Kusintha kwamasinthidwe a zinthu zosaoneka bwino m'maganizo a erectile (2012)

NDEMANGA: 'Psychogenic ED' imatanthauza ED yochokera muubongo. Nthawi zambiri imatchedwa 'psychological ED.' Mosiyana ndi zimenezi, 'organic ED' imatanthauza ED pamlingo wa mbolo, monga ukalamba wamba, kapena mavuto a mitsempha ndi mtima.

Kafukufukuyu adapeza kuti psychogenic ED inali yogwirizana kwambiri ndi kuchepa kwa imvi m'malo operekera mphotho ( nucleus accumbens ) ndi malo olumikizirana a hypothalamus . Imvi ndi komwe maselo amitsempha amalankhulana. Kuti mudziwe zambiri, onerani makanema anga awiri (malire akumanzere), omwe amalankhula za dopamine ndi dopamine receptors. Ndicho chomwe kafukufukuyu adafufuza.

Ngati munaonera kanema wanga wa Porn & ED, mwawona chithunzi chokhala ndi muvi wochokera ku nucleus accumbens kupita ku hypothalamus, komwe kuli malo olumikizirana ziwalo za ubongo. Dopamine mu hypothalamus ndi nucleus accumbens ndiye injini yayikulu yomwe imayambitsa chilakolako cha kugonana ndi chilakolako cha kugonana.

Zopanda kanthu zimasonyeza kuti pali maselo osokoneza bongo omwe amachititsa dopamine komanso maselo osokoneza ubongo a dopamine. Mwa kuyankhula kwina, phunziroli likunena kuti psychogenic ED sichimaganizo, koma m'malo: kutsika kwa dopamine ndi dopamine. Zotsatirazi zikugwirizana bwino ndi maganizo anga pa ED.

Anapanganso mayesero a m'maganizo poyerekeza anyamata omwe ali ndi ED maganizo kwa anyamata omwe alibe ED. Iwo apeza:

  • "Ngakhalenso nkhawa, monga momwe zimayesedwa ndi STAI, kapena umunthu, monga momwe zimayesedwa ndi sikelo ya BIS / BAS, sizinawonetse tanthauzo pakati pak kusiyana kwamagulu. Kusiyanitsa kwakukulu kudawoneka pakukweza "Kufunafuna Kusangalala" kwa sikelo ya BIS / BAS yokhala ndi ziwopsezo zazikulu kuposa zowongolera odwala "

Zotsatira: palibe kusiyana kwa nkhawa kapena umunthu, kupatula kuti anyamata omwe ali ndi psychogenic ED analibe zosangalatsa zambiri (dopamine yotsika). Mukuganiza?? Funso ndi lakuti, "N'CHIFUKWA CHIYANI amuna 17 awa omwe ali ndi psychogenic ED anali ndi imvi yochepa m'malo awo opatsa mphotho ndi hypothalamus poyerekeza ndi olamulira?" Sindikudziwa. Zaka zinali kuyambira 19-63. Avereji ya zaka = 32. Kodi chinali kugwiritsa ntchito zolaula?

PLoS One. 2012;7(6):e39118. doi: 10.1371/journal.pone.0039118. Epub 2012 Juni 18.

Cera N , Delli Pizzi S , Di Pierro ED , Gambi F , Tartaro A , Vicentini C , Paradiso Galatioto G , Romani GL , Ferretti A.

gwero

Dipatimenti ya Sayansi ya Ubongo ndi Kujambula, Institute for Advanced Biomedical Technologies (ITAB), Yunivesite ya G. d'Annunzio ya Chieti, Chieti, Italy. [email protected]

Kudalirika

Kulephera kwa erectile dysfunction (ED) kwafotokozedwa ngati kulephera kosalekeza kupeza ndi kusunga kukhwima kokwanira kuti munthu azitha kugonana. Kumasonyeza kuchuluka kwa amuna, zomwe zimakhudza kwambiri moyo wawo. Kafukufuku wochepa wa neuroimaging wafufuza za ubongo wa kulephera kwa erectile dysfunctions poona momwe ziwalo za m'mimba, ziwalo za m'mimba, ndi ziwalo za m'mimba zimagwirira ntchito panthawi yolimbikitsa chilakolako cha kugonana.

Ngakhale kuti kudziwika bwino kwa madera osiyana siyana monga hypothalamus ndi phokoso lachiwerewere la kugonana kwa amuna, komanso gawo lofunika kwambiri la phokoso lachisankho ndilopatsidwa mphoto, sankasamala kwambiri ntchito yawo yokhudza kugonana kwa amuna.

