LOS ANGELES, California (CNN) -- George Lucas didn't get to be a billionaire by delegating. George Lucas says he was "completely surprised" by "Star Wars in Concert." Holding fast to his vision -- and his marketing rights -- for the "Star Wars" empire has made it the biggest franchise in history, and made Lucas one of the most powerful people in entertainment. But while he's enthusiastic about the new touring show "Star Wars In Concert," it wasn't his idea, and when I talked with him before the first Los Angeles performance this week, he kept giving the credit to others. "Star Wars In Concert" is built around John Williams' well-known scores from the films, performed by a symphony orchestra and choir, and accompanied by specially edited clips from all six movies, displayed on a mammoth LED screen. Anthony Daniels, who has played and voiced the golden protocol droid "C3PO" in every film and most of the spinoffs, provides live narration -- and another reason for the "Star Wars" fans in the audience, especially those waving lightsabers and dressed as everything from sand people to Imperial stormtroopers, to cheer mightily, as they did the night I interviewed Lucas. iReporter praises the 'Force' of the show . George Lucas: I've seen some presentations of, you know, live orchestras with "Star Wars" clips, and that sort of thing. But this is so much more than that -- it's so much more emotional, because what they've done is taken the emotional content of the score ... one is obviously the Imperial March, one is obviously romantic ... and then they've cut all the pictures around that from all the movies, so that you get this really wide range of visuals going with the music, and it really is quite powerful when you see the depictions of all of the various Imperial shenanigans that were going on over the Imperial March. CNN: Obviously, when John Williams did the music for the original film, neither of you could have guessed your association would last so long, or that you'd be so identified with each other. How did he get involved originally? Lucas: What I did was, I was doing this space opera, and I was talking to Steve Spielberg and I said, "Look, I've got to get somebody who really knows the old-fashioned music score, I really am doing some giant romantic action adventure, you know, throwback to the '30s, and who do you know that can do that?" And he said, "Oh, there's only one person who can do that and that's John Williams -- he did 'Jaws' and he's perfect." And I said OK, and I met him, and we hit it off, you know, perfectly, and doing the first film was such a great experience -- he's so wonderful to work with -- that, you know, I'll never let him go. And Steve won't let him go either! CNN: How did this show come together? Lucas: Howard! [Lucas calls over Howard Roffman, the president of Lucas Licensing.] You're the man who did the whole thing -- I've got nothing to do with it. ... We would kid him about how his concert was going and he had to get Johnny [Williams] to buy in and me to buy in. Howard Roffman: Well, he always got it from the beginning, so he was an easy sell. CNN: But what was it he "got"? How did you sell him on a new concept for his franchise? Roffman: I think he understood that the music was so powerful and the images are so powerful that when you put that together with a live orchestra on a big venue, I mean, who would not be thrilled to see that? CNN: It's a very different experience, being live. Lucas: It's very powerful. I was completely surprised by it. And I've seen other live orchestra performances with "Star Wars" images, but nothing like this -- I mean this really works, because it was edited specifically to bring out the emotion.

"Star Wars in Concert' features John Williams' music and scenes from films .
George Lucas supported idea, though he's quick to give credit to others .
Effect of the arrangement? "It's very powerful," says Lucas .
"Star Wars" remains a tremendously successful franchise .


Art often confronts questions of life, death and the human condition. Now one introspective painter has delved even further into existential themes. He creates each of his works entirely from his own blood. Scroll down for video . Strange themes: Vincent Castiglia sees his methods as putting 'psychic energy' into each piece. Pictured, Beautiful Vivisection . Portrait of the artist: Castiglia extracts his blood in his studio and then uses it to paint the unsettling scarlet designs . Vincent Castiglia, from New York, insists that the content of his work - surrealistic human bodies in various stages of decay - overshadows the strange medium. The tattooed 30-year-old describes his figures as being painted with 'what could be described as "liquid flesh"'. He says that the iron oxide in human blood is a pigment common in paint, and also found naturally in rust and iron ore. His first experiments with using his blood as paint were prompted by a 'need to connect with his work on the most intimate level', but he insists the methods are not gimmicky. Underground sensation: The tattooed 30-year-old has created art for heavy metal band albums and MTV slasher film Savage County . Oxidised: Castiglia's macabre paintings can fetch up to $26,000 a time. Pictured, Stings of the Lash (2005) 'My response would be to really take a . look at the content of the work, which overshadows what it's made from, I . think,' he said. 'In order for something to be a gimmick, it really . would have to lack substance.' Castiglia's website says he 'practises a kind of modern-day phlebotomy [blood-letting]... siphoning the life force which contains his own psychic energy, while giving it an outlet and form [and dissolving] the barrier between artist and art.' He sketches out his pieces in graphite or pen, before extracting his blood in the studio and completing his scarlet artworks. The larger, more detailed . paintings can take more than three months to complete all the works cost between $950 and $26,000. Rock and blues musician Gregg . Allman recently acquired a 2006 painting by Castiglia called Gravity. Under your skin: The works look at birth, death, the human condition and deeper psychological questions. Pictured, Conqueror (2008) Castiglia's latest exhibition, Resurrection, consists of a collection of his blood paintings from the last 10 years, and runs throughout October in Soho, Manhattan. One of the pieces, Feeding, depicts a mother with decaying legs in a wheelchair gazing at an infant she is breastfeeding. Castiglia describes it as an expression of the fragility of life and the hope and drive that can still accompany it. His art may be familiar to slasher film . and heavy metal fans. In 2010, one of his works was used as the . poster for MTV horror film Savage County, and other paintings were used . as album art for Swiss heavy metal band Triptykon's debut Eparistera . Daimones in the same year. Castiglia's work has also featured on Spike TV and tattoo parlour reality show Miami Ink. Life's work: The rust-coloured pieces show human . bodies in various stages of decay. Left, Strata of Self (2010) and . right, Conqueror (2008)

Vincent Castiglia describes his unusual medium as 'liquid flesh'
His artworks have been used for rock band's albums and horror films .


The cost-saving measures we put into place at Columbia/HCA drove down national health care inflation from 18% to 8% in seven years.


You get shot walking to the store.


If Gov. Rick Scott activates the National Guard in anticipation of a federal disaster, the states costs, including the costs to recall any furloughed guardsmen, will be fully reimbursable by FEMA.


Weve got an average of 5,600 soldiers committing suicide. Thats about 20 a day.


Planned Parenthood is nothing more than a referral service. They dont do anything except profit from killing babies and then selling body parts of those aborted babies.


"Obama says Iran is a 'tiny' country, 'doesn't pose a serious threat.'"


What's involved here is the question of leadership for the whole free world.


Now Senator Kennedy has made some very strong criticisms of my part - or alleged part - in what has happened in Cuba.


We have been discouraged and we've been alienated.


I don't want to go down the path to Spain.


My favourite food is anything I didn't have to cook myself.


Now if he does off himself, everyone will think hes having a laugh screwing with people instead of actually dead


To make her feel threatened


OmG pEyToN iSn'T gOoD eNoUgH tO hElP uS iN tHe PlAyOfFs! Dumbass Broncos fans circa December 2015.


It might be linked to the trust factor of your friend.


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How do you change the water pump on a 1999 Taurus 3.0 24 valve?

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Non'significance of the battle of Britain?

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The reuslt of the battle of britain was?

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Battle of Britain was important because?


You want to convert data from tally 5.4 to tally 7.2 please tell you how?

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Nutrients that are formed from fatty acids and glycerol?

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Fat plus water plus glycerol plus fatty acids?

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Is formed when fatty acids bond to an alcohol other than glycerol?

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Nutruents that are formed from fatty acids and glycerol are?

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What does a dehydration synthesis reaction between glycerol and a single fatty acid yield?

Fats are formed by attaching fatty acids to?

When fatty acids cannot pack together to form a solid fat they have what?

What are the two reactive groups in forming a bond between a fatty acid and glycerol caqlled?

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Neutral fats or tryglicerides have what ratio of fatty acids to glycerol?

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Glycerol with three fatty acids creates what reaction to form a fat?

Fatty acids plus glycerol equals fat plus water?

Fats may be formed by attaching three fatty acids to?

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Structural feature of glycerol important in fat formation of fats?

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Describe the synthesis of fats from glycerol and fatty acids?

How many fatty acids and glycerol does it take to make a molecule of fat?


Does the hudson river connect to the atlantic ocean?

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The river in central africa and empties in the atlantic ocean?

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One of the best natural harbors in the world which runs throught eh Atlantic Ocean and the Hudson River is called?


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A militiaman during the revolutionary war he played a critical role in establishing the financial stability of the US?

