[Screening and evaluation of core prescriptions for impotence based on network robustness and data mining].

This study aims to explore and analyze ancient proven prescriptions and famous physician cases for treating impotence, so as to obtain the core prescriptions for traditional Chinese medicine(TCM) treatment of impotence. It further selected and evaluated these core prescriptions to provide a demonstration for the development of new drugs for advantageous diseases treated with TCM. Through the retrieval of ancient proven prescriptions and famous physician cases for treating impotence, a database of prescriptions for treating impotence was established, and the TCM inheritance computational platform was used to explore and analyze the medication patterns of these proven prescriptions and famous physician cases. Based on the TCM efficacy prediction platform of network robustness, the interference scores of core prescriptions in the ancient proven prescriptions and famous physician cases were calculated and analyzed. On this basis, the results of ancient proven prescriptions, famous physician cases, and computational analysis were comprehensively evaluated to determine the development priority level of the core prescriptions obtained through clustering. The results revealed that medicines in the ancient proven prescriptions and famous physician cases primarily aimed at tonifying deficiency, promoting blood circulation, eliminating blood stasis, clearing heat, and resolving external symptoms, with a particular focus on warm-natured and sweet-flavored medicines associated with the spleen, liver, kidney, and lung meridians. The core prescriptions obtained from the clustering analysis of ancient proven prescriptions and famous physician cases indicated that ancient proven prescriptions combination 1 had the most perturbing effect on the disease network as determined by network robustness analysis. A comprehensive evaluation indicated that prescription combination 1 had the most optimal development potential. TCM treatment for impotence focused on regulating the functions of the spleen, liver, kidney, and lung, aiming to tonify deficiency, with heat-clearing, blood-activating, stasis-resolving, and exterior-releasing medications supplemented. The obtained ancient proven prescriptions combination 1 exhibited the highest potential development value. The integrated strategy of "ancient proven prescriptions-famous physician cases-computational analysis" can be utilized to screen candidate TCM new drug prescriptions.

Unconsummated marriage: a systematic review of etiological factors and clinical management.

BACKGROUND: Unconsummated marriage (UCM) is the inability of the heterosexual married couple to have penovaginal sexual intercourse. AIM: The study sought to systematically review current evidence regarding the etiological factors and clinical management of UCM. METHODS: A comprehensive bibliographic search on the MEDLINE, Scopus, Web of Science, and Cochrane Library databases was performed in June 2023. Studies were selected if they described married couples who never had sexual intercourse in case report or case series evaluating the related causes and/or management and reporting data with qualitative, quantitative, or mixed methods. The review was reported according to PRISMA (Preferred Reporting Items for Systematic Review and Meta-analyses) statement and registered in PROSPERO with ID CRD42023433040. RESULTS: A total of 27 studies including 1638 males and 1587 females were selected. Eight (29.6%) articles were case reports involving a single couple and 19 (70.4%) studies were case series. Mean Murad score was 4.1 (range, 1-8) showing low-intermediate overall study quality. All articles had a level of evidence of 4. Most of studies were conducted in Egypt (n = 5 [18.4%]), Israel (n = 4 [14.9%]), and the United States (n = 4 [14.9%]). The mean age of males and females varied between 24.2 and 37.6 years and from 21 to 27.4 years, respectively. The reasons for the medical visit that led to the diagnosis of UCM were inability to consummate in 23 (85.2%) studies, inability to conceive in 1 (3.7%) article, and mixed in 3 (11.1%) articles. The mean duration of UCM varied from 7 days to 3.5 years. Eight studies involving both men and women showed that vaginismus (8.4%-81%) and erectile dysfunction (10.5%-61%) were the most common causes of UCM. Three articles reported that 16.6% to 26% of all UCM cases were due to both male and female factors. Sildenafil, tadalafil, intracavernosal injection, penile plication, female genital reconstructive surgery, vaginal dilators, lubricants, psychosexual therapy, and sex education were the various treatment modalities in 27 studies to achieve consummation rate of 66.6% to 100%. STRENGTHS & LIMITATIONS: A strength is that this is the first systematic review covering the entire spectrum of UCM. Limitations comprised the low quality of most of the included articles and the large percentage of UCM cases probably not published. CONCLUSION: Erectile dysfunction and vaginismus are the most reported causes of UCM; however, a strong psychological component certainly underlies a significant number of cases. A multidisciplinary approach based on strategic integration of sex education, medical therapy, psychosexual support, and surgical treatment would seem the most suitable option to manage couples with UCM.

