Tadalafil in the treatment of erectile dysfunction; an overview of the clinical evidence

Prevalence and severity of erectile dysfunction (ED) increase with aging and are often associated with illnesses, like diabetes mellitus, heart disease, and hypertension, pathologically characterized by endothelial dysfunction and whose prevalence increases with age. The assumption that ED is mainly a neurovascular disease is supported by the evidence that specific phosphodiesterase type 5 (PDE5) inhibition produces an efficient erection in a wide range of ages and conditions. The availability of specific PDE5 inhibitors has enabled the development of effective treatment strategies, in this contest, tadalafil may be considered as the least “typical” PDE5 inhibitor. In clinical trials, tadalafil significantly enhanced, in patients of different ages, all efficacy outcomes across disease etiologies and severities. With an effectiveness lasting up to 36h, tadalafil allows patients to choose when to have sexual activities without the need to time it, showing positive feedback in terms of quality of life related to the treatment. Headache and dyspepsia were the most frequent side-effects of tadalafil, followed by back pain, nasal congestion, myalgia, and flushing, but the impact that long time action could have on effectiveness and safety is not yet entirely defined. The aim of this article is to critically review the available evidence from the tadalafil clinical research program and give the physician a rational approach for intervention in the treatment of ED and related diseases.     

杜仲对糖尿病大鼠扑捉行为和阴茎组织神经传导通路的影响

目的:探讨杜仲改善勃起功能的药效和病理学机制。方法:雄性糖尿病(DM)大鼠30只随机分为3组:A组(10只,DM大鼠赋形剂灌胃组)、B组(10只,DM大鼠西地那非灌胃组)、C组(10只,DM大鼠杜仲灌胃组)及10只正常对照组大鼠(赋形剂灌胃,D组);灌胃4周后观察4组大鼠扑捉行为,透射电镜检查阴茎组织有髓神经纤维超微特征;用免疫组化二步法显示阴茎组织中神经元型一氧化氮合酶(nNOS)的表达。结果:与A组比较,C组大鼠扑捉次数显著增多(P<0.05),阴茎组织中nNOS表达显著增强(P<0.001)。透射电镜显示:A组大鼠阴茎组织有髓神经纤维排布失序,部分变性、板层分离形成透明空泡或网络状,C组大鼠有髓神经纤维排列规整,板层结构清晰。结论:杜仲可通过减轻有髓神经的损伤、增强阴茎组织中nNOS表达改善ED。     

Influence of the mother-child relationship on the development of the Type A Behavior Pattern

Investigation of the Type A Behavior Pattern (TABP) of pre-school children was conducted to determine the influence of the mother-child relationship on the development of TABP. The incidence of TABP was 44.2% (51.7% in boys and 38.7% in girls). The TABP tendency of the boys decreased as the manifest dissension or conflict in the family grew, in marked contrast with the tendency seen in girls, suggesting that conflict in the family can either weaken or reinforce TABP.     

Health and illness behavior and patient-practitioner relationships

Health is a product of culture and social structure. The routine organization and constraints of everyday settings shape our health. Socio-economic status is of major importance in determining exposure to disease risk and in shaping health and illness behavior responses. Lay explanations of illness affect illness appraisal, self-treatment, decisions to seek care and changes in daily regimen. Somatization of psychosocial stressors is a common concern in primary care systems throughout the world, and doctors are commonly frustrated by such patients. Somatizing patients are often enmeshed in environments of great psychosocial difficulty or are depressed, and many cultural and social factors affect how depression is expressed. Although depression has devastating disabling effects on patients, it is often neither recognized by doctors nor treated. But doctor-patient relationships are often the context for appropriate management of such problems, and how they are handled affect the future trajectory of illness and disability. Doctors' responses are conditioned by their attitudes, training, interviewing and psychosocial skills, and organizational and financial factors. Patient flow is an important intervening variable affecting the management of psychosocial difficulties and depression.     

Control of feeding and sexual behaviors by neuropeptide Y: physiological implications

Recent evidence suggests that a variety of hypothalamic neuropeptides may mediate interneuronal communication to coordinate diverse neuroendocrine and behavioral functions. In this work, we describe the effects of neuropeptide Y (NPY) on feeding and sexual behaviors. We observed that central administration of bolus NPY stimulated a robust, dose-related feeding response in satiated male and female rats. Continuous NPY receptor activation also evoked dose-related, intermittent feeding in a manner normally observed during nocturnal feeding. It appears that the paraventricular nucleus in the hypothalamus may be the primary site of NPY action because the anticipated reciprocal changes in NPY concentrations, in response to food deprivation followed by ad libitum food intake, occurred only in this site. Additional findings revealed that NPY-induced feeding may follow either substantial reduction or complete restraint of an inhibitory influence on feeding mediated by alpha 2-adrenoreceptor systems in satiated rats. Further, NPY was found to suppress male and female sexual behaviors. The suppressive effects on sexual behavior were apparent prior to or at the time of the onset of feeding after NPY administration. These observations may provide a neurochemical basis for clinical and animal studies on disorders of feeding associated with diminished reproductive functions.     

