Post-finasteride syndrome – does it really exist?

Abstract

Inhibitors of 5α-steroid reductase are drugs used to treat androgen-dependent conditions including prostate diseases and androgenic alopecia. Finasteride was the first on the market and is currently the most widely used inhibitor. Dutasteride was the second inhibitor to be approved and has a similar safety profile. Common adverse events of treatment consist of sexual disorders and a negative affect balance. It was described that the prolonged use of 5α-steroid reductase inhibitors in patients with alopecia can cause persistent side effects called a post-finasteride syndrome (PFS), that is not just a simple coexistence of events, but rather a definite syndrome with an iatrogenic background. PFS occurs in susceptible individuals even after small doses of the drug and can last for a long time after the discontinuation of treatment. A deterioration in the quality of life in affected individuals does not justify use of the drug. Wider recognition of PFS symptoms, its incidence, course, prevention, and treatment possibilities will allow the indications for drug use to be reconsidered and treatment to be more personalized. Knowledge about PFS will also help to provide the best treatment for affected individuals and to properly educate patients before obtaining an informed consent for therapy with 5α-steroid reductase inhibitors.     

The impact of metabolic syndrome on serum total testosterone level in patients with erectile dysfunction

Abstract

Objectives: To determine the association between metabolic syndrome (MetS) and serum testosterone levels (TT) in patients with erectile dysfunction (ED).

Methods: This study included 280 ED patients above 40-years-of-age. Participants were divided into two groups according to 2005 criteria of International Diabetes Federation. The severity of ED was determined according to the International Index of Erectile Function-EF (IIEF-EF score; 0–10 severe ED, 11–25 mild to moderate ED). The severity of ED, serum TT levels and other MetS components were compared between the groups.

Results: The mean age of the patients was 55.7?±?8.2 years. One hundred eighteen patients (%42.1) had MetS. Sixty-eight patients with MetS (57.6%) and 71 patients without MetS (43.8%) had severe ED (p?=?0.031). A total of 46 (16.4%) patients had hypogonadism. Hypogonadism was seen more prevalent in patients with MetS (22.9% vs. 11.7%, p?=?0.013). Logistic regression analyses for ED risk factors demonstrated that abnormal FBG increased the relative risk of severe ED up to 10.7-fold (p?<?0.001) but not presence of hypogonadism (p?=?0.706).

Conclusion: Metabolic syndrome was seen in almost half of the patients with ED. ED was more severe among MetS patients. Hypogonadism alone is a not risk factor for severe ED.     

强化干预代谢综合征改变心脑血管事件发生风险的纵向随访研究：社区人群心脑血管事件前瞻性研究系列之四

目的了解药物综合干预代谢综合征（MS）是否可以改变发生心脑血管事件的风险。方法采用随机整群抽样南宁市两个社区的1215人符合纳入标准为本次综合干预治疗的研究对象,随机分为强化干预组和对照组。强化干预组人群按照是否患有MS及其相关疾病、疾病前状态（包括高血压、血压前期、肥胖、超重、糖尿病、糖耐量减退、血脂异常）等分别采取不同的强化治疗方案进行干预;对照组人员维持志愿就诊和志愿服药的正常医疗状态,每年随访1次,按WHO—MONICA方案心血管病事件（CVD）的诊断标准登记本年度发生的CVD和死亡事件。结果前瞻性随访研究43．5个月后：①经比较对照组中MS亚组与非MS亚组,MS患者发生心脑血管事件比非MS显著增高（P=-0．02）;②经比较干预组中MS亚组与非MS亚组,干预后MS心脑血管事件下降明显,MS患者发生心脑血管事件与非MS相比无差异（P〉0．05）;③经比较干预和对照两组MS亚组之间心脑血管事件的发生率,干预组为2．7％,对照组为10．1％,差异显著（P=0．03,OR值=4．01,95％CL：1．07—15．10）;两组非MS亚组之间心脑血管事件的发生率分别为2.3％和4．2％,无显著性差异（P=0．12）。结论药物综合干预代谢综合征（MS）可以改变发生心脑血管事件的风险,与对照相比干预后风险降低了约4倍。     

