Long-term high-dose l-arginine supplementation in patients with vasculogenic erectile dysfunction: a multicentre, double-blind, randomized, placebo-controlled clinical trial

Purpose The current randomized, double-blind, placebo-controlled clinical trial addressed the effects on penile erectile function of relatively high daily oral doses (6 g/day) of l-ARG for 3 months (N = 51) compared to placebo (N = 47), in patients with vasculogenic ED, with comparison between mild–moderate and severe vasculogenic ED. Methods The outcome measures included IIEF-6 score and cavernous arteries peak systolic flow velocity (PSV) at dynamic penile duplex ultrasonography (PDU). Results l-ARG supplementation for 3 months significantly increased IIEF-6 score in the overall cohort (p < 0.0001) and in subgroups of patients with mild–moderate (p < 0.0001) and severe (p = 0.007) vasculogenic ED; PSV was significantly increased in the overall cohort (p < 0.0001) and in patients with mild–moderate (p < 0.0001), but not severe vasculogenic ED. At study completion, 74% of patients improved ED degree category, although only 24% of patients, mainly belonging to the baseline category of mild ED, reached IIEF-6 scores compatible with absence of ED; moreover, 20% of patients, exclusively belonging to the baseline category of mild–moderate vasculogenic ED, reached PSV values compatible with absence of ED. Conclusion The results of the current study demonstrated that supplementation with relatively high doses of l-ARG as a single compound for 3 months significantly improved penile erectile function, assessed by both IIEF-6 score and PSV at dynamic PDU in patients with mild–moderate, and improved IIEF-6 score, but not PSV, in patients with severe vasculogenic ED, therefore suggesting that l-ARG might be an alternative treatment in mild–moderate vasculogenic ED patients experiencing adverse effects or with contraindications for chronic treatment with PDE5i compounds.

Determinant components of newly onset versus improved metabolic syndrome in a population of Iran

This study aimed to determine the risk factors related to regression and progression of metabolic syndrome, in a 4-year cohort study. A total of 540 individuals (≥ 18 years old) participated in both phase of the study. Participants were categorized into 3 categories of regressed, progressed and unchanged metabolic syndrome (MetS). Demographic, anthropometric and biochemical parameters were assessed for each individual in both phase. Variables differences (delta: Δ) between the two phase of study were calculated. Unchanged group was considered as baseline category. Based on IDF, MetS had been regressed and progressed in 42 participants (7.7%) and 112 (20.7%) participants respectively, in the second phase. More than 47% of people, whose MetS regressed, experienced also NAFLD regression. Results of multiple variable analysis revealed that increased age, positive Δ-TG, and Δ-FBS, significantly increased the odds of MetS progression based on IDF and ATP III definitions, while negative Δ-HDL and Δ-neutrophil to lymph ration increased the odds of progression. On the other hand, negative Δ-TG and positive Δ-HDL significantly increased the odds of Mets regression based of both IDF and ATP III. Management of hypertriglyceridemia, hyperglycemia, and HDL is a critical, non-invasive and accessible approach to change the trend of MetS.

Trends in Shaken Baby Syndrome Diagnoses Among Young Children Hospitalized for Abuse

Objective To investigate national trends of SBS diagnosis codes and how trends varied among patient and hospital characteristics. Methods We examined possible and confirmed SBS diagnoses among children age three and younger who were hospitalized for abuse between 1998 and 2014 using a secondary analysis of the National Inpatient Sample, the largest US all-payer inpatient care database ( N = 52,562). A baseline category logit model was used based on a quasi-likelihood approach (QIC) with an independent working correlation structure. Results The rate of confirmed SBS diagnoses increased from 3.8 (± 0.3) in 1998 to 5.1 (± 0.9) in 2005, and decreased to 1.3 (± 0.2) in 2014. Possible SBS diagnoses were 0.6 (± 0.2) in 1998, and increased to 2.4 (± 0.4) in 2014. Confirmed SBS diagnoses have declined since 2002, while possible SBS diagnoses have increased. Possible SBS diagnoses were more common among urban teaching hospitals and small to medium hospitals than for other hospital types. Conclusions We investigated seventeen-year trends of SBS diagnoses among young children hospitalized for abuse. The discrepancy between trends in possible and confirmed SBS suggests differences in diagnostic norms for SBS and related conditions. Researchers should examine diagnostic processes for SBS and investigate why cases are diagnosed as SBS or a related diagnosis. We propose that researchers and pediatric medical providers agree to a standardized definition and diagnostic guidelines for SBS, much like the AHT guidelines proposed by CDC, which may help reduce discrepancies in diagnosis and improve options for surveillance.

