Interference inhibition in offending and non-offending pedophiles: A preliminary event-related fMRI study.

The ability to inhibit behavior is thought to be an import skill for avoiding criminal conduct, especially when combined with personal predispositions or criminogenic needs such as a pedophilic preference disorder. While previous research emphasized the relationship between impulsivity and child sexual offending, not pedophilia per se, studies on the underlying neurobiological mechanisms in subdomains of impulsivity remained scarce. Here, we focused on interference inhibition and examined event-related functional magnetic resonance imaging (fMRI) data of three groups of men performing a color-word Stroop task: (1) pedophiles with a history of CSO (P+CSO, n = 11), (2) pedophiles without a history of CSO (P-CSO, n = 8) and (3) non-pedophilic, non-offending healthy controls (HC, n = 10). On the behavioral level, P+CSO revealed increased Stroop interference as compared to P-CSO and HC. Moreover, increased Stroop interference in P+CSO was accompanied by enhanced conflict-related activity in left superior parietal cortex and precentral gyrus as compared to P-CSO. Albeit behavioral analyses of error and post-error processing revealed no significant between-group differences, P-CSO showed increased post-error-related activity in left posterior cingulate, precuneus and middle temporal gyrus as compared to P+CSO. Our preliminary data highlight inhibition deficits in offending as compared to non-offending pedophiles or healthy men and suggest that functional alterations in attention reallocation and impulse suppression/control may moderate the risk for committing CSO in men suffering from pedophilia.

An Exploratory Study on the Central Nervous Correlates of Sexual Excitation and Sexual Inhibition.

The Sexual Inhibition/Sexual Excitation Scales (SIS/SES) measure sexual excitation and sexual inhibition proneness. We used SIS and SES scores of 62 heterosexual teleiophilic men (Mage 34.3, SD = 9.9) to predict brain activation levels during the presentation of male and female visual sexual stimuli in a magnetic resonance imaging (MRI) scanner. Statistical analyses revealed significant correlations. SES and SIS1 scores were positively associated with brain activation in various brain regions during the presentation of both male and female stimuli. SIS2 turned out to be a weaker predictor of brain activation, still revealing one significant correlation in the right lateral orbitofrontal cortex. Significant regions for SES and SIS1 were, among others, primary and supplementary motor areas, the caudate nucleus, the dorsal anterior cingulate cortex, anterior insula, and prefrontal areas. Our study can be seen as an exploratory investigation of SIS and SES with means of functional brain imaging. The results provide a promising contribution to the assertion of neurophysiological systems of sexual inhibition and excitation proneness.

Gray matter anomalies in pedophiles with and without a history of child sexual offending.

Pedophilia is a psychiatric disorder that is inter-related with but distinct from child sexual offending (CSO). Neural alterations reportedly contribute to both pedophilia and CSO, but until now, no study has distinguished the brain structural anomalies associated with pedophilia from those specifically associated with CSO in pedophilic men. Using high-resolution T1-weighted brain images and voxel-based morphometry, we analyzed the gray matter (GM) volume of the following 219 men recruited at four acquisition sites in Germany: 58 pedophiles with a history of CSO, 60 pedophiles without any history of CSO and 101 non-pedophilic, non-offending controls to control for the effects of age, education level, verbal IQ, sexual orientation and the acquisition site. Although there were no differences in the relative GM volume of the brain specifically associated with pedophilia, statistical parametric maps revealed a highly significant and CSO-related pattern of above vs below the 'normal' GM volume in the right temporal pole, with non-offending pedophiles exhibiting larger volumes than offending pedophiles. Moreover, regression analysis revealed that the lower GM volume of the dorsomedial prefrontal or anterior cingulate cortex was associated with a higher risk of re-offending in pedophilic child molesters. We believe our data provide the first evidence that CSO in pedophilia rather than pedophilia alone is associated with GM anomalies and thus shed new light on the results of previous studies on this topic. These results indicate the need for new neurobehavioral theories on pedophilia and CSO and may be potentially useful for treatment or prevention approaches that aim to reduce the risk of (re)offending in pedophilia.

