Altered brain activity in diabetic patients with erectile dysfunction revealed by fractional amplitude of low-frequency fluctuation: A resting-state fMRI study.

INTRODUCTION: Diabetes mellitus is one of the major chronic diseases, which enhances the risk of erectile dysfunction. However, the central pathological mechanisms of erectile dysfunction in diabetes mellitus patients are still unclear. METHODS: Resting-state functional magnetic resonance imaging data were acquired in 30 type-2 diabetes mellitus, 31 type-2 diabetes mellitus with erectile dysfunction patients, and 31 healthy controls. The measure of fractional amplitude of low-frequency fluctuation was calculated and compared among groups. RESULTS: Differences of fractional amplitude of low-frequency fluctuation values were found in the left superior frontal gyrus (medial) and middle temporal gyrus among three groups. Compared with healthy controls group, type-2 diabetes mellitus group exhibited lower fractional amplitude of low-frequency fluctuation values in the left superior frontal gyrus (dorsolateral), anterior cingulate gyrus, calcarine fissure, and increased fractional amplitude of low-frequency fluctuation values in the left post-central gyrus. Compared with healthy controls group, erectile dysfunction with type-2 diabetes mellitus group exhibited lower fractional amplitude of low-frequency fluctuation values in the left superior frontal gyrus (medial), middle temporal gyrus, temporal middle (pole), and increased fractional amplitude of low-frequency fluctuation values in the right post-central gyrus. Compared with type-2 diabetes mellitus group, erectile dysfunction with type-2 diabetes mellitus group exhibited increased fractional amplitude of low-frequency fluctuation values in the right median cingulum gyrus and left calcarine fissure. CONCLUSION: Erectile dysfunction with type-2 diabetes mellitus patients showed functional changes in brain regions that were closely correlated with sexual dysfunction, which suggested that altered regional brain activity might be related to the pathophysiology of erectile dysfunction with type-2 diabetes mellitus.

The COVID-19 pandemic and unemployment: Evidence from mobile phone data from China.

Based on mobile phone records for 71 million users and location tracking information for one million users over almost three years, this study examines the labor market impacts of the COVID-19 pandemic in China's Guangdong province, whose GDP is larger than that of all but the top 12 countries in the world. Using a standard difference-in-differences framework, our analysis shows dramatic and protracted effects of the pandemic on the labor market: it increased unemployment by 72% and unemployment benefits claims by 57% even after the full reopening in 2020 relative to their levels in the same period in 2019. The impact was also highly heterogeneous, with women, workers older than 40, and migrants being more affected. Cities that rely more on export or that have a higher share of the hospitality industry in GDP but a lower share of the finance and healthcare industries experienced a more pronounced increase in unemployment. The lingering impact likely reflects the global transmission of the pandemic's effects through the supply chain and trade channels.

Potential biomarkers for distinguishing primary from acquired premature ejaculation: A diffusion tensor imaging based network study.

Introduction: Premature ejaculation (PE) is classified as primary and acquired and may be facilitated by different pathophysiology. Brain plays an important role in PE, however, differences in the central neuropathological mechanisms among subtypes of PE are unknown. Materials and methods: We acquired diffusion tensor imaging (DTI) data from 44 healthy controls (HC) and 47 PE patients (24 primary PE and 23 acquired PE). Then, the whole-brain white matter (WM) structural networks were constructed and between-group differences of nodal segregative parameters were identified by the method of graph theoretical analysis. Moreover, receiver operating characteristic (ROC) curves were performed to determine the suitability of the altered parameters as potential neuroimaging biomarkers for distinguishing primary PE from acquired PE. Results: PE patients showed significantly increased clustering coefficient C(i) in the left inferior frontal gyrus (triangular part) (IFGtriang.L) and increased local efficiency E loc (i) in the left precental gyrus (PreCG.L) and IFGtriang.L when compared with HC. Compared to HC, primary PE patients had increased C(i) and E loc (i) in IFGtriang.L and the left amygdala (AMYG.L) while acquired PE patients had increased C(i) and E loc (i) in IFGtriang.L, and decreased C(i) and E loc (i) in AMYG.L. Compared to acquired PE, primary PE patients had increased C(i) and E loc (i) in AMYG.L. Moreover, ROC analysis revealed that PreCG.L, IFGtriang.L and AMYG.L might be helpful for distinguishing different subtypes of PE from HC (PE from HC: sensitivity, 61.70-78.72%; specificity, 56.82-77.27%; primary PE from HC: sensitivity, 66.67-87.50%; specificity, 52.27-77.27%; acquired PE from HC: sensitivity, 34.78-86.96%; specificity, 54.55-100%) while AMYG.L might be helpful for distinguishing primary PE from acquired PE (sensitivity, 83.33-91.70%; specificity, 69.57-73.90%). Conclusion: These findings improved our understanding of the pathophysiological processes that occurred in patients with ejaculatory dysfunction and suggested that the abnormal segregation of left amygdala might serve as a useful marker to help clinicians distinguish patients with primary PE from those with acquired PE.

