bluuebunny/crossref_metadata_2025 huggingface dataset:
Stroke with supernumerary phantom limb: case study, review of literature and pathogenesis
Authors: Srivastava Abhishek , Taly Arun B. , Gupta Anupam , Murali Thyloth , Noone Mohan L. , Thirthahalli Jagadisha , Gangadhar B. N. , Kumar J. Keshav , Jayakumar P. N.
Published: June 2008

Objective:

Constitute hypothesis for origin of supernumerary phantom limb (SPL) after stroke.

Method:

Single case description, review of literature and formulation of hypothesis.

Results:

A 59-year-old lady was evaluated for complaints of left-sided hemiparesis and extra limbs attached to her left shoulder for the past 7 months. Neuropsychological assessment revealed left hemineglect with SPL, and profile suggested bilateral frontal, right parietotemporal and basal ganglia involvement. Magnetic resonance imaging brain scan showed gliotic cavity secondary to the old haematoma in right putamen with white matter changes in the right frontoparietotemporal lobes.

Conclusions:

The conceptual framework of body schema can be used to classify many of the neurological disorders of body representation. Generation of SPL comes under the subtype of pathology of updating among the disorders of body schema. The continuous updating allows the body schema to modulate perceptual processing of objects according to their position in space. Brain areas classified as parts of motor system can, under pathological conditions (haemorrhage), influence body perception. So, when she used to move her arm, the representation of the estimated position was not updated by the motor commands. Sensory and motor information therefore becomes discrepant, and failure to integrate these two sources of information leads to loss of normal coherence, and the perceived shape of the body was altered by adding a SPL to accommodate the discrepancy.
Skin rejuvenation by radiofrequency therapy: methods, effects and risks
Authors: Paasch Uwe , Bodendorf Marc Oliver , Grunewald Sonja , Simon Jan Christoph
Published: June 2008

Treatment of sun‐damaged skin and wrinkles is attracting increasing interest as the possible approaches expand. Recently mono‐ und bipolar radiofrequency devices have been introduced as new treatment options for skin rejuvenation. Initial studies have demonstrated changes in collagen content of the skin as the molecular basis of skin texture improvement. However, there are many possible risks and side effects. We describe a patient referred to us with severe facial scarring as a result of a bipolar radiofrequency treatment performed by non‐medical personnel. Due to the risk of permanent tissue damage, the indications for radiofrequency interventions should be made carefully. Potential contraindications should be considered and written informed consent about all possible side effects and risk factors should be obtained. According to current knowledge, the experience of the physician using radiofrequency devices is most important in determining the outcome of this procedure. Therefore the use of radiofrequency therapy requires extensive training.
Research in practice: the systemic aspects of psoriasis
Authors: Boehncke Wolf‐Henning , Boehncke Sandra
Published: June 2008

Psoriasis is a common, chronic inflammatory and frequently severe skin disease. Recent epidemiologic studies have documented an increased cardio‐vascular mortality in psoriasis patients. Our own work focuses on endothelial cells as mediators for the development of inflammatory infiltrates and more recently as a victim of injury caused by infiltrating cells. In this context, we have measured systemic effects of this seemingly cutaneous inflammation, which results in a metabolic state much like that in patients developing diabetes mellitus and insulin resistance. The latter is an important pathomechanism causing endothelial cell dysfunction and subsequently cardiovascular diseases such as myocardial infarction or stroke. Co‐morbidities observed in psoriatic patients therefore represent complications of the accompanying systemic inflammation and are likely to be mediated through the mechanism of insulin resistance. As psoriasis is a risk factor for cardiovascular diseases, its adequate management must include the treatment of other known risk factors. Dermatologists should discuss the elevated cardiovascular risk with their psoriasis patients and encourage them not to smoke and to normalize their body weight.
Subacute cutaneous lupus erythematosus induced by terbinafine: case report and review of literature
Authors: Lorentz Katharina , Booken Nina , Goerdt Sergij , Goebeler Matthias
Published: June 2008

Systemic lupus erythematosus and subacute cutaneous lupus erythematosus (SCLE) occasionally evolve as adverse reactions to a large variety of chemically different drugs. We here report on a 76‐year‐old woman who developed SCLE within 10 days after initiation of oral terbinafine. Analysis of the 27 cases of terbinafine‐induced SCLE in the literature revealed that this disorder has been reported 6 times more often in females than in males. Skin lesions evolved on average around 7 weeks after starting the drug. In 79% of the cases ANA could be detected while antibodies against Ro/SS‐A and La/SS‐B were found in 86% and 39%, respectively. Remarkably, anti‐histone antibodies were present in only 29%. In all cases terbinafine‐induced SCLE resolved after discontinuation of the triggering agent. Systemic treatment with anti‐malarials and/or corticosteroids does not appear to be mandatory.
Exploring the barriers to exclusive breastfeeding in black and minority ethnic groups and young mothers in the UK
Authors: Ingram Jenny , Cann Karen , Peacock Jennie , Potter Barbara
Published: June 2008

