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After being held captive and undergoing intense torture at the hands of Yamori, Kaneki's personality changed drastically. He trashed his previous ideology of "being hurt rather than hurting others," pledging to crush those who dared threaten his place of belonging. He adopted the habit of cracking his knuckles from his torturer, Yamori. In his subconscious, Kaneki ate "Rize," the image of his ghoul self. This displayed that he accepted the "ghoul" within him; instead of being influenced by it, he appeared to have become the one to surpass it. Kaneki became ruthless, cruel, and brutal in order to protect his friends, yet he managed to maintain complete composure. He no longer feared his ghoul side and was more violent during battles, such as when he cannibalized Yamori's kagune in order to strengthen himself, and mercilessly broke 103 of Ayato's bones.[20] By embracing his ghoul nature wholeheartedly, Kaneki gave up on being "human."

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Like Urie, Shirazu was prone to disregarding orders and doing whatever he wanted. Sasaki was frustrated by this inability to control his team, and confused when Shirazu argued with him before storming out. He remained unaware of Shirazu being poisoned against him, but this did not last long. After saving his team from Serpent, their relationship vastly improved. He recognized Shirazu's ability to consider his surroundings and prioritize his comrades, having faith in his potential as a leader. To this end, he made Shirazu the new squad leader and encouraged him to excel. He also helped Shirazu in dealing with his guilt over killing Nutcracker. After his death, Sasaki mourned him together with his remaining squad mates.

With regard to estimates of lifetime use of alcohol, the percentage was 53.2%, while the percentage dependent on alcohol was 6.6% (Table 4). In all the studied age groups there were more male dependents than female dependents, reaching almost seven times more among interviewees aged over 35 years (males: 8.9%; females: 1.3%).

The interviewees were questioned on the degree of difficulty in obtaining drugs, if they wanted to use them. The following responses were given: 36.2% reported that "it is very easy to obtain LSD (lysergic acid diethylamide)"; 38.3% said that "it is very easy to obtain heroin"; 62.2% said that "it is very easy to obtain cocaine/crack"; 70.2% said that "it is very easy to obtain marijuana" and 83.8% said that "it is very easy to obtain solvents".

Alcohol and tobacco were the drugs with the highest prevalence of lifetime use, accounting for 53.2% and 39.0%, respectively. The lifetime use of alcohol in the 24 major cities of the State of São Paulo was 53.2%. This was lower than the 70.8% observed in Chile and 81.0% in the United States, but higher than what was found in Colombia (35.5%). The size of these differences remained similar for the different age brackets.14,16,17

Practically the whole population considered that frequent use of any of the four drugs surveyed in this respect (alcohol, marijuana, cocaine and crack) represented a serious risk. It would seem to be common sense that the use of drugs is harmful to health when this is done abusively. Pointing this out in prevention programs may be worthwhile. The main concern regarding this is that when just the risks of drug use are shown in the prevention campaigns, there is the risk of failure through the attempt at scaring the possible user. Although drug use is known to be harmful, it is important to point out that dependence is an illness and such users have difficulty in abandoning their use. A policy of fear may just trigger anxiety in the user.

1. Cotrim BC. O consumo de substâncias psicotrópicas por estudantes secundários: o Brasil frente à situação internacional. [Psychotropic substance consumption by secondary students: Brazil in comparison with the international situation]. Rev ABP-APAL 1991;13(3):112-6. [ Links ]2. Galduróz JCF, Noto AR, Carlini EA. IV Levantamento sobre o uso de drogas entre estudantes de 1o e 2o graus em 10 capitais brasileiras 1997. São Paulo; Universidade Federal de São Paulo. Centro Brasileiro de Informações sobre drogas psicotrópicas CEBRID; 1997. p.130. [ Links ]3. Nappo SA, Galduróz JCF, Noto AR. O uso do "crack" em São Paulo: fenômeno emergente? [Crack use in Sao Paulo city: an emergent phenomenon?] Rev ABP-APAL 1994;16(2):75-83. [ Links ]4. IBGE PNAD - Década de 70. Série Relatórios Metodológicos Rio de Janeiro, 1971. Instituto Brasileiro de Geografia e Estatística - Anuário Estatístico do Brasil. Fundação Instituto Brasileiro de Geografia e Estatística, Rio de Janeiro: Impresso nos Serviços Gráficos do IBGE; 1993. p.238.

