Type V phosphodiesterase inhibitor treatments for erectile dysfunction increase testosterone levels.

OBJECTIVE Lack of sexual activity due to erectile dysfunction (ED) decreases testosterone (T) levels through a central effect on the hypothalamic-pituitary axis. In this paper we studied the effect of different type V phosphodiesterase (PDE5) inhibitor treatments for ED on the reversibility of this endocrine pattern. DESIGN Open-label, retrospective study. PATIENTS Seventy-four consecutive patients were treated on demand with sildenafil (Sild) (50 mg) and tadalafil (Tad) 20 mg. MEASUREMENTS The success in sexual intercourse was recorded and total (tT) and free testosterone (fT) levels were studied before and after 3 months of treatment. RESULTS Basal level of tT and fT were at the bottom of the normal range and LH levels were at the top of the high normal range. After treatments, this endocrine pattern was reversed in both groups. However, the T increase in Sild-treated patients was significantly lower than in those treated with Tad (4.7 +/- 2.7 vs. 5.1 +/- 0.9, P < 0.001). fT levels followed a directly proportional pattern, while the inverse was found when LH production was studied. The intercourse rate reflected this effect: in fact, the Sild group showed a 4.9 +/- 2.9/month full sexual intercourse rate while in the Tad group a significantly higher rate of sexual intercourse was found (6.9 +/- 4.6/month, P = 0.04). However, drug consumption was comparable between the groups (Sild 4.9 +/- 2.9 vs. Tad 4.4 +/- 2.8 pills/month, P = 0.72). CONCLUSIONS As it is unlikely that the two drugs have a different direct effect on the pituitary-testis axis, this effect is probably due to the higher frequency of full sexual intercourse in the Tad-treated group, because of the drug's longer half-life

Comparision of profile macro-estethic perception among orthodontists, dentistry students, orthodontic patients and surgical orthodontic patients

Background: The patient's needs should guide the orthodontist in choosing the most appropriate therapy. The purpose of the present survey was to compare the esthetic perception of the facial profile by orthodontists (O), dentistry students (DS), orthodontic patients (OP) and surgical-orthodontic patients (SOP) and to evaluate the influence of gender, age and level of study. Material and Methods: A facial profile photograph of a young female was taken and twelve modified images were made, altering the position of the jaws in protrusion and in retrusion. Two hundred caucasian examiners, divided into four groups (O, DS, OP, SOP), were selected. Each examiner was asked to complete the questionnaire with an approval rating from 1 to 10. An ordinary least square OLS model was applied. Significant levels were set at P ≤ 0.05. Results: All examiners considered a straight profile or a slight retrusion of the maxilla as the most attractive profile. Slight discrepancies (up to 2 mm) in jaw protrusion were barely perceived by patients. Mandibular retrusion (2 and 4 mm) was one of the least appreciated condition by all examiners. Surgical-orthodontic patients assigned lower ratings compared to orthodontic patients. Female subjects assigned lower ratings than males. Patients with secondary school education assigned higher statistically significant values compared to other levels of study. The lowest values were attributed by the sample of age &gt; = 17 years. Conclusions: The choice of the most appropriate therapy is based not only on a correct diagnosis, but on the evaluation of esthetic and psychological aspects

Measurement of the thickness of the urethrovaginal space in women with or without vaginal orgasm

Introduction. The physiology and anatomy of female sexual function are poorly understood. The differences in sexual function among women may be partly attributed to anatomical factors. Aim. The purpose of this study was to use ultrasonography to evaluate the anatomical variability of the urethrovaginal space in women with and without vaginal orgasm. Methods. Twenty healthy, neurologically intact volunteers were recruited from a population of women who were a part of a previous published study. All women underwent a complete urodynamic evaluation and those with clinical and urodynamic urinary incontinence, idiopathic detrusor overactivity, or micturition disorders, as well as postmenopausal women and those with sexual dysfunction were excluded. The reported experience of vaginal orgasm was investigated. Main Outcome Measure. The urethrovaginal space thickness as measured by ultrasound was chosen as the indicator of urogenital anatomical variability. Designated evaluators carried out the measurements in a blinded fashion. Results. The urethrovaginal space and distal, middle, and proximal urethrovaginal segments were thinner in women without vaginal orgasm. A direct correlation between the presence of vaginal orgasm and the thickness of urethrovaginal space was found. Women with a thicker urethrovaginal space were more likely to experience vaginal orgasm (r = 0.884; P = 0.015). A direct and significant correlation between the thickness of each urethrovaginal segment and the presence of vaginal orgasm was found, with the best correlation observed for the distal segment (r = 0.863; P < 0.0001). Interobserver agreement between the designated evaluators was excellent (r = 0.87; P < 0.001). Conclusions. The measurement of the space within the anterior vaginal wall by ultrasonography is a simple tool to explore anatomical variability of the human clitoris-urethrovaginal complex, also known as the G-spot, which can be correlated to the ability to experience the vaginally activated orgasm

