Social Perceptions of Masculinity and Sexual Esteem Are Impacted by Viagra Use, Testosterone, and Sexual Performance.

Sexual behaviors play a role in the social construction of masculinity. Moreover, this stereotype has been capitalized upon by pharmaceutical companies, as well as those that sell products not approved by the U.S. Food and Drug Administration, for purposes of marketing sexual medicines. Stereotypical notions of masculinity, however, also emphasize the importance of self-reliance, which may cause some to look unfavorably upon the use of sexual medicine. Consistent with this notion, a male target was viewed as more masculine when his female partner consistently reached orgasm, unless he had no history of erectile dysfunction (ED), but was taking Viagra anyway (Experiment 1; N = 522). In addition, when his partner consistently reached orgasm, ratings of his sexual esteem were also lower if he used Viagra than if he did not, but only if he had no history of ED. In Experiment 2 (N = 711), although there was no effect of a male target's use of testosterone, social perception of his masculinity and sexual esteem increased as his "natural" levels of testosterone increased. In addition, exploratory analysis revealed that if the male target had low (but not normal or high) "natural" levels of testosterone, ratings of his masculinity were higher if his female partner consistently had an orgasm, which suggests that female orgasm served to "rescue" masculinity. Because expectations about drugs drive their use, it is important to address preconceived notions about the use of sexual medicines for purposes of enhancing masculinity and sexual esteem, as the social perception of their use is much more complex.

Sexual Motivation and Sexual Reward in Male Rats are Attenuated by the Gonadotropin-Releasing Hormone Receptor Antagonist Degarelix.

BACKGROUND: Preclinical studies that have examined the effects of androgen deprivation therapies (ADTs) on sexual outcomes have either relied on a surgical castration model of ADTs or have largely focused on consummatory sexual behaviors. AIM: The aim of this study was to examine the effects of a single administration of the gonadotropin-releasing hormone receptor antagonist, degarelix, on sexual incentive motivation (SIM), sexual reward, consummatory sexual behaviors, anxiety-like behavior, and androgen receptor signaling in male rats, and to determine if sexual stimulation attenuates the effects of degarelix on SIM. METHODS: Male rats were treated with degarelix, or vehicle, and half of the rats in each condition were briefly exposed to a sexually receptive female immediately before SIM trials (experiment 1). Rats treated with degarelix or vehicle were also given a sex-conditioned place preference test (experiment 2A), weekly mating tests (experiment 2B), and an elevated zero maze test (experiment 3). Androgen-sensitive tissues were excised upon completion of testing. OUTCOMES: SIM was indicated by the percentage of time spent near a sexually receptive female on the SIM tests. The percentage of time spent in the chamber of a conditioned place preference maze associated with sexual experience was indicative of sexual reward. The percentage of trials in which a mount, intromission, and ejaculation occurred was indicative of copulatory ability. Sexual performance was characterized by the average latencies to first exhibit these behaviors, as well as the average frequency of these behaviors. Anxiety-like behavior was indicated by the percentage of time in the open zones of an elevated zero maze. Relative weights of the seminal vesicles and bulbourethral glands were used to quantify androgen activity. RESULTS: Rats treated with degarelix exhibited lower levels of SIM. In rats treated with degarelix, contact with a female immediately before SIM testing increased activity, but not SIM. Treatment with degarelix reduced the rewarding aspects of sexual behavior, as well as most aspects of copulatory ability and sexual performance. Degarelix treatment reduced androgen signaling, but did not impact anxiety-like behavior. CLINICAL IMPLICATIONS: The behavioral side effects associated with the use of degarelix may be restricted to sexual behaviors. STRENGTHS & LIMITATIONS: Strengths include the objective measurement of sexual behaviors. The study is limited in that only one ADT was examined. CONCLUSION: These findings serve as an extension of previous preclinical studies as they indicate that gonadotropin-releasing hormone receptor antagonism in male rats also attenuates sexual motivation and sexual reward, in addition to copulatory ability and sexual performance. Hawley WR, Kapp LE, Green PA, et al. Sexual Motivation and Reward in Male Rats are Attenuated by the Gonadotropin-Releasing Hormone Receptor Antagonist Degarelix. J Sex Med 2021;18:240-255.

Primary Blast-Induced Changes in Akt and GSK3ß Phosphorylation in Rat Hippocampus.