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Regulations to make a major port?
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this is wild surreal stuff , but brilliant and the camera just kind of sits there and lets you look at this and its like you 're going from one room to the next and none of them have any relation to the other .


i had to look away - this was god awful .


one of creepiest , scariest movies to come along in a long , long time , easily rivaling blair witch or the others .


a disappointment for those who love alternate versions of the bard , particularly ones that involve deep fryers and hamburgers .


ultimately feels empty and unsatisfying , like swallowing a communion wafer without the wine .


it 's worth seeing just on the basis of the wisdom , and at times , the startling optimism , of the children .


it 's of the quality of a lesser harrison ford movie - six days , seven nights , maybe , or that dreadful sabrina remake .


the film is based on truth and yet there is something about it that feels incomplete , as if the real story starts just around the corner .


not exactly the bees knees


recently , magnetic thin films used in magnetic components , such as inductive devices and magnetic heads , have attracted more and more attention because of the increasing demand for improvement and miniaturization of electromagnetic devices [ 1 - 3 ] .
the basic requirements for these films operated in the ghz range are high resistivity  , high permeability  , high saturation magnetization ms and appropriate large anisotropy field
hk so as to effectively suppress eddy current loss and to possess high ferromagnetic resonance ( fmr ) frequency fr ( which determines the cut - off frequency for high frequency application ) .
insulator granular films ( migf ) consisting of magnetic metal nano - granules uniformly distributed in an insulator matrix are one of the best candidates for satisfying above demands , because these films have the advantages of high ms and high  of magnetic metals and high  of insulator .
up to now , soft magnetic properties of granular films composed of magnetic metals ( and their alloys ) and various x-(oxide , nitride and fluoride ) where x is nonmagnetic elements such as hf , al , si , zr , rare earth , etc . have been investigated [ 4 - 8 ] .
the mechanism of the soft magnetic properties of migfs has been confirmed to be the exchange coupling between granules through the intergranular regions .
however , the microscopic origin of exchange coupling has not been totally understood , such as the medium of the exchange coupling for different constitution nano - granular films . by considering the high resistivity of semiconductor oxides , metal  semiconductor granular films ( msgf ) consisting of magnetic metal nano - granules uniformly distributed in semiconductor matrix , such as the feco  zno systems , may possess good high frequency properties .
as one kind of wide used semiconductor oxides due to the excellent electrical and optical properties , the current carriers of zno may mediate the exchange coupling between magnetic granules and hence favor good soft magnetic properties .
so far , there is no work studying systematically the soft magnetic properties of the feco
zno granule films reported . in order to test whether zno can mediate the exchange coupling , the structure , magnetic properties and electronic transport properties of feco  zno msgfs were systematically studied in this work .
( fe65co35)x(zno)1x granular thin films were deposited on water - cooled glass substrates by radio frequency ( rf ) magnetron sputtering at room temperature with a background pressure lower than 4  10 pa . a three - inch fe65co35 alloy disk covered with zno chips ( 5  5  1 mm )
the sputtering power was 100 w , and sputtering ar gas was kept at 0.40 pa .
an external magnetic field obtained by a pair of permanent magnets located on both sides of the substrates was applied during deposition to induce an in - plane uniaxial anisotropy for the samples , and the intensity of external magnetic field is 500 oe . the saturation magnetization 4ms , coercivity hc and in - plane magnetic anisotropy field hk were determined by a vibrating sample magnetometer ( vsm , lakeshore 7304 model ) .
the composition of the samples was measured by energy dispersive x - ray spectroscopy ( eds ) .
the structure and microstructure were analyzed by x - ray diffraction ( xrd ) ( philips xpert model ) with cu - k radiation and high resolution transmission electronic microscopy ( hrtem ) , respectively .
the permeability spectra were carried out with a pna e8363b vector network analyzer using the shorted microstrip transmission - line perturbation method , which works from 100 mhz to 5 ghz .
all the above measurements were performed for as - deposited samples without any post - heat treatment .
figure 1 shows the bright - field hrtem image ( a ) and the corresponding electron diffraction ( ed ) pattern ( b ) , as well as the xrd spectrum ( c ) for a typical sample of x = 0.67 .
it can be seen that the sample consists of bcc fe65co35 particles embedded uniformly in the insulating zno matrix from the image ( a ) .
the average size of fe65co35 particles and the distance between them are about 2 and 4.5 nm , respectively .
figure 1b exhibits the diffraction peaks from ( 110 ) and ( 200 ) planes of bcc fe65co35 alloys , ( 111 ) and ( 103 ) planes of zno , respectively , which are totally consistent with those of xrd shown in fig .
the average diameter of fe65co35 grains calculated by the full width at half maximum ( fwhm ) of the diffraction peak in xrd spectrum through scherrer s equation is about 2.1 nm , which is close to that of fe65co35 granules .
hrtem image ( a ) and the corresponding ed pattern ( b ) as well as the xrd spectrum ( c ) for a typical sample of x= 0.67 figure 2 expresses the x dependence of hc , hk and . it is seen that  increases slowly with decreasing x and then increases rapidly after x < 0.64 .
hc is less than 15 oe , and hkis over 43 oe in the range 0.63 < x < 0.72 , which means good soft magnetic properties are obtained in this range .
especially , for the sample with x = 0.67 , its in - plane hysteresis loop shown in fig .
the coercivities in hard and easy axes are 1.43 and 7.08 oe , respectively , 4ms = 9.85 kg , and  reaches 2.06 m cm , which is three orders higher than that of pure feco alloy .
these good soft magnetic properties and the high  imply that the films are promising for high frequency applications .
h curves for ( fe65co35)0.67(zno)0.33 film figure 4 shows the dependence of complex permeability  =
j on frequency f for the film of x = 0.67 , where  and  represent the real and imaginary parts of complex permeability , respectively .
it can be seen that  is more than 100 below 1.83 ghz and then gradually decreases with frequency , while the imaginary part  gradually increases to a maximum at f = 2.31 ghz , which can be ascribed to the ferromagnetic resonance ( fmr ) .
lifshitz equations taking account of the coherent spin procession , as shown by the solid lines in fig .
the fmr frequency obtained by this fitting is around 2.31 ghz , consistent with the experimental result .
the high fmr frequency also implies that the granular films are promising for applications in the high frequency range .
permeability spectra (  ~ f ) for the sample of x = 0.67 considering the mechanism of the good soft magnetic properties , we turn to the exchange coupling model . according to the herzer s statement , if the average size d of magnetic particles and the distance s between particles are reduced to be smaller than a characteristic length , namely , the exchange length lex , the exchange interaction between particles may take place , which tends to align the magnetic moments of neighboring particles parallel and so overcome the magneto - crystalline anisotropy and the demagnetization effect of individual particles . as a result ,
the effective magnetic anisotropy of materials is reduced significantly , which leads to the decrease in coercivity and hence the increase in permeability , and then good soft magnetic properties are obtained . for fe65co35 , the characteristic length lex is about 26 nm , while the d and s are 2.3 and 4.5 nm , respectively , based on the results of hrtem spectrum .
thus , ( d + s )  lex holds , exchange coupling can be realized in this film , which is responsible for the good soft magnetic properties . in order to study the microscopic origin of the exchange coupling between granules , the temperature dependence of resistivity
figure 5a depicts thecurve , which exhibits a negative temperature coefficient of resistivity ( tcr ) .
5b , which indicates that the mechanism of electronic transportation of the sample is weak localized electron  electron interaction .
these weak localized electrons may also be the medium of exchange coupling between magnetic granules .
resistivity as a function of temperature ( a ) and fitting result ( b ) for a typical sample of x = 0.67
( fe65co35)x(zno)1x granular films were fabricated by magnetron sputtering , and good soft magnetic properties have been obtained in x range from 0.63 to 0.72 with small hc and appropriate large hk . for the typical sample of x = 0.67 ,
the coercivity of 1.43 oe in the hard axis and 7.08 oe in the easy axis are obtained , and the resistivity reaches 2.06 m cm . at a frequency lower than 1.83 ghz , the real part of the complex permeability of this sample is more than 100 , and the fmr frequency reaches 2.31 ghz , which implies that the film is promising for high frequency applications .
the good soft magnetic properties origin from the exchange coupling between magnetic granules and the weak localized electrons existing in films may be the medium of this exchange coupling .
this work was supported by national natural science foundation of china ( grant no.50571041 ) .
this article is distributed under the terms of the creative commons attribution noncommercial license which permits any noncommercial use , distribution , and reproduction in any medium , provided the original author(s ) and source are credited .
this article is distributed under the terms of the creative commons attribution noncommercial license which permits any noncommercial use , distribution , and reproduction in any medium , provided the original author(s ) and source are credited .

