RESUMO
Cardiac sex differences represent a pertinent focus in pursuit of the long-awaited goal of personalized medicine. Despite evident disparities in the onset and progression of cardiac pathology between sexes, historical oversight has led to the neglect of gender-specific considerations in the treatment of patients. This oversight is attributed to a predominant focus on male samples and a lack of sex-based segregation in patient studies. Recognizing these sex differences is not only relevant to the treatment of cisgender individuals; it also holds paramount importance in addressing the healthcare needs of transgender patients, a demographic that is increasingly prominent in contemporary society. In response to these challenges, various agencies, including the National Institutes of Health, have actively directed their efforts toward advancing our comprehension of this phenomenon. Epigenetics has proven to play a crucial role in understanding sex differences in both healthy and disease states within the heart. This review presents a comprehensive overview of the physiological distinctions between males and females during the development of various cardiac pathologies, specifically focusing on unraveling the genetic and epigenetic mechanisms at play. Current findings related to distinct sex-chromosome compositions, the emergence of gender-biased genetic variations, and variations in hormonal profiles between sexes are highlighted. Additionally, the roles of DNA methylation, histone marks, and chromatin structure in mediating pathological sex differences are explored. To inspire further investigation into this crucial subject, we have conducted global analyses of various epigenetic features, leveraging data previously generated by the ENCODE project.
RESUMO
BACKGROUND AND PURPOSE: There is limited evidence supporting the conservative management of patients with cervical myelopathy. The purpose of this report is to describe the intervention and outcomes of conservative physical therapy interventions for one patient with chronic cervical myelopathy. CASE DESCRIPTION: This case was a 50-year-old male who sustained a neck injury following a rear-end collision 4 years prior to this therapeutic episode. The patient presented with decreased range of motion in the cervical spine and right upper extremity, strength deficits, altered sensation, poor posture, and reported chronic cervical region pain and difficulty sleeping. INTERVENTION: The patient completed 10 weeks of conservative physical therapy. The patient completed the Neck Disability Index (NDI), Medical Outcome Survey Sleep Scale (MSS), short-form McGill Pain Questionnaire (SFMPQ), Patient-Specific Functional Scale (PSFS), and baseline clinical measurements of flexibility and strength were obtained. OUTCOMES: After the 10-week episode of care, the following changes were noted from baseline: 18% improvement on the NDI, 26% improvement on the MSS, 25% decrease in pain on the SFMPQ, and a 39% improvement on the total score of the PSFS. Cervical range of motion measurements increased between 25% and 100%. Grip strength demonstrated a 465% increase on the right upper extremity and a 25% increase on the left upper extremity. DISCUSSION: This case report suggests that conservative management of chronic traumatic cervical myelopathy was effective in helping to improve pain, sleep, and function in this patient with a traumatic mechanism of injury.