Mu phunziro lino, tinatsimikiza kuti pali zinthu zofiira (GM) zomwe zimachitika pamtundu wa amygdala, hippocampus, nucleus accumbens, nucleus, putamen, pallidum, thalamus, ndi hypothalamus kwa odwala ED komanso amuna abwino. Pambuyo pofufuza za Rigiscan, matenda okhudza ubongo, mankhwala ochiritsira, opaleshoni ndi mahomoni, kuwunika maganizo ndi maganizo a anthu, odwala 17 omwe ali ndi ED psycho ndi 25 maulamuliro a thanzi adatumizidwa kuti azikhala ndi gawo la MRI.

Kuchepa kwakukulu kwa GM kwa nucleus accumbens kunawonedwa mbali zonse ziwiri mwa odwala pankhani ya zowongolera. Kusanthula kwa mawonekedwe kunawonetsa kuti kuchepa kumeneku kunali kumanzere kwa medial-anterior ndi kumbuyo kwa accumbens. Kuchuluka kwa nucleus accumbens mwa odwala omwe ali ndi vuto lochepa la erectile monga momwe kunayesedwera ndi IIEF-5 (International Index of Erectile Function). Kuphatikiza apo, kuchepa kwa GM kwa hypothalamus yakumanzere kunawonedwanso. Zotsatira zathu zikusonyeza kuti kuchepa kwa nucleus accumbens kumachita gawo lofunikira pamavuto a erectile. Tikukhulupirira kuti kusinthaku kungakhudze gawo lokhudzana ndi chilimbikitso cha khalidwe logonana. Zomwe tapeza zimathandiza kufotokoza maziko a mitsempha ya psychogenic erectile dysfunction.

Introduction

Kulephera Kugonana Kwamaganizo (Psychogenic Erectile Dysfunction (ED)) kwatanthauzidwa ngati kulephera kukhazikika ndikukhalabe ndi chilakolako chokwanira kuti munthu azitha kugonana . Kuphatikiza apo, psychogenic ED imayimira vuto lokhudzana ndi thanzi la maganizo ndipo limakhudza kwambiri moyo wa odwala komanso okondedwa awo. Kafukufuku wa matenda a epidemiological wasonyeza kufalikira kwakukulu komanso kuchuluka kwa psychogenic ED pakati pa amuna.

M'zaka khumi zapitazi, maphunziro ambiri okhudza ubongo omwe amagwira ntchito m'thupi ayang'ana kwambiri madera a ubongo omwe amayambitsidwa ndi zinthu zokhudzana ndi kugonana, zomwe zikusonyeza kuti pali kugwirizana pakati pa kapangidwe ka ubongo ndi kapangidwe kake ka subcortical, monga cingulate cortex, insula caudate nucleus, putamen, thalamus, amygdala ndi hypothalamus [1] - [5] . Maphunziro awa alola kusiyanitsa udindo womwe madera angapo a ubongo amachita m'magawo osiyanasiyana a chilakolako chogonana choyang'aniridwa ndi maso. Zoonadi, chilakolako chogonana cha amuna chaganiziridwa ngati chochitika chamitundu yambiri chokhudzana ndi zinthu zamaganizo, zamaganizo komanso zathupi zomwe zimagwirizana ndi madera ambiri a ubongo. Mosiyana ndi zimenezi, maphunziro ochepa okhudza ubongo omwe afufuza za kugwirizana kwa ubongo kwa kusagwira bwino ntchito kwa khalidwe la kugonana kwa amuna. Maphunzirowa akuwonetsa kuti madera ena a ubongo, monga, cingulate ndi frontal cortex, akhoza kukhala ndi mphamvu yoletsa kugonana kwa amuna [6] - [8] . Komabe, maumboni ambiri [9] - [12] akusonyeza kufunika kwa kapangidwe ka subcortical m'magawo osiyanasiyana a khalidwe logonana. Zoonadi, hypothalamus imagwira ntchito yofunika kwambiri [4] , [5] pakuwongolera pakati pa kukhazikika kwa mbolo. Malinga ndi Ferretti ndi anzake [4], hypothalamus ikhoza kukhala gawo la ubongo lomwe limayambitsa kuyankha kwa erectile komwe kumabwera chifukwa cha zithunzi zolaula.

Palibe zambiri zodziwika bwino zokhudza udindo wa ziwalo zotsala za subcortical mu kusagwira bwino ntchito kwa amuna pakugonana. Pakati pa madera a deep grey matter (GM), nucleus accumbens imagwira ntchito yodziwika bwino mu magawo a mphotho ndi zosangalatsa [13] - [16] ndi caudate nucleus mu ulamuliro wa mayankho owonekera a khalidwe la chilakolako chogonana [2].

