IMIBUZO: 'I-Psychogenic ED' ibhekisa ku-ED evela ebuchosheni. Kuvame ukubizwa ngokuthi 'i-ED yengqondo.' Ngokuphambene nalokho, 'i-organic ED' ibhekisa ku-ED ezingeni lendoda, njengokuguga okudala okucacile, noma izinkinga zezinzwa nezinhliziyo.
Lolu cwaningo lufumene ukuthi i-psychogenic ED yayisondelene kakhulu ne-atrophy yendaba ebomvu esikhungweni somvuzo (i-nucleus accumbens) nezikhungo zocansi i-hypothalamus. Okumpunga kulapho amaseli ezinzwa axhumana khona. Ngemininingwane, bukela uchungechunge lwamavidiyo wami amabili (imajini engakwesokunxele), ekhuluma nge-dopamine ne-dopamine receptors. Yilokho okuhloliwe yilolu cwaningo.
Uma ubuke wami Ividiyo ye-Porn & ED ubone isilayidi esinomcibisholo ogijima usuka ku-nucleus accumbens wehlela phansi kwi-hypothalamus, lapho kukhona izikhungo zobuchopho. I-Dopamine kuzo zombili i-hypothalamus ne-nucleus accumbens iyinjini eyinhloko ngemuva kwe-libido kanye nokwakhiwa.
Indaba encane ebomvu ikhombisa amangqamuzana amancane we-dopamine-producing cell cells. Ngamanye amazwi, ucwaningo lusho ukuthi i-psychogenic ED ayiyona ingqondo, kodwa kunokwenyama: ukuphazamiseka okuphansi kwe-dopamine nokubonisa i-dopamine. Lokhu okutholakele kufanelana ngokugcwele ngombono wami ku-ED eyenziwe ngocansi.
Benza nokuhlolwa kwengqondo ngokuqhathanisa abafana abane-psychogenic ED kubafana abangenayo i-ED. Bathola:
- “Nokukhathazeka, njengoba kulinganiswa yi-STAI, noma ubuntu, njengoba kukalwa isikali se-BIS / BAS, akubonisanga okuphawulekayo phakathi kokwehluka kweqembu. Umehluko obonakalayo ubonwe ku-subscale "Fun Funing" yesikali se-BIS / BAS esinamaphuzu asezingeni eliphakeme kakhulu wezilawuli kuneziguli "
Ezenye: akukho mehluko ekukhathazekeni noma ebuntwini, ngaphandle kokuthi abafana abane-psychogenic ED babenenjabulo encane (i-dopamine ephansi). Uyacabanga ?? Umbuzo uwukuthi, "KUNGANI laba abangu-17 abanamadoda angama-psychogenic ED benodaba oluncane esikhungweni sabo semivuzo nakwi-hypothalamus uma kuqhathaniswa nezilawuli?" Angazi. Iminyaka isukela ku-19-63. Isilinganiso seminyaka = 32. Ngabe bekungukusebenzisa i-porn?
I-PLoS One. 2012; 7 (6): e39118. i-doi: 10.1371 / iphephandaba.pone.0039118. I-Epub 2012 Jun 18.
Cera N, I-Delli Pizzi S, I-Di Pierro ED, I-Gambi F, I-Tartaro A, Vicentini C, Paradiso Galatioto G, I-Romani GL, I-Ferretti A.
Umthombo
UMnyango weNeuroscience and Imaging, Institute for Advanced Biomedical Technologies (ITAB), University G. d'Annunzio waseChieti, eChieti, e-Italy. [i-imeyili ivikelwe]
abstract
Ukukhubazeka kwe-erectile yengqondo (ED) kuye kwachazwa ngokuthi ukuhluleka okuqhubekayo ukuthola nokugcina ukulungiswa okwanele ukuvumela ukusebenza kocansi. Kubonisa ukukhubazeka okuphezulu nokusabalalisa phakathi kwamadoda, nomthelela omkhulu kwizinga lempilo. Ucwaningo oluthile lwezinkanyezi luye lwaphenya ngesisekelo se-cerebral ye-erectile dysfunctions ebona indima edlalwa yi-prefrontal, i-cingulate, ne-parietal cortices ngesikhathi sokugqugquzela ukukhathazeka.
Naphezu kokubandakanya kwaziwa kwezifunda ezingaphansi komhlaba njenge-hypothalamus ne-caudate nucleus ekuphenduleni kwabantu ngokocansi, futhi indima eyinhloko ye-nucleus iqoqa ngenjabulo nomvuzo, ukunakekelwa okungekho emholweni kukhokhelwe indima yabo ekusebenziseni ubulili besilisa.