Altered Regional Homogeneity in Patients With Diabetic Erectile Dysfunction: A Resting-State fMRI Study.

Introduction: Erectile dysfunction (ED) is a common complication of Type-2 Diabetes Mellitus (T2DM) for male patients and it is considered to be associated with different causes including hyperglicemia-induced vascular endothelial cell damages. However, the possible central neural mechanisms shared by these two diseases remain unclear. This study aimed to explore the changes of brain activity and their relationships with the clinical characteristics in patients with diabetic ED. Methods: The data of resting-state functional magnetic resonance imaging were acquired in 31 T2DM patients with ED (DM-ED) and 31 matched healthy controls (HCs). The whole-brain regional homogeneity (ReHo) values were calculated and compared between groups. In addition, Pearson correlation analysis was performed to evaluate the relationships between brain regions with altered ReHo values and clinical characteristics in the patient group. Results: The DM-ED group exhibited increased ReHo values in the right middle frontal gyrus (orbital part) and decreased ReHo values in the left superior frontal gyrus (dorsolateral), paracentral lobule, precuneus and bilateral supplementary motor area when compared with the HCs group. Moreover, significantly negative correlations were found between ReHo values of the left superior frontal gyrus (dorsolateral) and IIEF-5 scores, as well as the level of HbA1c in the DM-ED group. Conclusion: The altered spontaneous brain activity in cognitive-related regions revealed by ReHo values might provide new insights into the neurological pathophysiology underlying DM-ED and serve as potential neuroimaging biomarkers for detecting and evaluating ED in diabetes patients.

Differences in structural connectivity between diabetic and psychological erectile dysfunction revealed by network-based statistic: A diffusion tensor imaging study.

Introduction: Type 2 diabetes mellitus (T2DM) has been found to be associated with abnormalities of the central and peripheral vascular nervous system, which were considered to be involved in the development of cognitive impairments and erectile dysfunction (ED). In addition, altered brain function and structure were identified in patients with ED, especially psychological ED (pED). However, the similarities and the differences of the central neural mechanisms underlying pED and T2DM with ED (DM-ED) remained unclear. Methods: Diffusion tensor imaging data were acquired from 30 T2DM, 32 ED, and 31 DM-ED patients and 47 healthy controls (HCs). Then, whole-brain structural networks were constructed, which were mapped by connectivity matrices (90 × 90) representing the white matter between 90 brain regions parcellated by the anatomical automatic labeling template. Finally, the method of network-based statistic (NBS) was applied to assess the group differences of the structural connectivity. Results: Our NBS analysis demonstrated three subnetworks with reduced structural connectivity in DM, pED, and DM-ED patients when compared to HCs, which were predominantly located in the prefrontal and subcortical areas. Compared with DM patients, DM-ED patients had an impaired subnetwork with increased structural connectivity, which were primarily located in the parietal regions. Compared with pED patients, an altered subnetwork with increased structural connectivity was identified in DM-ED patients, which were mainly located in the prefrontal and cingulate areas. Conclusion: These findings highlighted that the reduced structural connections in the prefrontal and subcortical areas were similar mechanisms to those associated with pED and DM-ED. However, different connectivity patterns were found between pED and DM-ED, and the increased connectivity in the frontal-parietal network might be due to the compensation mechanisms that were devoted to improving erectile function.

[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.

[Cordyceps sinensis combined with Jujing Pills for male infertility].