 a series of nano - granular films composed of magnetic metal ( fe65co35 ) granules with a few nanometers in size and semiconductor oxide ( zno ) have been fabricated by a magnetron sputtering method , and excellent soft magnetic properties have been achieved in a wide metal volume fraction ( x ) range for as - deposited samples due to the exchange coupling between feco granules ( a ferromagnetic interaction in nano - scale ) . in a wide range ( 0.53 < x < 0.71 ) , the films exhibit coercivity hc not exceeding 15 oe , along with high resistivity . especially for the sample with x = 0.67 , coercivities in hard and easy axes are 1.43 and 7.08 oe , respectively , 4ms = 9.85 kg , and  reaches 2.06  103  cm . the dependence of complex permeability  =   j on frequency shows that the real part  is more than 100 below 1.83 ghz and that the ferromagnetic resonance frequency reaches 2.31 ghz , implying the promising for high frequency application .
 the measured negative temperature coefficient of resistivity reveals that may be the weak localized electrons existing in samples mediate the exchange coupling .


juxtafacet cysts ( jfcs ) are uncommon intraspinal , extradural lesions that arise from the facet joints .
jfcs can be further distinguished as either synovial cysts , if histology confirms the presence of a synovial lining membrane , or alternatively as a ganglion cyst , if no such membrane is present .
however , few differences exist between the two in terms of diagnosis and management.1
 2
 3
 4
 5
 6
 7 their pathogenesis remains unclear , with most authors citing excessive joint mobility leading to synovial fluid herniation through joint capsule defects.2
 4
 7
  calcification in the cyst walls is a common finding on imaging for jfcs , appearing as peripheral areas of high attenuation on computed tomography ( ct ) and peripheral hypointensity on t1- and t2-weighted magnetic resonance imaging ( mri).8
 9
 10 but although calcification of the cyst walls are commonly reported findings,9
 10
 11 complete calcification of the cyst is exceedingly rare.11
 12
 13 we present here an unusual case of a jfc presenting as a giant , multilobular , completely calcified mass with significant extraforaminal extension .
the patient was a 57-year - old woman who presented with a 2-year history of gradually worsening lower back and left leg pain .
she also reported numbness in her left heel and foot and subjective weakness in the left foot .
her past medical history was significant for hypothyroidism , hypertension , mild levoscoliosis , rheumatoid arthritis , and scleroderma managed on weekly methotrexate injection .
her past surgical history was negative for any previous lumbar surgeries , but the patient had received multiple cervical surgeries resulting in c3c7 fusion . on neurologic exam ,
the patient was found to have decreased strength in plantarflexion and dorsiflexion of the left lower extremity but was otherwise nonfocal .
the patient 's imaging was most notable for a large , multilobular mass , measuring 54    31    30  mm , arising from the left l5s1 facet joint that had caused destruction of the joint itself and that showed severe encroachment of the adjoining foramen , with coexisting grade i anterolisthesis of l5 on s1 .
the lesion was hyperdense on plain radiograph ( fig . 1 ) and on ct imaging ( fig
. 2a , 2b , and 2c ) and appeared hypointense on t1- and t2-weighted mri sequences ( fig .
preoperative plain film of the lumbar spine showing a large , completely calcified lesion extending out from the l5s1 intervertebral space .

( a ) axial computed tomography ( ct ) image taken preoperatively , showing the origin of the lesion from the left l5s1 facet joint .
( b ) a preoperative midsagittal ct image demonstrating grade 1 anterolisthesis of l5 on s1 . ( c ) a preoperative sagittal ct image demonstrating foraminal stenosis at l5s1 caused by the lesion .
 ( a ) t1-weighted magnetic resonance image ( mri ) of the same lesion , which appears uniformly hypointense . ( b )
the patient underwent an l5 laminectomy for excision of the mass along with an l5 to s1 fixation and fusion .
intraoperatively , the lesion was noted to consist of a pastelike material that was compressing the thecal sac and that extended ventrally out of the foramen .
histologic analysis identified the lesion as a mineralized simple pseudocyst , containing mineralized proteinaceous material that did not refract plane polarized light after ethanol fixation ( fig . 4a and 4b ) .
( a ) hematoxylin and eosin  stained sections of the resection reveal dense membranous fibrous connective tissue separating spaces associated with dense calcifications as well as smaller loculated spaces filled with calcium ( 20 magnification ) .
( b ) higher magnification ( 40 ) reveals the wall of the spaces to be associated with granular calcifications and no obvious cellular lining .
the patient experienced no intraoperative or postoperative complications , and her postoperative hospital course was unremarkable . by postoperative day 2 , the patient had recovered full strength in her extremities but still had some residual numbness , and she was discharged to home in stable condition on postoperative day 3 . at 2-year follow - up ,
the patient continued to be free of her lower extremity pain and weakness and had not experienced any subsequent postsurgical complications ( fig . 5a and 5b ) .

( a ) postoperative plain film ( anterior - posterior ) showing removal of the mass and placement of fixation hardware .
mineralized , extradural lesions of the lumbar spine arising from the facet joint are uncommon causes of spinal pathology .
the differential diagnosis consists of several uncommon disorders , including synovial osteochondromatosis,14 tumoral calcinosis,15 tumoral calcium pyrophosphate dehydrate crystal deposition disease ( pseudogout),16 and lumbar presentation of ossification of the ligamentum flavum.17 the case we present here represents another potential consideration in that differential diagnosis .
completely calcified jfcs are rare , with only a handful of instances existing in the literature .
almefty et al presented four patients with multiple - level , bilateral , consistently calcified thoracic spinal cysts.12 these lesions were atypical due to their number , location , and mineralization .
kasliwal and deutsch presented on the case of a unilateral lumbar jfc at the l4l5 level.13 similar to our case , the patient presented with radicular symptoms in the setting of a lumbar lesion that appeared hypointense on t1- and t2-weighted mri .
it should be noted that calcification of jfcs can result from treatment as well , as mtellus et al noted a case of a cyst undergoing complete calcification after intracystic steroid injection therapy.11
  the case presented here was remarkable not just for its mineralization but also for its size .
jfcs have typically been recorded to be between 10 and 20  mm in diameter at their widest dimension on imaging.10
 18 the case we report here , however , measured 54  mm at its widest dimension , showing significant extension into nearby structures .
moreover , although jfcs frequently extend into the spinal canal and cause compression of the thecal sac,2 the majority of the lesion in our case existed outside the spinal canal .
this may explain how the cyst grew to be so large before the patient presented for evaluation .
it should also be noted that our patient 's medical history included rheumatoid arthritis and scleroderma , and systemic inflammatory diseases have been associated with jfcs in the past.1
 19 moreover , inflammatory arthritides are known to contribute to the pathogenesis of synovial cysts outside of the spine.20 however , no studies to date have established systemic inflammation as a risk factor for jfc development , and the role of inflammatory joint disease in the pathogenesis jfcs remains unclear .
many methods of treating jfcs have been described , including simple laminotomy with cystectomy and the potential addition of a laminectomy , hemilaminectomy , mesial facetectomy , or foraminotomy.3
 4 minimally invasive approaches with tubular retractors have also been described.19
 21 in terms of treatment of this patient , it was presumed that the symptoms of back pain were secondary to facet dysfunction and that the left - sided plantar flexion weakness was due to foraminal stenosis . due to the size and mineralization of the lesion
, it was felt that a complete facetectomy was needed to adequately address the underlying pathology , necessitating a concurrent fusion .
our case highlights the significant variation that exists in the size , location , and content of jfcs .
although uncommon , jfcs should be considered in the differential diagnosis of lesions arising from the facet joint , even if they appear calcified and noncystic in nature .

 study design  case report .

 objective  to report the case of one patient who developed a giant , completely calcified , juxtafacet cyst .
 methods  a 57-year - old woman presented with a 2-year history of progressively worsening lower back pain , left leg pain , weakness , and paresthesias .
 imaging showed a giant , completely calcified mass arising from the left l5s1 facet joint , with coexisting grade i l5 on s1 anterolisthesis .
 the patient was treated with laminectomy , excision of the mass , and l5s1 fixation and fusion .

 results  the patient had an uncomplicated postoperative course and had complete resolution of her symptoms as of 1-year follow - up .

 conclusions  when presented with a solid - appearing , calcified mass arising from the facet joint , a completely calcified juxtafacet cyst should be considered as part of the differential diagnosis .


