Altered regional brain activity and functional connectivity in primary intravaginal anejaculation patients revealed by resting-state fMRI.

ABSTRACT: Ejaculation is regulated by the central nervous system. However, the central pathophysiology of primary intravaginal anejaculation (PIAJ) is unclear. The present study aimed to examine the changes in regional brain activity and functional connectivity underlying PIAJ. A total of 20 PIAJ patients and 16 healthy controls (HCs) were enrolled from September 2020 to September 2022 in the Department of Andrology, Nanjing Drum Tower Hospital (Nanjing, China). Magnetic resonance imaging data were acquired from all participants and then were preprocessed. The measures of fractional amplitude of low-frequency fluctuation (fALFF), regional homogeneity (ReHo), and functional connectivity (FC) were calculated and compared between the groups. PIAJ patients showed increased fALFF values in the left precuneus compared with HCs. Additionally, PIAJ patients showed increased ReHo values in the left precuneus, left postcentral gyrus, left superior occipital gyrus, left calcarine fissure, right precuneus, and right middle temporal gyrus, and decreased ReHo values in the left inferior parietal gyrus, compared with HCs. Finally, brain regions with altered fALFF and ReHo values in PIAJ patients showed increased FC with widespread cortical regions, which included the frontal, parietal, temporal, and occipital regions, compared with HCs. In conclusion, increased regional brain activity in the parietal, temporal, and occipital regions, and increased FC between these brain regions, may be associated with PIAJ occurrence.

The application of intraoperative neurophysiological monitoring in selective dorsal neurotomy for primary premature ejaculation: a prospective single-center study.

Selective dorsal neurotomy (SDN) is a surgical treatment for primary premature ejaculation (PE), but there is still no standard surgical procedure for selecting the branches of the dorsal penile nerves to be removed. We performed this study to explore the value of intraoperative neurophysiological monitoring (IONM) of the penile sensory-evoked potential (PSEP) for standard surgical procedures in SDN. One hundred and twenty primary PE patients undergoing SDN were selected as the PE group and 120 non-PE patients were selected as the normal group. The PSEP was monitored and compared between the two groups under both natural and general anesthesia (GA) states. In addition, patients in the PE group were randomly divided into the IONM group and the non-IONM group. During SDN surgery, PSEP parameters of the IONM group were recorded and analyzed. The differences in PE-related outcome measurements between the perioperative period and 3 months' postoperation were compared for the PE patients, and the differences in effectiveness and complications between the IONM group and the non-IONM group were compared. The results showed that the average latency of the PSEP in the PE group was shorter than that in the normal group under both natural and GA states (P < 0.001). Three months after surgery, the significant effective rates in the IONM and non-IONM groups were 63.6% and 34.0%, respectively (P < 0.01), and the difference in complications between the two groups was significant (P < 0.05). IONM might be useful in improving the short-term therapeutic effectiveness and reducing the complications of SDN.

[Exploring the mechanisms of Jujing pill on varicocele-associated male infertility via network pharmacology and molecular docking technology].

OBJECTIVE: To investigate the potential mechanism of treating varicocele-associated male infertility with Jujing pill using network pharmacology and molecular docking technology. METHODS: The TCMSP and BATMAN databases were used to search for the Chinese medicine components of the Jujing pill and obtain the corresponding targets. The databases GeneCards, DISGENET, OMIM, and HPO were searched for 'varicocele' and 'male infertility' to identify the potential targets of varicocele-associated male infertility. Wayne diagrams were drawn using the jvenn tool to determine the intersection targets of the Chinese medicine targets and disease targets. The intersecting targets were further analyzed to identify the components and Chinese medicine corresponding to them. A Chinese medicine-active ingredient-target network map was constructed in Cytoscape 3.8.2. The protein-protein interaction (PPI) network of the intersecting targets was constructed using the STRING platform. The intersecting targets were imported into the DAVID database for GO enrichment analysis and KEGG-based pathway enrichment analysis. The KEGG database was used to select the most relevant pathway to the topic, and a KEGG pathway map was constructed using the mapper tool. The top 15 pathways with FDR values and their related targets and components were used to draw a core ingredient-target-pathway map. Finally, molecular docking was performed to verify the protein receptors and small molecule ligands of the core genes, and the results were visualized using AutoDock and PyMol software. RESULTS: A total of 207 ingredients and 1103 predicted targets of Jujing pill were screened. Additionally, 285 targets of varicocele were also identified. By using a Venn diagram, 86 common targets were obtained. The analysis of Gene Ontology (GO) results revealed significant enrichment in various biological processes (BP) such as positive regulation of gene expression, positive regulation of transcription, positive and negative regulation of apoptotic processes, response to hypoxia, response to estradiol, and positive regulation of nitric oxide biosynthesis processes. Furthermore, significant enrichment in cellular components (CC) was observed in macromolecules, cytoplasm, nucleus, and phosphatidylinositol 3-kinase complex. In terms of molecular function (MF), enrichment was found in enzyme binding, identical protein binding, transcriptional co-activator binding, and others. KEGG analysis demonstrated enrichment in pathways related to cancer, AGE-RAGE signaling pathway in diabetic complications, HIF-1 signaling pathway, FoxO signaling pathway, and more. Molecular docking results indicated that the core ingredients exhibited a strong binding capacity with the key targets. Conclusion： The effective active ingredients of Jujing pill exert their therapeutic effects on varicocele-associated male infertility through multiple targets and pathways. These findings provide a theoretical basis for future cell and animal experiments to verify the mechanism of action of Jujing pill in treating varicocele-associated male infertility.

