuando se trata de escuchar a sus pacientes, no se escuchan ni hablan entre sí con una mentalidad abierta y respetuosa. En este trabajo se examinan los factores subyacentes en esta situación, en particular la interacción de las motivaciones narcisistas dirigidas a uno mismo y las motivaciones de la curiosidad dirigida al exterior. Entre los problemas de la comunicación institucional se consideran las limitaciones estructurales de la mente humana (como la necesidad de abstraer aspectos de la experiencia para focalizar en ellos la atención, así como la tendencia de la mente a pensar en forma de categorías), los derivados del psicoanálisis individual (como la vulnerabilidad de la autoestima) y los vinculados con la dinámica grupal (los provenientes de las nuevas ideas y la adhesión que generan, la ¶mentalidad provinciana§ y el desarrollo de escuelas radicales, así como la rivalidad entre las escuelas). También se destacan los efectos de las influencias culturales y de la determinación múltiple en el uso del lenguaje. Se ve un hilo común en la finitud del individuo y en su sentimiento de extrañeza ante el Universo y ante la presencia de los otros
Asunto(s)
PsicoanálisisRESUMEN
Pese a la sensibilidad clínica que evidencian los psicoanalistas cuando se trata de escuchar a sus pacientes, no se escuchan ni hablan entre sí con una mentalidad abierta y respetuosa. En este trabajo se examinan los factores subyacentes en esta situación, en particular la interacción de las motivaciones narcisistas dirigidas a uno mismo y las motivaciones de la curiosidad dirigida al exterior. Entre los problemas de la comunicación institucional se consideran las limitaciones estructurales de la mente humana (como la necesidad de abstraer aspectos de la experiencia para focalizar en ellos la atención, así como la tendencia de la mente a pensar en forma de categorías), los derivados del psicoanálisis individual (como la vulnerabilidad de la autoestima) y los vinculados con la dinámica grupal (los provenientes de las nuevas ideas y la adhesión que generan, la ômentalidad provincianaõ y el desarrollo de escuelas radicales, así como la rivalidad entre las escuelas). También se destacan los efectos de las influencias culturales y de la determinación múltiple en el uso del lenguaje. Se ve un hilo común en la finitud del individuo y en su sentimiento de extrañeza ante el Universo y ante la presencia de los otros
Asunto(s)
PsicoanálisisRESUMEN
Um guia prático para o planejamento e a implementação da pesquisa clínica. Direto e de fácil leitura, o texto oferece a médicos e a investigadores clínicos descrições rigorosas dos componentes básicos, enfatizando o bom senso como o ingrediente fundamental do sucesso. Diferenciais dessa segunda edição: exemplos e idéias sobre o que há de novo na pesquisa clínica; expansão dos tópicos relativos ao delineamento e à implementação de ensaios clínicos randomizados; novas abordagens para estimativas de tamanho de amostra, abrangendo novas opções de delineamento; atualização nas questões éticas e na condução responsável da pesquisa clínica; novos capítulos sobre estudos de testes médicos, dados secundários (incluindo estudos suplementares e metanálise), gerenciamento de dados e pesquisa comunitária e internacional.
Asunto(s)
Humanos , Métodos Epidemiológicos , Investigación Biomédica , Proyectos de Investigación , Ética en Investigación , Análisis de Datos , Control de Calidad , Diagnóstico Clínico , Ensayos Clínicos como Asunto/métodos , Entrevistas como Asunto , Estudios Transversales , Estudios de Cohortes , Financiación de la Investigación , ÉticaAsunto(s)
Humanos , Masculino , Femenino , Niño , Adulto , Persona de Mediana Edad , Anciano , Investigación/estadística & datos numéricos , EpidemiologíaRESUMEN
BACKGROUND: Pemphigus foliaceus is an autoimmune skin disease mediated by autoantibodies against desmoglein 1. The endemic form is thought to have an environmental cause. The Terena reservation of Limão Verde in Mato Grosso do Sul, Brazil, is a recently identified focus of the disease, with a prevalence of 3.4 percent in the population. We tested the hypothesis that normal subjects living in an endemic area have antibodies against desmoglein 1. METHODS: We used an enzyme-linked immunosorbent assay to detect antibodies against desmoglein 1 in serum samples from 60 patients with endemic pemphigus foliaceus (fogo selvagem) who lived in Limão Verde or elsewhere in Brazil, 372 normal subjects (without pemphigus foliaceus) from Limão Verde and surrounding locations, and 126 normal subjects from the United States and Japan. RESULTS: Antibodies against desmoglein 1 were detected in 59 of the 60 patients with fogo selvagem (98 percent) but in only 3 of the 126 normal subjects from the United States and Japan (2 percent). Antibodies were also detected in 51 of the 93 normal subjects from Limão Verde (55 percent) and in 54 of the 279 normal subjects from surrounding areas (19 percent). Serum samples obtained one to four years before the onset of disease were available for five patients; all five had antibodies in the initial serum samples, and the onset of disease was associated with a marked increase in antibody values. CONCLUSIONS: The prevalence of antibodies against desmoglein 1 is high among normal subjects living in an area among where fogo selvagem is endemic, and the onset of the disease is preceded by a sustained antibody response. These findings support the concept that the production of antibodies against desmoglein 1 is initiated by exposure to an unknown environmental agent.