panax ginseng ( ginseng ) has been used traditionally in eastern asia over thousands of years .
it has been used orally to treat various diseases including hypertension , diabetes mellitus , liver and kidney dysfunction , mental disorders , and postmenopausal disorders .
in addition , topical applications have also been used to heal wounds and reduce skin inflammation . in the past few decades
, it has been proved that ginseng extracts actually show a wide range of effects against human diseases .
their potential therapeutic effects have been mainly attributed to its immunomodulatory , neuroprotective , antioxidative , antitumor , and hepatoprotective activities .
ginseng contains a number of active ingredients including ginsenosides , polysaccharides , phytosterols , peptides , polyacetylenes , fatty acids , and polyacetylenic alcohols , which have different effects on carbohydrate and lipid metabolism , cognition , angiogenesis , and the neuroendocrine , immune , cardiovascular , and central nervous systems . among the active constituents of ginseng ,
ginsenosides are known to be the major biologically active components of ginseng and the most widely studied .
several studies have shown that ginsenosides play important roles in the pharmacological effects of ginseng .
. however , ginseng contains other constituents , including ginsenoyne , phenolic compounds , polyacetylenes , sesquiterpenes , methoxypyrazine , alkylpyrazine derivatives , sesquiterpene alcohols , panasinsanols , and -carboline .
white ginseng is peeled , dried , ginseng root and red ginseng is produced by steaming fresh ginseng root at 98100c for 23  h , and then drying until the moisture content is < 15% .
red and white ginseng have both been shown to have immunomodulatory , anti - inflammatory , antioxidant , and antiatopic activities . moreover ,
red ginseng has been reported to have more potent pharmacological activities than white ginseng in some respects [ 2022 ] .
the differences in biological activities between red and white ginseng are caused by the chemical changes of ginsenosides after the steaming process .
steaming partially converts the original ginsenosides to deglycoslated derivatives . as a result , the species and amounts of ginsenosides are quite different based on the processing method used .
chu et  al   showed that a total of 53 and 43 compounds were tentatively identified in white ginseng and red ginseng samples , respectively .
the featured compounds are mainly malonyl ginsenosides in white ginseng , and decarboxyl products of mal - ginsenosides and the dehydrated compounds from polar ginsenosides were characteristic in red ginseng .
it is interesting that ginsenosides show a wide variety of biological activities , although the absorption rates from orally administered intact ginsenosides are very low . in the human intestinal tract ,
thus , the pharmacological actions of these ginsenosides have been closely related to their biotransformation by human intestinal bacteria . in this context
several studies showed that the transformation of ginsenosides into deglycosylated ginsenosides is needed to increase ginseng 's effectiveness in  vivo
 .
abnormal changes in skin color induce significant cosmetic problems with a negative effect on quality of life .
there are two groups of pigmentary disorders : disorders of the quantitative and qualitative distribution of normal pigment and the abnormal presence of exogenous or endogenous pigments in the skin .
hyperpigmentation - related diseases include melasma , lentigines , nevus , ephelis , freckles , postinflammatory hyperpigmentation , and age spots .
postinflammatory hyperpigmentation appears in many skin conditions , including acne , eczema , and contact dermatitis .
skin color is determined by various factors including melanin content , oxygenation state of hemoglobin in capillary vessels , carotenoid content , water content , and organization of collagen fibers in the dermis . among these factors , melanin is the major determinant of skin color . in this context ,
melanogenesis is a biochemical pathway responsible for melanin synthesis that is controlled by complex regulatory mechanisms .
melanogenesis occurs in melanocytes confined in separate cytoplasmic organelles called melanosomes , which contain key enzymes of melanogenesis .
differences in skin color are related to the size , number , shape , and distribution of melanosomes , whereas melanocyte density typically remains relatively constant  .
although tyrosinase is the key regulatory enzyme of melanogenesis , tyrosinase - related protein ( trp)-1 , dopachrome tautomerase ( dct / trp2 ) , and melanosomal matrix proteins ( pmel17 , mart-1 ) carry out important roles in regulating melanogenesis .
the genes of tyrosinase , trp-1 , and dct contain common transcription starting sites , the microphthalmia - associated transcription factor ( mitf ) binding sites .
the intracellular signal transduction pathways of protein kinase c , cyclic amp ( camp ) , and nitrogen oxide are involved in the regulation of melanogenesis .
various endogenous and exogenous factors , such as estrogen and ultraviolet ( uv ) radiation , affect melanogenesis via signal transduction pathways .
these endogenous / exogenous factors exert their actions directly on melanocytes or indirectly via surrounding skin cells .
melanocytes , keratinocytes , dermal fibroblasts , and other skin cells communicate with each other by factors that are secreted and cell  cell contacts .
it has been shown that the interactions between keratinocytes and melanocytes are critical in the regulation of melanogenesis .
in addition , dermal factors have been found to be involved in the regulation of melanogenesis . at the same time , stimulated melanocytes secret a number of signal molecules targeting not only keratinocytes but also skin immune cells .
soluble factors released by melanocytes include proinflammatory cytokines and chemokines such as interleukin ( il)-1/1 , il-6 , il-8 il-10 , tumor necrosis factor ( tnf)- , transforming growth factor ( tgf)- , catecholamines , eicosanoids , serotonin , -melanocyte stimulating factor ( -msh ) , and nitric oxide ( no ) .
a variety of hypopigmenting agents including hydroquinone , arbutin , tretinoin , kojic acid , azelaic acid , vitamin c , n - acetylglucosamine , niacinamide , linoleic acid , ellagic acid , methimazole , dioic acid , soy extract , licorice extract , rucinol , and glycolic acid have been used alone or in combination to treat abnormal hyperpigmentation .
these agents can interfere with the pigmentation process at several different steps of skin pigmentation .
however , the treatment of hyperpigmented conditions still remains challenging and the results are often discouraging .
thus there is a need for novel skin - whitening agents that are highly effective and tolerable . in this article
, we review recent reports investigating the skin - whitening effect of ginseng and its components and the underlying mechanisms of action , and then discuss their potential as candidates for novel skin - whitening agents .
p.  ginseng is one of the most widely used medicinal plants in traditional oriental medicine . over thousands of years
, it has been used to improve the overall condition of skin , as well as to treat a wide variety of diseases . however
, genuine scientific approaches to clarify the efficacy of ginseng in skin have only been made in recent years .
several reports have shown that ginseng extract , powder , or some other constituents could inhibit melanogenesis in  vitro and in  vivo . table  1 summarizes the direct effects of ginseng and its components on skin color and key enzymes involved in melanogenesis .
song et  al reported that red ginseng powder improved melasma in a human clinical trial .
they orally administered korean red ginseng powder for 24 weeks to female patients with melasma .
after 24 weeks , the melasma area and severity index score decreased and melasma quality of life scale showed improvement in 91% of patients .
in addition , 74% of the patients showed some improvement on the patient- and investigator - rated global improvement scales .
most of reports investigating the antimelanogenic effect of ginseng were conducted in  vitro used purified tyrosinase or melanocyte cell lines . in melan - a cells treated with ethanol extract of ginseng seeds , melanin content and
in addition to the crude extract or powder , several studies tested the effects of specific constituents of ginseng . the phenol compounds inhibited tyrosinase activity while ginsenoside prevents uvb - induced intracellular increase of reactive oxygen species [ 4648 ] . in some reports , ginsenosides alone exerted antimelanogenic effects .
aglycone of ginsenoside rh4 inhibited melanin synthesis in b16 melanoma cells , possibly by involvement of protein kinase a pathway .
it significantly reduced melanin content and tyrosinase activity in -msh and forskolin - stimulated b16 melanoma cells .
it reduced the camp level and camp response - element binding protein level in b16 melanoma cells , and this might be responsible for the downregulation of mitf and tyrosinase .
in addition , ginsenoside rb1 inhibited melanogenesis through the inhibition of tyrosinase activity in -msh - stimulated b16 cells in a dose - dependent manner .
the crude methanol extract of the fresh leaves of p.  ginseng showed inhibitory activity on mushroom tyrosinase , and p - coumaric acid was characterized as the principal tyrosinase inhibitor in the extract .
p - coumaric acid inhibited melanogenesis in b16f10 melanoma cells stimulated by -msh , and was suggested to interfere with melanogenesis by its structural similarity with tyrosine .
interestingly , p - coumaric acid showed weaker inhibition against mushroom tyrosinase but more strongly inhibited human or murine tyrosinase in comparison with kojic acid and arbutin .
enzyme kinetics analysis indicate that p - coumaric acid is a mixed type ( for tyrosine ) or competitive inhibitor ( for dopa ) of human tyrosinase .
in addition , p - coumaric acid potently inhibits melanogenesis in human epidermal melanocytes exposed to uvb .
cinnamic acid , one of the major components of cinnamomum cassia blume , is found in the root and seed of p.  ginseng
 .
cinnamic acid significantly reduced melanin production , tyrosinase activity , and tyrosinase expression in the melan - a cells .
in addition , cinnamic acid showed depigmenting activity on the uvb - tanned skin of brown guinea pigs .
it is already known that the pharmacological actions of these ginsenosides have been closely related to their biotransformation by human intestinal bacteria . although the contents of total ginsenosides in red ginseng and fermented red ginseng using lactobacillus brevis were not significantly different , the ginsenoside metabolite content was higher in fermented red ginseng compared to red ginseng .
the tyrosinase inhibitory activity of fermented red ginseng extract was more potent compared with red ginseng extract in a test using mushroom tyrosinase .
as reviewed above , crude extract or some components of ginseng and its components showed antimelanogenic activities by direct inhibition on key enzymes of melanogenesis , such as tyrosinase .
moreover , ginseng and its components could exert antimelanogenic activity via action on the several factors related in melanocyte physiology . among a large number of soluble factors produced from melanocytes , keratinocytes , fibroblasts , and immune cells in skin , adrenocorticotropic hormone ( acth ) , -msh , endothelin-1 , prostaglandin e2 , prostaglandin f2 , no , and histamine are well - known stimulators of melanogenesis [ 37,5963 ] .
il-1/1 and granulocyte - macrophage colony - stimulating factor ( gm - csf ) stimulate melanogenesis , while il-6 , tgf-1 , and tnf- downregulate melanin production .
gm - csf has been reported to be involved in regulating the proliferation and differentiation of epidermal melanocytes .
treatment of melan - a cells with conditioned media from uv - irradiated sp-1 keratinocytes increased melanocyte proliferation , and the proliferative effect of the conditioned media was blocked by anti - gm - csf antibody treatment . when uv - irradiated sp-1 keratinocytes were treated with red ginseng extract or saponin of red ginseng , the increased melanocyte proliferation by the conditioned media was blocked . in that report ,
red ginseng extract or saponin of red ginseng treatment decreased the expression of gm - csf induced by uv - b irradiation in sp-1 keratinocytes .
as mentioned above , inflammatory cytokines such as il-1 and tnf- take part in the regulation of melanogenesis .
ginseng extracts and ginsenosides have been reported to have anti - inflammatory activities in several different studies .
ginsenosides inhibit different inducer - activated signaling protein kinases and transcription factor nuclear factor ( nf)-b , and then decrease the production of proinflammatory cytokines and mediators of inflammation .
korean red ginseng extracts decreased tnf- and il-8 production in lipopolysaccharide ( lps)-stimulated hacat keratinocytes and show radical scavenging and antioxidant activity in human dermal fibroblasts .
these findings suggest that ginseng extracts and ginsenosides might affect melanogenesis through their anti - inflammatory activities . the effect of ginseng on no production is still questionable .
sun ginseng , a new processed ginseng prepared by steaming at high temperature , reduced uv - b - induced cell damage and decreased no production by inhibition of inducible no synthase mrna synthesis in hacat keratinocytes and human dermal fibroblasts .
red ginseng marc oil inhibited inducible no synthase and cyclooxygenase-2 via nf-b and p38 pathways in lps - stimulated raw264.7 cells .
in addition , ginsenjilinol , a protopanaxatriol - type saponin obtained from the roots of p.  ginseng , shows inhibitory activity on no production in lps - stimulated raw264.7 cells .
by contrast , there are some controversial reports that ginseng extract enhanced no production or no signaling .
hong et  al reported that ginseng extract administration stimulated nongenomic endothelial no synthase activation and enhanced no production in spontaneously hypertensive rats . in another report , water extract of korean red ginseng exerted vasoprotective effects through augmentation of no production by inhibiting arginase .
therefore , the effect of ginseng on melanogenesis via no signaling remains to be clarified by further study .
considerable numbers of immune cells including langerhans cells , macrophages , mast cells , and t cells are working actively in skin tissue . because the immunostimulatory activities of many ginsenosides are known , it is not surprising that ginsenosides could enhance the reactivity of skin immune cells . in a recent paper ,
a cream containing 0.1% ginsenoside f1 ( a metabolite of ginsenoside rg1 ) showed a significant whitening effect on artificially tanned human skin .
however , ginsenoside f1 did not directly inhibit mrna expression of tyrosinase or dct in normal human epidermal melanocytes .
instead , ginsenoside f1 enhanced production of il-13 from human epidermal  t cells , and il-13 significantly reduced the mrna expression and protein amount of both tyrosinase and dct resulting in visible brightening of normal human epidermal melanocyte pellets .
these results suggest that ginsenosides might be able to regulate melanogenesis via their effect on skin immune cells .
recently , several reports have shown that extract , powder , or some constituents of ginseng could inhibit melanogenesis in  vivo or in  vitro
. the underlying mechanisms of the antimelanogenic effect of ginseng or its components included the direct inhibition of key enzymes of melanogenesis ( tyrosinase and dct ) , inhibition of transcription factors ( mitf , nf-b ) or signaling pathways ( protein kinase a pathway and protein kinase c pathway ) involved in melanogenesis , decreasing the production of inducers of melanogenesis ( camp , gm - csf ) , and enhancing production of antimelanogenic factor ( il-13 ) . fig .
although issues surrounding the antimelanogenic activity of ginseng still remain controversial , especially in its effect on the production of proinflammatory cytokines and no , these recent findings suggest that ginseng and its constituents might be potential candidates for novel skin - whitening agents .

