ABSTRACT
Recently, learning-based multi-exposure fusion (MEF) methods have made significant improvements. However, these methods mainly focus on static scenes and are prone to generate ghosting artifacts when tackling a more common scenario, i.e., the input images include motion, due to the lack of a benchmark dataset and solution for dynamic scenes. In this paper, we fill this gap by creating an MEF dataset of dynamic scenes, which contains multi-exposure image sequences and their corresponding high-quality reference images. To construct such a dataset, we propose a 'static-for-dynamic' strategy to obtain multi-exposure sequences with motions and their corresponding reference images. To the best of our knowledge, this is the first MEF dataset of dynamic scenes. Correspondingly, we propose a deep dynamic MEF (DDMEF) framework to reconstruct a ghost-free high-quality image from only two differently exposed images of a dynamic scene. DDMEF is achieved through two steps: pre-enhancement-based alignment and privilege-information-guided fusion. The former pre-enhances the input images before alignment, which helps to address the misalignments caused by the significant exposure difference. The latter introduces a privilege distillation scheme with an information attention transfer loss, which effectively improves the deghosting ability of the fusion network. Extensive qualitative and quantitative experimental results show that the proposed method outperforms state-of-the-art dynamic MEF methods. The source code and dataset are released at https://github.com/Tx000/Deep_dynamicMEF.
ABSTRACT
X-ray phase contrast imaging (X-PCI) is a powerful technique for high-resolution, three-dimensional imaging of soft tissue samples in a non-destructive manner. In this technical report, we assess the quality of standard histopathological techniques performed on formalin-fixed, paraffin-embedded (FFPE) human tissue samples that have been irradiated with different doses of X-rays in the context of an X-PCI experiment. The data from this study demonstrate that routine histochemical and immunohistochemical staining quality as well as DNA and RNA analyses are not affected by previous X-PCI on human FFPE samples. From these data we conclude it is feasible and acceptable to perform X-PCI on FFPE human biopsies.
Subject(s)
Percutaneous Coronary Intervention , Synchrotrons , Humans , X-Rays , Feasibility Studies , Imaging, Three-Dimensional , Paraffin Embedding , Formaldehyde , Tissue FixationABSTRACT
The Gene Ontology (GO) knowledgebase (http://geneontology.org) is a comprehensive resource concerning the functions of genes and gene products (proteins and noncoding RNAs). GO annotations cover genes from organisms across the tree of life as well as viruses, though most gene function knowledge currently derives from experiments carried out in a relatively small number of model organisms. Here, we provide an updated overview of the GO knowledgebase, as well as the efforts of the broad, international consortium of scientists that develops, maintains, and updates the GO knowledgebase. The GO knowledgebase consists of three components: (1) the GO-a computational knowledge structure describing the functional characteristics of genes; (2) GO annotations-evidence-supported statements asserting that a specific gene product has a particular functional characteristic; and (3) GO Causal Activity Models (GO-CAMs)-mechanistic models of molecular "pathways" (GO biological processes) created by linking multiple GO annotations using defined relations. Each of these components is continually expanded, revised, and updated in response to newly published discoveries and receives extensive QA checks, reviews, and user feedback. For each of these components, we provide a description of the current contents, recent developments to keep the knowledgebase up to date with new discoveries, and guidance on how users can best make use of the data that we provide. We conclude with future directions for the project.
Subject(s)
Databases, Genetic , Proteins , Gene Ontology , Proteins/genetics , Molecular Sequence Annotation , Computational BiologyABSTRACT
To explore the application effect of the Knowledge, Attitude, and Practice (KAP) model combined with motivational interviewing for health education in the chronic disease management of female patients with systemic lupus erythematosus (SLE). In this study, 84 women with SLE who were admitted to a tertiary hospital in Tianjin from July 2021 to April 2022 were enrolled in this study and divided into observation (nâ =â 42) and control groups (nâ =â 42). The control group received routine health education and treatment for chronic diseases. Based on the control group, the KAP method and questionnaire survey were adopted. Health literacy and compliance in the 2 groups were compared in the first and third months after the intervention. The observation group had a higher total score of health literacy in the third month than the control group. From before the intervention to the first and third months, improvement in the observation group was compared with that in the control group (Fâ =â 36.543, Pâ 6..001; Fâ =â 4.884, Pâ =â .03; Fâ =â 23.881, Pâ 3..001). The observation group had a higher total compliance score in the third month than the control group (tâ =â 5.101, Pâ =â .007). From before the intervention to the first and third months of the intervention, the improvement in the observation group demonstrated an interaction with the time group compared with that in the control group (Fâ =â 68.116, Pâ 8..001; Fâ =â 4.884, Pâ =â .032; Fâ =â 24.789, Pâ <â .001). Motivational interviewing based on the KAP model is effective in the short-term overall health literacy of female patients with SLE, especially in terms of communication, health improvement, and information acquisition; after 3 months, it can influence and maintain high patient compliance.