OBJECTIVE: To observe the clinical effect and safety of Cordyceps sinensis (CS) combined with Jujing Pills (JJP) in the treatment of male infertility. METHODS: We randomly divided 90 male infertility patients into three groups of an equal number and treated them with JJP tid 5g once, CS bid 1g once and CS+JJP, respectively, all for 12 weeks. Before and after 4, 8 and 12 weeks of medication, we obtained the semen volume, sperm concentration, percentages of progressively motile sperm (PMS) and morphologically normal sperm (MNS) and sperm DNA fragmentation index (DFI), and compared them between the two groups of patients. RESULTS: The total therapeutic effectiveness rate was significantly higher in the CS+JJP than in the CS and JJP groups (96.42% vs 78.57% and 63.33%, P < 0.05), and so was PMS (ï¼»30.05 ± 10.24ï¼½% vs ï¼»24.74 ± 11.24ï¼½% and ï¼»22.71 ± 13.60ï¼½%, P < 0.01). The CS+JJP group also showed a higher percentage of MNS than the JJP group (ï¼»4.16 ± 2.86ï¼½% vs ï¼»2.73 ± 1.86ï¼½%, P < 0.01) but lower than the CS group (ï¼»5.03 ± 2.99ï¼½%) (P < 0.05). The sperm DFI was markedly lower in the CS+JJP than in the CS and JJP groups (ï¼»15.26 ± 6.93ï¼½% vs ï¼»15.90 ± 7.39ï¼½% and ï¼»16.85 ± 8.52ï¼½%, P < 0.05). CONCLUSIONS: Cordyceps sinensis combined with Jujing Pills can effectively improve sperm quality and reduce sperm DFI. Based on the TCM theory of "mutual generation between metal and water", Cordyceps sinensis can significantly enhance the effectiveness of the kidney-tonifying therapy.

[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.

Abnormal Functional Connectivity Between the Left Medial Superior Frontal Gyrus and Amygdala Underlying Abnormal Emotion and Premature Ejaculation: A Resting State fMRI Study.

INTRODUCTION: Premature ejaculation (PE) is a common sexual dysfunction and is found to be associated with abnormal emotion. The amygdala plays an important role in the processing of emotion. The process of ejaculation is found to be mediated by the frontal-limbic neural circuits. However, the correlations between PE and emotion are still unclear. METHODS: Resting-state functional magnetic resonance imaging (rs-fMRI) data were acquired in 27 PE patients with stable emotion (SPE), 27 PE patients with abnormal emotion (NPE), and 30 healthy controls (HC). We used rs-fMRI to explore the underlying neural mechanisms in SPE, NPE, and HC by measuring the functional connectivity (FC). Differences of FC values among the three groups were compared when choosing bilateral amygdala as the regions of interest (ROIs). We also explored the correlations between the brain regions showing altered FC values and scores of the premature ejaculation diagnostic tool (PEDT)/Eysenck Personality Inventory about neuroticism (EPQ-N) in the PE group. RESULTS: When the left amygdala was chosen as the ROI, the SPE group exhibited an increased FC between the left medial superior frontal gyrus (SFGmed) and amygdala compared with the NPE or HC group. When the right amygdala was chosen as the ROI, the NPE group exhibited a decreased FC between the left SFGmed and right amygdala compared with the HC group. In addition, FC values of the left SFGmed had positive correlations with PEDT and negative correlations with EPQ-N scores in the PE group. Moreover, FC values of the left superior temporal gyrus had positive correlations with EPQ-N scores in the PE group. CONCLUSION: The increased FC values between the left SFGmed and amygdala could reflect a compensatory cortical control mechanism with the effect of stabilized emotion in the limbic regions of PE patients. Abnormal FC between these brain regions could play a critical role in the physiopathology of PE and could help us in dividing PE into more subtypes.

Increased attentional network activity in premature ejaculation patients with anxiety revealed by resting-state functional magnetic resonance imaging.