Kulesi sifundo, sinqume ukuba khona kwamaphethini we-grey (GM) amathrekhi we-atrophy ezintweni ezingaphansi kwe-amygdala, i-hippocampus, i-nucleus accumbens, i-nucleus, i-putamen, i-pallidum, i-thalamus, ne-hypothalamus kuziguli ezine-psychogenic ED namadoda aphilile. Ngemuva kokuhlola kwe-Rigiscan, ukuhlukumezeka kwemvelo, ukuhlolwa kwezempilo, umzimba kanye nokuhlolwa kwamaphilisi, ukuhlolwa kwengqondo nokuhlolwa kwengqondo, iziguli ze-17 ezine-psychogenic ED kanye ne-25 zokulawula okunempilo zaqashwa isikhathi sesakhiwo se-MRI.
I-GM i-atrophy ephawulekayo ye-nucleus accumbens ibonwe ngeziguli ngeziguli ngokuphathelene nokulawula. Ukuhlaziywa kohlobo kubonise ukuthi le-atrophy itholakala engxenyeni yesobunxele-yangaphakathi nangemuva ngemuva kwe-accumbens. I-nucleus engxenyeni engakwesokunxele ihlangene neziguli ezihambisana nokusebenza okuphansi kwe-erectile njengoba kulinganiswa i-IIEF-5 (International Index of Erectile Function). Ngaphezu kwalokho, i-atrophy ye-GM ye-hypothalamus kwesobunxele iphinde ibonwe. Imiphumela yethu ikhombisa ukuthi i-atrophy ye-nucleus accumbens idlala indima ebalulekile ekusebenziseni okungasebenzi kwe-erectile yengqondo. Sikholelwa ukuthi lolu shintsho lungathonya isici esihlobene nesisusa sokuziphatha kocansi. Okutholakele kwethu kusiza ukucacisa isisekelo se-neural senkinga yokusebenza kwengqondo erectile.
Isingeniso
Ukukhubazeka kwe-Erectile Psychogenic (ED) kuchazwe ngokuthi ukuhluleka okuqhubekayo ukuthola nokugcina ukulungiswa okwanele ukuvumela ukusebenza kocansi. Ngaphezu kwalokho, i-psychogenic ED imelela isifo esihlobene nempilo yengqondo futhi sinomthelela omkhulu kwizinga lempilo yababili abagulayo kanye nabalingani babo. Ucwaningo lwe-epidemiological lubonise ukusabalala okuphezulu kanye nesimo se-psychogenic ED phakathi kwamadoda.
Kule minyaka eyishumi edlule, izifundo eziningi zokusebenza nge-neuroimaging ziye zagxila ezifundeni zobuchopho ezikhushulwa yisenzo esithinta ubulili, kubonisa ukubandakanya kwezakhiwo ezahlukene ze-cortical ne-subcortical, njenge-cingulate cortex, i-insula caudate nucleus, i-putamen, i-thalamus, i-amygdala ne-hypothalamus [1]-[5]. Lezi zifundo ziye zavumela ukuphazamisa indima edlalwa yizifunda eziningana zobuchopho ngezigaba ezahlukene zokuvuswa kocansi okubonakalayo. Ngempela ukuvuvukala kwesilisa ngokobulili kuye kwavezwa njengento ehlukahlukene yokubandakanya izingxenye ezingqondweni, ezingokomzwelo nezingokwenyama ezithinta isamba esiphezulu sezindawo zobuchopho. Ngakolunye uhlangothi, ucwaningo oluncane lwezinkanyezi luye lwaphenya ama-correlates e-cerebral ekusebenziseni ukuziphatha kabi ngokocansi. Lezi zifundo zibonisa ukuthi ezinye izifunda zobuchopho, njengokuthi, i-cortex enama-cingulate futhi yangaphambili, ingaba nomthelela wokuvimbela impendulo yesilisa ngokobulili [6]-[8]. Nokho, ubufakazi obuningi [9]-[12] bakhombise ukubaluleka kwezinhlaka ezingaphansi kwezingxenye ezihlukene zokuziphatha okukopisayo. Ngempela, i-hypothalamus idlala indima ebalulekile [4], [5] ekulawuleni okuphakathi kwe-penile erection. Ngokusho kukaFerretti nozakwabo [4] i-hypothalamus ingaba yindawo yobuchopho edala impendulo ye-erectile ekhishwe yiziqeshana ezishisayo.
Okuncane okuyaziwa ngendima edlalwa yizinhlaka ezisele ezisezingeni eliphansi ekusebenzeni komzimba wesilisa ngokobulili. Phakathi kwezifunda ezijulile ezimpunga (GM), i-nucleus accumbens idlala indima ehlonishwe kahle emkhatsini wokuvuza kanye nezifunda ezijabulisayo [13]-[16] futhi i-nucleus ye-caudate ekulawuleni impendulo yokuziphatha ngokweqile yokuvusa ucansi [2].