Workload and cortisol levels in helicopter combat pilots during simulated flights / Carga mental y niveles de cortisol en pilotos de helicóptero de combate en vuelos simulados / Carga de trabalho e níveis de cortisol em pilotos de helicópteros de combate durante voos simulados

Objective. Examine and compare the cortisol levels before and after a simulated flight related to workload in experienced helicopter combat pilots, searching for physiological levels of anxiety. Method. 15 volunteer Spanish Army helicopter combat pilots (36.83 ± 8.04 years) were studied before and after a simulated flight (eight new tasks). Salivary cortisol was measured by DRG salivary cortisol ELISA, and we studied workload using the NASA-TLX. Results. The differences in the mean values of cortisol level before (5.33 ± 1.55) and after the task at the flight simulator (4.47 ± 0.73) are statistically significant (t14 = 3.301; p = .005) with a high effect size (d = 0.75). Similar significant differences were also found (t14 = 3.301; p = .005) between the workload before (19.76 ± 10.54), and after the task (24.82 ± 10.42; medium effect size d = −0.48). No significant relationships were found between the cortisol levels and the workload. Conclusions. Cortisol levels in saliva and workload are the usual in stress situations, and change inversely: workload increases at the end of the task, whereas the cortisol levels decrease after the simulated flight. The somatic anxiety decreases as the task is done. In contrast, when the pilots are faced with new and demanding tasks, even if they fly this type of helicopter in different conditions, the workload increases toward the end of the task. From an applied point of view, these findings should impact the tactical, physical and mental training of such pilots (AU)

Objetivo. Examinar y comparar los niveles de cortisol antes y después de un vuelo simulado en relación con la carga de trabajo de pilotos de helicópteros con experiencia de combate, en busca de niveles fisiológicos de la ansiedad. Método. Se estudió a 15 pilotos de helicópteros voluntarios del Ejército Español (36.83 ± 8.04 años) antes y después de un vuelo simulado compuesto por 8 tareas nuevas. El cortisol salival se midió por DRG Cortisol ELISA y la carga de trabajo con el NASA-TLX. Resultados. Las diferencias entre los valores medios de nivel de cortisol antes (5.33 ± 1.55) y después de la tarea en el simulador de vuelo (4.47 ± 0.73) son estadísticamente significativas (t14 = 3.301; p = 0.005; elevado tamaño de efecto, d = 0.75), así como (t14 = 3.301; p = 0.005) entre la carga de trabajo antes (19.76 ± 10.54) y después de la tarea (24.82 ± 10.42; tamaño de efecto medio, d = −0.48). No hubo relaciones significativas entre los niveles de cortisol y la carga de trabajo. Conclusiones. Los niveles de cortisol en saliva y la carga de trabajo son habituales en situaciones de estrés, y cambian inversamente: la carga de trabajo aumenta al final de la tarea, mientras que los niveles de cortisol —y de ansiedad somática— disminuyen después del vuelo simulado. En cambio, frente a tareas nuevas y exigentes, la carga de trabajo aumenta al final. Estos hallazgos deberían afectar la planificación del entrenamiento táctico, físico y mental de estos pilotos (AU)

Objetivo. Examinar e comparar os níveis de cortisol antes e depois de voo simulado em relação a carga de trabalho de experientes pilotos de helicóptero de combate, procurando por níveis fisiológicos de ansiedade. Métodos. 15 voluntários pilotos de helicópteros de combate do exército espanhol (36.83 ± 8.04 años) foram estudados antes e depois de um voo simulado (8 novas tarefas). Cortisol salivar foi mensurado por DRG Cortisol salivar ELISA, e foi estudado a carga de trabalho usando o NASA-TLX. Resultados. As diferenças nos valores médios dos níveis de cortisol antes (5.33 ± 1.55) e depois da tarefa no simulador de voo (4.47 ± 0.73) foram estatisticamente significantes (t14 = 3.301; p = .005) com o tamanho do efeito (d = 0.75). Diferenças significantes similares também foram encontradas (t14 = 3.301; p = .005) entre a carga de trabalho antes (19.76 ± 10.54), e depois da tarefa (24.82 ± 10.42); tamanho do efeito médio (d = −0.48). Nenhuma relação significativa foi encontrada entre os níveis de cortisol e a carga de trabalho. Conclusão. Níveis de cortisol na saliva e carga de trabalho são comuns em situações de estresse, e mudam inversamente: a carga de trabalho aumenta ao final da tarefa, enquanto o nível de cortisol diminui depois do voo simulado. A ansiedade somática diminui quando a tarefa acaba. Em contraste, quando os pilotos enfrentam uma nova e exigente tarefa, mesmo que eles voem no mesmo tipo de helicóptero em diferentes situações, a carga de trabalho aumenta em direção ao final da tarefa. Para um ponto de vista aplicável, os achados devem impactar o treinamento tático, físico e mental destes pilotos (AU)

Human face processing is tuned to sexual age preferences.