Psychological account hypothesizes that premature ejaculation (PE) is a learned pattern of rapid ejaculation maintained by anxiety about sexual failure, whereas neuropsychological accounts hypothesizes that PE is the result of dysfunction of central nervous system regulating ejaculatory. However, the central neural mechanism underlying PE patients with anxiety remains unclear. Resting-state functional magnetic resonance imaging (fMRI) data were collected in 20 PE (diagnoses based on PE Guidelines drafted by the International Society for Sexual Medicine [ISSM]) patients with anxiety and 25 matched healthy controls (HCs) from January 2019 to December 2020. The values of fractional amplitude of low-frequency fluctuation (fALFF) were compared between groups. Moreover, the correlations between fALFF and the severity of PE and anxiety of patients were examined. PE patients with anxiety had increased fALFF values in the right inferior frontal gyrus (opercular part) and middle frontal gyrus. In addition, significant positive correlations were found between the scores of PE diagnostic tool (PEDT) and fALFF values of the right inferior frontal gyrus (opercular part), as well as the right middle frontal gyrus. Moreover, fALFF values of the right inferior frontal gyrus (opercular part) and middle frontal gyrus were positively correlated with the scores of self-rating anxiety scale (SAS). Our results suggested that increased attentional network activity might play a critical role in the neural basis of PE patients with anxiety.

Impaired frontal-parietal control network in chronic prostatitis/chronic pelvic pain syndrome revealed by graph theoretical analysis: A DTI study.

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is characterized by chronic pain in pelvic area and lower urinary tract symptoms (LUTS). Previous neuroimaging studies demonstrated that chronic pain was associated with the altered brain activity. However, the pathological mechanisms associated with altered brain control of CP/CPPS are not well-understood. Therefore, we sought to investigate the topological properties of white matter brain networks in patients with CP/CPPS and whether the topological configuration of frontal-parietal control network was disrupted. We collected 19 patients with CP/CPPS and 32 matched healthy controls (HCs). Diffusion tensor imaging data of all participates were used to map the white matter structural networks. Graph theoretical method was applied to investigate the alterations of topological properties of brain network in patients. Moreover, we also investigated whether the alerted brain regions might be correlated with any clinical features of patients by the method of Pearson correlation analysis. Both CP/CPPS patients and HCs exhibited a 'small-world' behavior or economical small-world architecture of the white matter brain networks. In addition, CP/CPPS had a lower global efficiency in the right middle frontal gyrus (orbital part) and a higher global efficiency in the left middle cingulate and paracingulate gyri. CP/CPPS also showed increased local efficiency in the left middle cingulate and paracingulate gyri and paracentral lobule. Moreover, the local efficiency of the left middle cingulate gyrus was positively correlated with the scores of the influence of symptoms on the quality of life. The local efficiency of the left precuneus and right supplementary motor area were positively correlated with the total scores of NIH-CPSI and the scores of pain and discomfort symptoms, respectively. Together, we found that patients with CP/CPPS had alterations of connections within the frontal-parietal control network, which suggested that the altered connectivity involved in the executive control processing procedures might contribute to the pathogenesis of the pelvic pain and LUTS in CP/CPPS. Thus these results provided new insights into the understanding of CP/CPPS.

Aberrant default mode network and auditory network underlying the sympathetic skin response of the penis (PSSR) of patients with premature ejaculation: A resting-state fMRI study.

INTRODUCTION: Hyperactivity of the sympathetic nervous system is considered as an important component involved in the pathological mechanisms of premature ejaculation (PE). However, the neural mechanisms of PE with high sympathetic activity are still not well understood. METHODS: The activity of the sympathetic innervations in the penis was evaluated by the sympathetic skin response of the penis (PSSR) with an electromyograph and evoked potential equipment. Resting-state functional magnetic resonance imaging (fMRI) data were acquired from 18 PE patients with high sympathetic activity (sPE), 17 PE patients with normal sympathetic activity (nsPE), and 24 healthy controls (HC). We investigated the neural basis of sPE based on the measure of regional homogeneity (ReHo). Moreover, the correlations between brain regions with altered ReHo and PEDT scores and PSSR latencies in the patient group were explored. RESULTS: Altered ReHo values among three groups were found in the temporal, cingulated, and parietal cortex in the default mode network (DMN), as well as the temporal cortex in the auditory network (AUD). Compared with HC, Patients with sPE had increased ReHo values of brain regions in DMN, AUD, and decreased ReHo values of brain regions in DMN. In addition, increased ReHo values were found in DMN of patients with nsPE, while decreased ReHo values were found in DMN and the attention network (AN). Moreover, sPE patients had increased ReHo values in AUD and decreased ReHo values in DMN when compared with nsPE patients. Finally, altered ReHo values of brain regions in DMN and AUD were associated with PEDT scores and PSSR latencies in the patient group. CONCLUSION: Our results suggested that PE patients had abnormal ReHo values in DMN, AUD, and AN. Patients with sPE were characterized by increased neuronal activity in AUD and decreased activity in DMN. This highlighted the significances of DMN, AUD, and AN in the pathophysiology of PE and also provided potential neuroimaging biomarkers for distinguishing sPE from nsPE and HC.