 abnormal changes in skin color induce significant cosmetic problems and affect quality of life .
 there are two groups of abnormal change in skin color ; hyperpigmentation and hypopigmentation .
 hyperpigmentation , darkening skin color by excessive pigmentation , is a major concern for asian people with yellow  brown skin .
 a variety of hypopigmenting agents have been used , but treating the hyperpigmented condition is still challenging and the results are often discouraging .
 panax ginseng has been used traditionally in eastern asia to treat various diseases , due to its immunomodulatory , neuroprotective , antioxidative , and antitumor activities . recently
 , several reports have shown that extract , powder , or some constituents of ginseng could inhibit melanogenesis in  vivo or in  vitro .
 the underlying mechanisms of antimelanogenic properties in ginseng or its components include the direct inhibition of key enzymes of melanogenesis , inhibition of transcription factors or signaling pathways involved in melanogenesis , decreasing production of inducers of melanogenesis , and enhancing production of antimelanogenic factor .
 although there still remain some controversial issues surrounding the antimelanogenic activity of ginseng , especially in its effect on production of proinflammatory cytokines and nitric oxide , these recent findings suggest that ginseng and its constituents might be potential candidates for novel skin whitening agents .


aneuploid strains were generated by sporulation of the above polyploid strains , followed by karyotype stability tests and determination as described in fig .
qpcr assays were designed with primers in non - coding regions on each chromosome arm ( supplementary table 1 lists primer sequences ) .
dna samples were prepared by alkaline lysis , and qpcr reactions were performed in 384-well plates using a biomek fx ( beckman coulter ) to assemble 10 l reactions and an abi 7900ht ( applied biosystems ) for cycling .
equal amounts ( od600 ) of aneuploid and euploid control cultures were spotted , using the biomek fx robot , onto omnitrays containing various solid media and grown under conditions listed in supplementary table 2 .
omnitrays representing three biological replicates of each tested condition were scanned on an hp scanjet 4070 desktop scanner .
whole - cell lysates were prepared from 50 ml cycling yeast cultures by bead - beating .
the ms / ms datasets were searched using sequest23 against a database of 11,986 sequences , consisting of 5,816 s. cerevisiae non - redundant proteins ( ncbi ) , 177 contaminants and 5,993 decoy sequences .
all statistical analyses were performed in the r environment25 using standard packages and custom scripts .
aneuploid strains were generated by sporulation of the above polyploid strains , followed by karyotype stability tests and determination as described in fig .
qpcr assays were designed with primers in non - coding regions on each chromosome arm ( supplementary table 1 lists primer sequences ) .
dna samples were prepared by alkaline lysis , and qpcr reactions were performed in 384-well plates using a biomek fx ( beckman coulter ) to assemble 10 l reactions and an abi 7900ht ( applied biosystems ) for cycling .
equal amounts ( od600 ) of aneuploid and euploid control cultures were spotted , using the biomek fx robot , onto omnitrays containing various solid media and grown under conditions listed in supplementary table 2 .
omnitrays representing three biological replicates of each tested condition were scanned on an hp scanjet 4070 desktop scanner .
whole - cell lysates were prepared from 50 ml cycling yeast cultures by bead - beating .
the ms / ms datasets were searched using sequest23 against a database of 11,986 sequences , consisting of 5,816 s. cerevisiae non - redundant proteins ( ncbi ) , 177 contaminants and 5,993 decoy sequences .
all statistical analyses were performed in the r environment25 using standard packages and custom scripts .