Cholinga cha phunziroli ndi kufufuza ngati odwala matenda a EDG akuwonetsa kusintha kwakukulu kwa zomangamanga zomwe zimakhudza kugonana kwa amuna, mu chisangalalo ndi mphotho.

Pofuna kuyesa lingaliro ili, kuwunika kwa MRI kwa kapangidwe kake ka GM ka subcortical ka ubongo, monga nucleus accumbens, amygdala, caudate, hippocampus, pallidum, putamen, thalamus ndi hypothalamus kunachitidwa pa gulu la anthu omwe adaphunzira za psychogenic ED ndi anthu omwe amawongolera. Ngati pali kusiyana kulikonse pakati pa magulu awiriwa m'madera ena, chidwi chathu ndikuwona kukhalapo kwa ubale pakati pa kusintha kwa kuchuluka kwa malo enaake a ubongo ndi miyeso ya khalidwe.

Pitani ku:

Njira

Chikhalidwe

Kafukufukuyu adavomerezedwa ndi komiti ya makhalidwe abwino ya University of Chieti (PROT 1806/09 COET) ndipo adachitika motsatira Chikalata cha Helsinki. Chitetezo cha chidziwitso cha munthu payekha komanso ubwenzi wawo zidatsimikizika potsatira malangizo omwe Rosen ndi Beck adapereka [17] . Kapangidwe ka kafukufukuyu kanafotokozedwa mwatsatanetsatane ndipo chilolezo cholembedwa kuchokera kwa onse omwe adatenga nawo mbali mu kafukufukuyu chidaperekedwa.

Kupanga Phunziro

Odwala a 97 omwe anapita ku chipatala cha odwala kuchipatala cha matenda okhudzana ndi kugonana kwa Division of Urology a Dipatimenti ya Health Sciences ya University of L'Aquila pakati pa January 2009 ndi May 2010 adatumizidwa ku phunziro ili. Odwala omwe anapita ku chipatala akudandaula chifukwa cholephera kugwira ntchito, koma nkhani zabwino zinkatumizidwa kudzera pa zowunikira ku University of Chieti ndi Hospital of Teramo.

Otsatira onse adayesedwa malinga ndi ndondomeko yovomerezeka yowonjezera, kuphatikizapo kafukufuku wamkulu wa zachipatala, urologic ndi andrologic, kuwunika kwa maganizo ndi maganizo ndi ubongo wonse wa MRI.

Ophunzira

Odwala anabwera kuchipatala cha odwala omwe sanagonepo chifukwa cha mavuto okhudzana ndi kugonana komanso mavuto omwe odwalawo anakumana nawo kapena kudziwitsidwa ndi anzawo. Odwalawo adagawidwa m'magulu monga omwe ali ndi vuto la erectile dysfunction (lomwe limakhudza anthu ambiri kapena lokhudzana ndi zochitika) kapena vuto la erectile dysfunction (lomwe limakhudza mitsempha yamagazi, lokhudzana ndi mitsempha, lokhudzana ndi mahomoni, lokhudzana ndi kagayidwe kachakudya, loyambitsidwa ndi mankhwala). Kuwunika kwa Urologic kunachitika motsatira malangizo omwe alipo pakali pano pozindikira vuto la erectile dysfunction [18].

Kuwunika matenda a psychogenic erectile dysfunction (mtundu wodziwika bwino) kunachitika pogwiritsa ntchito mayeso akuthupi makamaka pa ziwalo za m'mimba, endocrine, mitsempha yamagazi ndi mitsempha. Kuphatikiza apo, kuima kwabwinobwino usiku ndi m'mawa kunayesedwa ndi chipangizo cha Rigiscan mkati mwa masiku atatu otsatizana, pomwe, kuima kwabwinobwino kwa mbolo kunayesedwa pogwiritsa ntchito utoto wa Doppler Sonography. Odwala onse 80 sanasankhidwe chifukwa ambiri a iwo sanakwaniritse zofunikira zolembetsera mu kafukufukuyu. Ena mwa iwo anali kumwa mankhwala oletsa kupsinjika maganizo, kapena anali ndi vuto la mahomoni. Komabe, odwala onse omwe anali ndi vuto la psychogenic erectile dysfunctions adalembetsedwa. Mayeso omwewo azachipatala adachitidwa pa anthu omwe ali ndi vuto la erectile. Kuima kwabwinobwino usiku kunatsimikiziridwanso m'magulu owongolera.