Subject(s)
Health Literacy , Lupus Erythematosus, Systemic , Motivational Interviewing , Humans , Female , Health Knowledge, Attitudes, Practice , Health Education/methods , Lupus Erythematosus, Systemic/therapyABSTRACT
Threat and extinction memories are crucial for organisms' survival in changing environments. These memories are believed to be encoded by separate ensembles of neurons in the brain, but their whereabouts remain elusive. Using an auditory fear-conditioning and extinction paradigm in male mice, here we discovered that two distinct projection neuron subpopulations in physical proximity within the insular cortex (IC), targeting the central amygdala (CeA) and nucleus accumbens (NAc), respectively, to encode fear and extinction memories. Reciprocal intracortical inhibition of these two IC subpopulations gates the emergence of either fear or extinction memory. Using rabies-virus-assisted tracing, we found IC-NAc projection neurons to be preferentially innervated by intercortical inputs from the orbitofrontal cortex (OFC), specifically enhancing extinction to override fear memory. These results demonstrate that IC serves as an operation node harboring distinct projection neurons that decipher fear or extinction memory under the top-down executive control from OFC.
Subject(s)
Extinction, Psychological , Fear , Animals , Extinction, Psychological/physiology , Fear/physiology , Male , Mice , Neurons/physiology , Nucleus Accumbens/physiology , Prefrontal Cortex/physiologyABSTRACT
The cardiac conduction system (CCS) comprises critical components responsible for the initiation, propagation, and coordination of the action potential. Aberrant CCS development can cause conduction abnormalities, including sick sinus syndrome, accessory pathways, and atrioventricular and bundle branch blocks. Gene Ontology (GO; http://geneontology.org/) is an invaluable global bioinformatics resource which provides structured, computable knowledge describing the functions of gene products. Many gene products are known to be involved in CCS development; however, this information is not comprehensively captured by GO. To address the needs of the heart development research community, this study aimed to describe the specific roles of proteins reported in the literature to be involved with CCS development and/or function. 14 proteins were prioritized for GO annotation which led to the curation of 15 peer-reviewed primary experimental articles using carefully selected GO terms. 152 descriptive GO annotations, including those describing sinoatrial node and atrioventricular node development were created and submitted to the GO Consortium database. A functional enrichment analysis of 35 key CCS development proteins confirmed that this work has improved the in-silico interpretation of this CCS dataset. This work may improve future investigations of the CCS with application of high-throughput methods such as genome-wide association studies analysis, proteomics, and transcriptomics.
ABSTRACT
A new resonant-type inertial impact piezoelectric motor based on a cam locking mechanism was designed, assembled, and tested. The motor is composed of a stator, a rotor, and other auxiliary components. The cam clamping foot of the stator in contact with the inner surface of the rotor forms a cam locking mechanism, which can make the resonant vibration of the stator effective in a half cycle. By receiving sinusoidal signals, the stator generates bending deformation due to the regular deformation of the piezoelectric plate, which drives the cam clamping foot to move and subsequently causes the rotor to rotate. COMSOL5.4 finite element analysis software was used to design the structure of the piezoelectric motor, and an experimental device was built to evaluate and verify the performance of the motor. The maximum no-load speed of the prototype reached 21.61 rpm and the maximum load torque of the motor was 84 N mm under a driving voltage of 360 Vp-p and a driving frequency of 388 Hz. The motor achieved a net efficiency of 5.6% under a preload torque of 2 N mm with the same condition. The maximum resolution of the motion angle of the new motor prototype was 0.0748° with a driving voltage of 160 Vp-p and the same frequency.
