A Longitudinal Assessment of Associations Between Women’s Tendency to Pretend Orgasm,Orgasm Function,and Intercourse-Related Pain in Different Partner Relationship Constellations

The aim of the present study was to investigate how women’s tendency to pretend orgasm during intercourse is associated with orgasm function and intercourse-related pain, using a longitudinal design where temporal stability and possible causal relationships could be modeled. The study sample consisted of 1421 Finnish women who had participated in large-scale population-based data collections conducted at two time points 7 years apart. Pretending orgasm was assessed for the past 4 weeks, and orgasm function and pain were assessed using the Female Sexual Function Index for the past 4 weeks. Associations were also computed separately in three groups of women based on relationship status. Pretending orgasm was considerably variable over time, with 34% of the women having pretended orgasm a few times or more at least at one time point, and 11% having done so at both time points. Initial bivariate correlations revealed associations between pretending orgasm and orgasm problems within and across time, whereas associations with pain were more ambiguous. However, we found no support in the path model for the leading hypotheses that pretending orgasms would predict pain or orgasm problems over a long period of time, or that pain or orgasm problems would predict pretending orgasm. The strongest predictor of future pretending in our model was previous pretending (R ² = .14). Relationship status did not seem to affect pretending orgasm in any major way.     

Research Priorities for Optimizing Geriatric Pharmacotherapy: An International Consensus

Medication management is becoming increasingly challenging for older people, and there is limited evidence to guide medication prescribing and administration for people with multimorbidity, frailty, or at the end of life. Currently, there is a lack of clear research priorities in the field of geriatric pharmacotherapy. To address this issue, international experts from 5 research groups in geriatric pharmacotherapy and pharmacoepidemiology research were invited to attend the inaugural Optimizing Geriatric Pharmacotherapy through Pharmacoepidemiology Network workshop. A modified nominal group technique was used to explore and consolidate the priorities for conducting research in this field. Eight research priorities were elucidated: quality of medication use; vulnerable patient groups; polypharmacy and multimorbidity; person-centered practice and research; deprescribing; methodological development; variability in medication use; and national and international comparative research. The research priorities are discussed in detail in this article with examples of current gaps and future actions presented. These priorities highlight areas for future research in geriatric pharmacotherapy to improve medication outcomes in older people.     

Muscle tone in different joint positions and at submaximal isometric torque levels

The aim was to evaluate the tone and electric activity of the quadriceps muscle at rest and different torque levels. The second aim was to study whether thickness of soft tissues and change in the joint position would affect muscle tone. Eighteen healthy subjects participated. Computerized muscle tonometer (CMT) and surface electromyography (sEMG) measurements were performed: seated, first at rest with leg straight and then with the knee at 60 degrees . Thereafter measurements were obtained at levels of 80, 60, 40 and 20% of the maximum isometric torque at the same knee angle. Thickness of skin, subcutis and muscle was measured by ultrasound. The CMT values taken were the depth the indenter travelled and the work it did while compressing the right rectus femoris and vastus intermedius muscles. Expressed as mean (SD) depth the change in muscle tone changed from 29.2 (3.6) mm in the relaxed position to 16.9 (5.2) mm at 80% of maximal torque, and expressed as work the values were from 1589 (150) mJ to 739 (149) mJ respectively. The correlation between CMT, sEMG and torque measurements varied from r = -0.52 to -0.71 (p < 0.01). CMT was able to detect a change of 20% in torque production and 4% in tone. Tone values, at each torque level, were significantly separate from the values at the other force levels (p < 0.001-0.04). Soft tissue thickness explained most of the tone results at rest (57%). The repeatability of the CMT measures was good (ICCs 0.75-0.99). Both depth and work correlated with electric activity and muscle torque, but the correlation with work was higher. In conclusion, muscle activity, length and thickness have to be taken into account when evaluating muscle tone.     

Spontaneous defibrillation after cessation of resuscitation in out-of-hospital cardiac arrest: a case of Lazarus phenomenon

This report describes a case of out-of-hospital cardiac arrest with spontaneous defibrillation and subsequent return of circulation after cessation of resuscitative efforts. A 47-year-old man was found in cardiac arrest and resuscitation was initiated. As no response was achieved, the efforts were withdrawn and final registered cardiac rhythm was ventricular fibrillation. Fifteen minutes later the patient was found to be normotensive and breathing spontaneously. The patient made a poor neurological recovery and died 3 months after the arrest. The authors are unable to give an explanation to the event, but suspect the effect of adrenaline combined with mild hypothermia to have contributed to the self-defibrillation of the myocardium.     