Conservative Non-surgical Options for Erectile Dysfunction.

PURPOSE OF REVIEW: This study aimed to review recent evidence on conservative non-surgical options for erectile dysfunction (ED) in men. A narrative review of the literature was performed. A comprehensive search in the MEDLINE, Embase, and Cochrane databases was done. Papers in English language, published from May 2017 until May 2022, were included. Papers reporting basic research or animal research were excluded, as long as reviews or meta-analyses. Congress reports, clinical cases, or clinical trials protocols with no results were also excluded. RECENT FINDINGS: We found a multitude of different treatment modalities for ED. We must take into account the type of patient, their comorbidities, the origin of their ED, and its severity in order to reproduce effective results using these therapies. Some of the treatments show good results with a good level of evidence (new IPDE5 formulations, intracavernous injections, shock wave therapy, hormonal theraphy, psycho-sexual theraphy). However, others (some new molecules, stem cell theraphy, platelet-rich plasma injections, oxygenation-based therapy, nutraceuticals), although some of them present promising results, require randomized studies with a larger number of patients and a longer follow-up time to be able to establish firm recommendations. Regarding the conservative treatment of erectile dysfunction, in recent years, some therapies have been consolidated as effective and safe for certain types of patients. On the other hand, other treatment modalities, although promising, still lack the evidence and the necessary follow-up to be recommended in daily practice.

[Exploration of erectile dysfunction syndrome and syndrome differentiation based on latent structure].

OBJECTIVE: In order to exploring Erectile Dysfunction(ED) syndrome and syndrome differentiation based on latent structure to provide objective evidence to support Traditional Chinese Medicine(TCM) dialectic. METHODS: Cases and clinical experience in the treatment of erectile dysfunction in Chinese medicine in CNKI, Wanfang Database, cqVIP Database, were searched. Time from the database construction to January, 2023. Extraction and specification of symptom data with reference to national standards. Lantern 5.0 software was used to make the latent structure of the data based on LTM-EAST method. Latent probability, conditional probability, information coverage, mutual information and other data were combined to manually interpret the model and perform clustering analysis on the latent classes to analyze the symptomatic features and clinical evidence of erectile dysfunction and establish the rules of identification. RESULT: A total of 361 cases of erectile dysfunction were included, 21 latent variables were constructed, 9 comprehensive clustering models and 13 discriminative rules were established. The pathological factors of the obtained erectile dysfunction are dampness, heat, yin deficiency, blood stasis, spleen deficiency, kidney deficiency, liver depression, and qi stagnation. The certificate types are stasis of blood, liver qi stagnation, damp-heat entrapment (dampness is heavy, heat is heavy, damp-heat is heavy), yin deficiency (yin deficiency with heat, kidney yin deficiency), vital fire failure, qi deficiency (qi deficiency with heat, kidney qi deficiency), heart and spleen deficiency, panic injury to kidney, spleen and kidney deficiency. CONCLUSION: The common types of erectile dysfunction obtained are generally consistent with existing guidelines, but more subcategories exist in the certificate type. The presence of symptoms that cannot be well matched in some of the certificate types is presumed to be due to the complex pathogenesis of erectile dysfunction common compound evidence, many evidence models are seen in the main symptoms of liver qi stagnation evidence pulse strings, suggesting that clinical treatment should pay attention to the regulation of emotional and moral, to ease the patient's emotions. The corresponding dialectical rules can quantify the dialectical criteria and provide an objective basis for non-TCM professionals to clinically determine the TCM evidence type of patients.

Difficulties in Combining Somatic and Psychiatric Care in Psychogeriatry.