ABSTRACT
Human immunodeficiency virus (HIV)-positive women can breastfeed with minimal risk of mother-to-child transmission if taking antiretrovirals. Guidelines surrounding infant feeding for HIV-positive women have evolved several times over the last two decades. Our review aimed to explore perspectives of breastfeeding with antiretrovirals from HIV-positive women since the World Health Organization (2010) infant feeding and antiretroviral guidelines. HIV-positive pregnant and postnatal women from all countries/settings were eligible. HIV-positive women were either on an antiretroviral regimen at the time of the study, previously on an antiretroviral regimen, not initiated on a regimen yet, or enrolled in prevention of mother-to-child transmission (PMTCT) care. Quality assessment of all included studies were conducted. Four databases (CINAHL, EMBASE, MEDLINE and PsycINFO) were searched for studies conducted from January 2010 to October 2020. Nine papers were included in the review, of which two presented findings from the same study. Five analytical themes were developed via thematic synthesis: (1) awareness of breastfeeding with antiretrovirals, (2) turmoil of emotions, (3) coping mechanisms, (4) the intertwining of secret, stigma and support and (5) support needed. Support from family and health care professionals and coping approaches were important to overcome stigma and the emotional challenges of breastfeeding with antiretrovirals. Health care professionals should be familiar with the most updated national and local guidance surrounding infant feeding and antiretrovirals. Further research into interventions to encourage HIV-positive women to adhere and commit to lifelong antiretroviral treatment (Option B+) for breastfeeding is required.
Subject(s)
HIV Infections , Pregnancy Complications, Infectious , Breast Feeding , Female , HIV , HIV Infections/drug therapy , Humans , Infant , Infectious Disease Transmission, Vertical/prevention & control , Pregnancy , Pregnancy Complications, Infectious/drug therapy , Pregnancy Complications, Infectious/prevention & controlABSTRACT
This review aimed to synthesize qualitative evidence of views and experiences of partners and other family members who provided breastfeeding support for a relative. The Joanna Briggs Institute (JBI) methodology for systematic reviews of qualitative evidence was followed. Seven databases: CINAHL, MEDLINE, EMBASE, PsycINFO, Scopus, Maternal and Infant Care, and Web of Science were searched. Partners and other family members (e.g. grandmothers, siblings) of women in any countries were included. Included papers were critically appraised. The JBI meta-aggregative approach was used to analyze data and form synthesized findings. Seventy-six papers from 74 studies were included. Five synthesized findings were: (i) spectrum of family members' breastfeeding knowledge, experiences and roles; (ii) the complexity of infant feeding decision making; (iii) the controversy of breastfeeding in front of others; (iv) impact of breastfeeding on family; and (v) it takes more than just family members: support for family members. Partners' and family members' views and experiences of breastfeeding support reflected multi-faceted personal, social, financial, cultural, religious, emotional, psychological, and societal factors of the support they provided (or not). Healthcare professionals should engage them in breastfeeding discussions with the woman, and offer tailored and practical guidance relevant to help them to appropriately support the woman. This article is part of the theme issue 'Multidisciplinary perspectives on social support and maternal-child health'.
Subject(s)
Breast Feeding/psychology , Family/psychology , Humans , Spouses/psychologyABSTRACT
In a typical digital fringe projection (DFP) system, the shadows in the fringe images cause errors in the phase map. We propose a novel discriminative repair approach to remove the shadow-induced error in the phase map. The proposed approach first classifies the shadow area in the phase map obtained by the DFP into two categories: valid shadow area and invalid shadow area. Then the valid shadow area is repaired by a proposed neighboring information fusion phase estimation (NIFPE) method, which fuses the phase gradient into the result of kernel density estimation (KDE) through the Kalman filter (KF) algorithm. The invalid shadow area is repaired by a proposed background phase matching (BPM) method. The experimental results demonstrate that the shadow-induced error in the phase map can be removed, which verifies the effectiveness of the proposed approach.