[Action mechanism of Professor Xu Fusong's Shuilu Erxian Dan in the treatment of premature ejaculation: An exploration based on network pharmacology and molecular docking technology].

OBJECTIVE: To analyze the potential action mechanism of Shuilu Erxian Dan in the treatment of premature ejaculation based on network pharmacology. METHODS: The TCMSP database was searched for the main chemical constituents of Euryale and golden cherry, the core components of Shuilu Erxian Dan. Oral bioavailability and medicinal properties were set as the parameters for screening active components, premature ejaculation-related disease targets retrieved from the DisGeNET, GeneCards, OMIM and TTD databases, the common targets of drug pairs and diseases identified with the Wayne diagram, and a drug-active ingredient-target-disease network map constructed with the software Cytoscape. A PPI network map designed through the STRING platform, the website Metascape used for GO and KEGG analyses of the common targets, and the protein receptors and small molecular ligands of the core genes employed for molecular docking and PyMOL visualization. RESULTS: A total of 7 chemical constituents and 171 predictive targets, 1 918 premature ejaculation targets and 113 common targets were identified. GO analysis showed significant enrichment of BP in response to toxic substances and inorganic substances, CC in membrane raft and plasma membrane protein complex, and MF in transcription factor binding and kinase binding. KEGG analysis manifested markedly enriched TNF signaling pathway, JAK-STAT signaling pathway and Cocaine addiction. The results of molecular docking exhibited a good binding energy between the core gene and the component. CONCLUSION: Network pharmacology has revealed the potential action mechanism of Shuilu Erxian Dan in the treatment of premature ejaculation, which has paved the theoretical ground for verification of the effectiveness of Shuilu Erxian Dan in the treatment of premature ejaculation via animals and cells.

[Correlations between resting-state brain functional characteristics and TCM syndrome in premature ejaculation patients with heart-kidney disharmony].

OBJECTIVE: To investigate the correlation between the characteristics of resting-state brain function and the types of traditional Chinese medicine (TCM) syndrome in premature ejaculation (PE) patients with heart-kidney disharmony, and the pathogenesis of abnormal ejaculation of the patients. METHODS: We enrolled 33 PE patients with heart-kidney disharmony and 32 healthy controls matched in general demographic data, evaluated the severity of the main and concurrent symptoms of PE using the PE Diagnostic Tool (PEDT) and TCM Syndrome Scale (TCMSS), and obtained the brain structural and functional MRI data. We processed the collected data and calculated the amplitude of low-frequency fluctuations (ALFF), fractional ALFF (fALFF) and regional homogeneity (Reho) of the brain with the DPABI software. Using the REST software package, we compared the significantly different brain areas between the PE and control groups by two-sample t-test and corrected the results for multiple comparisons by AlphaSim, followed by Pearson correlation analysis of ALFF, fALFF and Reho in abnormal brain areas and the PEDT and CMSS scores of the patients. RESULTS: The PE patients showed decreased ALFF values in the bilateral inferior temporal gyrus, left middle frontal gyrus and left orbital part of the inferior frontal gyrus, and increased ALFF values in the bilateral hippocampus, thalamus and precuneus, right inferior occipital gyrus, right calcarine and left inferior parietal, with positive correlations of the ALFF values of the left thalamus with the scores on PEDT (r = 0.35, P < 0.05) and TCMSS (r = 0.44, P < 0.05). The fALFF values of the patients were also decreased in the left temporal pole of the middle temporal gyrus and left anterior cingulate gyrus, but increased in the left inferior temporal gyrus. The Reho values of the patients were decreased as well in the right inferior temporal gyrus, left middle frontal gyrus, right dorsolateral superior frontal gyrus, right middle occipital gyrus, right middle occipital gyrus and right precuneus, but increased in the left temporal pole of the middle temporal gyrus, left middle frontal gyrus and left superior frontal gyrus, with negative correlations between the Reho value of the right superior parietal gyrus and TCMSS scores (r = －0.35, P < 0.05). CONCLUSION: Abnormal brain regions were found in PE patients with heart-kidney disharmony, with might be the pathologically associated with PE symptoms and heart-kidney disharmony of the patients.