 aneuploidy , referring here to genome contents characterized by abnormal numbers of chromosomes , has been associated with developmental defects , cancer , and adaptive evolution in experimental organisms19 .
 however , it remains unresolved how aneuploidy impacts gene expression and whether aneuploidy could directly bring phenotypic variation and improved fitness over that of euploid counterparts . in this work
 , we designed a novel scheme to generate , through random meiotic segregation , 38 stable and fully isogenic aneuploid yeast strains with distinct karyotypes and genome contents between 1n and 3n without involving any genetic selection . through phenotypic
 profiling under various growth conditions or in the presence of a panel of chemotherapeutic or antifungal drugs , we found that aneuploid strains exhibited diverse growth phenotypes , and some aneuploid strains grew better than euploid control strains under conditions suboptimal for the latter . using quantitative mass spectrometry - based proteomics ,
 we show that the levels of protein expression largely scale with chromosome copy numbers , following the same trend observed for the transcriptome .
 these results provide strong evidence that aneuploidy directly impacts gene expression at both the transcriptome and proteome levels and can generate significant phenotypic variation that could bring about fitness gains under diverse conditions .
 our findings suggest that the fitness ranking between euploid and aneuploid cells is context- and karyotype - dependent , providing the basis for the notion that aneuploidy can directly underlie phenotypic evolution and cellular adaptation .


