Vaginismus and Dyspareunia: Automatic vs. Deliberate Disgust Responsivity

IntroductionThe difficulty of penetration experienced in vaginismus and dyspareunia may at least partly be due to a disgust-induced defensive response.AimsTo examine if sex stimuli specifically elicit: (i) automatic disgust-related memory associations; (ii) physiological disgust responsivity; and/or (iii) deliberate expression of disgust/threat.MethodsTwo single target Implicit Association Task (st-IAT) and electromyography (EMG) were conducted on three groups: vaginismus (N = 24), dyspareunia (N = 24), and control (N = 31) group.Main Outcome Measuresst-IAT, to index their initial disgust-related associations and facial EMG for the m. levator labii and m. corrugator supercilii regions.ResultsBoth clinical groups showed enhanced automatic sex-disgust associations. As a unique physiological expression of disgust, the levator activity was specifically enhanced for the vaginismus group, when exposed to a women-friendly SEX video clip. Also at the deliberate level, specifically the vaginismus group showed enhanced subjective disgust toward SEX pictures and the SEX clip, along with higher threat responses.ConclusionsSupporting the view that disgust is involved in vaginismus and dyspareunia, for both, clinical groups’ sex stimuli automatically elicited associations with disgust. Particularly for the vaginismus group, these initial disgust associations persisted during subsequent validation processes and were also evident at the level of facial expression and self-report data. Findings are consistent with the notion that uncontrollable activated associations are involved in eliciting defensive reactions at the prospect of penetration seen in both conditions. Whereas deliberate attitudes, usually linked with the desire for having intercourse, possibly generate the distinction (e.g., severity) between these two conditions. Borg C, de Jong PJ, and Schultz WW. Vaginismus and dyspareunia: Automatic vs. deliberate disgust responsivity.     

Guest Editorial: Knowledge transfer and the path of translational medicine

Translational medicine is at the forefront of academic health care. Although readers might recognize the term, few will be familiar with the principles of this emerging discipline. For many years, clinicians and scientists were concerned that discovery and innovation in cutting‐edge science and biomedicine were not being used to cure or treat patients. This “problem” fostered a new academic paradigm, the aims being to develop a pathway to bridge the preclinical to clinical care interface and, ultimately, to bring treatments and therapies to the real world of patients and of health‐care providers. There are three integrated “phases” of the “bench‐to‐bedside” translational medicine journey. A brief introduction to the discipline of translational medicine is presented.     

Effective and Safe Anesthesia for Yorkshire and Yucatan Swine with and without Cardiovascular Injury and Intervention

The goal of this study was to identify an injectable anesthetic protocol that provides sedation sufficient for peripheral vascular catheterization, intubation, and transport while minimizing cardiovascular changes in Yorkshire and Yucatan pigs with and without cardiovascular injury and intervention (CI). Phase 1 examined the safety and efficacy of acepromazine–ketamine, diazepam–ketamine, midazolam–ketamine, and medetomidine–ketamine in 5 healthy Yorkshire pigs. For each drug combination, we obtained multiple measurements of heart rate, blood pressure, respiratory rate, temperature, sedation score, ability to catheterize and intubate, and recovery score. Phase 2 evaluated and refined the dose of the most effective Phase 1 anesthetic combination (midazolam–ketamine) in healthy and CI Yorkshire pigs (n = 53 trials). Phase 3 mirrored Phase 2 but tested midazolam–ketamine in healthy and CI Yucatan pigs (n = 34 trials). Midazolam (0.5 mg/kg)–ketamine (25 to 27 mg/kg) was the most effective anesthetic combination in healthy Yorkshire pigs, but this dose was less effective in healthy Yucatan pigs and CI Yorkshire and Yucatan pigs. Midazolam–ketamine resulted in tachycardia and apnea more frequently in CI pigs than healthy pigs. This combination also caused vomiting in one CI Yucatan pig. Overall, midazolam–ketamine provided safe and effective sedation for catheterization and intubation of both healthy and CI pigs. This study suggests Yucatan pigs may require a higher dose midazolam–ketamine to achieve the same level of sedation as that in Yorkshire pigs. Although anesthetic complication rates were higher in CI pigs, our results indicate that midazolam–ketamine can be safely used for sedation of both pig breeds with and without CI.Abbreviation: CI, cardiovascular injury and interventionPigs (Sus scrofa) are common models of cardiovascular injury and intervention (CI) that largely have replaced traditional canine cardiology models. Advantages of swine compared with dogs include anatomic and physiologic characteristics similar to humans, such as similar coronary artery distribution and effective collateralized blood flow to the myocardium after coronary artery blockage.²³ However, pigs are difficult to restrain and anesthetize due to their size and resistance to sedative drug combinations, including those with morphine.²⁴ Injectable sedative drugs may result in cardiovascular and respiratory effects such as increased cardiac work and oxygen consumption, tachycardia, bradycardia, apnea, hypertension, and hypotension.^{5,6,8-12,14,19,20,25-29} These side effects can pose considerable problems for CI pigs, and anesthesia protocols with minimal effects on cardiovascular function are needed. A literature review revealed no published studies of anesthetic protocols in swine with existing cardiovascular injury; published research is limited to investigating anesthesia protocols for experimental induction of CI or determining in vitro and in vivo drug effects on healthy cardiovascular systems.^{4-6,8-12,14,19-21,25-29} Other published studies have limited investigations to studying sedative and physiologic effects in healthy Yorkshire, Yucatan, mixed-breed, Landrace, and Gottingen miniature swine.^{2,3,10,13,17,18,20-22}We conducted the current study to address the need for a systematic investigation of anesthetic protocols in CI Yorkshire and Yucatan pigs. The goals of this study were to determine an injectable-only anesthetic protocol for both Yorkshire and Yucatan pigs that yielded sufficient sedation for peripheral vascular catheterization, sufficient duration for transport, and minimal cardiovascular effects while being safe and effective for CI pigs.     

Infra-red thermometry: the reliability of tympanic and temporal artery readings for predicting brain temperature after severe traumatic brain injury

Introduction

Temperature measurement is important during routine neurocritical care especially as differences between brain and systemic temperatures have been observed. The purpose of the study was to determine if infra-red temporal artery thermometry provides a better estimate of brain temperature than tympanic membrane temperature for patients with severe traumatic brain injury.

Methods

Brain parenchyma, tympanic membrane and temporal artery temperatures were recorded every 15–30 min for five hours during the first seven days after admission.

Results

Twenty patients aged 17–76 years were recruited. Brain and tympanic membrane temperature differences ranged from -0.8 °C to 2.5 °C (mean 0.9 °C). Brain and temporal artery temperature differences ranged from -0.7 °C to 1.5 °C (mean 0.3 °C). Tympanic membrane temperature differed from brain temperature by an average of 0.58 °C more than temporal artery temperature measurements (95% CI 0.31 °C to 0.85 °C, P < 0.0001).

Conclusions

At temperatures within the normal to febrile range, temporal artery temperature is closer to brain temperature than is tympanic membrane temperature.