BACKGROUND: This article attempts to understand the difficulties encountered in the articulation of health care, particularly between the organic and psychiatric aspects. It also aims to provide solutions to these collaboration issues. METHODS: We realized a literature review based on articles dated from 2002 to 2021 and selected from following databases: Pubmed, Cochrane, Scopus, Cairn, Psychinfo and Google. Used key words are "aging, multidisciplinarity, psychiatric stigma, impotence, efficiency". RESULTS: Medical staff may encounter different problems in terms of care, faced to psychogeriatricpatients.These are both related to the medical aspect, including the difficulty of establishing a clear diagnosis in the face of a complex medical situation,clinical unknownledge, multiplication of intervenants with loss of centralisation in terms of care, etc. Added to this, is the organization of health care, which is increasingly specialized and restrictive in terms of hospitalization criteria. Finally to this, is the relational experience of the caregiver, both in relation to the patient and his disorders, and to their colleagues. CONCLUSION: In the era of the advent of medicinal progress and the advance of diagnostic and therapeutic techniques, it seems mandatory to place the human being at the center of our care. Interhuman interactions constituting the basis of medical care especially in terms of transdisciplinary collaboration. This last point could lead to cost reduction, a more efficient diagnostic and therapeutic management. It seems to be mandatory to reinforce our health care politics in order to time and importance to these various essential and fundamental relational issues.

GWAS Identifies Risk Locus for Erectile Dysfunction and Implicates Hypothalamic Neurobiology and Diabetes in Etiology.

Erectile dysfunction (ED) is a common condition affecting more than 20% of men over 60 years, yet little is known about its genetic architecture. We performed a genome-wide association study of ED in 6,175 case subjects among 223,805 European men and identified one locus at 6q16.3 (lead variant rs57989773, OR 1.20 per C-allele; p = 5.71 × 10-14), located between MCHR2 and SIM1. In silico analysis suggests SIM1 to confer ED risk through hypothalamic dysregulation. Mendelian randomization provides evidence that genetic risk of type 2 diabetes mellitus is a cause of ED (OR 1.11 per 1-log unit higher risk of type 2 diabetes). These findings provide insights into the biological underpinnings and the causes of ED and may help prioritize the development of future therapies for this common disorder.

The Impact of Abstinence From Alcohol on Erectile Dysfunction: A Prospective Follow up in Patients With Alcohol Use Disorder.

BACKGROUND: There is a compelling evidence for the relation between alcohol use and erectile dysfunction (ED), however the impact of alcohol abstinence on improvement of ED is explored sparsely. AIM: This study aimed to determine the impact of alcohol abstinence on ED. The association between total duration of drinking, the quantity of alcohol consumed, sociodemographic, clinical variables and ED were also studied. METHODS: One hundred and four subjects with alcohol use disorder and complaints of ED meeting the inclusion and exclusion criteria were recruited into the study after taking written informed consent. The subjects were assessed at baseline and after 3 months of abstinence from alcohol with IIEF-5 and a specially designed pro forma. Wilcoxon signed rank test was used to assess the change in ED after 3 months of abstinence. Chi square test was done to assess the associations and binary logistic regression was done to determine the significance of variables after 3 months of abstinence. OUTCOMES: Improvement in ED after 3 months of abstinence from alcohol and its association between socio demographic and clinical variables were assessed. RESULTS: Of the 104 subjects studied, 88.5% (92) showed improvement in ED after 3 months of abstinence from alcohol. Wilcoxon signed rank test showed that the improvement in ED after 3 months of abstinence was significant. (Z = 8.708, P < .001). Significant association was found between age, alcoholic liver disease, total duration of drinking, and number of standard drinks per day with ED after 3 months of abstinence. CLINICAL IMPLICATIONS: Information that ED will improve with abstinence from alcohol can be used in deaddiction treatment to provide a motivation for change. STRENGTH AND LIMITATIONS: This study aims to fill the gap in literature as only a few studies have examined the impact of abstinence from alcohol on ED. The main limitations of this study are short follow up period and since this study was conducted in a tertiary care hospital it could have given rise to Berksonian bias. CONCLUSION: Results indicate that ED shows improvement with abstinence from alcohol. Absence of alcoholic liver disease, younger age, shorter duration of drinking, lesser number of standard drinks per day had a significant influence in the improvement of ED with alcohol abstinence and this information can be beneficial in treatment to provide an impetus for change. Karunakaran A., Michael J. P. The Impact of Abstinence From Alcohol on Erectile Dysfunction: A Prospective Follow up in Patients With Alcohol Use Disorder. J Sex Med 2022;19:581-589.

"What can I possibly do?": White individual responsibility for addressing racism as a public health crisis.