in order to assess sexual well - being and provide treatment or education for iranian women 's sexuality , it is necessary to understand their sexuality and the meanings they give to sexual behaviors .
sexual behavior is a complex concept that is difficult to measure . according to webster 's online dictionary ,
the manner of conducting oneself and  sexual simply means whatever relates to  sex ,  the sexes or
sexual reproduction. thus , sexual behavior would be an act by someone that expresses their sexuality . in the archive for sexology , erwin j. haeberle introduces
sexual as a word with double meaning , referring to  human anatomy as well as to human behavior  . he defines  sexual behavior as erotic behavior .
therefore , in contrast with webster , the critical dictionary in the archive for sexology defines human reproduction as  asexual behavior  because it concentrates on  the biological facts without reference to the erotic feelings of the man and the woman involved  .
the functional analysis of sexual behaviors has led researchers to develop instruments to gather observable data . in order to change subjective meanings to observable data ,
the researchers need to extract meanings from the contexts and populations they seek to measure .
many sexually related measures and instruments have been published ; they measure perceptions , attitudes , beliefs and so on . however , the contexts from which the concepts and meanings were extracted to develop these instruments vary .
doubtless , their reliability in measuring sexual behaviors as socially constructed , complex and dynamic phenomena can be questioned . in order to determine a research approach for the context of iranian women 's sexuality , review and assessment of existing instruments was essential . after a brief overview of the existing instruments measuring
non - risky  sexual behaviors among heterosexual women , we look at their cultural appropriateness to measure sexual behaviors within an iranian context .
finally , because we find these instruments insufficient , we suggest criteria for cultural - specific sexually related measures in the iranian settings .
for the purpose of this paper , we searched literature using medline , pub - med , psychinfo and cinahl from june 2006 to june 2011 .
the mesh terms used to search title and abstract included  sexuality  ,  sexual behavior  ,  questionnaire  and  sexual behavior and questionnaire  or
sexually related measure  ,  sexually related tools  limited to  human , female , english and reproductive age  . focused exclusively on the concept of sexual behavior , we screened titles and abstracts . considering that not all abstracts highlighted the specified population and name of the applied tools ,
these articles were found in full , and methods sections were reviewed to identify populations and the tools used .
retrieved articles were included if they used a structured instrument(s ) to measure sexual behaviors of the female population .
we excluded those studies whose outcome of interest included risky sexual behaviors or sexual behaviors measured among same sex relationships .
we excluded same sex relationships because this form of relationships is illegal and deniable in iran .
if the original paper was unavailable , we selected the article that used the given tool to measure the study outcomes . in this stage , tools in languages other than english , those employed just for menopausal women and those not related to sexual behaviors were excluded . using gagnon and simon sexual script theory as the theoretical framework ,
cultural appropriateness ( i.e. understanding and language of sexuality , ethics , and morality ) was our selection criteria for the instruments .
evaluation of the 143 articles revealed that a majority of them ( 65% ) had utilized the female sexual function index ( fsfi ) in their research .
the second most used scale was the pelvic organ prolapsed / urinary incontinence sexual function questionnaire ( pisq-12 ) , utilized in 10.4% of the final articles .
the golombok - rust inventory of sexual satisfaction ( griss ) and the arizona sexual experience scale ( asex ) were the next most used instruments by 6.9% and 5.6% of articles , respectively .
we reviewed all instruments and determined the subscales as well as measurement types [ table 1 ] .
we categorized these instruments into three groups based on their working definitions of  sexual behavior and theoretical frameworks .
these instruments were reviewed by the authors , who are iranian experts in sexology , reproductive health , and epidemiology .
of 50 instruments , we found 19 tools applicable in the iranian culture [ table 2 ] .
the third group included those which were focused on a specific sexual problem rather than looking at sexual behaviors overall [ table 4 ] .
the multidimensional derogatis sexual functioning inventory ( dsfi ) did not fit into any of those three categories . with this overview
, it appears that there are significant challenges to using these instruments in iranian contexts .
instruments features including the subscales compatible scales for iranian culture instruments incompatible with iranian culture problem - focused instruments
inspiring gagnon and simon 's description of sexual behaviors defined with  social scripts , understanding and language of sexuality , ethics , and morality are the main cultural determinants of sexual norms in the iranian society . in her linguistic analysis of sexuality expression of iranian women ,
merghati - khoei has revealed the ways of developing terminology and cultural explanations , which are juxtaposed with the exploration of the development of women 's sexuality .
iranian women expressed their sexuality differently from western women even though they understood and talked about the same issues .
there is , however , a hesitation when it comes to discussing or reporting the emotional aspects of sexual encounters .
the power of culture in dictating daily language for females has been highlighted in morocco as an arab - islamic context .
similarly , culturally meaningful ambiguity in language guides iranian people 's behavior . even though persian vocabulary ,
concepts and expressions about sexual matters exist in art , poetry and the beauty of nature , these linguistic resources are not applied in daily life to express sexuality .
for example , the sexual attitude scale ( sas ) , certainly a well - designed tool for use within many cultures measures a person 's awareness toward her / his sexual interests and needs as well as sexual - self judgment .
communication of sexual needs or interests with others is another feature of this tool . as a neglected subject matter in the iranian culture , questioning people about their sexual needs and interests or sexual - self concept seems impractical .
sexuality is an unspoken issue , and individuals might not be linguistically skilled to communicate their sexuality with an interviewer . in sum , the art of using a rich vocabulary of metaphors and euphemisms is a characteristic of iranian speech , used to communicate and encapsulate matters not normally spoken explicitly .
for example , for fluent english speakers phrase  marital life may indicate all kinds of relationships within a marital framework , while in farsi zendegi - e - zanashoyi ( literally marital life ) has sexual connotations and is usually understood to mean the sexual relationship between husband and wife .
another difficulty in asking about sexuality during a study is the struggle between conscious embarrassment and sexual talk . by conscious embarrassment , we mean the shame , prohibition and modesty about sex .
the majority of the women who participated in merghati - khoei 's qualitative study pointed out that they were not culturally expected to be straightforward or frank in expressing sexual matters .
for example , the sexual desire inventory tends to measure sexual desire as a biologic factor . out of 14 items ,
4 focus on masturbation and 2 items ask about having interest in casual sex . in iranian contexts ,
none of these 6 items would be posed by researchers or responded to by the participants .
why human have sex ? ( ysex ) is another example , which measures number of variables .
for instance , some of the items focus on motivations leading people to out - of - wedlock or casual sex .
although casual or extra marital sex happens in every society , questioning iranians about these behaviors is not ethically and religiously possible or feasible .
this assertion is based on the common assumptions . in iran , people strongly hold onto the traditional culture of sexuality based on  purity ( paki ) ,
 chastity ( nejabat ) ,  honour ( aberoo ) and  honesty ( sedagat ) underlying the family structure .
there is also the belief commonly permeating iranian society that people are fairly innocent in terms of sexuality compared with non - muslim or western societies .
however , with these assumptions we can not minimize the impact of factors such as modernization , worldwide communication and cultural transformations in younger generations and the way they learn about sex , practice and develop their sexual understandings . undoubtedly , these factors change behaviors and attitudes .
social conduct and religiosity define the ethical aspect of sexuality in the iranian culture . in iran
the teachings of islamic principles tie strongly to shia interpretations , which form the basis for iranians understandings of sexuality  .
the expression of sexuality is considered legitimate only within the framework of islamic marriage ( nikah ) . moreover , as shown in merghati et al .
study , sexual obedience was seen as the primary goals of the committed muslim woman .
the concept of nejabat ( modesty ) is the most important ethical code applied to an iranian woman who is not sexually expressive .
in contrast , islamic scholar morteza motahari pointed out the islamic clear guidelines toward sexuality ,  leading neither to any sense of sexual deprivation and frustration , nor to any repressed or inhibited sexual desire  .
however , in the islamic doctrine  freeing sexual desire and lifting of traditional moral restraints is not accepted . as a criterion ,
religiosity has significant effects on iranian women 's sexual understandings ; and that experts working in the fields of gender and sexuality need to be sensitive to the notion that some muslim women may not speak out their sexuality as an indicator of submission to religious codes , of modesty and of being an idealized muslim wife .
in her linguistic analysis of sexuality expression of iranian women , merghati - khoei has revealed the ways of developing terminology and cultural explanations , which are juxtaposed with the exploration of the development of women 's sexuality .
iranian women expressed their sexuality differently from western women even though they understood and talked about the same issues .
. there is , however , a hesitation when it comes to discussing or reporting the emotional aspects of sexual encounters .
the power of culture in dictating daily language for females has been highlighted in morocco as an arab - islamic context .
even though persian vocabulary , concepts and expressions about sexual matters exist in art , poetry and the beauty of nature , these linguistic resources are not applied in daily life to express sexuality .
for example , the sexual attitude scale ( sas ) , certainly a well - designed tool for use within many cultures measures a person 's awareness toward her / his sexual interests and needs as well as sexual - self judgment .
communication of sexual needs or interests with others is another feature of this tool . as a neglected subject matter in the iranian culture , questioning people about their sexual needs and interests or sexual - self concept seems impractical .
sexuality is an unspoken issue , and individuals might not be linguistically skilled to communicate their sexuality with an interviewer . in sum , the art of using a rich vocabulary of metaphors and euphemisms is a characteristic of iranian speech , used to communicate and encapsulate matters not normally spoken explicitly .
for example , for fluent english speakers phrase  marital life may indicate all kinds of relationships within a marital framework , while in farsi zendegi - e - zanashoyi ( literally marital life ) has sexual connotations and is usually understood to mean the sexual relationship between husband and wife .
another difficulty in asking about sexuality during a study is the struggle between conscious embarrassment and sexual talk . by conscious embarrassment , we mean the shame , prohibition and modesty about sex .
the majority of the women who participated in merghati - khoei 's qualitative study pointed out that they were not culturally expected to be straightforward or frank in expressing sexual matters .
for example , the sexual desire inventory tends to measure sexual desire as a biologic factor . out of 14 items ,
4 focus on masturbation and 2 items ask about having interest in casual sex . in iranian contexts ,
none of these 6 items would be posed by researchers or responded to by the participants .
for instance , some of the items focus on motivations leading people to out - of - wedlock or casual sex .
although casual or extra marital sex happens in every society , questioning iranians about these behaviors is not ethically and religiously possible or feasible .
this assertion is based on the common assumptions . in iran , people strongly hold onto the traditional culture of sexuality based on  purity ( paki ) ,  chastity ( nejabat ) ,  honour ( aberoo ) and  honesty ( sedagat ) underlying the family structure .
there is also the belief commonly permeating iranian society that people are fairly innocent in terms of sexuality compared with non - muslim or western societies .
however , with these assumptions we can not minimize the impact of factors such as modernization , worldwide communication and cultural transformations in younger generations and the way they learn about sex , practice and develop their sexual understandings .
undoubtedly , these factors change behaviors and attitudes . social conduct and religiosity define the ethical aspect of sexuality in the iranian culture .
in iran the teachings of islamic principles tie strongly to shia interpretations , which form the basis for iranians understandings of sexuality  .
the expression of sexuality is considered legitimate only within the framework of islamic marriage ( nikah ) . moreover , as shown in merghati et al .
study , sexual obedience was seen as the primary goals of the committed muslim woman .
the concept of nejabat ( modesty ) is the most important ethical code applied to an iranian woman who is not sexually expressive .
in contrast , islamic scholar morteza motahari pointed out the islamic clear guidelines toward sexuality ,  leading neither to any sense of sexual deprivation and frustration , nor to any repressed or inhibited sexual desire  .
however , in the islamic doctrine  freeing sexual desire and lifting of traditional moral restraints is not accepted . as a criterion ,
religiosity has significant effects on iranian women 's sexual understandings ; and that experts working in the fields of gender and sexuality need to be sensitive to the notion that some muslim women may not speak out their sexuality as an indicator of submission to religious codes , of modesty and of being an idealized muslim wife .
to investigate sexual behaviors in an iranian context , we recognize the importance of identifying or developing an instrument to assess sexual behavior domains among women in the particular context of iranian culture .
we thought that such an instrument would be essential tool for achieving a more systematic and in - depth understanding of iranian women 's sexuality , may be useful in applied settings , and would advance sexuality research as a whole . no matter the context or use
, however , measuring a construct such as sexual behavior is subjective and therefore entirely dependent on self - report .
it has been argued that iranian women may not report properly if they believe sexuality has nothing to do with health .
for example , a woman 's inability to gain sexual pleasure due to painful intercourse might not be defined as a sexual health problem to be reported , whereas other people would consider it as a sexual health problem for the woman .
this suggests the idea that the culture of sexuality affects people 's interpretations of sexually related problems .
developing a contextualized instrument to measure the domains of sexual behavior would allow sexuality and gender researchers to better answer questions related to the influence of culture in those domains , sexual scripts across diverse cultures , and other factors influencing sexual health outcomes . in the 1970s , gagnon and simon 's sexual conduct represented the first truly sociological analysis of sexual behavior .
gagnon and simon defined  sexual behavior within a new theoretical framework of  social scripts. they produced a critique that moved us beyond the objective definition of sexual behavior : our concern here is to understand sexual activities of all kinds  as the outcome of a complex psychological process of development , and it is only because they are embedded in social scripts that the physical acts themselves become possible  it is neither fixed by nature or by the organs themselves .
the very experience of sexual excitement that seems to originate from hidden internal sources is in fact a learned process and it is only our insistence on the myth of naturalness that hides these social components from us . the
character through a  cultural scenario in which they take up , internalize and enact culturally prescribed normative roles ;  interpersonal scripts in which they make a suitable identity based on desired expectations and  intrapsychic scripting in which they make  the self in relation to social life .
thus , sexual practice is separated from the biology of the body and one 's sexuality is strongly formed by the very complex social world .
having investigated the history of human sexuality , we believe sexuality is influenced by the society , culture and era in which people live . within an iranian context , we therefore recognized existing instruments targeting
non - risky  sexual behaviors among heterosexual women are insufficient to measure sexual behaviors .
we categorized instruments as culturally compatible or incompatible based on the sexuality domains they tend to measure .
the instruments , by which the biological aspects of sexual behaviors are measured were found applicable for any given community or population , the iranian context included .
alternatively , those measuring outcomes related to subjects attitudes , understanding or sexual scripts were identified as culturally incompatible .
most of the tools seem reasonable candidates for use in the iranian culture and society with minor revisions [ table 1 ] .
review of these instruments shows that most of them are functional based , such as the most used scale in literature , ( fsfi ) .
other well known tools , such as the arizona sexual experience scale ( asex ) and the golombok - rust inventory of sexual satisfaction ( griss ) , are also functional based .
some other tools are problem - focused [ table 3 ] and specific to measure only disorder - based outcomes .
we argue that the medically oriented instruments employed in the field are drawn from concepts and meanings based on investigations conducted in western societies .
yet as researchers , we sometimes found ourselves disappointed by the level of difficulty , which we professionals encountered in fitting our participants into those biomedical frameworks .
the culture - bound nature of sexuality limits the research - based information in iran . in our society
, the lack of information in the sexual domain will be most productively addressed first through research attention to subjective concepts .
lack of sufficient knowledge in the field of sexuality in iranian contexts , makes it important to identify normative sexual behaviors qualitatively before applying problem - oriented tools in research .
there are social and cultural challenges arising from the recognition that iranians use culturally specific sexual expressions .
these expressions may construct different ways of perceiving sexuality that are not easily translatable or even understandable by outsiders .
this means that sexuality is a complex phenomenon embedded in various meanings and understandings , not merely objective and measurable behavior . explaining those meanings and perceptions makes sexuality a  dynamic phenomenon through one 's life time .  how we know what we know changes periodically and therefore , creating an epistemological crisis in knowledge as well as the research process .
however , scholars in science and human behavior such as skinner have powerfully questioned the reliability of subjective measures of private events such as sexual behaviors .
we concluded that the published instruments are well - designed and used worldwide ; however , we must also acknowledge that the sexual scripts of iranian women define  sexual behaviors differently , limiting their communication in the research setting and compromising the compatibility of these instruments .
therefore , exploring and analyzing the lexicon and expressions used by the iranian women creates a ground for developing a culturally comprehensive measure , which can adequately examine how these women explain their sexual behaviors .