Reversal of dexfenfluramine-induced anorexia and c-Fos/c-Jun expression by lesion in the lateral parabrachial nucleus

The external subdivision of the lateral parabrachial nucleus (LPBE) shows strong Fos-like immunoreactivity (FLI) following anorectic doses of the indirect serotonin agonist dexfenfluramine (DFEN). In an effort to determine the contribution of the LPBE to DFEN-induced anorexia, bilateral ibotenate lesions were made in the LPBE, and the effects of the lesion on DFEN-induced anorexia and FLI as well as c-June-like immunoreactivity (JLI) were examined. It was found that LPBE lesion significantly attenuated DFEN anorexia: in a 1-h food intake test following 24-h food deprivation, DFEN (2 mg/kg) suppressed food intake by 60% in intact rats but only 34% in rats with LPBE lesions. In addition to this behavioral change, LPBE lesion completely abolished DFEN-induced FLI and JLI in the lateral subdivision of the central nucleus of the amygdala (CeL) and laterodorsal subdivision of the bed nucleus of stria terminalis (BSTLD), both of which showed strong FLI and JLI in intact rats. DFEN-induced FLI and JLI in other brain regions were not affected by LPBE lesion, including the ventromedial and lateral hypothalamus, caudate-putamen, and the nucleus of the solitary tract (NST). The parallel loss of DFEN-induced anorexia and FLI/JLI following LPBE lesion raises the novel possibility that LPBE-CeL/BSTLD pathway may be involved in DFEN anorexia.     

Use of the Child Behavior Checklist in an Israeli adolescent psychiatric unit

This article deals with the Hebrew version of an instrument for the diagnosis of psychopathology in young adolescents: the Child Behavior Checklist and the associated Child Behavior Profile developed by Achenbach (1978). We report on a study of the reliability and validity of the checklist and its suitability for use with severely disturbed adolescents in Israel. Parents of 130 adolescents, 89 healthy and 41 sick, participated in the research. The scales were found to be valid in that two-thirds of the items were correctly assigned by clinicians in Israel to their respective scales; it is internally consistent as measured by the Cronbach coefficient; and it is reliable in distinguishing between patient and control groups. Scores for control adolescents in Israel were found to be very similar to norms in the United States, the Netherlands and Chile. This finding may have important implications for cross-cultural research.     

Changes in the mouthful weights of familiar foods with age of five years,eight years and adults

For effective mastication and swallowing, to take optimum mouthful food regularly is necessary. The purpose of this study is to compare the weights and the variance of a mouthful food between children and adults. We studied mouthful weight and the coefficient variation in 5-year-old children (n = 10), 8-year-old children (n = 10) and adults (n = 10) while they were eating rice, bread, sausage and apple on two different days. The test foods were served in random order 2–4 hours after lunch. Each portion was weighed before and after each bite to measure the mouthful weight, and the weight of the last bite of each portion was eliminated from the data. The mean weight and coefficient variation in each subject were calculated. The results showed the mean weight was largest in the adults, intermediate in the 8-year-old children, and smallest in the 5-year-old children for all test foods (ANOVA). Moreover, the mean coefficient variation among the weights of the groups revealed that mouthful weight within an individual varied most widely in the 5-year-old children and most narrowly in the adults, and that 8-year-old children could show the same coefficient variation of mouthful weight as adults in rice and apple (Steel-Dwass test). Our results suggest that mouthful weight becomes larger and more regularly with age.     

Intracerebroventricular LHRH relieves behavioral deficits due to vomeronasal organ removal

Contact between the sexes in many species is known to produce hormonal changes in the male [increases in serum luteinizing hormone (LH) and/or testosterone] that can be interpreted as due to an intracerebral release of LH-releasing hormone (LHRH). In some circumstances, these hormonal changes appear to depend on an intact vomeronasal sensory system. Exogenous LHRH is also known to facilitate mating behavior in several species. We show here that LHRH delivered into the cerebral ventricles can restore some mating behavior lost when the vomeronasal organs are removed from sexually inexperienced male hamsters. The results are consistent with our working hypothesis that intracerebral LHRH release is an intermediate in the facilitation of mating behavior by vomeronasal sensory input.     

岳麓区小学中高年级学生问题行为调查

目的 了解小学生早期问题行为的发生与发展，为开展相关教育提供帮助。方法 采用《问题儿童早期发现测验》(PPCT)对长沙市岳麓区部分小学四～六年级学生146名进行调查。结果 146名学生中，有20名(13．70％)存在不同程度的问题行为，男生的问题行为较女生更多，六年级学生出现的问题行为更严重。结论 小学中高年级学生问题行为的产生与其身心发展的不均衡、自控力下降以及所处环境的影响有关。