Odwala khumi ndi asanu ndi awiri ogonana ndi amuna kapena akazi okhaokha omwe ali ndi vuto la psychogenic erectile dysfunction (zaka zapakati ± SD=34.3±11; chiwerengero cha 19–63 ) ndi amuna makumi awiri ndi asanu athanzi ogonana ndi amuna kapena akazi okhaokha omwe ali ndi thanzi labwino (zaka zapakati ± SD= 33.4±10; chiwerengero cha 21–67 ) adalembedwa ntchito pa kafukufukuyu. Odwala ndi owongolera thanzi lawo adafanana osati kokha pankhani ya fuko, zaka, maphunziro, komanso pankhani ya kugwiritsa ntchito nikotini [19].

Psychiatric and Psychological Assessment

Anthu onse adafunsidwa mbiri ya zamankhwala kwa ola limodzi ndi dokotala wa matenda amisala ndipo adalemba Mini-International Neuropsychiatric Interview (MINI) [20].

Ntchito ya kugonana, kukonda kugonana, mkhalidwe wamaganizo, nkhawa ndi umunthu zinayesedwa pogwiritsa ntchito mafunso otsatirawa: International Index of Erectile Function (IIEF) [21] , Sexual Arousal Inventory (SAI) [22] , SCL-90-R [23] , State-Trait Anxiety Inventory (STAI) [24] , ndi Behavioral Inhibition/Behavioral Activation Scale (BIS/BAS scale) [25] , motsatana.

Kupeza Zambiri za MRI

MRI Yonse ya ubongo inagwiritsidwa ntchito kudzera m'thupi lonse la 3.0 T "Achieva" Philips (Philips Medical System, Best, The Netherlands).

Voliyumu yopangidwa ndi resolution yapamwamba idapezeka kudzera mu 3D fast field echo T 1 -weighted sequence. Ma parameter a kupeza anali motere: kukula kwa voxel 1 mm isotropic, TR/TE=8.1/3.7 ms; chiwerengero cha magawo=160; palibe kusiyana pakati pa magawo; kuphimba ubongo wonse; flip angle=8°, ndi SENSE factor=2.

Kusanthula Deta

Deta ya MRI yopangidwa ndi kapangidwe kake idasanthulidwa pogwiritsa ntchito chida chochokera ku Functional MRI of the Brain (FMRIB) Software Library [FLS, http://www.fmrib.ox.ac.uk/fsl/index.html ] [26] , [27] mtundu 4.1. Deta isanakonzedwe, kuchepetsa phokoso la zithunzi zomangidwa kunkachitika pogwiritsa ntchito njira ya SUSAN [ http://www.fmrib.ox.ac.uk/analysis/research/susan/ ].

Kuyeza kwa Miyeso ndi Kujambula Kusanthula kwa Zithunzi Zogonjetsa

Chida cha FLIRT chinagwiritsidwa ntchito pochita kulinganiza zithunzi za 3D T 1 pa template ya MNI152 (Montreal Neurological Institute) pogwiritsa ntchito kusintha kwa affine kutengera madigiri 12 a ufulu (monga kumasulira katatu, kuzungulira katatu, kukula katatu ndi kusinthasintha katatu) [28] , [29] . Kugawika kwa kapangidwe ka subcortical grey matter (GM) ndi kuyerekezera kwathunthu kwa voliyumu ya amygdala, hippocampus, nucleus accumbens, caudate nucleus, putamen, pallidum ndi thalamus kunachitika pogwiritsa ntchito FIRST [30] . Motsatizana, madera a subcortical adawunikidwa mowoneka ngati ali ndi zolakwika.

Pa kapangidwe kalikonse ka GM subcortical, zotsatira za FIRST zimapereka mesh pamwamba (mu malo a MNI152) yomwe imapangidwa ndi gulu la ma triangles. Ma apices a ma triangles oyandikana nawo amatchedwa ma vertices. Chifukwa chiwerengero cha ma vertices awa mu kapangidwe kalikonse ka GM ndi chokhazikika, ma vertices ofanana amatha kuyerekezeredwa pakati pa anthu ndi pakati pa magulu. Kusintha kwa matenda kumasintha mawonekedwe a vertex mosasintha. Mwanjira imeneyi, kusintha kwa mawonekedwe am'deralo kunayesedwa mwachindunji pofufuza malo a vertex ndikuyang'ana kusiyana kwa malo apakati a vertex pakati pa olamulira ndi magulu a odwala. Kuyerekeza kwa magulu a ma vertices kunachitika pogwiritsa ntchito ziwerengero za F [30] , [31] . Matrix yopangira ndi regressor imodzi yomwe imafotokoza umembala wa gulu (zero wa olamulira, omwe ndi a odwala).