Traumatic brain injury (TBI) due to blast from improvised explosive devices has been a leading cause of morbidity and mortality in recent conflicts in Iraq and Afghanistan. However, the mechanisms of primary blast-induced TBI are not well understood. The Akt signal transduction pathway has been implicated in various brain pathologies including TBI. In the present study, the effects of simulated primary blast waves on the phosphorylation status of Akt and its downstream effector kinase, glycogen synthase kinase 3ß (GSK3ß), in rat hippocampus, were investigated. Male Sprague-Dawley (SD) rats (350-400 g) were exposed to a single pulse shock wave (25 psi; ~7 ms duration) and sacrificed 1 day, 1 week, or 6 weeks after exposure. Total and phosphorylated Akt, as well as phosphorylation of its downstream effector kinase GSK3ß (at serine 9), were detected with western blot analysis and immunohistochemistry. Results showed that Akt phosphorylation at both serine 473 and threonine 308 was increased 1 day after blast on the ipsilateral side of the hippocampus, and this elevation persisted until at least 6 weeks postexposure. Similarly, phosphorylation of GSK3ß at serine 9, which inhibits GSK3ß activity, was also increased starting at 1 day and persisted until at least 6 weeks after primary blast on the ipsilateral side. In contrast, p-Akt was increased at 1 and 6 weeks on the contralateral side, while p-GSK3ß was increased 1 day and 1 week after primary blast exposure. No significant changes in total protein levels of Akt and GSK were observed on either side of the hippocampus at any time points. Immunohistochemical results showed that increased p-Akt was mainly of neuronal origin in the CA1 region of the hippocampus and once phosphorylated, the majority was translocated to the dendritic and plasma membranes. Finally, electrophysiological data showed that evoked synaptic N-methyl-d-aspartate (NMDA) receptor activity was significantly increased 6 weeks after primary blast, suggesting that increased Akt phosphorylation may enhance synaptic NMDA receptor activation, or that enhanced synaptic NMDA receptor activation may increase Akt phosphorylation.

The Effect of Underwater Blast on Aggregating Brain Cell Cultures.

Although the deleterious effects of primary blast on gas-filled organs are well accepted, the effect of blast-induced shock waves on the brain is less clear because of factors that complicate the interpretation of clinical and experimental data. Brain cell aggregate cultures are comprised of multiple differentiated brain cell types and were used to examine the effects of underwater blast. Suspensions of these cultures encased in dialysis tubing were exposed to explosive-generated underwater blasts of low (∼300 kPa), medium (∼2,700 kPa), or high (∼14,000 kPa) intensities and harvested at 1-28 days post-exposure. No changes in gross morphology were noted immediately or weeks after blast wave exposure, and no increases in either apoptotic (caspase-3) or necrotic (lactate dehydrogenase) cell death were observed. Changes in neuronal (neurofilament H, acetylcholinesterase, and choline acetyltransferase) and glial (glial fibrillary acidic protein, glutamine synthetase) endpoints did not occur. However, significant time- and pressure-related increases in Akt (protein kinase B) phosphorylation were noted, as well as declines in vascular endothelial growth factor levels, implicating pathways involved in cellular survival mechanisms. The free-floating nature of the aggregates during blast wave exposure, coupled with their highly hydrolyzed dialysis tubing containment, results in minimized boundary effects, thus enabling accurate assessment of brain cell response to a simplified shock-induced stress wave. This work shows that, at its simplest, blast-induced shock waves produce subtle changes in brain tissue. This study has mechanistic implications for the study of primary blast-induced traumatic brain injury and supports the thesis that underwater blast may cause subtle changes in the brains of submerged individuals.

High-Fidelity Simulation of Primary Blast: Direct Effects on the Head.

The role of primary blast in blast-induced traumatic brain injury (bTBI) is controversial in part due to the technical difficulties of generating free-field blast conditions in the laboratory. The use of traditional shock tubes often results in artifacts, particularly of dynamic pressure, whereas the forces affecting the head are dependent on where the animal is placed relative to the tube, whether the exposure is whole-body or head-only, and on how the head is actually exposed to the insult (restrained or not). An advanced blast simulator (ABS) has been developed that enables high-fidelity simulation of free-field blastwaves, including sharply defined static and dynamic overpressure rise times, underpressures, and secondary shockwaves. Rats were exposed in head-only fashion to single-pulse blastwaves of 15 to 30 psi static overpressure. Head restraints were configured so as to eliminate concussive and minimize whiplash forces exerted on the head, as shown by kinematic analysis. No overt signs of trauma were present in the animals post-exposure. However, significant changes in brain 2',3'-cyclic nucleotide 3'-phosphohydrolase (CNPase) and neurofilament heavy chain levels were evident by 7 days. In contrast to most studies of primary blast-induced TBI (PbTBI), no elevation of glial fibrillary acidic protein (GFAP) levels was noted when head movement was minimized. The ABS described in this article enables the generation of shockwaves highly representative of free-field blast. The use of this technology, in concert with head-only exposure, minimized head movement, and the kinematic analysis of the forces exerted on the head provide convincing evidence that primary blast directly causes changes in brain function and that GFAP may not be an appropriate biomarker of PbTBI.