The unusual event of penile fracture occurs when there is a disruption of the tunica albuginea surrounding engorged erectile tissue during aggressive sexual behavior. There is often an audible crack and rapid detumescence with subcutaneous hemorrhage that follows. Medical literature has described the etiology and treatment of penile fracture. We report the remarkably unusual social situations of a series of patients who sustained this unique injury. We conducted a retrospective chart review of 16 patients whose injury was severe enough to require surgical repair at the University of Maryland between 2007 and 2011. Particular attention was paid to the intake interview in the emergency department and the postoperative chart notes by the attending urologist to ascertain out-of-the-ordinary social situations in which the injury was sustained. The occurrence of penile fracture is sufficiently rare that the author was able to interact personally with most of the patients. The patients were remarkably forthcoming with the personal social dynamics of the sexual encounter. Half of these penile fracture patients sustained the injury during an extramarital affair. Only three patients sustained the injury in a bedroom; the remainder was in out-of-the-ordinary locations for sexual intercourse, e.g., cars, elevator, the workplace, and public restrooms. Penile fracture patients appear to be a unique population of men who are having sexual intercourse under stressful situations. Extramarital affairs and out-of-the-ordinary locations appear common in patients sustaining this relatively rare injury. 2011 International Society for Sexual Medicine.

Congenital ventral penile curvature without hypospadias is often treated surgically in childhood. The history of untreated ventral curvature is unknown. This study's aim was to examine the association of untreated ventral penile curvature with various sexual and psychosexual outcomes. An electronic survey was advertised to men older than 18 years on Facebook. Men with possible ventral penile curvature identified themselves by choosing sketches that most closely represented their anatomy. Outcomes assessed included: Sexual Health Inventory for Men, difficulty of intercourse because of curvature, International Prostate Symptom Score, Penile Perception Score, psychosexual milestones, paternity, infertility, sitting to urinate, and the CDC HRQOL-4 module. Among participants, 81 out of 684 men (11.8%) reported untreated ventral penile curvature. Participants with self-reported curvature noted more difficulty with intercourse because of curvature (4.5 vs 4.9, p

Traditional beta-blockers have sometimes been associated with erectile dysfunction (ED). Nebivolol is a cardioselective β(1)-adrenoceptor antagonist that promotes vasodilation through a nitric oxide (NO)-dependent mechanism. We evaluated the effects of nebivolol on the NO/cyclic guanosine monophosphate (cGMP) signaling pathway, on erectile function and dysfunction, and in human penile vascular tissues. Erectile response to cavernosal nerve electrical stimulation in control and diabetes-induced ED rats were evaluated, along with serum nitrite/nitrate (NOx) concentration and plasma/tissue cGMP levels. Endothelium-dependent and sildenafil-induced relaxation of isolated human corpus cavernosum (HCC) and human penile resistance arteries (HPRA) were also determined. The effects of nebivolol on erectile function and dysfunction and on NO/cGMP-mediated responses. Treatment with nebivolol significantly potentiated erectile response in control rats, regardless of its effects on blood pressure. Nebivolol increased NOx and plasma cGMP by 3-fold and 2.75-fold, respectively, and significantly augmented the elevation of plasma cGMP produced by sildenafil. Nebivolol enhanced endothelium-dependent and sildenafil-induced relaxations of HCC tissue, and produced endothelium-dependent vasodilation of HPRA. Nebivolol, but not atenolol, significantly improved erectile response in diabetic rats (51.6%, 53.2%, and 87.1% of response at 3 Hz in nondiabetic rats, for vehicle-treated, atenolol-treated, and nebivolol-treated diabetic rats, respectively); after sildenafil administration, ED was completely reversed in nebivolol-treated diabetic rats (69.6% and 112% for diabetic rats treated with sildenafil and nebivolol plus sildenafil, respectively). Accordingly, nebivolol restored systemic NOx levels and cGMP content in penile tissue from these animals. Nebivolol in vivo activated the NO/cGMP pathway, enhanced erectile response and reversed ED in diabetic rats. Moreover, nebivolol in vitro


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