Chiwerengero cha ubongo wamatope Volume

SIENAX [ http://www.fmrib.ox.ac.uk/fsl/fast4/index.html#FastGui ] idagwiritsidwa ntchito poyesa kuchuluka kwa minofu ya ubongo. Pambuyo pochotsa ubongo ndi chigaza, chithunzi choyambirira cha kapangidwe ka munthu aliyense chidalembetsedwa ku MNI 152 space monga tafotokozera m'gawo lapitalo. Kugawika kwa minofu [32] kunachitika kuti kuyese kuchuluka kwa GM, white matter (WM), peripheral GM, ventricular CSF ndi kuchuluka kwa ubongo. Intracranial volume (ICV) idawerengedwa powonjezera kuchuluka kwa madzi am'mimba a ubongo, GM yonse ndi WM yonse pamodzi.

ROI Voxel yochokera ku Morphometry (VBM) Analysis

Malinga ndi njira zomwe zanenedwa ndi mabuku [33] , kusanthula kwa ROI-VBM kwa hypothalamus kunachitika kuti awone kusintha kwa mawonekedwe a thupi komwe kumachitika mwa odwala a ED kuposa anthu omwe ali ndi vuto la ED. ROI ya hypothalamus yakumanja ndi yakumanzere idajambulidwa pamanja pogwiritsa ntchito MRI atlas [34].

Deta idasanthulidwa pogwiritsa ntchito kusanthula kwa VBM [35] , [36] . Pambuyo pochotsa ubongo pogwiritsa ntchito BET [37] , kugawa kwa minofu kunachitika pogwiritsa ntchito FAST4 [32] . Zithunzi za GM zomwe zidapezeka zidalumikizidwa ku MNI152 standard space pogwiritsa ntchito chida cholembetsera cha affine FLIRT [28] , [29] , kutsatiridwa ndi nonlinear registration pogwiritsa ntchito FNIRT [38] , [39] . Zithunzi zomwe zidatuluka zidawerengedwa kuti apange template, yomwe zithunzi za GM zachikhalidwe zidalembetsedwanso mosagwirizana. Pofuna kukonza kukula kapena kuchepa kwa malo, zithunzi za gawo lolembetsedwa zidasinthidwa pogawa ndi Jacobian wa warp field. Pomaliza, magulu a odwala ndi olamulira adayerekezeredwa pogwiritsa ntchito ziwerengero za voxel-wise (5000 permutations) ndi njira yowonjezera magulu yopanda malire mu chida choyesera "randomize" permutation mu FSL [ http://www.fmrib.ox.ac.uk/fsl/randomise/index.html ]. Kuti athetse chiopsezo cha zabwino zabodza, malire a kusiyana pakati pa magulu adakhazikitsidwa pa p<0.05 okonzedwa chifukwa cha zolakwika za mabanja (FWE). Kusanthula kwa ubale ndi IIEF-5 ndi SAI kunachitikanso.

Chiwerengero cha Kusanthula

Statistica® 6.0 idagwiritsidwa ntchito kusanthula deta. Odwala a ED ndikuwongolera athanzi amafanizidwa ndi kusanthula kosiyanasiyana (1-way ANOVA) ya msinkhu, mulingo wamaphunziro, kugwiritsa ntchito chikonga, ICV ndi magawo azimvi padera. Pofuna kuchepetsa kuthekera kwa mtundu woyamba I, kusanthula kwama multivariate kusiyanasiyana (MANOVA) pogwiritsa ntchito magawo angapo azinthu zomwe zimakonzedwa ndi ma ICV pakuwunika kulikonse kosiyanasiyana monga kudalira. Kenako, ma ANOVA a njira imodzi (pakati pa magulu) amayendetsedwa pamtengo uliwonse. Mulingo wofunikira wa p <1 udagwiritsidwa ntchito. Kenako, ubale womwe ulipo pakati pamakhalidwe ndi kuchuluka kwama voliyumu ukufufuzidwa. Zomwe zimatanthawuza kuchuluka kwa mayendedwe ake ndi machitidwe ake, ophatikizidwa pakusanthula kwamalingaliro, ndi omwe adawonetsa kusiyana pakati pagulu. Kusanthula kwamgwirizano kunachitika kudzera mu coefficient ya Spearman's rho, yamagulu awiriwa mosiyana, yokonzedwa poyerekeza angapo (p <0.05).

Pitani ku:

Results

Zizindikiro za anthu m'magulu awiriwa zawonetsedwa mu Table 1.

Gulu 1                

Makhalidwe a chiwerengero cha anthu.

Odwala ED ndi owongolera thanzi lawo sanali osiyana kwambiri malinga ndi zaka, maphunziro awo, kumwa nikotini ndi ICV (Intra Cranial Volume mu mm3 ) , kuchuluka kwa imvi ndi zoyera komanso kuchuluka kwa ubongo wonse.