Inhloso yalolu cwaningo ukuphenya uma iziguli ze-psychogenic ED zikhombisa ukuguqulwa kokuhlelekile kwezakhiwo ze-GM ezijulile ezibandakanyeka ekuphenduleni kwesilisa ngokocansi, ngenjabulo nomvuzo.
Ukuze kuhlolwe lesi sizathu, ukuhlolwa kwe-MRI yokwakhiwa kwezinguquko eziyisishiyagalombili ze-GM zobuchopho, njenge-nucleus accumbens, i-amygdala, i-caudate, i-hippocampus, i-pallidum, i-putamen, i-thalamus ne-hypothalamus yenziwa kubantu abacwaninga abaguli be-psychogenic ED nezihloko zokulawula. Uma kukhona ukungafani phakathi kwamaqembu amabili kwezinye zalezi zifunda, intshisekelo yethu ukubona ukutholakala kobudlelwane phakathi kwezinguquko ezinhlokweni ezithile zendawo yobuchopho nezindlela zokuziphatha.
izindlela
Isitatimende Sokuziphatha
Ucwaningo luvunyiwe yikomiti yokuziphatha yaseYunivesithi yaseChieti (PROT 1806 / 09 COET) futhi iqhutshwa ngokuhambisana neHelsinki Declaration. Ukuvikelwa kolwazi lomuntu siqu kanye nokusondelana kwabo kwaqinisekiswa ngokusebenzisa isiqondiso esasikhulunywa nguRosen noBekk [17]. Umklamo wokutadisha wachazwa ngokuningiliziwe kanye nokubhalwa kwemvume enolwazi kwatholakala kubo bonke abahlanganyeli abathintekayo esifundweni sethu.
I-Study Design
Iziguli ze-97 ezavakashela umtholampilo wesipiliyoni ngenxa yokuhlukunyezwa ngokobulili kweCandelo le-Urology loMnyango wezeMpilo eSayensi ye-University of L'Aquila phakathi kukaJanuwari 2009 noMeyi 2010 abaqashiwe kulolu cwaningo. Iziguli ezavakashela umtholampilo zikhononda ngokungasebenzi kahle kwe-erectile, kanti izifundo ezinempilo zaqashwa ngesaziso ebhodini lezincwajana e-University of Chieti naseSibhedlela iTeramo.
Bonke abahlanganyeli bahlolwe ngokulandela uhlelo olulandelwayo olubandakanya ukuhlolwa okuvamile kwezokwelapha, urologic kanye ne-andrologic, ukuhlolwa kwesifo sengqondo nokusebenza kwengqondo kanye ne-MRI ebuchosheni.
Tifundvo letifundvwa
Iziguli zafika emtholampilo wesipiliyoni ngenxa yezidakamizwa zesifo socansi kanye nobunzima obhekene neziguli noma aziswe ngabalingani babo. Iziguli zahlukaniswa ngokuthi zikhona psychogenic ukungasebenzi kwe-erectile (izinhlobo ezijwayelekile noma ezisezingeni) noma eziphilayo ukungasebenzi kwe-erectile (vasculogenic, neurogenic, hormonal, metabolic, izidakamizwa ezenziwe). Ukuhlolwa kwe-Urologic kwenziwa ngemuva kweziqondiso zamanje zokuxilongwa kwe-erectile ukungasebenzi [18].
Ukuhlolwa kokuhlunga kwe-psychogenic erectile ukungasebenzi (uhlobo olujwayelekile) kwenziwa ngokuhlolwa kwangokwenyama ngokugcizelela ngokukhethekile ezakhiweni ze-genitourinary, endocrine, amasosha kanye nezinzwa ze-neurological. Ukwengeza, ukuvinjelwa okujwayelekile kokuhlwa ebusuku nokuhlolwa kwansuku kwahlolwa ngedivayisi yamaRigiscan phakathi nobusuku obuthathu obulandelanayo, kuyilapho, i-hemodynamics evamile ye-penile yahlolwa ngokusebenzisa umbala we-Doppler Sonography. Ngokuphelele, iziguli ze-80 zazingeniswa ngoba eziningi zazo azihlangabezane nemigomo yokubhalisa ekuhlolweni. Ezinye zazo zaziphethwe yi-anti-depressants, noma zinezinsalela ze-hormonal. Kodwa-ke, zonke iziguli ezine-erectile psyysic dysfunctions zibhalisiwe. Ukuhlolwa okufanayo kwemitholampilo kwenziwa ezikoleni zokulawula. Ukulungiswa okujwayelekile kwebusuku nakho kwaqinisekiswa ezilawulweni.
Iziguli eziyishumi nesikhombisa ezinikezwa izidakamizwa ezithintekayo ngokuxilongwa kwe-psychogenic erectile (dis age age) I-SD = 34.3 ± 11; ibanga 19-63) kanye namashumi amabili nanhlanu ilungelo elinempilo elinikezwa amadoda angama-sex (sex age) ± SD =I-33.4 ± 10; ibanga 21-67) baboshwa kulolu cwaningo. Iziguli kanye nokulawula okunempilo akufaniswanga nje kuphela ngokobuzwe, ubudala, imfundo, kodwa nangokusetshenziswa kwe-nicotine [19].