UK health policy for many years has been to increase rates of breastfeeding because of the health benefits conferred on mothers and babies. World Health Organization recommends that babies should be breastfed exclusively for 6 months (without water or other fluids) and the National Institute for Health and Clinical Excellence promotes the provision of peer supporters or breastfeeding support groups to increase breastfeeding rates. This study aimed to explore the barriers to exclusive breastfeeding to 6 months with black and minority ethnic groups and with young mothers, and the strategies for overcoming these barriers, including peer support. Twenty‐two mothers from Somali, Afro‐Caribbean and South Asian communities or young mothers groups attended five focus groups. Transcripts were analysed using thematic and framework methods. There was enthusiasm for breastfeeding support groups, but with a wider remit to discuss other baby‐related issues and provide general social support as well as support for breastfeeding. The Somali and South Asian women preferred the groups to be for their ethnic group, Afro‐Caribbean women were keen that they should be open to all cultures and young mothers would like groups for their peers only. Encouraging mothers to breastfeed exclusively to 6 months should be promoted more and emphasized by health professionals when supporting women post‐natally, and good support with breastfeeding management should be given to enable mothers to achieve this goal. Breastfeeding support groups may play a part in increasing breastfeeding continuation of breastfeeding, but for the groups studied this was not the greatest influence, with families and older women in the community having more influence in changing practice.
Determinants of termination of breastfeeding within the first 2 years of life in India: evidence from the National Family Health Survey‐2
Authors: Malhotra Rahul , Noheria Amit , Amir Omar , Ackerson Leland K. , Subramanian S.V.
Published: June 2008

The present study assesses socio‐demographic and health service determinants of termination of breastfeeding within the first 2 years of life in India by analysing data from the nationally representative National Family Health Survey‐2 using Cox regression modelling techniques. While the likelihood of stopping breastfeeding increased with increasing household wealth status, it declined with increasing maternal age at childbirth. The likelihood of stopping breastfeeding was significantly higher among female children compared with male children, and the gender differential was attenuated by increasing maternal educational status. Overall, findings of the present study suggest that breastfeeding promotion programmes in India should focus on certain high‐risk mother–child pairs such as female infants, first‐born babies, babies born in the private sector and in urban areas, as well as mothers who are literate, have a higher wealth status, are aged less than 20 years and belong to Sikh or Christian communities. Qualitative studies to understand cultural factors or norms and causal pathways responsible for the association of identified factors and early termination of breastfeeding, especially household wealth status and maternal education, are also called for.
Body image perceptions in Western and post‐communist countries: a cross‐cultural pilot study of children and parents
Authors: Humenikova Lenka , Gates Gail E.
Published: June 2008

The development of an unrealistic ideal body image and body size dissatisfaction among children is common in Western countries, including the USA and many European nations. However, little is known about children's body image perceptions in post‐communist countries. This pilot study evaluated body image perceptions in a sample of Czech school‐aged children and their parents and compared them with the perceptions of American children and parents. Ninety‐seven Czech and 45 American 4th–6th graders and their parents from eight urban schools participated in this study. A previously developed silhouette body image instrument was utilized in a parent questionnaire and during child interviews to measure perceived and ideal body image perceptions of children and parents. Descriptive statistics, independent t‐tests and paired t‐tests were used to compare differences between children's and parents’ perceived and ideal body image perceptions. Associations between body image perceptions and other variables were explored using bivariate correlations. American children had a thinner ideal body image compared with Czech children (P < 0.05). However, a larger proportion of Czech boys desired to be thinner compared with American boys (34.2% vs. 20%). Parent's ideal body image for their children did not differ by nationality (P = 0.858). While the pressure on children to look thinner was apparent among both American and Czech children, Czech children considered a larger body size as more ideal. A future study should evaluate body image perceptions and factors influencing these perceptions in a representative sample of Czech children and parents.
Maternal obesity and initiation and duration of breastfeeding: data from the longitudinal study of Australian children
Authors: Donath Susan M. , Amir Lisa H.
Published: June 2008

The aim of this paper is to investigate whether the lower rate of breastfeeding at 6 months by overweight and obese mothers is primarily due to these women giving up breastfeeding in the first week postpartum using a cross‐sectional population survey. The sample is children from the infant cohort (about 12 months of age) of Wave 1 (2004) of the Longitudinal Study of Australian Children for whom breastfeeding and maternal information were available (n = 3075). Definitions used: normal‐weight body mass index (BMI, kg/m2) 20 to <25, overweight BMI 25 to <30, obese BMI ≥30. Breastfeeding initiation was 95.1% for normal‐weight women, 92.8% for overweight women and 87.1% for obese women. At 6 months, 64% of normal‐weight women were breastfeeding, compared with 54% of overweight and 44% of obese women. On multivariate analysis, for women who initiated breastfeeding, overweight women had an odds ratio (OR) of 1.52 [95% confidence interval (CI) 1.02, 2.28] and obese women had an OR of 2.54 (95% CI 1.70, 3.79) of stopping breastfeeding by 1 week compared with normal‐weight women (adjusted for maternal age, education, smoking, level of socio‐economic disadvantage, caesarean birth, admission to special care nursery). For women who breastfed for at least 1 week, overweight women had an adjusted OR of 1.26 (1.04, 1.53) and obese women had an adjusted OR of 1.38 (1.10, 1.73) of ceasing to breastfeed before 6 months, compared with normal‐weight women. In conclusion, among overweight/obese women who initiate breastfeeding, higher rates of cessation of breastfeeding in both the immediate postpartum period and in the first 6 months contribute to the shorter duration.
Newborn care practices in Pemba Island (Tanzania) and their implications for newborn health and survival
Authors: Thairu Lucy , Pelto Gretel
Published: June 2008

Newborn mortality accounts for about one‐third of deaths in children under five. Neglecting this problem may undermine the fourth Millennium Development Goal of reducing child mortality by two‐thirds by 2015. This study was conducted in Tanzania, where an estimated 32/1000 infants die within the first 28 days. Our objective was to describe newborn care practices and their potential impact on newborn health. We interviewed two purposive samples of mothers from Pemba Island, a predominantly Muslim community of Arab‐African ethnicity, and one of Tanzania's poorest. The first sample of mothers (n = 12) provided descriptive data; the second (n = 26) reported actual practice.