Kusiyana kwakukulu pakati pa magulu kunapezeka pa chiwerengero chonse cha IIEF-5 chokhala ndi zigoli zapamwamba mu gulu lowongolera kuposa gulu la odwala (F (1,40) = 79; p <0.001), ndi chiwerengero chonse cha SAI chokhala ndi F (1,40) = 13 ndi p <0.001). Makamaka, pa "Kusangalala" kwa oyang'anira thanzi a SAI kunawonetsa chigoli chapakati chachikulu kwambiri kuposa odwala a ED (F (1,40) = 22.3; p <0.001). Nkhawa, monga momwe zinayesedwera ndi STAI, kapena umunthu, monga momwe zinayesedwera ndi sikelo ya BIS/BAS, sizinawonetse kusiyana kwakukulu pakati pa magulu. Kusiyana kwakukulu kunawoneka pa "Kufunafuna Zosangalatsa" kwa sikelo ya BIS/BAS yokhala ndi chigoli chapakati chachikulu cha oyang'anira kuposa odwala (F (1,40) = 5.2; p <0.05).

Mu phunziro lililonse, ma subcortical structures 7 (thalamus, hippocampus, caudate, putamen, pallidum, amygdala, ndi accumbens) adagawidwa m'magawo ndipo ma volumes awo adayesedwa ndi chida cha FIRST ( Chithunzi 1 ). Gome 2 limafotokoza za avereji ya volumes (M) ndi standard deviation (SD) ya madera omwe atchulidwa pamwambapa mu ma cubic millimeters kwa odwala a ED ndi magulu olamulira. Gome 3 likuwonetsa ma volumes a avereji a ma subcortical structures m'magulu odwala ndi olamulira a hemispheres ziwiri za ubongo padera. A MANOVA idawonetsa kukhalapo pakati pa kusiyana kwa magulu m'malo a subcortical (Wilks λ=0.58; F=3,45; p=0.006). Kenako, mndandanda wa ma ANOVA otsatira njira imodzi adawonetsa kuchepa kwakukulu kwa volume ya nucleus accumbens mwa odwala a ED poyerekeza ndi ma controls (F (1,40) =11,5; p=0.001).

Chithunzi 1   
Chigawo cha zozama zakuya.
Gulu 2                 

Mitengo yambiri yamagulu a masentimita masentimita a odwala a ED Psychogenic ndi magulu olamulira abwino.
Gulu 3                  

Mitengo yambiri yamagulu a masentimita masentimita a mthupi la ED Psychogenic ndi magulu othandizira odwala komanso maubongo awiri a ubongo.

MANOVA yowonjezera, yomwe idachitidwa pa kuchuluka kwa ma voliyumu a madera akumanzere ndi akumanja a subcortical, idawonetsa kusiyana kwakukulu pakati pa odwala a ED ndi owongolera (Wilks λ=0.48; F=2,09; p=0.04). Chifukwa chake, ma ANOVA otsatira njira imodzi adawonetsa kuchepa kwakukulu kwa ma voliyumu a nucleus yakumanzere ndi yakumanja mwa odwala a ED pankhani ya owongolera athanzi (F (1,40) =9.76; p=0.003; F (1,40) =9.19; p=0.004 motsatana).

Zotsatira za kusanthula mawonekedwe zomwe zachitika pa ma nucleus accumbens zawonetsedwa pa Chithunzi 2.

Chithunzi 2     Chithunzi 2             

Kuyerekeza kwachidziwitso pakati pa odwala ndi ED Psychogenic ED.

Kuyerekeza kwa malo a vertex pakati pa magulu awiriwa kunasonyeza kwambiri atrophy m'dera mwa odwala ED mu makalata kumanzere kumbuyo-anterior ndipo, bilaterally, mpaka gawo lowererior ya nucleus accumbens.

Monga momwe zanenedwera mu Chithunzi 3 , kusanthula kwa R OI-VBM kunawonetsa kufooka kwa GM mu hypothalamus yakumanzere (p<0.05, kuchuluka kwa FWE kumayendetsedwa). Makamaka, kutayika kwa GM kunapezeka mu supraoptic nucleus ya anterior hypothalamic area ( x, y, z coordinates: −6, −2, −16, p=0.01corrected), ventromedial nucleus ya hypothalamus ( x, y, z coordinates: −4, −4, −16 , p=0.02corrected), ndi medial preoptic nucleus ( x, y, z coordinates:−4, 0, −16, p=0.03corrected).

Chithunzi 3    Chithunzi 3             

Mutu wautali umatayika wotsalira wa hypothalamus mu ED odwala kuposa maphunziro abwino.