[Personality characteristics of erectile dysfunction patients with different traditional Chinese medicine syndromes].

OBJECTIVE: To explore the correlation between personality characteristics and traditional Chinese medicine (TCM) syndromes in ED patients. METHODS: We collected the general demographic data from 97 ED patients with different types of TCM syndromes, including the syndromes of liver-qi depression, fear-induced kidney injury, vital gate fire declination, heart and spleen deficiency, downward diffusion of damp-heat, yin-deficiency and fire-hyperactivity, and blood vessel stasis and obstruction. Using the Eysenck Personality Questionnaire (EPQ), we analyzed the personality types of the patients by comparing their EPQ scores with those of the adult males in the national norm group. RESULTS: Statistically significant differences were found between the ED patients and the males in the national norm group in the EPQ scores on neuroticism (11.97 ± 5.58 vs 4.61 ± 2.93, P < 0.01) and extraversion-introversion (10.06 ± 3.66 vs 7.38 ± 2.85, P < 0.01). Different personality types were significantly associated with the TCM syndrome types of the ED patients (P < 0.01), choleric temperament and melancholic temperament correlated with the syndrome of liver-qi depression (P < 0.01), and sanguine temperament with that of fear-induced kidney injury (P < 0.01). CONCLUSION: TCM syndrome differentiation has underlying correlations with personality characteristics. It is clinically feasible to divide ED into more subtypes based on correlation of the TCM syndrome differentiation with personality characteristics of the patient.

Prostate-derived IL-1ß upregulates expression of NMDA receptor in the paraventricular nucleus and shortens ejaculation latency in rats with experimental autoimmune prostatitis.

Experimental autoimmune prostatitis (EAP)-induced persistent inflammatory immune response can significantly upregulate the expression of N-methyl-D-aspartic acid (NMDA) receptors in the paraventricular nucleus (PVN). However, the mechanism has not yet been elucidated. Herein, we screened out the target prostate-derived inflammation cytokines (PDICs) by comparing the inflammatory cytokine levels in peripheral blood and cerebrospinal fluid (CSF) between EAP rats and their controls. After identifying the target PDIC, qualified males in initial copulatory behavior testing (CBT) were subjected to implanting tubes onto bilateral PVN. Next, they were randomly divided into four subgroups (EAP-1, EAP-2, Control-1, and Control-2). After 1-week recovery, EAP-1 rats were microinjected with the target PDIC inhibitor, Control-1 rats were microinjected with the target PDIC, while the EAP-2 and Control-2 subgroups were only treated with the same amount of artificial CSF (aCSF). Results showed that only interleukin-1ß(IL-1ß) had significantly increased mRNA-expression in the prostate of EAP rats compared to the controls (P < 0.001) and significantly higher protein concentrations in both the serum (P = 0.001) and CSF (P < 0.001) of the EAP groups compared to the Control groups. Therefore, IL-1ß was identified as the target PDIC which crosses the blood-brain barrier, thereby influencing the central nervous system. Moreover, the EAP-1 subgroup displayed a gradually prolonged ejaculation latency (EL) in the last three CBTs (all P < 0.01) and a significantly lower expression of NMDA NR1 subunit in the PVN (P = 0.043) compared to the respective control groups after a 10-day central administration of IL-1ß inhibitors. However, the Control-1 subgroup showed a gradually shortened EL (P < 0.01) and a significantly higher NR1 expression (P = 0.004) after homochronous IL-1ß administration. Therefore, we identified IL-1ß as the primary PDIC which shortens EL in EAP rats. However, further studies should be conducted to elucidate the specific molecular mechanisms through which IL-1ß upregulates NMDA expression.

[Changes in the functional connectivity of the thalamus in insomniac ED patients with yin deficiency and fire syndrome: An exploration based on functional MRI findings].