Ukuhlolwa Kwengqondo Nezimo Zengqondo
Zonke izifundo zathola ingxoxo yomlando wezokwelapha ze-1-h nomuntu wezifo zengqondo futhi zithatha ingxoxo ye-Mini-International Neuropsychiatric Interview (MINI) [20].
Umsebenzi we-Erectile, ukuvuselela ngokobulili, isimo sengqondo, ukukhathazeka nobuntu kuhlolwe kusetshenziswa imibuzo elandelayo: I-International Index of Erectile Function (IIEF) [21], I-Arousal Inventory ye-Sexual (SAI) [22], I-SCL-90-R [23], Ukuxhaswa Kwezinkathazo Zombuso (STAI) [24], nesimo sokuvimbela ukuziphatha / Isenzo sokuqalisa ukusebenza (Isilinganiso se-BIS / BAS) [25]Ngokulandelana.
Ukutholakala kwedatha ye-MRI
I-Whole Brain MRI yenziwa nge-3.0 T "Achieva" i-Philips isithwebuli somzimba wonke (i-Philips Medical System, i-Best, i-Netherlands), isebenzisa ikhoyili yomsakazo wonke womzimba ukuze kuvezwe isignali kanye nekhoyili yekhanda eliyisishiyagalombili yokuthola isignali.
Ivolumu yesakhiwo esiphezulu isakhiwe nge-3D field field echo T1ukulandelana kwesisindo. Amapharamitha okuthola izinto anjengokulandelayo: usayizi we-voxel 1 mm isotropic, TR / TE = 8.1 / 3.7 ms; inombolo yezigaba = i-160; akukho nhlobo phakathi kwezigaba; ukuhlanganisa konke ubuchopho; flip angle = 8 °, ne-SENSE factor = 2.
Ukuhlaziya Data
Idatha yesakhiwo se-MRI yahlaziywa ngokusebenzisa ithuluzi kusuka ku-Functional MRI ye-Brain (FMRIB) Software Library [FLS, http://www.fmrib.ox.ac.uk/fsl/index.html] [26], [27] version 4.1. Ngaphambi kokucubungula idatha, ukunciphisa imisindo kwezithombe ezakhiwe kwenziwa ngokusebenzisa i-SUSAN algorithm [http://www.fmrib.ox.ac.uk/analysis/research/susan/].
Ukulinganisa Ukulinganisa Nokubunjwa Kwezinhlaka Zokwakhiwa Kwezingqungquthela
Ithuluzi le-FLIRT lisetshenziselwe ukwenza ukulungiswa kwe-affine ye-3D T1 izithombe kwi-template ye-MNI152 (i-Montreal Neurological Institute) ngokusebenzisa ukuguqulwa kwe-affine okusekelwe kuma-degree angama-12 wenkululeko (okusho izinguqulo ezintathu, ukushintshaniswa okuthathu, ukulinganisa okuthathu kanye nezintathu ezintathu) [28], [29]. Isakhiwo segrey (GG) se-grey subcortical (GM) kanye nokulinganisa okuphelele kwe-amygdala, i-hippocampus, i-nucleus accumbens, i-nucleus ye-caudate, i-putamen, i-pallidum ne-thalamus yenziwa nge-FIRST [30]. Izindawo eziphumelelayo, izindawo ezingaphansi kwe-subcortical zihlolwe ngokubuka amaphutha.
Ngokwesakhiwo ngasinye se-GM esincane, iziphumo ze-FIRST zinikeza isisindo somhlaba (endaweni ye-MNI152) esakhiwe isethi yezintathu. I-apices ye-triangles ebizwa ngokuthi i-vertices. Ngenxa yokuthi inani lala ma-vertices isakhiwo ngasinye se-GM, i-vertices ehambisanayo ingaqhathaniswa nabantu ngabanye naphakathi kwamaqembu. Ukuguqulwa kwamathambo kuguqula isimo se-vertex esiqondisayo / isikhundla. Ngale ndlela, isimo sendawo sishintsha ngokuqondile ngokuhlolisiswa kwezindawo ze-vertex nangokubheka umehluko we-vertex ephakathi kokulawula nezigaba zeziguli. Ukuqhathaniswa kweqembu kwamagceke kwenziwa nge-F-izibalo [30], [31]. I-matrix yomklamo i-regressor eyodwa ecacisa ubulungu beqembu (zero for controls, ezodwa iziguli).