We identified cultural beliefs and practices that promote early initiation of breastfeeding and bonding, including ‘post‐partum seclusion’. We also identified practices which are potentially harmful for newborn health, such as bathing newborns immediately after delivery, a practice motivated by concerns about ‘ritual pollution’, which may lead to newborn hypothermia and premature breast milk supplementation (e.g. with water and other fluids) which may expose newborns to pathogens. Some traditional practices to treat illness, such as exposing sick newborns to medicinal smoke from burning herbs, are also of concern. It is unclear whether the practice of massaging newborns with coconut oil is harmful or beneficial.

Interventions to reduce neonatal mortality need to identify and address the cultural rationales that underlie negative practices, as well as reinforce and protect the beliefs that support positive practices. The results suggest the need to improve use of health services through improving health worker communication skills and social management of patients, as well as by lowering healthcare costs.
Maternal common mental disorder and infant growth – a cross‐sectional study from Malawi
Authors: Stewart Robert C. , Umar Eric , Kauye Felix , Bunn James , Vokhiwa Maclean , Fitzgerald Margaret , Tomenson Barbara , Rahman Atif , Creed Francis
Published: June 2008

The objective of the study was to investigate the association between maternal common mental disorder (CMD) and infant growth in rural Malawi. A cross‐sectional study was conducted at a district hospital child health clinic. Participants were consecutive infants due for measles vaccination, and their mothers.

Mean infant weight‐for‐age and length‐for‐age z‐scores were compared between infants of mothers with and without CMD as measured using the self‐reporting questionnaire (SRQ).

Of 519 eligible infants/mothers, 501 were included in the analysis. Median infant age was 9.9 months. 29.9% of mothers scored 8 or above on the SRQ indicating CMD. Mean length‐for‐age z‐score for infants of mothers with CMD (−1.50 SD 1.24) was significantly lower than for infants of mothers without CMD (−1.11 SD 1.12) Student's t‐test: P = 0.001. This association was confirmed in multivariate analysis. Mean weight‐for‐age z‐score for infants of mothers with CMD (−1.77 SD 1.16) was lower than for infants of mothers without CMD (−1.59 SD 1.09) but this difference was not significant on univariate (Student's t‐test: P = 0.097) or multivariate analysis.

The study demonstrates an association between maternal CMD and infant growth impairment in rural sub‐Saharan Africa.
The Treatment of Adolescent Transsexuals: Changing Insights
Authors: Cohen-Kettenis Peggy T. , Delemarre-van de Waal Henriette A. , Gooren Louis J.G.
Published: June 2008

Introduction

Treatment of individuals with gender identity disorder (GID) has in medicine nearly always met with a great deal of skepticism. Professionals largely follow the Standards of Care of the World Professional Association for Transgender Health. For adolescents, specific guidelines have also been issued by the British Royal College of Psychiatrists.

Aim

To describe the stepwise changes in treatment policy which, in recent years, have been made by the team of the Gender Identity Clinic at the VU University Medical Center in Amsterdam, The Netherlands.

Methods

The first step taken to treat adolescents was that, after careful evaluation, (cross-sex hormone) treatment could start between the ages of 16 and 18 years. A further step was the suppression of puberty by means of gonadotropin-releasing hormone analogs in 12–16 year olds; the latter serves also as a diagnostic tool. Very recently, other clinics in Europe and North America have followed this policy.

Results

The first results from the Amsterdam clinic show that this policy is promising.

Conclusion

Professionals who take responsibility for these youth and are willing to help should yet be fully aware of the impact of their interventions. In this article, the pros and cons of the various approaches to youngsters with GID are presented, hopefully inciting a sound scientific discussion of the issue.
The Effectiveness of Psychological Interventions for the Treatment of Erectile Dysfunction: Systematic Review and Meta-Analysis, Including Comparisons to Sildenafil Treatment, Intracavernosal Injection, and Vacuum Devices
Authors: Melnik Tamara , Soares Bernardo G.O. , Nasello Antonia Gladys
Published: June 2008

Introduction

In contrast to the impressive advances in somatic research of erectile dysfunction (ED), scientific literature shows contradictory reports on the results of psychotherapy for the treatment of ED.

Aim

Authors conducted a meta-analysis to evaluate the effectiveness of psychological interventions for the treatment of ED compared to oral drugs, local injection, vacuum devices, or other psychological intervention.

Method

Distinct sources of randomized controlled trials (RCTs) were searched: electronic databases (between 1966 and 2007), cross checking of references, and contact with scientific societies.

Main Outcome Measures

For dichotomous outcomes the pooled relative risks were calculated and for continuous outcomes mean differences between interventions. Statistical heterogeneity was addressed.

Results

Eleven RCTs involving 398 men met the inclusion criteria.