Brief Report: Understanding Crisis Behaviors in Hospitalized Psychiatric Patients with Autism Spectrum Disorder--Iceberg Assessment Interview.

Children and adolescents with autism spectrum disorder (ASD) are at risk for emotional dysregulation and behavior problems that can escalate to levels requiring psychiatric hospitalization. Evaluating the etiology of such behaviors can be challenging for health care providers, as individuals with ASD can have difficulty self-reporting concerns. This brief report introduces the Iceberg Assessment Interview (IAI), a tool to organize and elucidate the assessment of issues potentially underlying problem behaviors. A summary of IAIs from a chart review of patients ages 5-18 with ASD (n = 23) admitted to a specialized psychiatric hospital unit illustrates the clinical utility of this tool. Summarized IAI data includes presenting crisis behaviors, caregiver-perceived environmental conditions, and underlying psychosocial and medical problems.

Medical students talking to hospice patients.

BACKGROUND: All newly qualified doctors will look after patients in the last stages of life. CONTEXT: This article is a review of the literature regarding medical students learning from hospice patients, focusing on practical concerns of relevance to those involved in organising or conducting medical student teaching. INNOVATION: Medical students have increasing opportunities to learn about palliative care from talking to patients in a hospice. This resource is not fully utilised, in part because of concerns about patient and student welfare. These concerns are not supported by current research findings, including a qualitative interview study of patients and staff. IMPLICATIONS: We would encourage course coordinators to use opportunities for medical students to talk to hospice patients in order to enhance the education of medical students.

The recognition and documentation of delirium in hospital palliative care inpatients.

OBJECTIVE: Delirium is a clinical syndrome that is known to be under recognized by palliative care teams. A wide variation in reported prevalence may reflect differences in definitions and assessment methods, patient characteristics, and study design. The aim of this study was to test an intervention to improve recognition of delirium in the inpatient palliative care setting. METHOD: We conducted a retrospective palliative care notes review of documented prevalence of delirium among 61 patients referred to the Specialist Palliative Care Advisory Team (SPCT). Subsequently, training in the use of the Confusion Assessment Method (CAM) was provided to the SPCT and a prospective survey of the prevalence of delirium measured by the CAM was undertaken with the next 59 patients referred. RESULTS: In the retrospective chart review, the term "delirium" was not used, and synonyms were identified and used to establish a delirium prevalence of 11.5%. In the intervention utilizing the CAM in a prospective sample of 59 referred patients, a prevalence rate of 8.5-15.2% for delirium was found. Use of the CAM was received favorably by the SPCT. SIGNIFICANCE OF RESULTS: The institution of the use of the CAM as a screening and assessment tool in the inpatient palliative care setting did not significantly increase the recognition of delirium. Reasons for the low prevalence of delirium are discussed.

Palliative care in multiple sclerosis and motor neurone disease.

The general physician can help patients and families living with advanced multiple sclerosis and motor neurone disease in a number of practical ways. The key areas requiring a palliative approach are the management of physical symptoms, psychosocial support, decisions around potentially life-prolonging treatments and end-of-life care.

Beneficial effect of autologous endometrial cell coculture in patients with repeated implantation failure.

OBJECTIVE: To confirm the beneficial effect of endometrial coculture in patients with repeated failures with assisted reproductive techniques (ART). DESIGN: Patients with previous failures were offered a repetition of ART in conjunction with autologous endometrial coculture. SETTING: Private fertility center. PATIENT(S): Sixty-eight couples who had attempted 92 cycles of IVF or intracytoplasmic sperm injection without obtaining an evolutive pregnancy. INTERVENTION(S): Patients repeated one cycle of ART with concomitant endometrial coculture of their embryos. MAIN OUTCOME MEASURES(S): Comparative pregnancy and delivery rates in conventional ART cycles vs. cycles with autologous endometrial coculture. RESULT(S): In the previous 92 cycles (146 ETs, fresh plus frozen) only 8 pregnancies were initiated, and all ended in spontaneous abortion. Upon repeating 68 cycles (76 ETs) using coculture, 39 pregnancies were obtained, of which 19 resulted in live births, 10 are ongoing evolutive pregnancies, and 10 ended in spontaneous abortions. CONCLUSION(S): These results confirm the usefulness of autologous endometrial coculture for the treatment of patients with repeated implantation failure.