强化干预代谢综合征对血脂影响的纵向随访研究：社区人群心脑血管事件前瞻性研究系列之十二

目的前瞻性对南宁市社区人群中代谢综合征组分异常进行干预,随访3年。研究探讨社区人群中应对代谢综合征的方法和有效性。方法广西南宁市部分事业单位居民社区横断面随机调查7917人,纳入1215人,完成1072例。对其中含有一项或以上血脂异常的研究对象,随机分为干预治疗组和对照组,采取饮食、运动、药物和宣教等措施,随访3年,观察血脂衍变情况。结果①干预人群与对照组人群两组合并MS组,T—Ch,TG,HDL异常比例较无MS组增高,尤以TG升高明显,其次依次为T—Ch,HDL。无MS组,LDL异常比例略为增多。②按照性别分组,血脂组分异常占同组、同性别比例,各组相当。以T—Ch升高比例为最多,HDL异常比例较小,TG,LDL居中,二者比例接近。③T-Ch,LDL基线时,对照组与干预治疗组无差异,T—Ch、LDL干预组3年时略有升高;TG干预组3年似有升高,但无统计学意义;HDL基线干预组稍高,3年后也稍高,亦无统计学意义。④本组血脂异常患者干预后相关代谢指标FBG,PBG,Fins,HOMAIR较干预前有明显降低,干预组血压干预后较干预前有降低,但无统计学意义,而对照组血压干预后较干预前稍高;两组UA和Waist指标干预后较干预前稍高。结论①MS合并血脂异常比例较无MS人群比例增高,提示MS发病机制是引发血脂异常根源;性别在本组对MS影响不明显。在本组血脂异常中,以T—Ch升高比例为最多,HDL异常比例较小,TG,LDL居中,二者比例接近。②经过3年干预治疗,本组相关代谢指标较干预前有明显降低,提示生活方式干预及药物治疗可改善MS。③经过3年干预治疗,本组血脂改善不明显,提示血脂调整可能需长期坚持努力才可获得,如不注意健康生活方式,随着时间延长,血脂正常难以维持。     

PubMed和CBMWeb中有关艾滋病的文献分析

目的：探讨艾滋病从发现至今的研究现状和发展趋势。方法：采用主题词检索的方法对PubMed和CBMWeb中所收录的有关艾滋病的论文进行文献计量学分析。结果：我国对艾滋病的研究与国际形势大体一致,文献的总量偏重于基础医学、临床医学类和公共卫生领域,心理学和社会学领域的研究相比而言非常薄弱。并且近十年我国在艾滋病研究方面的进展很快。结论：艾滋病研究应加强对治疗尤其是预防和控制方面的研究,并且需要医学人员、心理学家、社会学家的共同努力．     

中医学创新发展与现代科技的关系

现代科技革命使整个科学方法和科学观念都发生了巨大的变化。中医学的理论及其思维方法与现代科学理论及思维方法相吻合。发展中医学的战略原则是 :坚持中医学基本理论的指导 ,立足中医学的主体地位 ,大力吸收现代科学技术 (包括现代医学的知识和技术 ) ,弥补中医学微观、量化及准确性等方面的不足 ,在实践的基础上实现中医学的创新发展。辨证论治是中医的特色和优势 ,是中医理论的归宿和落脚点。将现代科技指标纳入辨证论治体系是中医学创新发展的关键     

试论美国文化精神的起源与发展

各国历史发展和进程的不同,既有政治、经济的影响,又有文化精神的动因。美国近一百多年来经济的飞速发展和政治进步,得益于它站在巨人肩上的起点,得益于它独特的地理环境和历史条件,更得益于它丰富而充满活力的民族文化精神。美利坚民族文化精神的形成,是有一个历史过程和特殊文化起点的,欧洲大陆的民主传统、清教精神的弘扬、开国者的政治远见、林肯的伟大的解放、进步主义运动之于文化的拯救,都在不同程度上推动和促进了美     

Bivariate frailty model for the analysis of multivariate survival time

Because of limitations of the univariate frailty model in analysis of multivariate survival data, a bivariate frailty model is introduced for the analysis of bivariate survival data. This provides tremendous flexibility especially in allowing negative associations between subjects within the same cluster. The approach involves incorporating into the model two possibly correlated frailties for each cluster. The bivariate lognormal distribution is used as the frailty distribution. The model is then generalized to multivariate survival data with two distinguished groups and also to alternating process data. A modified EM algorithm is developed with no requirement of specification of the baseline hazards. The estimators are generalized maximum likelihood estimators with subject-specific interpretation. The model is applied to a mental health study on evaluation of health policy effects for inpatient psychiatric care.     

STATISTICAL CHALLENGES OF AIDS: (The 1990 Knibbs Lecture, Canberra, 27 November 1990)

Issues that are central to the understanding and management of the HIV epidemic have generated numerous statistical challenges. This paper considers questions concerning the incubation period, the effects of treatments, pre diction of AIDS cases, the choice of surrogate end points for the assessment of treatments and design of strategies for screening blood samples. These issues give rise to a broad range of intriguing problems for statisticians. We describe some of these problems, how they have been tackled so far and what remains to be done. The discussion touches on topical statistical methods such as smoothing, bootstrapping, interval censoring and the ill-posed inverse problem, as well as asking fundamental questions for frequentist statistics.     

Some recent developments for regression analysis of multivariate failure time data

Cox's seminal 1972 paper on regression methods for possibly censored failure time data popularized the use of time to an event as a primary response in prospective studies. But one key assumption of this and other regression methods is that observations are independent of one another. In many problems, failure times are clustered into small groups where outcomes within a group are correlated. Examples include failure times for two eyes from one person or for members of the same family.This paper presents a survey of models for multivariate failure time data. Two distinct classes of models are considered: frailty and marginal models. In a frailty model, the correlation is assumed to derive from latent variables (frailties) common to observations from the same cluster. Regression models are formulated for the conditional failure time distribution given the frailties. Alternatively, marginal models describe the marginal failure time distribution of each response while separately modelling the association among responses from the same cluster.We focus on recent extensions of the proportional hazards model for multivariate failure time data. Model formulation, parameter interpretation and estimation procedures are considered.