Human faces can motivate nurturing behaviour or sexual behaviour when adults see a child or an adult face, respectively. This suggests that face processing is tuned to detecting age cues of sexual maturity to stimulate the appropriate reproductive behaviour: either caretaking or mating. In paedophilia, sexual attraction is directed to sexually immature children. Therefore, we hypothesized that brain networks that normally are tuned to mature faces of the preferred gender show an abnormal tuning to sexual immature faces in paedophilia. Here, we use functional magnetic resonance imaging (fMRI) to test directly for the existence of a network which is tuned to face cues of sexual maturity. During fMRI, participants sexually attracted to either adults or children were exposed to various face images. In individuals attracted to adults, adult faces activated several brain regions significantly more than child faces. These brain regions comprised areas known to be implicated in face processing, and sexual processing, including occipital areas, the ventrolateral prefrontal cortex and, subcortically, the putamen and nucleus caudatus. The same regions were activated in paedophiles, but with a reversed preferential response pattern.

Brain potentials related to corpus cavernosum electromyography.

The aim of this study was to elucidate the relation between electrical activity in the corpus cavernosum (CC), penile responses and brain processes. EEG potentials, penile circumference and electrical activity of the CC (CC-EMG) were recorded simultaneously while male subjects were exposed to visual sexual stimuli. The trials were sorted by the penile response of the subjects (erection, maintenance or detumescence). The corresponding EEG recordings were subjected to independent component analysis (ICA) and then correlated with CC activity. We found that CC activity was decreased in the case of erection. EEG activity was found to be correlated with CC activity in most cases at the same instant or with subsequent CC activity. EEG activity at early time points after stimulus onset (<300 ms) was found to be correlated with CC activity, indicating penile response preparation at a pre-attentive processing level. These data indicate that (i) CC activity is under the control of brain processing and (ii) autonomous input reaches the CC in fractions of a second after sexual stimulus onset. Our experimental paradigm should be used for the study of psychogenic erectile dysfunctions and could help in the development of an objective measurement of this disturbance.

Brain potentials related to the human penile erection.

The aim of this study was to elucidate the brain processes preceding penile responses. Electroencephalographic (EEG) potentials and penile circumference were recorded simultaneously while male subjects were exposed to visual sexual stimuli (VSS). The trials were sorted by the penile response of the subjects (erection, maintenance or detumescence). The corresponding EEG recordings were then subjected to independent component analysis. We found that 200 ms after VSS onset brain potentials differ according to the genital response to follow. Whereas early posterior negativity (EPN) was predominantly related to erection and maintenance, P3-like activity was found to precede detumescence. EPN indicates a more 'emotional' processing state of the brain, whereas P3-like activity related to detumescence indicates a more 'cognitive' processing state. The latter is assumed to reflect activity of the locus coeruleus-norepinephrine system. Further research should evaluate the contribution of P3-related brain activity to psychogenic erectile dysfunction.

Long-term results of tacrolimus in cyclosporine- and prednisone-dependent myasthenia gravis.

Seventy-nine patients with cyclosporine- and prednisone-dependent myasthenia gravis (MG) after thymectomy received tacrolimus for a mean of 2.5 +/- 0.8 years. Prednisone was withdrawn in all but two patients. Anti-acetylcholine antibodies and MG score for disease severity decreased significantly and muscular strength increased by 39%. Complete stable remission was achieved in 5% of patients and pharmacologic remission in 87.3%. All patients resumed full activities of daily living.

[Methodology and didactics of training children and adolescents in topical treatment of atopic dermatitis]. / Methodik und Didaktik der lokaltherapeutischen Schulung für Kinder und Jugendliche mit atopischer Dermatitis.

There are increasing numbers of education programmes for children and young people with atopic dermatitis. These also include directions for the treatment of atopic dermatitis. However, the methods to be followed and the treatment to be applied are usually not clearly defined or explained. Presented are the key aspects of the local treatment of atopic dermatitis to be taught to children. The introduction of a basic therapeutic concept helps sort out which are the best preparations to use, some with and others without active ingredients. The interactions between basic care, active ingredients and skin conditions are explained in such a way that children can understand them.

[Application of extracorporeal lithotripsy in intestinal subocclusion caused by a clam shell]. / Aplicación de la litotricia extracorpórea en la suboclusión intestinal por valva de molusco.

A patient with intestinal obstruction secondary to a foreign body (clam shell) impacted in the ileocecal valve was treated by extracorporeal shock wave lithotripsy. The resolution of ileus without complications was obtained.