ABSTRACT
Pixel-by-pixel phase unwrapping (PPU) has been employed to rapidly achieve three-dimensional (3-D) shape measurement without additional projection patterns. However, the maximum measurement depth range that traditional PPU can handle is within 2π in phase domain; thus PPU fails to measure the dynamic object surface when the object moves in a large depth range. In this paper, we propose a novel adaptive pixel-by-pixel phase unwrapping (APPU), which extends PPU to an unlimited depth range. First, with PPU, temporary phase maps of objects are obtained referring to the absolute phase map of a background plane. Second, we quantify the difference between the image edges of the temporary phase maps and the practical depth edges of dynamic objects. Moreover, according to the degree of the edge difference, the temporary phase maps are categorized into two classes: failed phase maps and relative phase maps. Third, by combining a mobile reference phase map and the edge difference quantization technique, the failed phase maps are correspondently converted into relative phase maps. Finally, the relative phase maps are innovatively transformed into the absolute phase maps using a new shadow-informed depth estimation method (SDEM). The proposed approach is suitable for high-speed 3-D shape measurement without depth limitations or additional projection patterns.
ABSTRACT
Prosthetic heart valves have been commonly used to address the increasing prevalence of valvular heart disease. The ideal prosthetic heart valve substitute should closely mimic the characteristics of a normal native heart valve. Despite the development of various interventions, an exemplary valve replacement does not exist. This review provides an overview of the novel engineering valve designs and explores emergent immunologic insights into age-dependent structural valve degeneration (SVD).
ABSTRACT
Construction of 3-vinylindoles (3) and ß,ß-diindolyl propionates (4) through solvent-free C-H functionalization has been explored under high-speed ball-milling conditions. The reaction selectivity is influenced by the catalyst dramatically: Pd(OAc)2 provides 3 in moderate to good yields, whereas PdX2 (X = Cl, I) affords 4 as the major products. The reaction mechanism has been further studied by using electrospray ionization mass spectrometry, implicating the dimeric palladium complex A as the key intermediate in an explanation of the selectivity.
ABSTRACT
This study aimed to examine the number of circulating Toll-like receptor 4 (TLR4) + CD14+ monocytes in patients with different stages of chronic kidney disease (CKD), their responses to lipopolysaccharide (LPS), and to explore the potential association of the number of TLR4+CD14+ monocytes with clinical laboratory measures. The numbers of TLR4+CD14+, LPS-stimulated TNF-α+CD14+ and interleukin (IL)-6+CD14+ monocytes were determined by flow cytometry in 9 patients with stage 3 CKD, 11 with stage 4 CKD, 16 with stage 5 CKD, and 19 healthy controls (HCs). Their laboratory tests were performed by routine methods and the potential association among these measures was analyzed by Pearson's correlation analysis. The numbers of CD14+, CD14+TLR4+, LPSstimulated TNF-α+CD14+ and IL-6+CD14+ monocytes in patients with CKD were significantly less than those of HCs (all P<0.05), and were negatively associated with patient disease severity. The number of CD14+TLR4+ monocytes was positively correlated with estimated glomerular filtration rate (eGFR, P<0.001) and the levels of hematocrit (P<0.01), but negatively correlated with the levels of blood urine nitrogen, serum creatinine, and C-reactive protein (P<0.001 for all), in the CKD patients. Our data indicate that significant reduction in the number of TLR4+ monocytes and their impaired responses to LPS may be associated with the progression of CKD in Chinese patients.
Subject(s)
Cytokines/metabolism , Kidney Failure, Chronic/metabolism , Lipopolysaccharide Receptors/metabolism , Lipopolysaccharides/pharmacology , Monocytes/metabolism , Toll-Like Receptor 4/metabolism , HumansABSTRACT
OBJECTIVE: To compare the age-specific detection rates of colorectal neoplasms by colonoscopic screening among high-risk population in rural area and to provide evidence for determining the initial age in the colorectal cancer screening. METHODS: The age-specific detection rates of colorectal cancers and adenomas, and the proportion of detected cases in each age group after screening by the optimized sequential colorectal cancer screening program in Jiashan County, Zhejiang Province, were analyzed. RESULTS: Mass screening with the optimized sequential colorectal cancer screening program in Jiashan was conducted and 8867 colonoscopic examinations were performed. A total of 1811 individuals with at least one colorectal neoplastic lesion were found. Among them, there were 92 (1.04%) colorectal cancer patients, 1164 (13.13%) patients with at least one adenoma and 377 (4.25%) patients with at least one advanced adenoma. The detection rate of colorectal neoplastic lesions for the age group 40 - 44 was considerably lower than that in the age group 45 - 49. Hypothetically, to increase the initial age to 45-years for the optimized sequential colorectal cancer screening program would yield a 7.84% increase in the detection rate of total colorectal neoplastic lesions, 13.46% increase in the detection rate of colorectal cancer, 8.76% increase in the detection rate of adenoma, 12.24% increase in the detection rate of advanced adenoma and 19.64% lower in the cost of initial screening, 13.30% lower in the cost of colonoscopic screening. CONCLUSIONS: Among the high-risk population aged 40 to 74, the detection rates of colorectal cancer and adenoma are increasing with the increase of age, the detection rates of colorectal cancer and adenoma as well as proportion of detected cases in the 40 - 44 age group are considerably lower. To increase the initial age to 45 for colorectal cancer screening in rural area of China is reasonable.