OBJECTIVE: To investigate the changes of nocturnal erectile function and functional connectivity (FC) of bilateral thalami in insomniac ED patients with yin deficiency and fire syndrome. METHODS: We enrolled 30 healthy controls and 87 ED patients with yin deficiency and fire syndrome, 41 with and the other 46 without insomnia. Using IIEF-5 and Pittsburgh Sleep Quality Index (PSQI), we evaluated the nocturnal erectile function and sleep quality of the patients and compared the clinical indicators between the two groups. Then we collected and preprocessed the MRI data on the cerebral function of the 15 ED patients with insomnia, another 15 without insomnia and the 30 healthy controls. With the thalamus as the region of interest (ROI), we calculated and compared the FC values of brain regions between the ED patients (with or without insomnia) and healthy controls, and corrected the results for multiple comparisons using the AlphaSim method. RESULTS: Compared with the patients without insomnia, those with insomnia had a lower duration of erectile episode and tumescence and rigidity activity units in the tip of the penis. With the left thalamus as the ROI, the right middle frontal gyrus and inferior parietal were shown to be the differential brain regions among the three groups. Compared with the healthy controls, the patients without insomnia showed decreased FC values between the left thalamus and left orbital part of the middle frontal gyrus, insula, putamen and right thalamus, while those with insomnia exhibited decreased FC values between the left thalamus and bilateral middle frontal gyri, inferior parietal, calcarine fissure, parahippocampal gyrus, left superior parietal gyrus, right precuneus and inferior temporal gyrus, and they also exhibited decreased FC values between the left thalamus and middle frontal gyrus in comparison with those without insomnia. With the right thalamus as the ROI, the left medial superior frontal gyrus, bilateral calcarine fissure and right thalamus were found to be the differential brain regions among the three groups. Compared with the healthy controls, the patients without insomnia showed decreased FC values between the right thalamus (including the right thalamus itself) and left medial orbital superior frontal gyrus, superior temporal gyrus (temporal pole), middle temporal gyrus, insula and right orbital part of the inferior frontal gyrus, while those with insomnia manifested decreased FC values between the right thalamus and middle frontal gyrus, inferior parietal, left superior parietal gyrus and calcarine fissure, and they also manifested increased FC values between the right thalamus and medial superior frontal gyrus, and decreased FC values between the right thalamus and left calcarine fissure in comparison with those without insomnia. CONCLUSION: ED patients with insomnia have more serious clinical symptoms, with FC changes in the thalamocortical loop, which might be the pathological mechanisms of ED with insomnia.

[Pressing acupuncture therapy combined with auricular pressure beans for the treatment of chronic prostatitis / chronic pelvic pain syndrome].

OBJECTIVE: To explore the application value of the pressing acupuncture therapy (PAT) combined with auricular pressure beans in the treatment of chronic prostatitis / chronic pelvic pain syndrome (CP/CPPS). METHODS: We selected 50 cases of CP/CPPS confirmed in our Department of Andrology from January to December 2019 and randomly divided them into an observation (n = 25) and a control group (n = 25), the former treated by PAT combined with auricular pressure beans in addition to medication, and the latter with auricular pressure beans in combination with drug therapy, both for 14 successive days. We compared the scores on NIH-CPSI and General Comfort Questionnaire (GCQ) between the two groups of patients before and after treatment. RESULTS: After treatment, the patients in the observation group, compared with the controls, showed a significantly higher total effectiveness rate (92% vs 68%, P < 0.05) and GCQ score (ï¼»95.00 ± 9.39ï¼½ vs ï¼»80.16 ± 9.96ï¼½, P < 0.05), and a lower pain symptom score ( ï¼»6.92 ± 2.34ï¼½ vs ï¼»10.08 ± 2.22ï¼½, P < 0.05), urination symptom score (ï¼»3.16 ± 1.46ï¼½ vs ï¼»4.80 ± 1.19ï¼½, P < 0.05), quality of life score (ï¼»4.68 ± 1.35ï¼½ vs ï¼»6.80 ± 1.71ï¼½, P < 0.05) and total NIH-CPSI score (ï¼»14.76 ± 3.31ï¼½ vs ï¼»23.68 ± 3.05ï¼½, P < 0.05). CONCLUSIONS: The pressing acupuncture therapy, with the advantage of dynamic needle retention with good compliance, can relieve the clinical symptoms of CP/CPPS and improve the life comfort of the patients, and is therefore worthy of further clinical research and application.

[Acupoint application combined with virtual reality technology to relieve pain after circumcision in children].

OBJECTIVE: To explore the effect of acupoint application combined with virtual reality (VR) technology in relieving pain after circumcision in children. METHODS: Using a random number table, we divided 106 children undergoing circumcision into a control and an intervention group of an equal number, the former receiving routine nursing care, and the latter acupoint application combined with VR technology. We compared between the two groups the postoperative pain scores with the Changhai pain ruler, the Hamilton Anxiety Scale (HAMA) scores, and the satisfaction of the patients and their families. RESULTS: Compared with the controls, the patients in the intervention group showed a significantly lower HAMA score (ï¼»2.94 ± 0.98ï¼½ vs ï¼»1.06 ± 0.92ï¼½, P < 0.05) and postoperative pain score (ï¼»5.96 ± 1.24ï¼½ vs ï¼»3.66 ± 1.18ï¼½, P < 0.05), but higher satisfaction in the patients and their families (86.79% vs 98.11%, P < 0.05). CONCLUSIONS: Acupoint application combined with VR technology for children after circumcision has the advantages of effectively relieving the anxiety of the patients, distracting their attention, increasing the pain perception threshold, reducing the perception of pain, improving the satisfaction of the patients and their family members.