Kusanthula kwa mgwirizano kunachitika pakati pa miyeso ya khalidwe (IIEF ndi SAI) ndi zotsatira za FIRST ndi ROI-VBM. Kugwirizana kwabwino kunawonedwa pakati pa IIEF mean scores ndi left nucleus accumbens mu gulu la odwala (rho=0,6; p<0.05, yokonzedwa kuti iyerekezedwe kangapo) ndi pakati pa SAI total score ndi left hypothalamus (p=0.01, FWE rate ndi yosalamulirika).

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Kukambirana

Kafukufuku wathu adafufuza momwe subcortical region atrophy imakhudzira amuna omwe ali ndi vuto la erectile. Kusanthula kwa MRI komwe kumachitika m'thupi kunawonetsa kuchepa kwakukulu kwa GM kwa ma nucleus akumanzere ndi akumanja komanso kumanzere kwa hypothalamus mwa odwala omwe adapezeka ndi vuto la psychogenic ED la mtundu wodziwika bwino pankhani ya olamulira athanzi. Kusintha kwa ma macro-structural kumeneku sikudalira zaka, kumwa nikotini, kuchuluka kwa maphunziro, komanso kuchuluka kwa ubongo. Kuphatikiza apo, kuchepa kwa GM kwa ma nucleus akumanzere kunawonetsa mgwirizano wabwino ndi kusagwira bwino ntchito kwa erectile mwa odwala, monga momwe adayesedwera ndi International Index of Erectile Function (IIEF). Kuphatikiza apo, kutayika kwa voliyumu ya GM m'madera akumanzere a hypothalamic kunali kogwirizana ndi zigoli za Sexual Arousability Inventory (SAI) zomwe zikuyimira muyeso wina wa khalidwe logonana. Madera onsewa a subcortical amachita nawo njira zambiri zamaubongo ndi ntchito zokhudzana ndi kudzilamulira ndi malingaliro.

Kutengera ndi zotsatira zathu, zomwe tapeza mu kafukufukuyu zikuyimiridwa ndi GM atrophy yomwe imapezeka mu nucleus accumbens ya gulu la odwala. Udindo womwe nucleus accumbens imachita mu khalidwe la kugonana la amuna unathandizidwa ndi umboni wa thupi mwa makoswe aamuna [40] komanso maphunziro okhudza ubongo mwa amuna athanzi panthawi yolimbikitsa chilakolako chogonana [2] . Kutulutsidwa kwa dopamine mu nucleus accumbens kumayendetsa dongosolo la mesolimbic lomwe limakhudzidwa ndi kuyambitsa khalidwe poyankha zizindikiro zomwe zimasonyeza kukhalapo kwa zolimbikitsa kapena zolimbikitsa [41] . Izi zimathandizidwa ndi umboni wa thupi womwe umagwirizanitsa ntchito ya dopaminergic mu NAcc ndi khalidwe la chilakolako chogonana mwa makoswe aamuna [40] , [41] . Zoonadi, kuchuluka kwa dopamine mu nucleus accumbens ya makoswe aamuna kumawonedwa pamene makoswe akazi adamubweretsera. Kuwonjezeka kumeneku kunachepa panthawi yogonana pambuyo pa nthawi yogonana.

Poganizira izi, ntchito mu nucleus accumbens inali yogwirizana ndi kulamulira mayankho a malingaliro. Ma nucleus accumbens a munthu akuwoneka kuti amasankha zithunzi zosangalatsa zomwe zimayambitsa osati mphamvu [42] . Malinga ndi Redoutè ndi anzake [2], ma nucleus accumbens mwina amatenga nawo mbali mu gawo lolimbikitsa chilakolako cha kugonana kwa amuna. Ma nucleus accumbens a munthu amayamba kugwira ntchito panthawi yomanga yomwe imayambitsidwa ndi kukondoweza kwa maso [1] , [2].

Komanso, zotsatira zathu pa kusiyana kwa mawonekedwe zikuwoneka kuti zikugwirizana ndi lingaliro la chilimbikitso, popeza kuti kufooka komwe kwawonedwa kumakhudza makamaka chipolopolo cha nucleus accumbens. Chipolopolo chikuyimira dera lomwe limawoneka logwirizana kwambiri ndi chilimbikitso ndi machitidwe a chilakolako [43] , [44] . Mu mbewa yamphongo, kuletsa kwa electrophysiological kwa chipolopolo, koma osati pakati pa nucleus accumbens, kumawoneka kuti kukuwonjezeka poyankha chizindikiro chosapereka mphotho [45].

Zomwe tapeza zikugwirizana ndi umboni wakale wa nyama womwe wawona momwe kutulutsidwa kwa dopamine kuchokera ku nucleus accumbens ndi dera la medial preoptic la hypothalamus kumawonekera kuti kumawongolera bwino gawo lolimbikitsa la machitidwe ogonana.

