Testosterone therapy in erectile dysfunction

Studies in animals have indicated that the nitric oxide erectile pathway is testosterone-dependent. Castration induces erectile dysfunction and a reduction in nitric oxide synthase-stained nerves in erectile tissue. Furthermore, castration adversely affects penile hemodynamics and smooth muscle content, leading to veno-occlusive dysfunction. Testosterone replenishment reverses these physiological, biochemical and structural changes. Several clinical studies have demonstrated the benefits of a combination of testosterone and sildenafil. A recently published, multicenter study evaluated the safety and efficacy of testosterone gel 1% (Testogel®; Schering AG, Germany/AndroGel®; Solvay Pharmaceuticals) vs. placebo gel in conjunction with sildenafil, in producing an erectile response in hypogonadal men who did not respond to treatment with sildenafil alone for erectile dysfunction. The selection criteria required subjects to have had erectile dysfunction for at least 3 months, to be non-responsive to 100 mg sildenafil and to have low testosterone levels (<?400 ng/dl). The primary efficacy measurement was the mean change from baseline in the Erectile Function domain of the International Index of Erectile Function (IIEF). Secondary outcome measures included the mean change from baseline in the other domains and the total sum of the IIEF. Subjects were randomized to receive either testosterone gel + sildenafil, or placebo gel + sildenafil for 12 weeks. Testosterone therapy with testosterone gel improved the erectile response to sildenafil. Therefore, testosterone therapy may be considered for the treatment of erectile dysfunction in men with low to low-normal testosterone levels, who have failed prior treatment with sildenafil alone. Consequently, it is important to screen for hypogonadism in men who fail PDE5 inhibitors.     

Nursing Home Deficiency Citations for Safety

Deficiency citations for safety violations in U.S. nursing homes from 2000 to 2007 are examined (representing a panel of 119,472 observations). Internal (i.e., operating characteristics of the facility), organizational factors (i.e., characteristics of the facility itself), and external factors (i.e., characteristics outside of the influence of the organization) associated with these deficiency citations are examined. The findings show that nursing homes increasingly receive deficiency citations for resident safety issues. Low staffing levels, poor quality of care, and an unfavorable Medicaid mix (occupancy and reimbursement) are associated with the likelihood of receiving deficiency citations for safety violations. In many cases, this likely influences the quality of life and quality of care of residents.     

芥川龙之介历史小说中利己主义的多样性——以小说《罗生门》和《鼻》为例

芥川龙之介是近代日本文学的代表作家之一,其早期的历史小说多体现利己主义的主题,其中以《罗生门》和《鼻》最具代表性.两部小说虽然都着眼于对利己主义主题的挖掘,但从不同角度描绘了两种不同内涵的利己主义,即为生存的利己主义和旁观者的利己主义.然而,他并没有止步于对利己主义本身的批判,而是以敏锐的洞察力从人性的角度出发,将利己主义作为一个工具,揭示了人性中的善恶并存,并进一步批判了认同这种利己主义的扭曲的社会道德.     

Three definitions of metabolic syndrome applied to a sample of young obese men and their relation with plasma testosterone

This study tested 60 men, aged <40 years, with a BMI 27–35 kg/m² to determine whether they had metabolic syndrome. The three definitions used to test this were from the National Cholesterol Education Program (NCEP), the World Health Organization (WHO) and the International Diabetes Federation (IDF). Further, the relationship between a positive definition and plasma testosterone (T) and calculated free T was analysed.

Using the above three definitions of metabolic syndrome (MetS), there was a large degree of overlap of identifying obese men as having the syndrome, but there were quantitatively significant differences as well. So, it is relevant in studies to identify which of the present definitions of the syndrome has been used. With aging there is an increasing prevalence of the syndrome and age itself might be a factor in the lower T levels encountered in these men. But low plasma total T and calculated free T were also consistent features of men <40 years with metabolic syndrome, regardless of which definition had been applied. Including low T levels in the definition of metabolic syndrome, may be helpful.     

A four-year efficacy and safety study of the long-acting parenteral testosterone undecanoate

Introduction. This is a four-year follow-up of 25 men who received parenteral testosterone undecanoate (TU), 1000 mg every 12 weeks for at least four years. This study was a continuation of a 30-week study wherein the effects of TU had been compared to those of parenteral testosterone enanthate.