[Associations between the efficiency of the brain white matter network and clinical symptoms in patients with type â ¢ B prostatitis].

OBJECTIVE: To investigate the changes in the topological properties of the global and local nodal efficiencies of the brain white matter network in patients with type III B prostatitis, and to analyze the correlation between the information transmission efficiency of different brain regions and pelvic pain. METHODS: We enrolled 19 patients with type Ⅲ B prostatitis and 32 normal controls matched in general demographic data for this study. We assessed the pelvic pain of the patients based on the NIH-CPSI, obtained the structural and diffusion-weighted MR images of the brain, preprocessed the MRI data, constructed the brain structural networks and calculated the topological properties of the nodal local and global efficiencies using the FSL software package and brain connection toolbox. Finally, we compared the topological properties between the two groups by t-test with the SPSS 20 software, performed multiple correction of the values using the false discovery rate (FDR) method, and investigated the associations of the altered brain regions with the NIH-CPSI scores by Pearson correlation analysis. RESULTS: The global efficiency of the orbital part of the right median frontal gyrus in the patients with type Ⅲ B prostatitis, compared with that in the normal controls, was dramatically decreased (0.095 ± 0.046 vs 0.13 ± 0.015, P < 0.01) while that of the left median cingulate gyrus markedly increased (0.16 ± 0.027 vs 0.14 ± 0.019, P < 0.01), which were corrected by FDR. The local efficiency of the left median cingulate gyrus was also remarkably decreased in the patients as compared with that in the controls (0.25 ± 0.075 vs 0.19 ± 0.036, P < 0.01), and so was that of the left paracentral lobule (0.25 ± 0.088 vs 0.17 ± 0.065, P < 0.01), which were corrected by FDR. In the patients, the local efficiencies of the left precuneus (r = 0.46, P = 0.045), right supplementary motor area (r = 0.47, P = 0.043) and left median cingulate gyrus (r = 0.60, P = 0.0065) were positively correlated with the total score of NIH-CPSI, the scores of pain and discomfort symptoms, and the scores of the influence of the symptoms on the quality of life. CONCLUSIONS: The changes of the brain regions in the executive control network of the patient with type Ⅲ B prostatitis might be involved in enhancing his sensitivity to pain and discomfort, and consequently lead to pelvic pain and discomfort.

Upregulated expression of NMDA receptor in the paraventricular nucleus shortens ejaculation latency in rats with experimental autoimmune prostatitis.

BACKGROUND: Estimated 30%-40% of patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) suffer from premature ejaculation (PE), which is difficult to cure, but the mechanism is still unknown. Based on the results of our previous clinical studies and animal experiments, we propose that the glutamatergic system dysfunction in the paraventricular nucleus (PVN) may be involved. METHODS: To test this hypothesis, we used experimental autoimmune prostatitis (EAP) rats to investigate the effects of CP/CPPS on ejaculation behavior through integrating copulatory behavior testing, neuroelectrophysiologic experiments, and molecular biology technologies. RESULTS: Histological examination of prostate tissue in EAP rats exhibited consistent pathological findings with that in CP/CPPS patients. Behavior testing showed that ejaculation latency (EL) of EAP rats significantly shortened compared with the controls (5.1 ± 1.8 vs 9.1 ± 2.4 min, P < .001). Sympathetic nervous system (SNS) activity testing revealed that EAP rats displayed significantly higher plasma norepinephrine (NE) level (1780 ± 493 vs 1421 ± 453 pg/mL, P = .043) and SNS sensitivity (67.8 ± 9.6 vs 44.6 ± 8.7%, P < .001). Immunohistochemical detection and Western blot analysis both displayed that NR1 subunit expression of N-methyl-D-aspartic acid (NMDA) receptors in the PVN of EAP rats was significantly upregulated (P = .007 and P < .001). Furthermore, the expression of NMDA NR1 subunit positively correlated both with SNS sensitivity (r = .917, P < .001) and prostatic inflammation scores (r = .964, P < .001). CONCLUSION: This study shows that EAP rats suffer from the same PE symptom as CP/CPPS patients. CP/CPPS-induced inflammatory-immune response can significantly upregulate the expression of NMDA receptors in the PVN, which shortening the EL by enhancing SNS sensitivity. However, the exact mechanism of chronic inflammation in the prostate causing the upregulated expression of NMDA receptors needs to be further studied.

Dynamic infusion cavernosometry and cavernosography for classifying venous erectile dysfunction and its significance for individual treatment.