What responsibilities do individuals have when it comes to combating large-scale public health crises such as racism? A seductive argument borrowed from the climate ethics literature suggests that focusing on individual morality for a structural problem such as racism is at best unhelpful and at worst actively harmful. In response, we argue that individuals have good moral reasons to modify their own behaviors to help in the fight against large, structural public health emergencies in general, and that the public health crisis of racism, in particular, demands heightened moral responsiveness from individual white people to resist white supremacy. The moral reasons that support white engagement in antiracist work extend above and beyond those regarding individual involvement in the fight against other collectively created public health challenges. Our conclusions help to defend the claim that racial literacy and antiracist education aimed at individuals are vital.

Role of shear wave elastography (SWE) in erectile dysfunction patients for evaluation of daily tadalafil treatment outcome.

The purpose of this study was to evaluate and anticipate the outcome of daily use of tadalafil in patients with erectile dysfunction using elastography. 183 volunteers and 183 patients with erectile dysfunction were included. Pretreatment SWE readings for our patients were calculated with a linear probe. IIEF score Q was measured once at the start of the study for volunteers and twice for patients, one prior to the start of tadalafil administration and the other on one year of 5 mg daily tadalafil after the second post-washout (one month post-treatment stopped). There was no significant difference between patients and volunteers in mean age or risk factors except in SWE values as mean SWE of volunteers was 14.03 ± 1.54 kpasc, while mean SWE of patients was 21.278 ± 8.228 kpasc. The presence of comorbid diabetes, severe disease and pre-SWE ≥23.635 was significantly associated with poor outcome. We conclude that penile SWE could be useful to select probable good responders for a continuous tadalafil use, thus avoiding the unnecessary cost and time in non-responders.

Erectile dysfunction: causes, assessment and management options.

Erectile dysfunction is one of the most common male sexual dysfunctions. The diagnosis can usually be made by a detailed history and examination. Men with erectile dysfunction benefit from multimodal management strategies. These include lifestyle modification, medical treatment and psychosexual counselling and therapy. An oral phosphodiesterase-5 inhibitor is often prescribed for erectile dysfunction. Providing simple and clear instructions is critical to realise the full benefits of these drugs. Those with severe vascular disease or a history of pelvic surgery may not respond to phosphodiesterase-5 inhibitors. Anxiety or unrealistic expectations can also result in a poor response.

Indeterminacy and impotence.

Recent work in applied ethics has advanced a raft of arguments regarding individual responsibilities to address collective challenges like climate change or the welfare and environmental impacts of meat production. Frequently, such arguments suggest that individual actors have a responsibility to be more conscientious with their consumption decisions, that they can and should harness the power of the market to bring about a desired outcome. A common response to these arguments, and a challenge in particular to act-consequentialist reasoning, is that it "makes no difference" if one takes conscious consumption action or not - that one is "causally impotent" to change an outcome. In this paper, I break causal impotence objections into three distinct lines of argument and present causal indeterminacy as a third, unexplored variation of much more common causal impotence lines. I suggest that the causal indeterminacy argument presents additional challenges to consequentialist moral theory because it acknowledges that individual actions can have an impact on outcome, but suggests instead that the outcome can neither be known nor secured by the action itself.

Erectile Dysfunction and Decreased Libido in Klinefelter Syndrome: A Prevalence Meta-Analysis and Meta-Regression Study.