Graph theory analysis reveals premature ejaculation is a brain disorder with altered structural connectivity and depressive symptom: A DTI-based connectome study.

Recent research has shown that premature ejaculation (PE) is associated with negative psychological effects (e.g., depression) and the decline of control over ejaculation is accompanied by structural and functional abnormalities in specific brain areas and connections. However, little is known about the alterations of topological organization in the brain network of patients with PE and its relationship with depressive symptom. We acquired diffusion tensor images, sexual function and depression assessment in 16 lifelong PE patients with depressive symptom, 16 lifelong PE patients without depression and 32 age- and education-matched healthy controls (HC). The differences in nodal centrality and different hub regions among the three groups were compared. Correlation analyses were conducted between the nodal centrality of brain regions displaying significant group differences and the clinical parameters of PE patients. PE patients with depression had increased nodal degree in the right middle frontal gyrus (orbital part) (ORBmid.R) (survived FDR-correction) compared with HC and PE without depression. PE patients with depression also had increased nodal degree in the left and right posterior cingulate gyrus (PCG.L; PCG.R) compared with HC. In addition, PE with depression had increased nodal betweenness in ORBmid.R compared with HC and PE without depression. Moreover PE with depression had decreased nodal participation in the right rolandic operculum (ROL.R), postcentral gyrus (PoCG.R) and supramarginal gyrus (SMG.R) compared with HC, and had decreased nodal participation in ROL.R and the right inferior parietal gyrus (IPL.R) compared with PE without depression, while PE without depression had increased nodal participation in the left precuneus (PCUN.L) compared with HC. The degree and betweenness of ORBmid.R were positively correlated with the total scores of Beck depression inventory (BDI) while the participation of IPL.R had a negative association with the total scores of BDI. Different hubs were found among PE patients with and without depression and HC based on nodal degree, betweenness and participation; however, no significant group differences were found in the frequency distribution of high-degree hubs, high-betweenness hubs, provincial hubs and connector hubs. These findings demonstrated that PE was a brain disorder with altered structural connectivity pattern of brain network and depressive symptom, which suggested that altered structural connectivities of the fronto-cingulate-parietal control network were core neurobiological features associated with PE and depression. Together, these alterations could prove helpful for understanding the pathophysiological mechanisms of PE in depression.

[Acupuncture therapy for chronic prostatitis / chronic pelvic pain syndrome and its central neural mechanisms].

Chronic prostatitis / chronic pelvic pain syndrome (CP/CPPS) is one of the common diseases in andrology, with the main clinical symptoms of long-term and repeated pain or discomfort in the pelvic region. Acupuncture has been widely used in the treatment of CP/CPPS-related pelvic pain and discomfort with rapid and long-lasting effects, and its combination with Western medicine can produce an even better effect than Western medicine alone. At present, various theories have been advanced on the action mechanisms of the acupuncture therapy for CP/CPPS, involving immunoregulation, improvement of inflammatory response, and so on, but all fail to give a full explanation. With the development of neuroimaging technology, CP/CPPS patients are found with changes in the structure and function of the brain, and a large number of studies have confirmed the effect of acupuncture in improving the cerebral function and structure of the patients with chronic pain symptoms. This review outlines the advances in the studies of acupuncture therapy for CP/CPPS and its underlying central neural mechanisms, paving the theoretical ground for a deeper insight into the central neural mechanisms of and an optimized protocol for acupuncture treatment of CP/CPPS-related pain symptoms.

Brain Functional Biomarkers Distinguishing Premature Ejaculation From Anejaculation by ALFF: A Resting-State fMRI Study.