Sex Differences and Psychological Factors Associated with General Health Examinations Participation: Results from a Vietnamese Cross-Section Dataset

This study focuses on the association of sex differences and psychological factors with periodic general health examination (GHE) behaviors. We conducted a survey in Hanoi and the surrounding areas, collecting 2068 valid observations; the cross-section dataset was then analyzed using the baseline category logit model. The study shows that most people are afraid of discovering diseases through general health examinations (76.64%), and the fear of illness detection appears to be stronger for females than for males (β1(male) = −0.409, p < 0.001). People whose friends/relatives have experienced prolonged treatment tend to show more hesitation in participating in physical check-ups (β2 = 0.221, p < 0.05). On the ideal frequency of GHEs, 90% of the participants agree on once or twice a year. The probability of considering a certain period of time as an appropriate frequency for GHEs changes in accordance with the last doctor visit (low probability of a health examination every 18 months) and one’s fear of potential health problems post-checkup (no fear raises probability of viewing a health examination every 6 months by 9–13 percentage points). The results add to the literature on periodic GHE in particular and on preventive health behaviors in general.

Distinguishing Occasional Abstention from Routine Indifference in Models of Vote Choice

Researchers commonly employ multinomial logit (MNL) models to explain individual-level vote choice while treating “abstention” as the baseline category. Though many view abstainers as a homogeneous group, we argue that these respondents emerge from two distinct sources. Some nonvoters are likely to be “occasional voters” who abstained from a given election owing to temporary factors, such as a distaste for all candidates running in a particular election, poor weather conditions, or other temporary circumstances. On the other hand, many nonvoters are unlikely to vote regardless of the current political climate. This latter population of “routine nonvoters” is consistently disengaged from the political process in a way that is distinct from that of occasional voters. Including both sets of nonvoters within an MNL model can lead to faulty inferences. As a solution, we propose a baseline-inflated MNL estimator that models heterogeneous populations of nonvoters probabilistically, thus accounting for the presence of routine nonvoters within models of vote choice. We demonstrate the utility of this model using replications of existing political behavior research.

Improvement in patient symptoms and functioning during long-term treatment with olanzapine long-acting injection (OLAI)

Introduction, objectives and aimsTo evaluate the outcome of patients with schizophrenia during maintenance treatment with OLAI.MethodsData from three studies with OLAI were pooled and patients classified according to a cluster analysis [Lipkovich, Psychiatry Res, 2009] into five categories according severity of psychiatric symptoms (sx) and functional impairment (imp):A(minimal sx/mild imp),B(minimal sx/moderate imp),C(moderate sx/mild to moderate imp),D(moderate sx/severe imp),E(moderate to severe sx/severe imp).Improvement was defined as a change from B or C to A, or from D or E to A, B or C. Changes between the categories in the 6 months were analyzed. Stepwise logistic regression modeling was done to determine factors associated with improvement.Results1182 patients were classified. Patients who remained in the studies at 6 months had lower baseline CGI-S (3.04 vs 3.28, p < 0.001), lower PANSS (61.38 vs 64.05, p = 0.012) and higher QLS (1.76 vs 1.39, p = 0.001). (Table 1) As patients in category A couldn’t improve and in category D&E couldn’t worsen, 261(39%) patients from categories B, C, D and E improved and only 55(10%) from categories A, B and C got worse during 6 months. Baseline factors associated with improvement were: baseline category (p < 0.001), CGI-S score (p = 0.022), and PANSS positive (p = 0.003)ConclusionsMajority of patients with schizophrenia who stay on 6 months treatment with OLAI improve or maintain their symptoms and functioning level. The strongest factor associated with a higher chance of improvement was poor baseline category.