Incidence of persistent renal dysfunction after contrast enhanced coronary CT angiography in patients with suspected coronary artery disease

Contrast-induced nephropathy (CIN) is a potentially serious complication of contrast agents used in computed tomography angiography (CTA). The aim of this study was to evaluate whether persistent renal dysfunction occurs in patients undergoing coronary CTA for suspected stable coronary artery disease (CAD). From a cohort of 957 patients undergone coronary CTA, we identified 402 patients with plasma creatinine levels collected before and within 6 months after CTA. According to the definition of CIN, patients with a ≥25?% increase in plasma creatinine after CTA were evaluated. The post-CTA measurements in 402 patients (195 men, age 62.9?±?9.3 years) were performed at a median of 99 days after CTA. On average, there was no change in plasma creatinine level between the pre- and post-CTA measurements (75.8?±?16.0 and 75.7?±?16.4 µmol/L, respectively; P?=?0.63) but both increases and decreases were commonly detected. Fourteen (3.5?%) patients had a ≥25?% increase in plasma creatinine levels after CTA. A more detailed evaluation of these patients revealed that in 4 patients the increase was explained by other morbidities, whereas in 9 patients the creatinine level returned to the previous levels at later follow-up (median time to normalization: 311 days). Only in 1 (0.2?%) remaining patient, there was a persistent increase in plasma creatinine level, possibly related to the iodine contrast agent exposure. Alterations in plasma creatinine concentration occur frequently. Persistent renal dysfunction attributable to iodine contrast agent exposure is rare in patients referred to coronary CTA for suspected CAD.     

DISTRIBUTION OF FIBROBLAST SURFACE ANTIGEN : Association with Fibrillar Structures of Normal Cells and Loss Upon Viral Transformation

The localization of a cell type-specific, soluble fibroblast surface antigen (SFA) was studied by immunofluorescence and by scanning electron microscopy of the same cells. The antigen had an uneven distribution forming streaks on chick embryo fibroblasts. It was localized to membrane processes and ridges, with a diameter of 50–200 nm. The processes extended from the periphery of the cells to the substratum or to other cells. Trypsin treatment completely removed detectable amounts of SFA. The antigen was detectable within 1 h after trypsin-treated cells were reseeded. The reappearance of SFA correlated with the restoration of membrane processes. Fibroblasts transformed by Rous sarcoma virus (RSV) showed loss of all or most SFA. When normal cells were transformed without subcultivation and trypsinization a fibrillar extracellular network of SFA remained under the transformed fibroblasts while the cells themselves were negative in immunofluorescence. When fibroblasts infected by RSV mutants were transferred to nonpermissive temperature for transformation new SFA was detected within 2 h. These data lead us to propose that loss of stabilizing and anchoring effect of SFA molecules in fibrillar cell surface structures may be critical in altered growth control and malignant transformation.     

What is appropriate surveillance for metal-on-metal hip arthroplasty patients?

The unexpected high revision rates of large-diameter (femoral head sizes of 36?mm or greater) metal-on-metal hip arthroplasties (MoMHAs) have led to worldwide regulatory authorities recommending regular surveillance, even for asymptomatic individuals. However, these recommendations are not evidence-based and are very costly. The rapidly evolving evidence base requires an update regarding the investigation and management of MoMHA patients. This article is the first of 2 (the second article in this series will consider the threshold for performing revision, and the outcomes following ARMD revision surgery: Matharu et al., Revision surgery of metal-on-metal hip arthroplasties for adverse reactions to metal debris: A clinical update. Acta Orthop 2018; in press), and considers the various investigative modalities used during surveillance, with specific focus on blood metal ion sampling and cross-sectional imaging. No single investigation can universally be used during MoMHA patient surveillance. Recent studies have now provided important information on interpreting blood metal ions (effective in identifying patients at low risk of problems), clarifying the roles of cross-sectional imaging (reserve combined ultrasound and MARS-MRI for complex cases), and providing parameters to safely exclude many asymptomatic patients from regular surveillance. This information will be useful when designing future surveillance protocols for MoMHA patients