INTRODUCTION: Premature ejaculation (PE) and anejaculation (AJ) are 2 opposite disorders of male ejaculatory dysfunction. Recent studies have demonstrated that the process of ejaculation is mediated by certain neural circuits in the brain. However, different mechanisms between PE and AJ are still unclear. AIM: Therefore, we used resting-state functional magnetic resonance imaging (fMRI) to explore the underlying neural mechanisms in patients with PE and AJ by measuring the amplitude of low-frequency fluctuations (ALFF). METHODS: Resting-state fMRI data were acquired in 17 PE, 20 AJ patients and 23 matched healthy controls (HC). MAIN OUTCOME MEASURE: Differences of ALFF values among the 3 groups were compared. We also explored the correlations between brain regions showing altered ALFF values and scores of Premature Ejaculation Diagnostic Tool (PEDT) in the PE group. RESULTS: There were widespread differences of ALFF values among the 3 groups, which included left anterior cingulate gyrus, precentral and postcentral gyrus, paracentral lobule, superior temporal gyrus, calcarine fissure, putamen; right postcentral gyrus, paracentral lobule, middle temporal gyrus, putamen. Compared with HC, PE patients had greater ALFF in the right inferior frontal gyrus (opercular part), AJ patients had greater ALFF in the left postcentral gyrus. In addition, PE patients exhibited greater ALFF in the left Rolandic operculum, anterior cingulate gyrus, inferior frontal gyrus (orbital part), putamen, and right putamen when compared with AJ patients, as well as decreased ALFF in the right postcentral gyrus. Moreover, positive correlations were found between ALFF of left postcentral gyrus, inferior frontal gyrus (orbital part), right inferior frontal gyrus (opercular part), and PEDT scores. CLINICAL IMPLICATIONS: The differences in central pathophysiological mechanisms between PE and AJ might be useful for improving the clinical diagnosis of ejaculation dysfunction. STRENGTH & LIMITATIONS: Our results showed that the method of fMRI could identify the differences of ALFF between PE and AJ and that these alterations in ALFF were related to clinical function. However, this was a relatively small sample study, and further multimodal neuroimaging studies with large samples were needed. CONCLUSION: The findings demonstrated that altered ALFF of frontal, parietal cortex, and putamen might help distinguish premature ejaculation from anejaculation. Abnormal function of these brain regions might play a critical role in the physiopathology of ejaculatory dysfunction of patients. Chen J, Yang J, Huang X, et al. Brain Functional Biomarkers Distinguishing Premature Ejaculation From Anejaculation by ALFF: A Resting-State fMRI Study. J Sex Med 2020;17:2331-2340.

Psychological factors and pain catastrophizing in men with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS): a meta-analysis.

BACKGROUND: Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a chronic disease with a variety of psychosocial and somatic symptoms. CP/CPPS has substantial health care costs with unclear etiology, which may be caused by psychosocial factors. Moreover, previous studies suggested that cognitive processes played a crucial role in the perception of somatic pain. Therefore, the aim of this meta-analysis was to analyze the psychosocial characteristics in men with CP/CPPS, especially the symptom of pain catastrophizing. METHODS: Relevant publications were searched in different databases including PubMed, MEDLINE, EMBASE, Google Scholar and the Cochran Library using the search terms of "Chronic prostatitis", "Chronic pelvic pain syndrome", "Psychosocial" and "Catastrophizing". The prevalence of psychological factors and pain catastrophizing in men with CP/CPPS were extracted and calculated. RESULTS: Ten studies inclusive of 1,308 patients were included. Analysis of NIH-CPSI scores showed that the severity of CP/CPPS was 23.20 (95% CI: 21.13-25.28). The severity of pain catastrophizing was 13.81 (95% CI: 9.83-17.79) estimated by coping strategies questionnaire (CSQ), while the severity of pain catastrophizing was 24.83 (95% CI: 9.19-40.47) estimated by pain catastrophizing scale (PCS). The prevalence of psychosocial symptom was 0.43 (95% CI: 0.32-0.55), while the prevalence of pain catastrophizing was 0.26 (95% CI: 0.21-0.31). CONCLUSIONS: The psychological factors and pain catastrophizing in men with CP/CPPS was serious. Furthermore, the prevalence of psychosocial symptom and pain catastrophizing was high. There might be a link between pain catastrophizing and somatic symptoms in CPPS. Thus, further prospective studies are needed to evaluate the importance of psychosocial factors in symptom severity of CP/CPPS.