Subject(s)
Adenoma/diagnosis , Carcinoma/diagnosis , Colorectal Neoplasms/diagnosis , Adenoma/epidemiology , Adenoma/pathology , Adult , Age Distribution , Aged , Carcinoma/epidemiology , Carcinoma/pathology , China/epidemiology , Colitis, Ulcerative/diagnosis , Colitis, Ulcerative/epidemiology , Colitis, Ulcerative/pathology , Colonic Polyps/diagnosis , Colonic Polyps/epidemiology , Colonic Polyps/pathology , Colonoscopy , Colorectal Neoplasms/epidemiology , Colorectal Neoplasms/pathology , Female , Humans , Incidence , Male , Mass Screening/methods , Middle Aged , Risk , Rural Population , Surveys and QuestionnairesABSTRACT
<p><b>OBJECTIVE</b>To compare the age-specific detection rates of colorectal neoplasms by colonoscopic screening among high-risk population in rural area and to provide evidence for determining the initial age in the colorectal cancer screening.</p><p><b>METHODS</b>The age-specific detection rates of colorectal cancers and adenomas, and the proportion of detected cases in each age group after screening by the optimized sequential colorectal cancer screening program in Jiashan County, Zhejiang Province, were analyzed.</p><p><b>RESULTS</b>Mass screening with the optimized sequential colorectal cancer screening program in Jiashan was conducted and 8867 colonoscopic examinations were performed. A total of 1811 individuals with at least one colorectal neoplastic lesion were found. Among them, there were 92 (1.04%) colorectal cancer patients, 1164 (13.13%) patients with at least one adenoma and 377 (4.25%) patients with at least one advanced adenoma. The detection rate of colorectal neoplastic lesions for the age group 40 - 44 was considerably lower than that in the age group 45 - 49. Hypothetically, to increase the initial age to 45-years for the optimized sequential colorectal cancer screening program would yield a 7.84% increase in the detection rate of total colorectal neoplastic lesions, 13.46% increase in the detection rate of colorectal cancer, 8.76% increase in the detection rate of adenoma, 12.24% increase in the detection rate of advanced adenoma and 19.64% lower in the cost of initial screening, 13.30% lower in the cost of colonoscopic screening.</p><p><b>CONCLUSIONS</b>Among the high-risk population aged 40 to 74, the detection rates of colorectal cancer and adenoma are increasing with the increase of age, the detection rates of colorectal cancer and adenoma as well as proportion of detected cases in the 40 - 44 age group are considerably lower. To increase the initial age to 45 for colorectal cancer screening in rural area of China is reasonable.</p>
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Adenoma , Diagnosis , Epidemiology , Pathology , Age Distribution , Carcinoma , Diagnosis , Epidemiology , Pathology , China , Epidemiology , Colitis, Ulcerative , Diagnosis , Epidemiology , Pathology , Colonic Polyps , Diagnosis , Epidemiology , Pathology , Colonoscopy , Colorectal Neoplasms , Diagnosis , Epidemiology , Pathology , Incidence , Mass Screening , Methods , Risk , Rural Population , Surveys and QuestionnairesABSTRACT
OBJECTIVE: To investigate the incidence of human papillomavirus (HPV) infection in women and its correlation with redundant prepuce or phimosis in the patients' sexual partners. METHODS: We conducted a questionnaire investigation among the women outpatients at the cervical disease clinic of Nanjing Maternity and Child Health Hospital from May to December 2011. We obtained information on their sexual life and determined whether their sexual partners had redundant prepuce or phimosis according to the schematic illustrations we offered. We used biology-hybridize HPV-type test kit, PCR and hybrid membrane methods for detection of different HPV genotypes in cervical exfoliated cells, taking any type of HPV detected as positive. We made between-group comparisons by chi-square test and analyzed independent risk factors by non-conditional logistic regression analysis. RESULTS: Of the 2 040 questionnaires, 1 568 were collected and 1 110 (71%) accepted as valid by inclusion criteria. Among the 1 110 subjects, 566 (50.9%) were infected with HPV, and 445 (78.6%) of the infected women admitted that their sexual partners had redundant prepuce or phimosis. The most frequent infection type was HPV16 (34.2%), followed by HPV58 (28.1%), HPV52 (20.2%) and HPV18 (10.8%). Multivariate logistic regression analysis suggested that redundant prepuce or phimosis in the women's sexual partners was an independent risk factor for HPV infection (OR 3.387, 95%CI [2.491-4.607]). CONCLUSION: In Nanjing urban area, the majority of the sexual partners of the HPV-infected women have redundant prepuce or phimosis, which is an independent risk factor for female cervical HPV infection. Male circumcision is necessitated in Nanjing to reduce the incidence of cervical HPV infection.