Ukulinganiswa kweBlue Tissue Volume
SIENAX [http://www.fmrib.ox.ac.uk/fsl/fast4/index.html#FastGui] isetshenziselwa ukulinganisa ivolumu yamathishu ebuchopho. Ngemuva kokukhishwa kobuchopho kanye ne-skull, isithombe sesakhiwo sokuqala sendaba ngayinye sasine-affine-ebhalisiwe kwisikhala se-MNI 152 njengoba kuchaziwe esigabeni esandulele. Isigaba se-tissue segmentation [32] kwenzelwa ukulinganisa umthamo we-GM, indaba emhlophe (WM), i-peripheral GM, i-ventricular CSF kanye nenani eliphelele lobuchopho. Ivolumu ye-intracranial (i-ICV) ibalwa ngokufaka umthamo we-cerebral fluinal spinal, i-GM yenani le-WM eliphelele ndawonye.
I-ROI Voxel-based based Morphometry (VBM) Analysis
Ngokusho ngezindlela ezibikwe yizincwadi [33], Ukuhlaziywa kwe-ROI-VBM ye-hypothalamus kwenziwa ukuhlola ushintsho lwe-morphological olwenzeka kuma-ED kunezihloko zokulawula. I-ROI ye-hypothalamus kwesokudla nengakwesokunxele yayidonselwe ngesandla ngesisekelo se-MRI atlas [34].
Idatha yahlaziywa ngokusebenzisa ukuhlaziywa kwe-VBM [35], [36]. Ngemuva kokucubungula ubuchopho usebenzisa i-BET [37], i-segmentation ye-tissue-segmentation yenziwa nge-FAST4 [32]. Izithombe zevolumu ze-GM ezilandelwayo ezilandelanayo zihambelana nendawo ejwayelekile ye-MNI152 besebenzisa ithuluzi lokubhalisa le-affine FLIRT [28], [29], kulandelwa ukubhaliswa okungekho emthethweni kusetshenziswa i-FNIRT [38], [39]. Izithombe ezifakiwe zenzelwe ukudala ithempulethi, lapho izifanekiso ze-GM zendawo zangaleso sikhathi zazingabhaliswa kabusha. Ukuze ulungise ukunwetshwa kwendawo noma ukukhwabanisa, izithombe zevolumu ezibhalisiwe ezingezansi zahlelwa ngokuhlukaniswa yi-Jacobian yenkambu ye-warp. Ekugcineni, amaqembu wegulane nokulawula aqhathaniswa esebenzisa izibalo ezihlakaniphile ze-voxel (ukugunyazwa kwe-5000) nokukhethwa kwesikhwama sokuthuthukiswa kwamagqabha-mahhala ku-"randomize" ithuluzi lokuhlola i-permutation ku-FSL [http://www.fmrib.ox.ac.uk/fsl/randomise/index.html]. Ukunqoba ubungozi bezinto ezingamanga, umkhawulo obalulekile wokungafani kweqembu usethwe ku-p <0.05 elungiswe ngephutha lokuhlakanipha komndeni (i-FWE). Ukuhlaziywa kokuhlanganiswa ne-IIEF-5 ne-SAI nakho kwenziwa.
Ukuhlaziywa kwesitatimende
IStatistica® 6.0 isetshenziselwe ukuhlaziywa kwedatha. Iziguli ze-ED nezilawuli ezinempilo zaqhathaniswa ngokusebenzisa ukuhlaziywa okungafani kokuhluka (i-1-way ANOVA) yobudala, izinga lemfundo, ukusetshenziswa kwe-nicotine, i-ICV kanye nenani lezakhiwo ezijulile ezimpunga ngokwehlukana. Ukuze kuncishiswe amathuba okuba nephutha lohlobo I, ukuhlaziywa okuphelele kwe-multivariate of variance (MANOVA) kusetshenziswa inani elilodwa lezakhiwo ezingaphansi ezilungiswe ama-ICVs kulokho kuhlaziywa njengokuhlukahluka okuthembele kukho. Ngemuva kwalokho, ama-ANOVA wendlela eyi-1 (phakathi kwamaqembu) abesetshenziselwa inani ngalinye levolumu. Izinga lokubaluleka kwe-p <0.05 lisetshenzisiwe. Ngemuva kwalokho, kuphenywa ubudlelwano obukhona phakathi kwezinyathelo zokuziphatha namanani wevolumu. Amanani wevolumu eshiwo nezinyathelo zokuziphatha, ezifakiwe ekuhlaziyweni kokuhlanganiswa, yizo ezibonise okukhulu phakathi kokwehluka kweqembu. Ukuhlaziywa kokuhlanganiswa kwenziwa nge-coefficient ye-Spearman's rho, yala maqembu amabili ngokwahlukana, alungiswa ngokuqhathanisa okuningi (p <0.05).
Imiphumela
Izibalo zomuntu zamaqembu amabili zikhonjisiwe Ithebula 1.
Iziguli ze-ED nezilawuli ezinempilo azifani kakhulu ngokweminyaka, izinga lemfundo, ukusetshenziswa kwe-nicotine ne-ICV (Intra Cranial Volume ngo-mm3), i-gray grey and white white volume and volume total brain.