Cell wall glycans and soluble factors determine the interactions between the hyphae of Candida albicans and Pseudomonas aeruginosa.

The fungus, Candida albicans, and the bacterium, Pseudomonas aeruginosa, are opportunistic human pathogens that have been coisolated from diverse body sites. Pseudomonas aeruginosa suppresses C. albicans proliferation in vitro and potentially in vivo but it is the C. albicans hyphae that are killed while yeast cells are not. We show that hyphal killing involves both contact-mediated and soluble factors. Bacterial culture filtrates contained heat-labile soluble factors that killed C. albicans hyphae. In cocultures, localized points of hyphal lysis were observed, suggesting that adhesion and subsequent bacteria-mediated cell wall lysis is involved in the killing of C. albicans hyphae. The glycosylation status of the C. albicans cell wall affected the rate of contact-dependent killing because mutants with severely truncated O-linked, but not N-linked, glycans were hypersensitive to Pseudomonas-mediated killing. Deletion of HWP1, ALS3 or HYR1, which encode major hypha-associated cell wall proteins, had no effect on fungal susceptibility.

Prenatal herpes simplex virus serologic screening beliefs and practices among obstetricians.

OBJECTIVE: To describe the beliefs and practices of obstetricians related to prenatal serologic testing for HSV infection. METHODS: A total of 265 (73% of eligible) currently practicing obstetricians in Washington State completed a 36-question mailed survey that assessed beliefs regarding genital herpes in pregnancy, neonatal herpes, serologic testing for herpes in pregnancy, and ease of testing. RESULTS: Ninety-five percent of respondents believed genital herpes was common in reproductive-aged women, 83% believed neonatal herpes was a serious health issue, and 73% believed it warranted systematic prevention efforts; 74% discussed herpes with pregnant patients as part of prenatal care, 31% provided written materials about herpes, and 15% used serologic tests for herpes in 75% or more of their prenatal patients. Factors independently associated with routine herpes serologic testing were academic practice setting (adjusted odds ratio [aOR] 10.4, 95% confidence interval [CI] 2.8-39.1) and metropolitan practice setting (aOR 3.3, 95% CI 1.4-7.9). Beliefs that testing would cause unnecessary distress in pregnancy (aOR 0.3, 95% CI 0.1-0.7), or that testing was not worth the expense (aOR 0.1, 95% CI 0.0-0.6) were associated with not testing. Availability of serologic tests for HSV was reported to be high and was not associated with prenatal HSV testing. CONCLUSION: Most obstetricians believe neonatal herpes prevention is important. LEVEL OF EVIDENCE: II.

Regiospecificity profiles of storage and membrane lipids from the gill and muscle tissue of Atlantic salmon (Salmo salar L.) grown at elevated temperature.

Regiospecific and traditional analysis, of both storage and membrane lipids, was performed on gill, white muscle, and red muscle samples taken from Atlantic salmon (Salmo salar) to gauge the effect of elevated water temperature. The fish, fed a commercial diet, were held at an elevated water temperature of 19 degrees C. Total n-3 PUFA, total PUFA, and n-3/n-6 and unsaturated/saturated fatty acid (UFA/SFA) ratios in the FA profile of the total lipid extract in the white muscle were fairly low compared with fish grown at 15 degrees C. Adaptation of structural and storage lipids at elevated temperatures was shown by a significant (P < 0.01) reduction in PUFA especially in the percentage of EPA (6-8%). Further adaptation was indicated by the percentages of SFA, which were significantly (P< 0.05) higher in gill (56%) and white muscle (58%) polar lipid fractions and coincided with lower percentages of n-3, n-6, and total PUFA. The regiospecific profiles indicated a high affinity of DHA to the sn-2 position in both the TAG (61-68%) and polar lipid (35-60%) fractions. The combination of detailed regiospecific and lipid analyses demonstrated adaptation of cell membrane structure in Atlantic salmon grown at an elevated water temperature.