Subject(s)
Foreskin/virology , Papillomavirus Infections/epidemiology , Sexual Partners , Adult , Aged , Cervix Uteri/virology , China/epidemiology , Female , Humans , Male , Middle Aged , Papillomavirus Infections/virology , Phimosis/virology , Retrospective Studies , Risk Factors , Young AdultABSTRACT
OBJECTIVE: Female sexual dysfunction (FSD) is a common problem affecting women's quality of life. However, reports are rarely seen on sexual problems in Chinese women. This study is to investigate the prevalence of FSD among urban Chinese women in Nanjing and offer some evidence for the establishment of preventative measures for FSD in China. METHODS: A cross-sectional hospital-based survey was conducted in Nanjing, China between August 2008 and March 2009. The sexual function of 609 women aged 20 -56 years from the urban area of Nanjing were investigated using the Female Sexual Function Index (FSFI). The total FSFI score of < 25 was used as the diagnostic criterion for FSD. RESULTS: The total FSFI score was 24.21 +/- 4.40 in this group of women, and it decreased with the increase of age. The overall prevalence of FSD was 56.8%, and it increased with the increase of age, 47.1%, 57.0%, 75.0% and 90.3% in the < 29 yr, 30 - 39 yr, 40 - 49 yr and > or = 50 yr groups, respectively. The most common problems were low sexual satisfaction (43.2%) and orgasm disorder (41.7%), followed by sexual pain (40.2%), hyposexuality (35.1%), vaginal dryness (31.4%) and sexual arousal disorder (29.6%). CONCLUSION: FSD is a common problem among urban Chinese women in Nanjing, and the most common sexual problems are low sexual satisfaction and orgasm disorder.
Subject(s)
Sexual Dysfunctions, Psychological/epidemiology , Adult , China/epidemiology , Cross-Sectional Studies , Female , Humans , Middle Aged , Prevalence , Sexual Behavior , Surveys and Questionnaires , Urban Population , Young AdultABSTRACT
OBJECTIVE: Dyspareunia is a common sexual trouble in women during the sexual intercourse. This study is to investigate the risk factors for dyspareunia in urban Chinese women and to supply some evidence for its preventive measures. METHODS: We conducted a hospital-based survey by distributing 2 658 copies of a questionnaire among the women in Nanjing urban area who came for regular physical examination in Nanjing Maternity and Child Health Hospital and their female companions aged over 20 years. The sexual function of the subjects was evaluated according to female sexual function indexes, dyspareunia indicated by sexual pain score < 4.4, and the results analyzed by multiple logistic regression analysis. RESULTS: Totally, 1 856 (69.8%) of the subjects completed the questionnaire, and 1 457 that met the criteria were included for analysis, of whom 43.0% (626/1457) admitted to dyspareunia during the sexual intercourse. Multiple logistic regression analysis showed that age (> or = 50 years) , smoking, hysterectomy, vaginal lubrication disorder, lack of sexual communication with partners were independent risk factors for dyspareunia (P < 0.05). CONCLUSION: Dyspareunia is associated with multiple factors including age (> or = 50 years), smoking, hysterectomy, vaginal lubrication disorder, lack of sexual communication with partners.