Is a two-month healing period long enough to achieve osseointegration? A prospective clinical cohort study

The aim of this study was to evaluate the effectiveness of loading at 2 months after the surgical placement of implants. A tapered implant was used. Implant stability was determined using resonance frequency analysis at implant insertion (T0; primary stability), after 2 months (T1), and at the 6-month follow-up (T2). Descriptive statistics and the t-test were used. Significance was at P ≤ 0.05. A total of 268 implants were inserted in 142 patients. No patient dropped out and no implant had failed at the 6-month follow-up. The mean implant stability quotient value (ISQ) increased over time, with a statistically non-significant difference for T0 vs. T1 (P = 0.08) and a statistically significant difference for T1 vs. T2 (P = 0.0018) and T0 vs. T2 (P = 0.000). Only 99 implants, characterized by an extremely high mean primary stability value (80.34), did not have a recorded increase in ISQ at T1. A 2-month healing period allowed the implant to achieve secondary stability, confirming the effectiveness of the loading protocol at 2 months

An experimental and numerical analysis of the dynamic variation of the angle of attack in a vertical-axis wind turbine

Simulation methods ensuring a level of fidelity higher than that of the ubiquitous Blade Element Momentum theory are increasingly applied to VAWTs, ranging from Lifting-Line methods, to Actuator Line or Computational Fluid Dynamics (CFD). The inherent complexity of these machines, characterised by a continuous variation of the angle of attack during the cycloidal motion of the airfoils and the onset of many related unsteady phenomena, makes nonetheless a correct estimation of the actual aerodynamics extremely difficult. In particular, a better understanding of the actual angle of attack during the motion of a VAWT is pivotal to select the correct airfoil and functioning design conditions. Moving from this background, a high-fidelity unsteady CFD model of a 2-blade H-Darrieus rotor was developed and validated against unique experimental data collected using Particle Image Velocimetry (PIV). In order to reconstruct the AoA variation during one rotor revolution, three different methods-detailed in the study-were then applied to the computed CFD flow fields. The resulting AoA trends were combined with available blade forces data to assess the corresponding lift and drag coefficients over one rotor revolution and correlate them with the most evident flow macro-structures and with the onset of dynamic stall.</p

The therapeutic dilemma: How to use tadalafil

Tadalafil, a type 5 phosphodiesterase inhibitor, is a new and effective therapy for erectile dysfunction. It has unique pharmacokinetic proper-ties in its drug class, which also includes sildenafil and vardenafil. It is also well tolerated with few side-effects, and can be used in difficult patients such as neuropaths or diabetics

Is there a learning curve in static computer-assisted implant surgery? A prospective clinical study

Static computer-assisted surgery (s-CAS) has been introduced to improve the results of implantology. A prospective cohort study was conducted following the STROBE guidelines to determine the presence of a learning curve in s-CAS. Six partially and six totally edentulous patients were treated by two surgeons experienced in implantology but completely inexperienced in s-CAS. Preoperative and postoperative computed tomography scans were matched to assess coronal, apical, and angular deviation and the positioning error. The accuracy data were used to evaluate the learning curve. Fifty-six implants were inserted. In partially and totally edentulous patients, the mean (range; standard deviation) coronal deviation was 0.87 (0.34–1.27; 0.35) and 1.24 (0.72–2.67; 0.79); the mean apical deviation was 1.13 (0.48–1.63; 0.39) and 1.52 (0.88–3.84; 1.15); the mean angular deviation was 2.63 (1.89–4.50; 0.98) and 3.59 (1.69–6.30; 1.65); and the mean positioning error was 0.80 (0.32–1.25; 0.35) and 1.14 (0.35–2.56; 0.77), respectively. A typical ‘learning curve’ effect was not identified for s-CAS

An experimental and numerical analysis of the dynamic variation of the angle of attack in a vertical-axis wind turbine

Simulation methods ensuring a level of fidelity higher than that of the ubiquitous Blade Element Momentum theory are increasingly applied to VAWTs, ranging from Lifting-Line methods, to Actuator Line or Computational Fluid Dynamics (CFD). The inherent complexity of these machines, characterised by a continuous variation of the angle of attack during the cycloidal motion of the airfoils and the onset of many related unsteady phenomena, makes nonetheless a correct estimation of the actual aerodynamics extremely difficult. In particular, a better understanding of the actual angle of attack during the motion of a VAWT is pivotal to select the correct airfoil and functioning design conditions. Moving from this background, a high-fidelity unsteady CFD model of a 2-blade H-Darrieus rotor was developed and validated against unique experimental data collected using Particle Image Velocimetry (PIV). In order to reconstruct the AoA variation during one rotor revolution, three different methods-detailed in the study-were then applied to the computed CFD flow fields. The resulting AoA trends were combined with available blade forces data to assess the corresponding lift and drag coefficients over one rotor revolution and correlate them with the most evident flow macro-structures and with the onset of dynamic stall.Wind Energ