Mwanjira imeneyi, hypothalamus imayimira dera lofunikira kwambiri polimbikitsa ntchito ya erectile [3] , [4] . Tapeza kuchepa kwa kuchuluka kwa imvi mu hypothalamus ya lateral mwa odwala omwe ali ndi vuto la erectile. Kusintha kumeneku mu kuchuluka kwa imvi kudawonedwa m'dera la supraoptic nucleus ya anterior hypothalamic area, medial preoptic ndi ventromedial nucleus.

Malinga ndi maumboni angapo oyesera, dera la medial preoptic ndi gawo lakunja la hypothalamus zimakhala ndi gawo lofunikira kwambiri pakulamulira khalidwe la kugonana kwa amuna mwa mtundu uliwonse wa nyama zoyamwitsa [ 46] . Makamaka, zilonda zamitundu iwiri za madera awa a hypothalamic zimathetsa chilakolako cha kugonana cha amuna mwa makoswe [47] , [48] . Ponseponse, kafukufukuyu akuwonetsa kuti zilonda zamitundu iwiri za medial preoptic nucleus ndi anterior hypothalamus zimawononga chilakolako chogonana mwa makoswe [40] , [47] , [49] . Kuphatikiza apo, kuchuluka kwa zochita panthawi ya chilakolako chogonana, njala ndi nkhanza kwawonedwa [50] . Georgiadis ndi anzake [5] adawonetsa momwe magawo osiyanasiyana a hypothalamus amagwirizanirana mosankha ndi magawo osiyanasiyana a kukhazikika mwa amuna athanzi. Zoonadi, hypothalamus ya mbali imodzi imagwirizana ndi kuzungulira kwa mbolo ndipo ikuwoneka kuti ikugwirizana ndi momwe zimakhalira ndi chilakolako chogonana.

Kafukufuku wokhudza ubongo wasonyeza kuti ziwalo zina za subcortical, monga hippocampus, amygdale ndi thalamus zinali ndi ntchito zambiri zokhudzana ndi kukopa chilakolako cha kugonana komanso magawo enaake a kukhwima kwa mbolo [4] . Malinga ndi zotsatira zathu, palibe kusintha kwa kuchuluka kwa ziwalo izi zakuda kwambiri m'gulu la odwala.

N'zochititsa chidwi kuti kafukufukuyu ali ndi zofooka zina. Popeza chida cha FIRST sichikuphatikizapo kugawa kwa hypothalamus, kusanthula kwa ROI-VMB ndiko njira yodalirika kwambiri yowunikira yokha kusintha kwa macro-structural mu hypothalamus. Koma njira iyi sinapangidwe poyamba kuti iwunikenso kapangidwe ka sub-cortical, chifukwa imakonda kupanga zinthu zakale mu subcortical GM. VMB imachokera ku kugawa kwa GM komwe kumachitika m'deralo ndipo motero imazindikira zolakwika za kugawa kwa minofu ndi kuchuluka kosalala kosasinthika [30] , [51] - [53] . Pachifukwa ichi kutanthauzira kwa zomwe zapezeka mu ROI-VBM kumafuna kusamala.

Kutsiliza

Ngakhale kuti chidwi cha ma brain correlates mu khalidwe la kugonana chikuwonjezeka, zovuta zogonana za amuna sizikusamalidwa bwino. Zomwe tapeza zikugogomezera kukhalapo kwa kusintha kwa macro-structural mu GM m'madera awiri a subcortical, nucleus accumbens ndi hypothalamus, zomwe zikuwoneka kuti zimagwira ntchito yofunika kwambiri pazochitika zolimbikitsa khalidwe la kugonana la amuna. Zomwe tapeza zikuwonetsa kufunika kwa gawo lolimbikitsa khalidwe la kugonana kuti lilole kuchita bwino kugonana kwa amuna athanzi. Kuphatikiza apo, zitha kukhala zomveka kuti kuletsa kuyankha kwa kugonana kwa odwala omwe ali ndi vuto la psychogenic erectile dysfunction kungathandize pa gawoli. Kusintha kwa kapangidwe ka subcortical komwe kutengedwa pamodzi ndi umboni wakale wa neuroimaging kukuwonetsa zatsopano pazovuta zovuta za kusagwira ntchito kwa kugonana kwa amuna.

Komanso, zotsatirazi zingathandize kukhazikitsa njira zothandizira zatsopano zamtsogolo komanso kuyesa zotsatira za omwe akugwiritsidwa ntchito.

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Mawu a M'munsi

 

Zokonda Zopikisana: Olembawo anena kuti palibe zokonda zopikisana zomwe zilipo.

Ndalama: Palibe ndalama zakunja zomwe zilipo pa kafukufukuyu.

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Zothandizira

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