 the cultural compatibility of sexually related instruments is problematic because the contexts from which the concepts and meanings were extracted may be significantly different from related contexts in a different society .
 this paper describes the instruments that have been used to assess sexual behaviors , primarily in western contexts .
 then , based on the instruments working definition of  sexual behavior and their theoretical frameworks , we will ( 1 ) discuss the applicability or cultural compatibility of existing instruments targeting women 's sexual behaviors within an iranian context , and ( 2 ) suggest criteria for sexually related tools applicable in iranian settings .
 iranian women 's sexual scripts may compromise the existing instruments compatibility .
 suggested criteria are as follows : understanding , language of sexuality , ethics and morality .
 therefore , developing a culturally comprehensive measure that can adequately examine iranian women 's sexual behaviors is needed .


a level of pain that completely incapacitates one individual may cause only a minor annoyance in another .
characterizing the genetic factors affecting susceptibility to chronic pain could lead to novel treatment or prevention strategies , which are desperately needed . a recent paper by costigan et al .
the authors performed a multi - dimensional analysis using rat gene expression and human genetic association that identified a new genetic factor affecting susceptibility to chronic pain .
this study   was initiated by analysis of gene expression changes within rat dorsal root ganglia obtained after nerve damage was induced in three different models of chronic pain .
the mrna for a potassium channel alpha subunit ( kcns1 ) was constitutively expressed in sensory neurons , but was downregulated after three types of nerve injury in these models .
other studies have successfully identified a human genetic susceptibility factor on the basis of a candidate gene emerging from analysis of a rodent model .
costigan and colleagues   therefore examined snp alleles within the human homolog ( kcns1 ) in five independent cohorts ( two with chronic low back pain , two after limb amputation and one after mastectomy ) that have a high incidence of chronic pain . in four of
the five cohorts studied , there was a significant association of the val allele at a nonsynonymous snp ( rs734784 , val / ile ) with increased risk for chronic pain .
for example , homozygous val / val individuals had a 2.4-fold increased relative risk of failing to achieve pain improvement 1 year after back surgery .
the proportion of individuals without phantom limb pain after leg amputation was 45% in those without the val allele , but fell to 22% in val / val homozygotes . among healthy volunteers that were subjected to multiple experimental pain stimuli ,
although experimental studies demonstrating an allelic effect were not presented , which is a substantial limitation of this study , these results   make it likely that kcns1 alleles contribute to susceptibility to chronic pain .
although kcns1 by itself does not have potassium channel function when tested in heterologous expression systems , its expression has been shown to modulate the currents formed by other channels [ 3 - 5 ] .
voltage - gated potassium channels have important effects on neuronal function , including altering the resting membrane potential and the shape and frequency of the action potential
. similarly , gain - of - function mutations in the nav1.7 sodium channel cause syndromes associated with increased pain sensitivity .
chronic pain has a huge impact on our society , and its treatment is a major driver for the increasing cost of health care . an estimated 76 million people in the us have chronic pain , which costs the us public over $ 100 billion per year .
approximately 25% of chronic pain is neuropathic ( caused by nerve damage ) , which is characterized by spontaneous pain that is burning or stabbing in nature .
this can develop after limb amputation , mastectomy or lower back injury , or in individuals with a long history of diabetes .
although multiple kinds of treatment can be used , they often have limited efficacy , and chronic pain is often managed by administration of opioids ( morphine and related synthetic compounds , including hydrocodone ) .
the increased focus on pain management resulted in a six - fold increase in the per capita sales of prescription opioid medications in the us between 1997 and 2006 .
hydrocodone - acetaminophen is prescribed over 100 million times per year in the us , which is far more than any other medication , including lipid - lowering and blood - pressure - lowering agents .
this has led to a dramatic increase in the incidence of opioid misuse , emergency room visits due to opioid analgesic poisoning , and fatal opioid overdose .
prescription opioids have now surpassed marijuana as the drug that is most commonly abused among the newly initiated .
because of the enormity of this public health problem , we desperately need new approaches for the prevention or treatment of chronic pain conditions .
it is likely that genetic discoveries can lead to new approaches for chronic pain , because genetic discoveries have catalyzed new approaches for related clinical conditions .
for example , haplotype - based computational genetic analysis has identified causative genetic factors affecting analgesic medication   and inflammatory pain responses , and it has identified four genes affecting narcotic drug responses [ 11,14 - 16 ] in mice .
the latter genetic discovery generated a new treatment strategy for preventing narcotic drug withdrawal symptoms , which was shown to be effective in humans .
moreover , the variable response to multiple classes of analgesic medications among inbred mouse strains was shown to be due to genetic variation within a genetic locus ( kcnj9 ) that also encodes a potassium channel ( girk3 ) .
hopefully , characterizing the functional role of kcns1 in neuronal responses and pain perception , and the impact of the allelic differences , could lead to new approaches for treatment of chronic pain .
although the tractability of kcns1 ( or other potassium channels ) as a therapeutic target remains to be determined , small molecules targeting potassium channels have been produced ( reviewed in ) , and one has attenuated neuropathic pain in animal models . although the kcns1 val allele explains only a small percentage of the total variance ( 4.6 to 7.8% ) in the chronic pain endpoints in the cohorts studied , the identification of an initial genetic factor for chronic pain is an important achievement for two reasons .
first , it shows that genetic factors can be identified for this condition , and this study provides a template for subsequent studies .
second , it is likely that a greater percentage of the genetic susceptibility to chronic pain can be explained by combining this genetic factor with other subsequently identified factors .
moreover , pain is a subjective sensory symptom ; it is difficult to measure ; and there are substantial psychological and emotional components that contribute to the perception of pain .
it has recently been found that there are different subtypes of chronic pain , which are distinct from the causative disease ( diabetic neuropathy , radicular back pain and so on ) .
it is likely that genetic factors determine whether a chronic pain syndrome will develop and the specific subtype that emerges after exposure to a triggering cause .
thus , the impact of a single genetic factor could be much larger if a specific pain subtype is examined relative to that measured in a large cohort of individuals with different types of chronic pain .
beyond finding new drug targets , identification of genetic factors affecting susceptibility to chronic pain syndromes could be the lever that drives advances in this difficult clinical area .
a genetic risk factor could have a substantial impact on clinical practice because individuals at increased risk for developing a chronic pain syndrome could be identified before a surgical procedure or immediately after a traumatic incident . the genetic information could be used to develop proactive methods for prevention of chronic pain syndromes , enabling interventions to be targeted to the high - risk subset . because of the great inter - individual variation in the response to painful stimuli and to analgesic drugs , knowledge of genetic risk factors could enable better stratification of chronic pain patients or aid in the selection of the appropriate therapy . rather than focusing on the disease that is etiologically associated with the chronic pain ,
study   is hopefully one of the first of many subsequent genetic studies that could lead to entirely new ways to approach chronic pain syndromes .
clearly , the clinical and research communities have a long way to go before genetically targeted therapies for chronic pain become a reality .
however , kcns1 ( or other channels ) could perhaps become the next target for a new class of analgesics that are selectively used in the 20% of the population that are homozygous for the val alleles of kcns1 .
the day might soon come when we no longer think of ' chronic pain ' as a single clinical entity , but have the tools to characterize the specific ' channelopathy ' that underlies the clinical presentation and targeted treatments for each subgroup .
gp is a professor and mz is the director of statistical research in the department of anesthesia at stanford university medical school .

 a recent publication that combined rat gene expression data and a human genetic association study has identified the first genetic risk factor for chronic pain in humans . in four of
 the five cohorts studied , there was a significant association of an allele within a gene ( kcns1 ) encoding a potassium channel ( kv9.1 ) with an increased risk for chronic pain .
 identification of genetic risk factors for chronic pain could catalyze new advances in this difficult clinical area that has become a major public health problem .
 genomic - medicine - based advances for chronic pain could include the development of a mechanism - based classification system for chronic pain , new treatment options , improved methods for treatment selection and targeted prevention strategies for high - risk individuals .