Okuphawulekayo phakathi kokuhlukana kweqembu kutholakale ngamaphesenti anguwonke we-IIEF-5 ngamanani aphakeme eqenjini lokulawula kuneqembu lesiguli (F(1,40)= 79; p <0.001), nangemiphumela ephelele ye-SAI ene-F(1,40)= 13 kanye p <0.001). Ikakhulukazi, ukuthi "ukukhushulwa" kwe-SAI okune-subscale kubonisa amaphuzu wezinga eliphakeme kakhulu kuneziguli ze-ED (F(1,40)= 22.3; p <0.001). Akukho ukukhathazeka, njengokulinganiswa yi-STAI, noma ubuntu, njengoba kulinganiswa ngezinga le-BIS / BAS, kubonise okuphawulekayo phakathi kokungafani kweqembu. Ukuhluka okuphawulekayo kubonwe nge-subscale "Ukufuna Ukuzijabulisa" kwesikali se-BIS / BAS enezinga eliphezulu eliphakeme lokulawula kuneziguli (F(1,40)= 5.2; p <0.05).
Esikhathini ngasinye isakhiwo se-7 se-subcortical (i-thalamus, i-hippocampus, i-caudate, i-putamen, i-pallidum, i-amygdala, ne-accumbens) yahlukaniswa futhi isilinganiso sayo silinganiswa ne-FIRST ithuluzi (I-Fig.1). Ithebula 2 kubika imiqulu eningi (M) kanye nokuphambuka okujwayelekile (SD) kwezifunda ezibalulwe ngenhla kumamitha ayi-cubic kuma-ED neziguli zokulawula. Ithebula 3 ikhombisa ukuthi yiziphi izakhi ezincane ezingaphansi kwamagciwane neziguli zokulawula i-hemispheres ezimbili zobuchopho ngokuhlukile. I-MANOVA ikhombise ukuthi kukhona phakathi kwamaqembu ahlukene phakathi kwezindawo ezingaphansi kwe-subcortical (Wilks λ = 0.58; F = 3,45; p = 0.006). Khona-ke, uchungechunge lokulandela i-ANOVA lwendlela eyodwa luveze ukwehla okukhulu kwevolumu ye-nucleus accumbens kuziguli ze-ED kuqhathaniswa nezilawuli (F(1,40)= 11,5; p = i-0.001).
I-MANOVA eyengeziwe, eyenziwa ngamanani wezindawo eziningi ezingaphansi kwesokunxele nesokudla, yembule umehluko omkhulu phakathi kweziguli ze-ED nezilawuli (i-Wilks λ = 0.48; F = 2,09; p = 0.04). Ngenxa yalokho, ukulandela i-ANOVAs-eyodwa wabonisa inani eliphansi lokuncipha kwe-nucleus engakwesokunxele nelungile ehlangene neziguli ze-ED ngokuphathelene nokulawula okunempilo (F(1,40)= 9.76; p = i-0.003; F(1,40)= 9.19; p = i-0.004 ngokulandelanayo).
Imiphumela yokuhlaziywa kwemajamo eyenziwa kwi-nucleus accumbens iboniswa ku Umfanekiso we-2.
Umfanekiso we-2 Ukuqhathaniswa kwe-vertex indawo phakathi kwala maqembu amabili kubonise i-atrophy ebalulekile yesifunda kuziguli ze-ED ezinobhalweni ezingxenyeni zangakwesokunxele zangaphakathi futhi, ngokubambisana, ukuya endaweni engezansi ye-nucleus accumbens.
Njengoba kubikiwe Umfanekiso we-3, RUkuhlaziywa kwe-OI-VBM kukhombise i-GM atrophy ku-hypothalamus yangakwesobunxele (p <0.05, izinga le-FWE lilawulwa). Ngokuqondile, ukulahleka kwe-GM kutholakale ku-nucleus ephezulu ye-anterior hypothalamic area (x, y, z izixhumanisi: -6, -2, -16, p = 0.01corrected), i-nucleus ye-ventromedial ye-hypothalamus (x, y, z izixhumanisi: -4, -4, -16, p = i-0.02 ilungisiwe), kanye nucleus yangaphambili ye-preoptic (x, y, z izixhumanisi: -4, 0, -16, p = i-0.03 ilungisiwe).
Umfanekiso we-3 Ukuhlaziywa kokuhlanganiswa kwenziwa phakathi kwezinyathelo zokuziphatha (IIEF ne-SAI) kanye nemiphumela ye-FIRST ne-ROI-VBM. Ukuhlangana okuhle kubonwe phakathi kwamanani ashiwo yi-IIEF kanye nama-nucleus accumbens eqenjini lesiguli (rho = 0,6; p <0.05, ilungiswe ukuqhathanisa okuningi) naphakathi kwamaphuzu aphelele we-SAI ne-hypothalamus yangakwesobunxele (p = i-0.01, izinga le-FWE lingalawulwa).