BACKGROUND: The precise pathophysiology of venous erectile dysfunction (VED) was still unclear. Dynamic infusion cavernosometry and cavernosography (DICC) was the gold standard approach for the diagnoses of VED. However, a standard operative procedure of DICC was needed and it was unclear whether DICC could show promise in accurate assessment and treatment of VED. The aim of this study was to establish an optimized operation process of DICC and evaluate the efficacy of DICC in the diagnoses and therapy of VED. METHODS: One hundred and forty-seven VED patients identified by the color doppler duplex ultrasonography (CDDU) were included. Then the method of DICC was adopted to assess the severity of VED and all patients were divided into 4 groups, including (1) non-VED; (2) mild VED; (3) moderate VED and (4) severe VED. All patients received the treatment of psychotherapy. Drug therapy, the intervention embolism of corpus cavernosum and the implantation of penile prosthesis were applied if psychotherapy was ineffective for patients. The international index of erectile function (IIEF-5) scores of patients were collected and compared before and after treatment. RESULTS: IIEF-5 score of non-VED group after psychotherapy (19.35 ±â€Š3.59) and drug therapy (23.31 ±â€Š0.75) was higher than that before psychotherapy (15.30 ±â€Š2.72, t = -4.31, P < 0.01) and drug therapy (16.62 ±â€Š1.50, t = -19.13, P < 0.01). IIEF-5 scores of mild VED (18.25 ±â€Š2.60) and moderate VED group (14.83 ±â€Š4.17) after treatment was improved significantly by intervention embolism of corpus cavernosum when compared with those before treatment (mild: 15.50 ±â€Š2.14, t = -2.31, P < 0.05; moderate: 11.83 ±â€Š2.86, t = -1.45, P < 0.05). However, drug therapy and intervention embolism (IE) of corpus cavernosum showed poor effects on patients with moderate and severe VED patients (P > 0.05). IIEF-5 score of severe VED group was increased under the treatment of implantation of penile prosthesis (23.25 ±â€Š0.71) compared with that before treatment (8.00 ±â€Š0.39, t = -53.25, P < 0.05). CONCLUSION: DICC was a valid diagnostic tool that could identify patients with VED. And DICC had great effect on the diagnosis and individual therapy for patients with VED in varying degrees. Moreover, the manipulation of DICC needed uniform standards.

[Brain magnetic resonance imaging in exploring the central neurophysiological mechanisms of penile erection: Progress in studies].

Previous studies have found that penile erection is not only dependent on the peripheral nervous and vascular systems, but also controlled by the central nervous system. Some brain regions are responsible for promoting and suppressing penile erection, respectively. Studies on the brain functions showed both activation and inactivation of the brain regions when receiving sexual stimulation, and those on the brain structure of ED patients revealed atrophy of the gray matter structure and abnormal connection of the white matter fibers. In addition, abnormal connections within emotional, cognitive and default and salience networks were found in patients with psychogenic ED. This article reviews the brain MRI-based studies on the central neurophysiological mechanisms of penile erection, aiming to gain a deeper insight into human neurophysiological mechanisms of the neural circuits controlling erectile function.

[Correlation of betweenness centrality of the right hemispheric network with ejaculatory function in premature ejaculation patients].

OBJECTIVE: To explore the topological properties of the betweenness centrality of the nodes and edges in the brain white matter network of premature ejaculation (PE) patients and analyze the correlation of the importance of the key brain regions and interregional white matter structural connectivity with the ejaculatory function of the patients.Method: We collected the demographic and clinical data, along with the T1 and MR diffusion tensor imaging (MR-DTI) data, on 18 PE patients and 22 normal controls matched in age, sex and education. After preprocessing of the data obtained, we divided the whole brain into 90 symmetrical cortical and subcortical regions (defined as nodes of the brain network) by automated anatomical labeling, examined the structural connectivity between different brain regions by probabilistic white matter fiber tracking (defined as edges of the brain network), and calculated the betweenness centrality of the nodes and edges using the brain connection toolbox. Then, we performed the Mann-Whitney U test on the betweenness centrality of the nodes and edges, subjected the results to false discovery rate (FDR) correction, and assessed the correlation of the attribute values of between-group differences with the ejaculatory function of the patients. RESULTS: Compared with the normal controls, the PE patients showed a significantly decreased betweenness centrality of the right superior occipital gyrus (SOG) (281.18 ± 255.26 vs 67.78 ± 58.98, Z = －3.49, FDR-corrected P < 0.05), but increased betweenness centrality of the right superior temporal gyrus (STG) (222.91 ± 155.60 vs 557.00 ± 322.65, Z = 3.55, FDR-corrected P < 0.05) and betweeness centrality of the edge between the right rolandic operculum and right insula (4.23 ± 8.39 vs 23.83 ± 23.91, Z = 3.84, FDR-corrected P < 0.05). The betweenness centrality of the right SOG was correlated negatively with the level of difficulty in delaying ejaculation (r = －0.51, P = 0.03) and the probability of ejaculation before expectation (r= －0.61, P = 0.01), while that of the right STG positively with PE-related frustration (r = 0.54, P = 0.02) and the level of concern about PE-related distress of the partner (r = 0.47, P = 0.04). CONCLUSIONS: Abnormalities of structural connections were found in the visual stimulus- and emotion processing-related regions in the right cerebral hemisphere of PE patients, which might be associated with rapid ejaculation or decreased ejaculation control and lead to a series of psychological problems.