BACKGROUND: Only few studies have assessed sexual dysfunction in men with Klinefelter syndrome (KS). AIM: To define pooled prevalence estimates and correlates of erectile dysfunction (ED) and decreased libido (DL) in KS. METHODS: A thorough search of Medline, Embase and Web of Science was performed to identify suitable studies. Quality of the articles was scored using the Assessment Tool for Prevalence Studies. Data were combined using random effect models and the between-studies heterogeneity was assessed by the Cochrane's Q and I2. The sources of heterogeneity were investigated by meta-regression and sub-group analyses. Funnel plot, Begg's rank correlation and trim-and-fill test were used to assess publication bias. MAIN OUTCOME MEASURE: The pooled prevalence of ED and DL in KS as well as 95% confidence intervals (CIs) were estimated from the proportion of cases of sexual dysfunction and the sample size. Variables that could affect the estimates were identified by linear meta-regression models. RESULTS: Sixteen studies included collectively gave information about ED and DL in 482 and 368 KS men, respectively, resulting in a pooled prevalence of 28% (95% CI: 19%-36%) for ED and 51% (95% CI: 36%-66%) for DL, with a large heterogeneity. The trim-and-fill adjustment for publication bias produced a negligible effect on the pooled estimates. At the meta-regression analyses, a higher prevalence of ED was significantly associated with an older age but not with lower testosterone levels. In series with a mean age >35 years, the ED prevalence estimate increased up to 38% (95% CI: 31%-44%) with no heterogeneity (I2=0.0%, P=0.6). On the contrary, the prevalence of DL increased significantly as testosterone levels decreased, without a significant relationship with age. CLINICAL IMPLICATIONS: While DL would largely reflect an androgen deficiency, in older men with KS, erectile function should be assessed irrespective of testosterone levels. STRENGTH & LIMITATIONS: This is the first meta-analysis defining pooled prevalence estimates and correlates of ED and DL in KS. Nevertheless, caution is required when interpreting results, due to the high risk of bias in many studies, as well as the dearth of data about psychosocial and/or psychosexological variables and age at the diagnosis. CONCLUSIONS: ED and DL represent common clinical complaints in KS. While the prevalence of ED would increase with age, DL gets more common as serum testosterone decreases. Further studies are warranted to elucidate the pathogenetic mechanism(s) underlying the age-dependent increase in the prevalence of ED, apparently unrelated to the androgenic status. A Barbonetti, S D'Andrea, W Vena, et al. Erectile Dysfunction and Decreased Libido in Klinefelter Syndrome: A Prevalence Meta-Analysis and Meta-Regression Study. J Sex Med 2021;18:1054-1064.

Erectile Dysfunction Resistant to Medical Treatment Caused by Cavernovenous Leakage: An Innovative Surgical Approach Combining Pre-operative Work Up, Embolisation, and Open Surgery.

OBJECTIVE: Thirty per cent of cases of erectile dysfunction (ED)/male impotence are resistant to oral treatment. Half of these cases are due to blood drainage from the corpora cavernosa occurring too soon, due to cavernovenous leakage (CVL). The aim of this study was to report on an innovative treatment scheme combining pre- and post-operative haemodynamic assessment, venous embolisation, and open surgery for drug resistant ED caused by CVL. METHODS: An analysis of prospectively collected data, with clinical and haemodynamic pre- and post-operative assessment, was carried out. Forty-five consecutive patients operated on for drug resistant ED caused by CVL were evaluated pre-operatively and three months post-operatively by pharmacologically challenged penile duplex sonography (PC-PDS), pharmacologically challenged Erection Hardness Score (PC-EHS), and pharmacologically challenged computed caverno tomography (PC-CCT). Follow up consisted of patient interview, PC-PDS, PC-EHS and if needed PC-CCT. RESULTS: Mean patient age was 43.9 ± 12.0 years (range 20-67). Forty-nine per cent of patients had primary ED. Patients with diabetes, a smoking habit, hypercholesterolaemia, and hypertension were 18%, 11%, 9%, and 4%, respectively. Three months post-operatively, PC-EHS increased from 2.0 ± 0.7 to 3.1 ± 0.74 (p < .001), with an EHS of 3 being the threshold allowing for penetration. Deep dorsal vein velocity, a haemodynamic marker of CVL, decreased from 14.2 ± 13.0 to 0.9 ± 3.5 cm/s (p < .001). After a 14.0 ± 10.7 month follow up, the primary success rate (clinical EHS ≥ 3, possible sexual intercourse with penetration, no vascular re-operation, no penile prosthesis implant) was 73.3%. Four patients (9%) underwent successful re-operation for persistent ED and CVL. Accordingly, compared with a possible penetration rate of 8.9% before surgery, 37 patients (secondary success rate: 82.2%) were able to achieve sexual intercourse with penetration. Type of ED (primary vs. secondary) and diabetes had no influence on the results. Thirty-two per cent of patients with secondary success achieved penetration with no medication. CONCLUSIONS: After a 14 month follow up, pre-operative work up, embolisation, and open surgery during the same procedure allowed patients with ED resistant to oral medical to achieve intercourse with penetration.

Whether Adding Vitamin D to Tadalafil 5 mg Treatment Is Useful in Patients with Erectile Dysfunction and Vitamin D Deficiency?