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Ukutadisha kwethu kuhlolwe amaphethini e-subcortical region atrophy ekusebenzeni okungasebenzi komzimba erectile. Ukuhlaziywa kwesakhiwo se-MRI kwembulwe i-GM atrophy ebalulekile ye-nucleus accumbens kanye ne-left hypothalamus ezigulini ezixilongwa nge-psychogenic ED ukungasebenzi komhlobo ojwayelekile ngokuphathelene nokulawula okunempilo. Lezi zinguquko ezinkulu ezizimele zazingekho yobudala, ukusetshenziswa kwe-nicotine, amazinga ezemfundo kanye nevolumu engavamile. Fi-GM atrophy ye-nucleus accumbens ekhohlo ibonise ukulungiswa okuhle nokusebenza kabi kwe-erectile kwiziguli, njengoba kulinganiswa yi-International Index of Erectile Function (IIEF). Mi-oreover, ukulahlekelwa kwevolumu ye-GM ezifundeni ze-hypothalamic kwesokunxele kwakuhlobene nezilinganiso ze-Sexual Arousability Inventory (SAI) ezimelela esinye isenzo sokuziphatha ngokobulili. Zombili lezi zifunda ezingaphansi komhlaba zihlanganyele ezindleleni eziningi ze-neural nemisebenzi ehlobene nokulawula okuzimele kanye nemizwelo.
Ngokusekelwe emiphumeleni yethu, ukutholakala okuyinhloko kwesifundo samanje kuboniswa yi-GM atrophy ebonwe kwi-nucleus accumbens yeqembu lesiguli. Indima edlalwa yi-nucleus ehlangene nokuziphatha ngokocansi yayixhaswe ubufakazi bokuphila emlonyeni wesilisa [40] futhi ngezifundo ezisebenza kahle nge-neuroimaging kumadoda enempilo ngesikhathi sokugqugquzela okubukeka okubonakalayo [2]. Tukukhululwa kwe-dopamine ku-nucleus accumbens kuqhuba uhlelo lwe-mesolimbic oluhilelekile ekusebenziseni ukuziphatha ngokusabela ekuboneni okubonakalayo okubonisa ukutholakala kokugqugquzela noma ukuqinisa [41]. Lokhu kusekelwa ubufakazi bokuphila obuxhumanisa umsebenzi we-dopaminergic ku-NAcc ekuziphatheni kocansi ekulongweni lwesilisa [40], [41]. Ngempela izinga eliphakeme le-dopamine ku-nucleus accumbens yesilwane sesilisa liyabonakala uma isilwane sowesifazane sitholwa kuye. Lokhu kwanda kuncishisiwe ngesikhathi se-post copulatory refractory.
Ngenxa yalokhu, umsebenzi we-nucleus accumbens wawuhlotshaniswa nokulawulwa kwezimpendulo zomzwelo. I-nucleus yomuntu eqoqayo ibonakala sengathi isebenziseka kalula emifanekisweni emnandi kunezinto ezijabulisayo kunokuba zibukhali [42]. Ngokusho kukaRedoutè kanye nozakwethu [2] i-nucleus accumbens kungenzeka iqhaza ekwakhiweni kokugqugquzela ngokobulili besilisa. I-nucleus yomuntu ihlangene ivuselelwa ngesikhathi kulungiswa ngenxa yokugqugquzela okubonakalayo [1], [2].
Ngaphezu kwalokho, imiphumela yethu ekuhlukeni kokuma kubonakala sengathi ihambisane nenhloso yokugqugquzela, ngenxa yokuthi i-atrophy ehlonziwe ihilela ngokuyinhloko igobolondo le-nucleus accumbens. I-Shell ibonisa isifunda esibonakala ngokukhethekile ngokuphathelene nesisusa kanye nokuziphatha okuphazamisayo [43], [44]. Esikhathini sesilwane samadoda ukukhethwa kwe-electrophysiological okukhethiweyo yegobolondo, kodwa hhayi eyinhloko ye-nucleus accumbens, kubonakala sengathi yanda ukuphendula ekukhokheni okungewona umvuzo [45].
Izinto esizifunayo zihambisana nezibonakaliso zangaphambili zesilwane eziye zabona indlela ukukhululwa kwe-dopamine kusuka ku-nucleus accumbens kanye nendawo yangaphambili yomlando we-hypothalamus kubonakala sengathi ilawula kahle isigaba sokugqugquzela ukuziphatha okuphambener.