Conclusions

There is evidence that group therapy improves ED. Focused sex group therapy showed greater efficacy than control group. Men randomized to receive psychotherapy plus sildenafil showed significant improvement of ED and were less likely than those receiving only sildenafil to drop out. Regarding to the effectiveness of psychological interventions for the treatment of ED compared to local injection and vacuum devices no difference was found.
Prevalence and Risk Factors for Low Sexual Function in Women: A Study of 1,009 Women in an Outpatient Clinic of a University Hospital in Istanbul
Authors: Aslan Ergul , Beji Nezihe Kizilkaya , Gungor Ilkay , Kadioglu Ates , Dikencik Birsen Kucuk
Published: June 2008

Introduction

Sexual functioning is a common and multidimensional problem, associated with multiple biological, medical, psychological, sociocultural, political, economic, and interpersonal factors.

Aim

The study was planned to determine the prevalence and risk factors for low sexual function in women in an outpatient clinic of a university hospital in Istanbul.

Methods

Totally, 1,009 women over 20 years of age or their healthy female companions were interviewed in the outpatient clinics of the Department of Internal Medicine in a university hospital in Istanbul.

Main Outcome Measures

Female Sexual Function Index (FSFI) was used to evaluate sexual function.

Results

The mean age of women was 38.62 ± 12.82 and 22.2% of women were postmenopausal. The mean FSFI score was found to be 24.25 ± 9.50 out of a maximum total score of 36. Based on the total FSFI score, 43.4% of the women had scores less then 26. The mean domain scores were: desire 3.14 ± 1.47, arousal 3.60 ± 1.85, lubrication 4.53 ± 2.01, orgasm 4.02 ± 1.97, satisfaction 4.27 ± 1.64, and pain 4.69 ± 1.96 out of a maximum domain score of six. The rate of low sexual function by the age groups were 22% for those 20–29 years, 39.7% for those 30–39 years, 50.2% for those 40–49 years, 71.3% for those 50–59 years, 82.9% for those 60–64 years, and 87.8% for those 65 and over. Lower educational level, menopause, depression, presence of sexual dysfunction in their partner, and contraceptive use were found to be significantly associated with low sexual function in women.

Conclusions

The prevalence of low sexual function in women was found to significantly increase with age. The most significantly affected domains were desire and arousal followed by orgasmic problems, satisfaction, and pain, respectively.
Risk Factors for Erectile Dysfunction in Patients with Urethral Strictures Secondary to Blunt Trauma
Authors: Feng Chao , Xu Yue-Min , Yu Jian-Jun , Fei Xiao-Fang , Chen Lei
Published: June 2008

Introduction

Erectile dysfunction (ED) is a well-known consequence of pelvic fracture, particularly in cases involving urethral injury. There are several risk factors that may be related to ED. However, no systemic approach is used to assess erectile function secondary to urethral trauma.

Aim

To investigate ED associated with urethral injury secondary to pelvic fracture and perineal trauma.

Methods

Forty patients with traumatic urethral strictures secondary to blunt traumatic impact episode to the pelvis or perineum were included in our study. Pelvic fractures and urethral strictures were categorized according to injury types and radiological findings. All patients underwent nocturnal penile tumescence (NPT) monitoring, dynamic color-duplex Doppler ultrasonography (D-CDDU) before surgery. NPT monitoring was conducted again after surgery.

Main Outcome Measures

The events of NPT and D-CDDU were recorded.

Results

In all patients, 11 had organic ED demonstrated by NPT. Vascular pathology was identified in three of 11 patients (27%). The peak systolic velocity of cavernosal artery was lower in patients with pubic diastasis in comparison to those without diastasis (P < 0.05). Significant changes in penile length and circumference were noted in posterior urethral injury compared with anterior urethral injury during erection (P < 0.05). The erectile duration time has a similar statistical difference in two groups mentioned above. However, no significant difference could be observed in the end-to-end anatomosis procedure before and after surgery (P > 0.05).

Conclusions

The pelvic fracture type, especially pubic diastasis, is a risk factor for ED following urethral injury. Location of the stricture is also a risk factor for subsequent erectile dysfunction.
Efficacy and Safety of Alprostadil Cream for the Treatment of Female Sexual Arousal Disorder: A Double-Blind, Placebo-Controlled Study in Chinese Population
Authors: Liao Qinping , Zhang Miao , Geng Li , Wang Xiangping , Song Xuehong , Xia Pei , Lu Tao , Lu Mingqi , Liu Vivian
Published: June 2008

Introduction

To date, no approved medication is available for the treatment of female sexual arousal disorder (FSAD).

Aim

The purpose of this study was to evaluate the clinical efficacy and safety of a novel alprostadil topical cream for the treatment of FSAD.

Methods

This was a multicenter, randomized, double blind, placebo-controlled, parallel design dose-ranging study. Four hundred female patients with FSAD (22–62 years of age), after a 4-week nontreatment baseline period, were provided with 10 blinded doses of 500, 700, or 900 mcg alprostadil or a placebo cream to be applied to the clitoris and the G-spot in the vagina prior to vaginal intercourse.

Main Outcome Measures

The primary efficacy end point was the arousal success rate (equal number of the Yes responses to Question 3 of the Female Sexual Encounter Profile [FSEP] or number of the sexual encounters). Secondary endpoints included the Female Sexual Function Index (FSFI), Global Assessment Questionnaire, other FSEP question responses, and post-treatment changes in Female Sexual Distress Scale.