INTRODUCTION: Numerous factors such as endothelial disease and hormonal disorder cause the development of erectile dysfunction (ED). However, the relationship between vitamin D deficiency (VDD) and ED is unclear. Moreover, the benefit of vitamin D replacement on ED patients with VDD is uncertain. As far as we know, there is no study yet in the literature regarding the addition of vitamin D to phosphodiesterase type 5 inhibitors in the treatment of ED patients with VDD. In this study, we investigated whether adding vitamin D to daily tadalafil treatment would be beneficial in ED patients with VDD. METHODS: A total of 111 patients with VDD accompanying ED were retrospectively evaluated between January 2016 and December 2019. Patients were divided into 2 groups according to the treatment they received. Group 1 (n = 58) was treated with daily oral tadalafil 5 mg, while group 2 (n = 53) received oral tadalafil 5 mg and 4,000 IU vitamin D3. Total International Index of Erectile Function-15 (IIEF-15) scores and vitamin D levels of the groups were compared at the end of the study. RESULTS: The mean vitamin D level was increased statistically significant in group 2, but no difference was seen in group 1 (p < 0.001 and p > 0.05, respectively). There was a significant increase in median erectile function, orgasmic function, sexual desire, sexual satisfaction, and overall satisfaction scores in both groups (p < 0.001). However, the increase in median erectile function and sexual desire scores was significantly higher in group 2 compared to group 1 at the end of the study (p = 0.01 and p < 0.001, respectively). CONCLUSION: We found that adding vitamin D to 5 mg oral daily tadalafil treatment may have an additional positive effect on erectile function and sexual desire in ED patients with VDD.

Psychoda albipennis myiasis as a rare cause of erectile dysfunction: A case report.

Urogenital myiasis occurring with the settlement of fly larvae of the order Diptera is facultative and is rarely encountered in humans. This study presents a case of urogenital myiasis caused by Psychoda albipennis in a 42-year-old male patient. The patient was admitted to our hospital with complaints of groin pain, pollakuria and erectile dysfunction and claimed that he saw motile larvae in his urine. Three larvae were collected from the patient's urine, microscopically examined and identified as fourth-stage larvae of P. albipennis. The patient's complaints ceased after the application of an antibiotic and urinary antiseptic. It was concluded that myiasis should be considered in patients with urogenital complaints.

Complete study for erectile dysfunction (CompED) improving diagnosis and treatment decision-making.

Erectile dysfunction is a condition associated with increasing age. Patient evaluation and management should follow a comprehensive, stepwise approach. The aim of this article was to report our experience with the complete study for erectile dysfunction, including intracavernous injection rigidity test, biothesiometry and colour duplex Doppler ultrasound. Data were collected and analysed prospectively. The primary end point was to determine whether treatment decision-making was eased by the CompED test. Secondary end points were to establish which clinical variables prior to the study could impact the results of the CompED test, to finally improve patient selection for the study. 187 patients were recruited, 31.2% of the patients had an axial rigidity below 50%, 28.5% had a peak systolic velocity <25 cm/s, 13.2% had an end-diastolic velocity >5cm/s and 27.5% had an abnormal biothesiometry. The factors that best predicted an abnormal result in any of the tests were age >70 years, IIEF domain A < 14 points, and previous radical prostatectomy or radiotherapy. The CompED test stands as a new alternative for the evaluation of patients with erectile dysfunction, being less time consuming, aiding in a more accurate determination of the aetiology and guiding treatment decision-making.

Predicting risk of erectile dysfunction in patients with nonalcoholic fatty liver disease.

Nonalcoholic fatty liver disease (NAFLD) is one of the risk factors for erectile dysfunction (ED). We aimed to predict the risk of ED in patients with NAFLD. The study included 146 male patients complaining impotence admitted to the urology outpatient clinic aged 24-80 years without a history of alcohol use who underwent abdominal ultrasonography between February 2018 and January 2019. 106 patients with NAFLD and 40 men without NAFLD were included in the study. Clinical and laboratory parameters, ED status according to International Index of Erectile Function-5 were compared between patients with and without NAFLD. The mean age of patients was 51.47 ± 10.34 years. NAFLD was detected in 72.6% of the patients. No statistically significant difference was found regarding mean age, BMI, IIEF-5 scores, DM status, serum glucose levels (p > .05). Fasting insulin levels, hypertension (HT), insulin resistance (IR) and ED status of the patients with NAFLD were significantly higher than patients without NAFLD (p < .05). NAFLD was found to be a significantly independent associated with ED. We also found that patients with NAFLD have risk of ED 2.92 times higher than without NAFLD (OR: 2.92). For the patients presenting with erectile dysfunction, hepatic steatosis should also be considered.