Methods & Results. Plasma testosterone (T) trough values of the injection interval of 12 weeks): median 11.9 – 15.9 nmol/L (N 10.0–30.0). E2 and SHBG were stable. Body weight, BMI, waist-to-hip ratio remained stable. Total cholesterol, and triglycerides were unchanged but plasma LDL declined while HDL, after an initial reduction over the first 30 weeks, had increased significantly after three years. Leptin levels, bone mineral density, blood pressure, liver function tests, haemoglobin and haematocrit levels remained stable without values above the upper limit of normal. Over the first 12 months of the study there was an increase in prostate volume from 19.7 ± 8.8 mL to 22.0 ± 8.4 mL (p < 0.05) but thereafter volumes remained stable, paralleled by an increase in PSA from 0.67 ± 0.38 µg/dL to 0.75 ± 0.35 µg/dL (p < 0.05) without any further changes after 12 months.

Conclusion. TU appears to be a stable and safe treatment modality of hypogonadal men.     

Association of bioavailable estradiol levels and testosterone levels with serum albumin levels in elderly men

Estrogens are reported to be the essential sex steroid acting on some male physiological functions, and bioavailable estrogens comprise the free and albumin-bound fractions. Moreover, most of the bioavailable sex steroid is made up of albumin-bound fraction. We examined the age-related change in serum free, albumin-bound and bioavailable estradiol levels in comparison with each fraction of testosterone and its relationship with serum albumin level in elderly men. Albumin-bound as well as bioavailable estradiol levels declined with age, and their decreases were associated much more with the decrease of albumin level than the increase of sex-hormone binding globulin (SHBG) level in sixties and seventies, and similar results were recognized in the level of each fraction of testosterone, suggesting albumin levels have an important role for maintaining bioavailable sex steroid levels in males aged over sixty. Moreover, our study showed that SHBG levels associated inversely with bioavailable sex steroid levels particularly when serum albumin level was low. It seems likely that the decrease of bioavailable estradiol as well as testosterone is induced by the decrease of albumin-bound fractions in combination with the increase of SHBG-bound fractions in males aged over sixty, and that their physical characteristics of aging could be induced by the decrease of albumin-bound fractions caused by the decrease of serum albumin regardless of total sex steroid levels.     

Discursive imbalance and deficiency in intercultural news communication

Intercultural news communication has become increasingly common in our current era of globalization. But why are certain topics and certain modes of speech adopted in news making rather than others, leading to discursive imbalance? Why are alternative modes of communication often excluded when news travels from one culture to another, causing discursive deficiency? We take a constructivist approach in this paper to examine intercultural news discourse, using examples from previous research and especially from reports on a controversial canine regulation in Beijing in 2006. By analyzing selected news accounts from both Chinese and American media, we attempt to elucidate the discursive power processes involved in this case and draw general lessons about intercultural news communication overall.     

从儿童认知理论看儿童电视节目的定位缺失

以儿童认知理论为切入点,分析我国儿童电视节目的存在现状,进而提出我国儿童电视节目提升的关键在于对受众、对节目本身的精准定位,而精准定位的准确切入点便是儿童成长过程中心理发展的优势需求。     

优化税制 启动消费需求

我国内需不足的原因是由于居民的可支配收入减少、收入差距扩大、心理预期不良以及消费观念滞后。对税收与内需关系的探讨和税制结构相应调整分析可知:应调高个人所得税起征点;调整个人所得税的税率;改利息税的比例税率为累进税率,允许一些特定的税收优惠;结构性调整现有的税种,并将一些新的税种纳入我国税收体系。只有充分发挥税收政策优势,改革和完善现行税制,才能切实拉动内需,推动经济增长。     

对毛泽东两类不同性质矛盾理论的反思

毛泽东的两类不同性质矛盾理论在今天已经显得不足。随着社会的发展,两类不同性质矛盾范畴对社会矛盾概括的不完全性日益凸显,公民范畴的缺失使正确区分和处理两类不同性质的矛盾失去可靠的保证,关于两类矛盾的性质和解决方法的理论正为实践所修正。