Results

A total of 374 FSAD patients completed the study. Primary efficacy analysis of the intent-to-treat (ITT) population showed a significant increase in arousal success rates with dose. Arousal success rates at the end of the total evaluation period were 33.1%, 46.3% (P = 0.0161), 43.5% (P = 0.0400), and 53.9% (P = 0.0002) in the placebo, 500, 700, and 900 mcg alprostadil groups, respectively. The changes of the FSFI score, relative to baseline were 14.7%, 20.7% (P = 0.067), 21.7% (P = 0.035), and 22.9% (P = 0.002) for the placebo, 500, 700, and 900 mcg treatment groups, respectively. The other secondary efficacy end point values showed a consistent trend in support of the primary efficacy results.

Conclusion

These results demonstrated that the application of topical alprostadil prior to vaginal intercourse significantly improved the sexual arousal rate of the subjects with FSAD.
Evaluation of the Association between Lower Urinary Tract Symptoms and Erectile Dysfunction, Considering its Multiple Risk Factors
Authors: Rhoden Ernani Luis , Riedner Charles Edison , Fornari Alexandre , Fuchs Sandra Costa , Ribeiro Eduardo Porto
Published: June 2008

Aim

To investigate the relationship between lower urinary tract symptoms (LUTS) and erectile dysfunction (ED), while considering multiple risk factors for ED, including an anthropometric evaluation of central obesity.

Methods

A cross-sectional study was carried out with 192 consecutive male subjects (≥40 years old). Conditions clearly associated with ED, other than obesity and age, were considered exclusion criteria. Men were evaluated routinely for clinical history, received a physical examination, and were subjected to blood analysis for fasting serum glucose, lipid profile, and serum testosterone. Patients with previous known history of diabetes mellitus or hypertension were excluded. Anthropometric measures taken included body mass index (general obesity) and waist circumference, waist-hip index, and sagittal abdominal diameter (visceral obesity). Analyses were performed using bivariate and multivariate models (multiple logistic regression). Age, education, alcohol consumption, smoking, sedentary lifestyle, fasting blood glucose level, dyslipidemia, hypogonadism, general obesity, and visceral obesity were taken into account as potential confounding factors.

Main Outcome Measures

All men completed the International Index of Erectile Function and International Prostate Symptom Score (IPSS).

Results

IPSS scores were low, intermediate, and high in 89 (46.4%), 76 (39.6%), and 27 (14.1%) men, respectively. Overall IPSS scores were significantly associated with ED (P = 0.002). In addition, an association between the severity of ED and LUTS was observed (P = 0.008). The mean quality of life assessment in the IPSS revealed a statistically significant difference between individuals with varying degrees of ED (P = 0.008). The logistic regression analyses showed that IPSS scores and ED remained independently associated even after the control for confounding factors (odds ratio = 1.07, 95% CI = 1.02–1.13, P = 0.01).

Conclusion

This study suggests that LUTS are independently associated with ED, taking into account various risk factors for ED, including visceral obesity.
Effect of Sildenafil Citrate on the Male Sexual Experience Assessed with the Sexual Experience Questionnaire: A Multicenter, Double-Blind, Placebo-Controlled Trial with Open-Label Extension
Authors: Jones LeRoy A. , Klimberg Ira W. , McMurray James G. , Padula Rebecca , Tseng Li-Jung , Stecher Vera J.
Published: June 2008

Introduction

The Sexual Experience Questionnaire (SEX-Q) enables quick and easy assessment of functional, emotional, and satisfaction-related aspects of the sexual experience in men with erectile dysfunction (ED).

Aim

To assess correlations between improvement on the SEX-Q and outcomes on other validated questionnaires.

Methods

Men with ED (score ≤25 on the Erectile Function domain of the International Index of Erectile Function [IIEF]) who had used less than or equal to six doses of any phosphodiesterase 5 inhibitor (none within 6 months) were randomized to 10 weeks of double-blind, placebo-controlled (DBPC) flexible-dose sildenafil citrate (50 or 100 mg, as needed), followed by 6 weeks of open-label (OL) sildenafil.

Main Outcome Measures

SEX-Q, IIEF, Quality of Erection Questionnaire (QEQ), Self-Esteem and Relationship (SEAR) Questionnaire, Erection Hardness Score (EHS), successful intercourse attempts (SIAs), Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS), and global efficacy questions (GEQs).

Results

Compared with the placebo group (N = 105), the sildenafil group (N = 104) at DBPC end of treatment (EOT) had significantly more improvement (P < 0.05) on all SEX-Q, IIEF (except the Sexual Desire domain), QEQ, and SEAR outcomes, more frequent SIAs and EHS 3 (hard enough for penetration but not completely hard) or EHS 4 (completely hard) erections (odds ratio [OR], 2.52 and 3.46, respectively), EHS 4 erections four times as often (OR, 6.41), more men satisfied with treatment (EDITS; OR, 2.6), approximately twice as many men with improved erections (GEQ1; OR, 5.8) and ability to have sexual intercourse (GEQ2; OR, 5.4), and GEQ3 scores that indicated better sex (P < 0.0001). SEX-Q score improvements correlated positively with all other outcomes. At OL EOT, most outcomes were >60% (and approximately half were ≥80%) of the maximum positive result.