[Psychological factors and penile blood supply in patients with erectile dysfunction].

OBJECTIVE: To explore the psychological factors and blood supply to the penis in ED patients. METHODS: From August to November 2018, we obtained Symptom Checklist 90 (SCL-90) scores and conducted an Eysenck Personality Questionnaire (EPQ) investigation among 106 ED patients in our Department of Andrology, followed by the test of intracavernosal injection of the vasoactive agent (ICI-VAA) and color duplex Doppler ultrasonography (CDDU). According to the results of ICI-VAA and CDDU, we divided the patients into a normal and an abnormal group, compared their item and total scores on SCL-90 with the national norm by t-test and analyzed the distribution of personality types in different groups by Chi-square test. RESULTS: The results of ICI-VAA and CDDU showed 42 cases to be normal and the other 64 abnormal. Compared with the normal group, the abnormal cases exhibited significantly decreased peak systolic velocity (PSV) in the left and right corpus cavernosum (ï¼»30.90 ± 6.83ï¼½ vs ï¼»19.39 ± 5.07ï¼½ cm/s, P < 0.01; ï¼»30.74 ± 7.00ï¼½ vs ï¼»18.98 ± 4.57ï¼½ cm/s, P < 0.01), but increased end-diastolic velocity (EDV) in the left corpus cavernosum (ï¼»1.77 ± 2.38ï¼½ vs ï¼»3.21 ± 2.78ï¼½ cm/s, P < 0.01). The ED patients undergoing ICI-VAA and CDDU obtained remarkably higher SCL-90 scores than the national norm on depression (1.70 ± 0.64 vs 1.50 ± 0.59, P < 0.01), anxiety (1.62 ± 0.56 vs 1.39 ± 0.43, P < 0.01), compulsion (1.86 ± 0.61 vs 1.62 ± 0.58, P < 0.01), hostility (1.65 ± 0.66 vs 1.48 ± 0.56, P < 0.01), phobia (1.33 ± 0.45 vs 1.23 ± 0.41, P = 0.02), and psychoticism (1.61 ± 0.55 vs 1.29 ± 0.41, P < 0.01) as well as a higher total score (1.61 ± 0.48 vs 1.44 ± 0.48, P < 0.01). The patients with normal results of CDDU got markedly increased scores on anxiety (1.60 ± 0.53, P < 0.01), compulsion (1.83 ± 0.63, P = 0.02) and psychoticism (1.61 ± 0.48, P < 0.01), and so did those with abnormal results of CDDU on depression (1.73 ± 0.65, P < 0.01), anxiety (1.64 ± 0.59, P < 0.01), compulsion (1.88 ± 0.60, P < 0.01), hostility (1.68 ± 0.75, P < 0.01), phobia (1.35 ± 0.44, P = 0.02), psychoticism (1.61 ± 0.59, P < 0.01) and an increased total score as well (1.63 ± 0.51, P < 0.01). Statistically significant differences were not found in either the item scores or the total score on SCL-90 (P > 0.05), nor in the distribution of the EPQ personality types between the normal and abnormal cases (χ2 = 1.12, P = 0.77). CONCLUSIONS: The personality types of ED patients are mainly phlegmatic and melancholic, and their psychological problems chiefly include depression and anxiety, which are more serious in those with insufficient penile blood supply.

Pancreatic kininogenase improves erectile function in streptozotocin-induced type 2 diabetic rats with erectile dysfunction.

Erectile dysfunction (ED) associated with type 2 diabetes is a severe problem that requires effective treatment. Pancreatic kininogenase (PK) has the potential to improve the erectile function of ED patients. This study aims to investigate the effect of PK on erectile function in streptozotocin-induced type 2 diabetic ED rats. To achieve this goal, we divided male Sprague-Dawley rats into five groups. One group was not treated, and the other four groups were treated with saline, sildenafil, PK or sildenafil, and PK, respectively, for 4 weeks after the induction of type 2 diabetic ED. Then, intracavernous pressure under cavernous nerve stimulation was measured, and penile tissue was collected for further study. Endothelial nitric oxide synthase levels, smooth muscle content, endothelium content, cyclic guanosine monophosphate (cGMP) levels in the corpus cavernosum, and neuronal nitric oxide synthase levels in the dorsal penile nerve were measured. Improved erectile function and endothelium and smooth muscle content in the corpus cavernosum were observed in diabetic ED rats. When treating diabetic ED rats with PK and sildenafil at the same time, a better therapeutic effect was achieved. These data demonstrate that intraperitoneal injection of PK can improve erectile function in a rat model of type 2 diabetic ED. With further research on specific mechanisms of erectile function improvement, PK may become a novel treatment for diabetic ED.