[Towards Academician Wang Qi's academic thought and medication philosophy in the treatment of secondary erectile dysfunction].

Professor Wang Qi, an academician of the Chinese Academy of Engineering and the founder of andrology of traditional Chinese medicine (TCM), has been engaged in theoretical and clinical researches on andrology of TCM for many years. Erudite and well-experienced, he advanced the idea of "treating impotence from the liver" and unique theories of TCM therapies for male diseases, with ingenuity and originality in clinical medication, proficient in using small and precise prescriptions to achieve high efficacy. This article summarizes and discusses the authors' experience in Professor Wang Qi's clinic learning from him his academic thought and medication philosophy in the treatment of secondary ED.

Melancholia Scytharum: the early modern psychiatry of transgender identification.

Herodotus's enigmatic Scythian theleia nousos/morbus femininus and its Hippocratic interpretation interested many early modern authors. Its seeming dimension of transgender identification invited various medico-psychological and psychiatric reflections, culminating in nosologist de Sauvages' tentative 1731 term, melancholia Scytharum. This article identifies pertinent discussions and what turn out to have been entangled, tentative psychologizations in late-seventeenth through mid-nineteenth-century mental medicine: of 'effeminacy of manners' (mollities animi such as observed in London's Beaux and mollies) and male homosexuality (amour antiphysique/grec); of the mental masculinity of some women (viragines, Amazones); of ubiquitous attributions of impotence to sorcery (anaphrodisia magica); and lastly, of transfeminine persons encountered throughout the New World and increasingly beyond.

A Thematic Analysis of the Online Discussion Board, FrankTalk, Regarding Penile Implant.

INTRODUCTION: Medical websites and discussion boards are commonly used by patients to obtain information. The online forum FrankTalk.org provides a venue specifically for men to discuss sexual dysfunction and particularly inflatable penile prosthesis (IPP). By querying and better understanding the content of this forum related to implants, we can better understand patient concerns before and after IPP. AIM: The aim of this study is to understand the main topics being discussed about IPPs online and to use these topics to understand patient concerns and patient needs and to improve care. METHODS: Messages posted in a 6-month window from January 2018 to June 2018 under the topic "Implant" were identified on FrankTalk.org. Posts were broken down into preoperative and postoperative and then organized using a 3-stage analysis to determine central themes of each post: open coding, axial coding, and selective coding. MAIN OUTCOME MEASURE: The primary outcome measure is the prevalence of each selective code. RESULTS: Of all 587 posts, 304 were written preoperatively with the most common theme being "Size" (23.0%), followed by "seeking support" (18.4%). 283 posts were considered postoperative, of which the most common theme was "Concern about healing" (22.6 %) which questioned if they needed to see a physician, followed by size concerns (20.1%).When analyzed with the 3-stage coding system, there were a total of 41 axial codes which were organized into 6 selective codes: "Social Support" (27.8% of all posts), "Pre-Operative Worries" (23.58%),"Technical Issues" (11.1%), "Prosthesis Logistics" (14.37%), "Post-Operative Worries" (20.22%), "Forum and Misc" (2.93%) for topics outside the scope of penile prosthesis. CLINICAL IMPLICATIONS: The percentage of men seeking medical opinion is concerning, and providers should consider using resources to better educate patients on normal postoperative findings. Implanters should continue to preoperatively counsel patients on size-related changes with surgery. STRENGTH & LIMITATIONS: Strengths include the use of a common online website for men to discuss IPPs and a systematic coding system. Limitations include the applicability of these results to nonheterosexual men as these are likely oversampled in this population. The inherent bias of those willing to post on an online forum may have influenced results along with no oversight for factual accuracy. CONCLUSION: Patients use online discussion boards like FrankTalk.org for social support, medical advice, and validation of their concerns. Providers should be aware of these online topic focuses to help open a discussion with patients about concerns they may feel are difficult to approach with providers. Lu JY, Miller EJ, Welliver C. A Thematic Analysis of the Online Discussion Board, FrankTalk, Regarding Penile Implant. J Sex Med 2020;17:325-330.