Conclusions

SEX-Q change scores correlate with several other functional, emotional, and satisfaction-related outcomes in men treated with sildenafil for ED, allowing a simple and focused evaluation of the sexual experience.
Prevalence and Predictors of Sexual Problems, Relationship Stress, and Depression in Female Partners of Infertile Couples
Authors: Nelson Christian J. , Shindel Alan W. , Naughton Cathy K. , Ohebshalom Michael , Mulhall John P.
Published: June 2008

Introduction

Infertility has been associated with anxiety, stress, and sexual problems in both men and women.

Aim

To assess quality of life, sexual health, and depression in the female partner of infertile couples.

Methods

Couples presenting for the evaluation of infertility at two tertiary care medical centers were invited to participate in a survey study.

Main Outcome Measures

Female partners completed the Female Sexual Function Index (FSFI) and a modified Self-Esteem and Relationship (SEAR) Questionnaire. Male partners completed the SEAR and the International Index of Erectile Function (IIEF). Both partners completed the Center for Epidemiological Studies Depression Scale (CES-D) for depression and the Short Form-36 (SF-36) for general quality of life. Demographic, fertility, and comorbidity information was recorded.

Results

One hundred and twenty-one couples constitute the study population. Mean female and male age was 32 ± 5 and 35 ± 7 years, respectively. Most (92%) couples were married. Mean duration of relationship and marriage were 6.4 ± 3.9 and 3.8 ± 3.2 years, respectively. Mean duration of attempted conception was 24 ± 24 months. On CES-D, 19% of women had moderate and 13% had severe depression. Women reported significantly worse SF-36 Mental Health subscale scores (mean = 47.8, P < 0.05) compared with normative values. The mean total FSFI score was 28 ± 7 (maximum score of 36), with 26% of the women scoring below 26.55, an established cut-off for high risk of female sexual dysfunction. FSFI scores had a modest positive correlation with male IIEF scores (r = 0.37, P < 0.01), and there was a trend toward a negative correlation with female CES-D scores (r = −0.16, P < 0.06). These relationships were maintained on multivariate analysis.

Conclusion

Depression and sexual dysfunction are prevalent in female partners of infertile couples. Female sexual function is positively correlated with male partner sexual function in this population.
Impact of Peyronie's Disease on Sexual and Psychosocial Functioning: Qualitative Findings in Patients and Controls
Authors: Rosen Raymond , Catania Joseph , Lue Tom , Althof Stanley , Henne Jeff , Hellstrom Wayne , Levine Laurence
Published: June 2008

Introduction

There are no validated scales for assessing the psychosocial impact of Peyronie's disease (PD), which affects approximately 5–10% of men over age 50.

Aim

To develop a psychometrically valid outcome measure for assessing psychosocial and sexual consequences of PD. To conduct a qualitative study of men with PD and age-matched controls, and design a new patient-reported outcome measure of PD.

Methods

An expert advisory panel identified relevant topics and conceptual areas to be addressed based on clinical experience and literature reviews. A conceptual model was developed to serve as a discussion guide for qualitative interviews with geographically and ethnically diverse PD subjects and controls. Interviews were conducted in a focus-group format by a trained interviewer and were recorded and transcribed for qualitative analysis according to grounded theory concepts.

Main Outcome Measure

Focus-group interviews.

Results

Focus-group interviews were conducted with 64 men (28 PD patients, 36 controls) in 13 separate focus groups over a 3-month period. Blinded analysis of the interview transcripts identified four core domains: (i) physical appearance and self-image; (ii) sexual function and performance; (iii) PD-related pain and discomfort; and (iv) social stigmatization and isolation. Based on feedback from participants and experts, a new outcome questionnaire was developed to assess core domain responses in a structured, self-report format.

Conclusion

This qualitative study helped to refine and broaden the focus of the conceptual model for further assessment. It also confirmed that PD has a major impact on sexual and psychological function in these patients.
Concept of Combinatorial De Novo Design of Drug‐like Molecules by Particle Swarm Optimization
Authors: Hartenfeller Markus , Proschak Ewgenij , Schüller Andreas , Schneider Gisbert
Published: June 2008

We present a fast stochastic optimization algorithm for fragment‐based molecular de novo design (COLIBREE®, Combinatorial Library Breeding). The search strategy is based on a discrete version of particle swarm optimization. Molecules are represented by a scaffold, which remains constant during optimization, and variable linkers and side chains. Different linkers represent virtual chemical reactions. Side‐chain building blocks were obtained from pseudo‐retrosynthetic dissection of large compound databases. Here, ligand‐based design was performed using chemically advanced template search (CATS) topological pharmacophore similarity to reference ligands as fitness function. A weighting scheme was included for particle swarm optimization‐based molecular design, which permits the use of many reference ligands and allows for positive and negative design to be performed simultaneously. In a case study, the approach was applied to the de novo design of potential peroxisome proliferator‐activated receptor subtype‐selective agonists. The results demonstrate the ability of the technique to cope with large combinatorial chemistry spaces and its applicability to focused library design. The technique was able to perform exploitation of a known scheme and at the same time explorative search for novel ligands within the framework of a given molecular core structure. It thereby represents a practical solution for compound screening in the early hit and lead finding phase of a drug discovery project.
Synthesis and Biological Activity of Endomorphin‐2 Analogs Incorporating Piperidine‐2‐, 3‐ or 4‐Carboxylic Acids Instead of Proline in Position 2
Authors: Staniszewska Renata , Fichna Jakub , Gach Katarzyna , Toth Geza , Poels Jeroen , Vanden Broeck Jozef , Janecka Anna
Published: June 2008