[Central nervous mechanisms of male ejaculation].

Ejaculation is the most important part of male sexual response. It is related not only to human reproduction, but also to sexual satisfaction of both men and women. Premature ejaculation or anejaculation is likely to cause male infertility and seriously affects the patient's quality of sexual life as well. In recent years, the study of male sexual dysfunction has attracted more and more biomedical researchers. However, previous studies have focused on the relationship between ejaculatory and peripheral or central neurotransmitters. The central physiological and pathological mechanisms underlying ejaculation and ejaculatory dysfunction, including premature ejaculation, remain unclear. This article reviews the central regulatory mechanism of ejaculation function and offers a deeper insight into the correlation of ejaculation behavior with the central nervous system and psychological factors, aiming to promote the development of more effective and practical biological indicators for the diagnosis and therapeutic effect evaluation of ejaculatory dysfunction.

[Correlation of abnormal topological properties of the white matter fibers connecting the left amygdale with psychogenic erectile dysfunction].

OBJECTIVE: To explore the topological properties of the degree and strength of nodes in the binary and weighted brain white matter networks of the patients with psychogenic erectile dysfunction (pED) and analyze the changes of myelin integrity, number and length of the white matter fibers in the topological space. METHODS: Diffusion tensor imaging data were obtained from 21 patients with pED and 24 healthy controls matched in sex, age, and years of education and subjected to preprocessing. The whole cerebral cortex was divided into 90 regions, followed by fiber tracking, construction of the binary and weighted white matter networks, and calculation of the node degrees and connectivity strengths in different brain regions. The property values were compared between the two groups using the two-sample t-test, the results were corrected by multiple testing correction, and the correlation of the property values with the erectile function of the patients was subjected to Pearson's correlation analysis. RESULTS: Compared with the healthy controls, the pED patients showed significantly decreased node degree of the left triangular part of inferior frontal gyrus (IFG) (7.54±1.44 vs 5.95±1.28, t = －3.88, corrected P = 0.02), medial orbital part of superior frontal gyrus (SFG) (10.08±3.60 vs 6.29±3.30, t = －3.67, corrected P = 0.02), and amygdala (6.50±2.11 vs 4.29±1.31, t = －4.16, corrected P = 0.01) in the binary networks, as well as the connectivity strength of the left triangular part of IFG (2.50±0.68 vs 1.72±0.50, t = －4.35, corrected P = 0.01), medial orbital part of SFG (3.17±0.97 vs 2.08±1.10, t = －3.53, corrected P = 0.03), and amygdala (1.80±0.69 vs 1.11±0.39, t = －4.03, corrected P = 0.01) in the fractional anisotropy (FA) weighted networks. The node degree of the left amygdala was negatively correlated with the total score (r = －0.47,P = 0.04), second item score (r = －0.46, P = 0.03), and third item score of IIEF-5 (r = －0.45, P = 0.04) in the pED patients. CONCLUSIONS: The myelin integrity of the white matter fibers in the left frontal lobe and amygdale is impaired in pED patients, which leads to the aberrant generation, processing and regulation of their emotions. The decreased pivotal role and importance of the white matter fibers connecting the left amygdale may be associated with pED.

[Contrast-enhanced ultrasonography in the diagnosis of venous erectile dysfunction].

OBJECTIVE: To investigate the effect and safety of contrast-enhanced ultrasonography (CEUS) in the diagnosis of venous erectile dysfunction (VED). METHODS: From June 2015 to March 2016, 43 ED patients underwent corpus cavernography, of whom 23 were diagnosed with and the other 20 without corpus cavernosal venous leakage (CCVL). All the patients received intracorporal injection of a vasoactive drug and CEUS. RESULTS: Of the 23 patients with CCVL, 21 were confirmed by CEUS, including 12 cases of double venous leakage, 2 cases of single venous leakage, 5 cases of crural venous leakage, and 2 cases of the mixed type, while the other 2 showed no CCVL on CEUS. Of the 20 patients with CCVL, 2 presented CCVL on CEUS. CONCLUSIONS: CEUS has the advantages of accuracy, safety, and less invasiveness in the diagnosis of VED.