Ngale ndlela, i-hypothalamus imelela isifunda esibalulekile sokuvuselela umsebenzi we-erectile [3], [4]. Sithole ukwehla kwe-gray matter ivolumu ye-hypothalamus lateral kwiziguli ezine-psychoreic erectile disys function. Lezi zinguquko ezinomthamo we-grey material zibonwe endaweni yesikhungo se-supraoptic sendawo yangaphambili ye-hypothalamic, i-nucleus yangaphakathi yangaphakathi neyindilinga.
Ngokusho kochungechunge lwezibonakaliso zokuhlola, indawo yangaphambili ye-preoptic kanye nesigaba sangaphakathi se-hypothalamus sidlala indima ebalulekile ekulawuleni ukuziphatha kobulili besilisa kuzo zonke izici zakwa-mammalians [46]. Ngokusobala, izilonda zomhlaba zalezi zindawo ze-hypothalamic ziqeda ngokungahambisani ukushayela kwesilisa ngokobulili kumagundane [47], [48]. Ukuhlanganiswa, lezi zifundo zibonisa ukuthi izilonda zomhlaba eziphakathi kwe-nucleus yangaphambili kanye ne-anterior hypothalamus zonakalisa isisusa socansi kuma-rats [40], [47], [49]. Ngaphezu kwalokho, umsebenzi okwandisiwe ngesikhathi sesisusa, ukulamba nokuhlukunyezwa kubonisiwe [50]. UGeorgiadis kanye nozakwethu [5] wabonisa ukuthi iziphi izingxenye ezihlukile ze-hypothalamus zihlobene ngokuqondile nezigaba ezahlukene zokulungiswa kwamadoda aphilile. Ngempela, i hypothalamus lateral ihambisana ne-penile circumference futhi ibonakala ihlotshaniswa namazwe avuswe.
Ucwaningo lwe-neuroimaging olusebenzayo luye lwabonisa ukuthi ezinye izakhiwo ezingaphansi kwe-subcortical, njenge-hippocampus, i-amygdale ne-thalamus zinikeze imisebenzi ephezulu ngokuphathelene nokugqugquzela okubukekayo nokuzibonela nakwezinye izigaba zokwakhiwa kwe-penile [4]. Ngokusho kwemiphumela yethu, kwakungekho ushintsho kumthamo walezi zakhiwo ezimpunga esigabeni sesiguli.
Kuyaphawuleka ukuthi lolu cwaningo lunamkhawulo. Njengoba ithuluzi lokuqala le-FIRST alibandakanyi ingxenye ye-hypothalamus, ukuhlaziywa kwe-ROI-VMB kubonisa isisombululo esinokwethenjelwa kakhulu sokuhlola ngokuzenzakalelayo ushintsho olukhulu lwe-hypothalamus. Kodwa le ndlela ayizange ibe yenzelwe ukuhlaziywa kwezinhlaka ezingaphansi kwe-cortical, ukujwayela isizukulwane sokuqhafaza ku-GM encane. I-VMB isekelwe ukuhlelwa kwe-GM okwenziwe endaweni yangakini ngakho-ke iyazizwela ukungalungi kokuhlukaniswa kwezicubu kanye nokukhanyisa okungahambisani [30], [51]-[53]. Ngenxa yalesi sizathu ukuhunyushwa kweziphumo ze-ROI-VBM kudinga ukuqapha.
Isiphetho
Ngisho nentshisekelo ekhulayo ye-correlates ye-cerebral ekuziphatheni ngokocansi, izidakamizwa zesilisa zobulili zithole ukunakekelwa okuncane. Okutholakele kwethu kugcizelela ukutholakala kwezinguquko ezinkulu ezakhiweni ze-GM ezifundeni ezimbili ezingaphansi kwe-subcortical, i-nucleus accumbens kanye ne-hypothalamus, ebonakala ibamba iqhaza elibalulekile ezinkambisweni zokugqugquzela ngokobulili. Okutholakele kwethu kugcizelela ukubaluleka kwesici esishukumisayo sokuziphatha ngokobulili ukuvumela ukusebenza okwenelisayo ngokocansi kumadoda aphilile. Ngaphezu kwalokho, kungase kuvezwe ukuthi ukuvimbela impendulo yezocansi ezigulini eziphethwe ukungasebenzi komzimba erectile kungasebenza ngalesi sigaba. Ukuguqulwa kwezakhiwo ezigciniwe ezithathwe kanye nobufakazi bokuqala bokusebenza kwe-neuroimaging kubonisa ukukhanya okusha ngesimo esiyinkimbinkimbi sokungasebenzi komzimba kubantu.
Ngaphezu kwalokho, le miphumela ingasiza ekuthuthukiseni ukwelashwa okusha kwekusasa nokuhlola umphumela walabo asebenzisayo manje.
Imibhalo yaphansi
Izintshisekelo zokuncintisana: Abalobi baye bathi akukho zintandokazi ezikhona.
Imali: Awekho imithombo yamanje yangaphandle yokuxhaswa kwemali ekhona kulolu cwaningo.
Okubhekwayo
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