Novel endomorphin‐2 (EM‐2) analogs have been synthesized, incorporating unnatural amino acids with six‐membered heterocyclic rings, such as piperidine‐2‐, 3‐ and 4‐carboxylic acids (Pip, Nip and Inp, respectively) instead of Pro in position 2. [(R)‐Nip2]EM‐2 displayed an extremely high affinity for the μ‐opioid receptor with IC50 = 0.04 ± 0.01 nm in comparison with IC50 = 0.69 ± 0.03 nm for EM‐2. This analog was also very potent in the aequorin luminescence‐based functional calcium assay and showed significantly enhanced stability in rat brain homogenate.
Development of Broad‐Spectrum Halomethyl Ketone Inhibitors Against Coronavirus Main Protease 3CLpro
Authors: Bacha Usman , Barrila Jennifer , Gabelli Sandra B. , Kiso Yoshiaki , Mario Amzel L. , Freire Ernesto
Published: June 2008

Coronaviruses comprise a large group of RNA viruses with diverse host specificity. The emergence of highly pathogenic strains like the SARS coronavirus (SARS‐CoV), and the discovery of two new coronaviruses, NL‐63 and HKU1, corroborates the high rate of mutation and recombination that have enabled them to cross species barriers and infect novel hosts. For that reason, the development of broad‐spectrum antivirals that are effective against several members of this family is highly desirable. This goal can be accomplished by designing inhibitors against a target, such as the main protease 3CLpro (Mpro), which is highly conserved among all coronaviruses. Here 3CLpro derived from the SARS‐CoV was used as the primary target to identify a new class of inhibitors containing a halomethyl ketone warhead. The compounds are highly potent against SARS 3CLpro with Ki’s as low as 300 nm. The crystal structure of the complex of one of the compounds with 3CLpro indicates that this inhibitor forms a thioether linkage between the halomethyl carbon of the warhead and the catalytic Cys 145. Furthermore, Structure Activity Relationship (SAR) studies of these compounds have led to the identification of a pharmacophore that accurately defines the essential molecular features required for the high affinity.
Ontic Vagueness and Metaphysical Indeterminacy
Authors: Williams J. Robert G.
Published: June 2008

Might it be that world itself, independently of what we know about it or how we represent it, is metaphysically indeterminate? This article tackles in turn a series of questions: In what sorts of cases might we posit metaphysical indeterminacy? What is it for a given case of indefiniteness to be ‘metaphysical’? How does the phenomenon relate to ‘ontic vagueness’, the existence of ‘vague objects’, ‘de reindeterminacy’ and the like? How might the logic work? Are there reasons for postulating this distinctive sort of indefiniteness? Conversely, are there reasons for denying that there is indefiniteness of this sort?
The Experience of Time and Change
Authors: Dainton Barry
Published: June 2008

Can we directly experience change? Although some philosophers have denied it, the phenomenological evidence is unambiguous: we can, and do. But how is this possible? What structures or features of consciousness render such experience possible? A variety of very different answers to this question have been proposed, answers which have very different implications for the nature of consciousness itself. In this brief survey no attempt is made to engage with the often complex (and sometimes obscure) literature on this topic. Instead, a largely schematic examination of the main options is conducted, with a view to determining the most promising avenues for further investigation.
What is the Frege‐Geach Problem?
Authors: Schroeder Mark
Published: June 2008

In the 1960s, Peter Geach and John Searle independently posed an important objection to the wide class of ‘noncognitivist’ metaethical views that had at that time been dominant and widely defended for a quarter of a century. The problems raised by that objection have come to be known in the literature as theFrege‐Geach Problem, because of Geach's attribution of the objection to Frege's distinction between content and assertoric force, and the problem has since occupied a great deal of the attention both of defenders of broadly noncognitivist views, and of their critics. In this article I explain Geach and Searle's historical objections, and put the subsequent discussion into dialectical context, paying some attention to the developments along the way and how they have enhanced our overall understanding of the problem. The article covers a lot of territory, so we will only be able to see the highlights, along the way. For further reading, see the Works Cited.
Philosophical Issues in Tort Law
Authors: Oberdiek John
Published: June 2008

The union of contemporary philosophy and tort law has never been better. Perhaps the most dynamic current in contemporary tort theory concerns the increasingly sophisticated inquires into the doctrinal elements of the law of torts, with the tort of negligence in particular garnering the most attention from theorists. In this article, I examine philosophically rich issues revolving around each of the elements constituting the tort of negligence: compensable injury, duty, breach, actual cause, and proximate cause.
Recent Work on Cinema as Philosophy
Authors: Livingston Paisley
Published: June 2008

Although the cinematic medium can be used in philosophically valuable ways, bold contentions about how films ‘do philosophy’ in an independent, innovative and exclusively cinematic manner are highly problematic. Philosophers’ interpretations of the stories conveyed in cinematic fictions do not actually support such bold claims about film's independent philosophical value; nor do they offer adequate appreciations of the films’ artistic value. Different kinds of interpretations having different goals and conditions of success should be kept in view if we are to take a sufficiently critical perspective on contributions in this area. In particular, ‘as if’ interpretations in which a philosophical problematic is freely applied to elements of a movie's story are contrasted to interpretations that target a film author's actual philosophizing.
Utopia and the doubters: truth, transition and the law
Authors: Campbell Colm , Turner Catherine
Published: June 2008