Evaluating the effectiveness of labor protection policy on occupational injuries caused by extreme heat in a large subtropical city of China.

On March 1, 2012, the Chinese government implemented the Administrative Measures on Heatstroke Prevention (AMHP2012) to combat the occupational health impacts of extreme heat, and reducing occupational injury was one of the main purposes. This study aimed at quantifying the intervention effects of the AMHP2012 on extreme heat-related occupational injuries and subsequent insurance payouts in Guangzhou, China. Data on occupational injuries and insurance payouts were collected from March 1, 2011, to February 28, 2013, from the occupational injury insurance system of Guangzhou. A quasi-experimental design with before-after control was adopted. Interrupted time series analysis was performed to quantify the change of occupational injuries and insurance payouts after policy implementation. The distributed lag non-linear model was used to explore whether injury claims and insurance payouts due to extreme heat decreased. A total of 9851 injury claims were included in the analysis. After policy implementation, the risk of occupational injuries and insurance payouts decreased by 13% (RR = 0.87, 95%CI: 0.75, 0.99) and 24% (RR = 0.76, 95% CI: 0.58, 0.94), respectively. The attributable fraction of extreme heat-related occupational injuries decreased from 3.17% (95%eCI: 1.35, 4.69) to 1.52% (95%eCI: -0.36, 3.15), which contributed to 0.86 million USD reduction of insurance payouts. Both males and females, low-educated, young and middle-aged workers, workers at small or medium-sized enterprises, engaging in manufacturing, and with both minor and severe injuries were apparently associated with decreased rates of extreme heat-related occupational injuries. The AMHP2012 policy contributed to the reduction of extreme heat-related occupational injuries and insurance payouts in Guangzhou, China, and this research provided novel evidence for decision-makers to better understand the necessity of implementing health protection policies among laborers under climate change.

Variation in Brain Subcortical Network Topology Between Men With and Without PE: A Diffusion Tensor Imaging Study.

INTRODUCTION: Premature ejaculation (PE) is a highly prevalent male sexual dysfunction. Previous studies have found abnormal activity in the sympathetic nervous system and penile sensory pathway of PE. Few studies have investigated the neural mechanisms underlying PE. AIM: The aim of this study was to examine whether the altered cortico-subcortical network topological properties of the brain white matter structural network could be used to differentiate patients with PE from healthy control (HC) subjects. METHODS: Diffusion tensor images data were collected from 32 patients with PE and 35 HC participants. Then, brain white matter structural networks were reconstructed from image acquisition. MAIN OUTCOME MEASURE: Furthermore, nodal measures were calculated and hub regions were identified using the graph-theoretical methods. RESULTS: For cortical brain regions, increased strength, global efficiency, and decreased shortest path length were found in the right superior frontal gyrus (medial), and superior frontal gyrus (medial orbital) were found in patients with PE. In addition, patients with PE also showed decreased strength in the right rolandic operculum and decreased shortest path length, and increased global efficiency in the right inferior frontal gyrus (triangular part). For subcortical brain structures, patients with PE were associated with decreased shortest path length and increased global efficiency in the left insula and right caudate nucleus. Finally, the results showed that 9 PE-specific hub regions were identified in patients compared with HCs, including 7 cortical regions and 2 subcortical regions. CLINICAL IMPLICATIONS: Our results provide new understanding about the pathology of PE and enhances the understanding of PE pathology. STRENGTH & LIMITATIONS: Our results offer biological markers for understanding the physiopathology of PE. However, our study is a cross-sectional design, longitudinal design studies need to explore the causal relationships between aberrant topological characteristics and PE. CONCLUSION: Our results provide new insights into the neural mechanism of PE involving cortico-subcortical network changes, which could serve as a potential biomarker to differentiate individuals with PE from HCs. Chen J, Yang J, Huang X, et al. Variation in Brain Subcortical Network Topology Between Men With and Without PE: A Diffusion Tensor Imaging Study. J Sex Med 2020;17:48-59.

[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.