Truth commissions have an intuitive appeal in squaring the circle of peace and accountability post-conflict, but some claims for their benefits risk utopianism. Law provides both opportunities and pitfalls for post-conflict justice initiatives, including the operation of truth commissions. Rather than adopting a heavily legalised approach, derived from Public Inquiries, an ‘holistic legal model’, employing social science fact-finding methodologies to explore pattern of violations, and drawing appropriately on legal standards, may provide the best option for a possible Northern Ireland truth commission.
Moving from cosmopolitan legal theory to legal practice: models of cosmopolitan law
Authors: Brown Garrett Wallace
Published: June 2008

There has been considerable debate about how it would be possible to move from cosmopolitan normative theory to cosmopolitan legal practice. These debates range from an uncertainty about what specific moral and normative principles should underwrite cosmopolitan law, to how those requirements should be institutionalised at the global level. In addition, many cosmopolitan theorists rest their more elaborate institutional models on the assumption of an already existing and thoroughgoing practice of cosmopolitan law, without detailed considerations regarding applied theory. The purpose of this paper is to examine the concept of cosmopolitan law and to argue how legal cosmopolitanism provides a necessary linchpin and transitional conduit between cosmopolitan theory and more institutionally based forms of cosmopolitanism. The paper examines the historical development of legal cosmopolitanism, the uniqueness of contemporary cosmopolitan legal theory within international legal debates, and maps the various approaches for moving cosmopolitan legal theory to legal practice. Through mapping the discipline, it is argued that Kantian legal cosmopolitanism represents the most coherent attempt to move from cosmopolitan legal theory to global institutional practice. This is due to the fact that it represents a minimal andmoderateform of legal cosmopolitanism that accepts that any move to a cosmopolitan order would need to evolve from our current legal order. In this regard, it is argued that Kantian legal cosmopolitanism can occupy a transitional position, that not only satisfies the cosmopolitan concern for human worth, but that is also not guilty of being grossly utopian in its quest toward global justice.
Third party challenges to the courts' treatment of offenders
Authors: Horder Jeremy
Published: June 2008

I will argue that – as an exception to the general rule adopted in England and Wales – third parties, including victims, should in some circumstances be permitted to bring proceedings for (inter alia) judicial review of sentences, and other measures, imposed on offenders. Such proceedings should not be ruled out when parts of sentences, or other orders, are meant to affect the interests of individual third parties themselves, and the prosecution cannot reasonably be expected to be solely responsible for protecting those interests. However, I will also conclude that, from a public law perspective, there is a preferable solution. Third parties who may be adversely affected by sentences or orders imposed on offenders should sometimes be given a limited degree of involvement in the process leading up to the imposition of those sentences or orders. Recent legislation takes us some way towards this goal.
Ghrelin signalling in guinea‐pig femoral artery smooth muscle cells
Authors: Mladenov M. I. , Hristov K. L. , Dimitriova D. Z. , Schubert R. , Lubomirov L. T. , Gjorgoski I. K. , Duridanova D. B. , Gagov H. S.
Published: June 2008

Aim:  Our aim was to study the new signalling pathway of ghrelin in the guinea‐pig femoral artery using the outward IK as a sensor.

Methods:  Whole‐cell patch‐clamp experiments were performed on single smooth muscle cells, freshly isolated from the guinea‐pig femoral artery. The contractile force of isometric preparations of the same artery was measured using a wire‐myograph.

Results:  In a Ca2+‐ and nicardipine‐containing external solution, 1 mmol L−1 tetraethylammonium reduced the net IK by 49 ± 7%. This effect was similar and not additive to the effect of the specific BKCa channel inhibitor iberiotoxin. Ghrelin (10−7 mol L−1) quickly and significantly reduced the amplitudes of tetraethylammonium‐ and iberiotoxin‐sensitive currents through BKCa channels. The application of 5 × 10−6 mol L−1 desacyl ghrelin did not affect the amplitude of the control IK but it successfully prevented the ghrelin‐induced IK decrease. The effect of ghrelin on IK was insensitive to selective inhibitors of cAMP‐dependent protein kinase, soluble guanylyl cyclase, cGMP‐dependent protein kinase or a calmodulin antagonist, but was effectively antagonized by blockers of BKCa channels, phosphatidylinositol‐phospholipase C, phosphatidylcholine‐phospholipase C, protein kinase C, SERCA, IP3‐induced Ca2+ release and by pertussis toxin. The ghrelin‐induced increase in the force of contractions was blocked when iberiotoxin (10−7 mol L−1) was present in the bath solution.

Conclusions:  Ghrelin reduces IK(Ca) in femoral artery myocytes by a mechanism that requires activation of Gαi/o‐proteins, phosphatidylinositol phospholipase C, phosphatidylcholine phospholipase C, protein kinase C and IP3‐induced Ca2+ release.
Mesopotamian Medicine and Religion: Current Debates, New Perspectives
Authors: Robson Eleanor
Published: June 2008

The study of Mesopotamian medicine, while unprecedentedly productive, is stuck in a historiographical rut that cognate disciplines left some years ago. I review the current state of the field from a peripheral vantage point and use case studies from Sumerian literature and Neo‐Assyrian royal letters to exemplify alternative approaches that do not sacrifice philological rigour for anthropological attention to socio‐intellectual context.