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The male sexual dysfunctions (MSD) can be causes of male sub-fertility (MSF), however in a restricted number of cases. Among MSD the two principal causes of MSF are the Erectile Dysfunctions (ED), in their variable gravity, even complete impotence and Ejaculation Dysfunctions: Premature Ejaculation (PE) and, on the opposite side, Delayed Ejaculation (DE). The mechanism with whom they induce MSF is common and basically represented by "Ipoposia", that is total or partial inability to have a normal sexual intercourse, ended by a valid intra-vaginal ejaculation. Therefore is mandatory to know the diagnostic and the therapy of these two pathologies for making the "couple", because it is an authentic "couple disease", in condition to have the best chances to obtain the maximum potential fertility rate. Diagnostic and therapy of ED: the erection is a complex neurovascular phenomenon that follows the release of nitric oxide (NO) as a result of sexual stimulation. In approximately 70% of the cases, the problems are of an organic nature. Half of the remaining 30% cases can be attributed to a mixture of organic and psychological causes, and the other half are due to purely psychological causes. The diagnostic procedure includes examinations of the case history, general and localised examination, and metabolic and hormonal screening. Level 2 includes the dynamic echo-colour-power Doppler test (ECD), and neurosexual evaluation. Recently, we also focused our attention on a study of the microcirculation in the penis. The diagnostic methods of documenting the alterations in this circulation are optic probe video-capillaroscopy (OPVC) and laser-Doppler testing (LDF). At therapeutic level, drugs administered through the trans-epidermal barrierTEB), appear to be effective in long term treatment (there is the problem of the movement through the tunica albuginea): we use "vasoactive patch" (troxerutine+ginkgo-biloba). Oxygen-ozone therapy (O2/O3) in the form of cycles of major self-transfusions acts directly on the erythrocytes, encouraging the release of 02 to the erection tissue even in the presence of minor angiopathy, with an effect on the haemo-rheological parameters. Still in the area of multi-points therapy it appears interesting to combine PDE5 inhibitors, at personalized dosage with 02/03. We evaluated 520 patients, affected with ED with consequent MSF, responder to PGE1-ICI, normal sexological counselling and normal laboratory testing. These patients were treated with combined 02/03 therapy, TEB complexation of Phosphatidyl-Coline-Troxerutine-Ginkgo-Biloba, first one week during two months, the latter t.i.d., topically for three months and pde5 inhibitors at personalized dosage(in relation to the number of sexual intercourses). Results and Conclusions: All the patients showed good clinical results, with improvement in the erection failure rate. From August 2009 to June 2010: examined 270 patients (age 20-45), affected with Ipoposia, causing MSF, related to the following diagnoses: 180 cases: (1) Primary PE dysfunction (lifelong); (2) Self-reported advanced strength of this kind of sexual disorder; (3) Distress; (4) Higher negative feedback of sexual activity of their sexual partners (distress); 20 cases: primary PE complicated by ED; 60 cases: Acquired PE involved by several psychological and ambiental dysfunctions or prosthatic diseases 10 cases of ED. PE:methods and Diagnostic Assessment: complete ambulatorial uro-andrological screening, counseling and anamnestic data compilation and physical examination. Spermiocolture. Endocrine Evaluation: LH, testosterone, fT, prolactin, T3, T4, TSH. Penis biothesiometry. PES, PEC. Viricare Test after PGE1 intra-cavernous vasoactive injection (ED and PE). Previous pharmacological treatments: SSRi- Paroxetine 20-40 mg, which was subministrated at the beginning chronically, and on demand in a following phase. All these patients required to interrupt this therapy wich was related to several collatheral effects Insurgence. Our purpose was the employment of Dapoxetine (Priligy-TM) 30 mg on demand, Dapoxetine (Priligy) 60 mg on demand (ante and per-portas severe PE). Patients report high advantage on IELT (Intercourse Endovaginal Latency Time) (among 3 times more). Patients indicates transformed kind of compliance and quality level life approaching sexual partner. The most important problem seems related to the therapy cost mostly in the youngest male population. We are performing and scheduling other observations about effectiveness and the security in drug taking. 5 cases of ED were treated successfully using Selegilina (Jumex™), at personalized dosage. [ABSTRACT FROM AUTHOR]

Background: Physical inactivity is a serious public health problem for people of all ages and is currently the fourth highest global risk factor for mortality. The transition period from adolescence to adulthood coincides with a marked reduction in participation in physical activity, with more than 50% (and up to 80%) of young adults stopping physical activity. This decrease in physical activity is more evident in women than in men. Despite efforts, existing programs face challenges in effectively initiating and maintaining physical activity among individuals, particularly women, for extended durations. To address these limitations, the Women's Involvement in Steady Exercise (WISE) randomized controlled trial (RCT) seeks to assess the efficacy of a digital high-intensity training intervention complemented by nutritional plans and other health-related advice., Methods: The study will be a three-center, randomized (1:1), controlled, parallel-group trial with a six-month intervention period. A total of 300 participants will be recruited at three study sites in Spain, Serbia and Italy. The participants will be randomized to one of the two groups and will follow a six-month program. The primary outcome of the study is the daily step count. Self-reported physical activity, the adherence to the exercise program, body composition, physical activity enjoyment, quality of sleep and physical capacities will also be evaluated.

Objective: To evaluate the usefulness of Power Doppler to improve the diagnostic work up of veno-occlusive erectile dysfunction patients., Materials and Methods: Patients affected by erectile dysfunction, mean IIEF 5 = 13.5 (12-17) for at least 6 months, were enrolled in a prospective cross-sectional study. All patients underwent Dynamic Power Doppler after intracavernous injection of vasoactive drugs (PGE1 20 mcg and Papaverine 6 mg). Poor responders' patients subsequently underwent to cavernosometry to get a full assessment of the vascular framework., Results: 202 patients (mean age 46 years), were included in the study. 96 subjects (47.5%) who did not adequately respond to the intracavernous injection -test, subsequently underwent to cavernosometry. In 42 of 96 patients (43.7%) cavernosometry was positive for veno-occlusive dysfunction. In a total of 160 patients who did not have veno-occlusive dysfunction (54 with negative cavernosometry + 106 intracavernous injection-test responders), the Power Doppler was normal in 126 (78.8%) and pathological in 34 (21.3%) in terms of steric conformation of "low flow" vessels corresponding to the Cavernosal Terminal Unit. The diagnostic sensitivity of Power Doppler towards veno-occlusive dysfunction was found to be 52.4% (Positive Predictive Value: 39.3%), the specificity was 78.8% (Negative Predictive Value: 86.3%) and the total diagnostic accuracy was equal to 73.3%., Conclusion: Collected data evidenced that patients who reported altered morphological features of the Cavernosal Terminal Unit had an approximately 4-fold greater risk of having veno-occlusive dysfunction compared to patients who had normal Power Doppler features (OR = 4.076; 95% CI: 1.996-8.327)., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Extracorporeal treatment with low intensity shock-wave therapy (LI-ESWT) is a recently introduced non-invasive method which purposes the restoration of the pathophysiological alterations at the base of vasculogenic ED in male patients. The evidence in favour of the neoangiogenic potential of this treatment derived from in vitro studies and on animal models. The purpose of this study, in which the Power Doppler method was applied, is to demonstrate 'objectively' the real efficacy of LI-ESWT at the level of the microcirculation of the corpora cavernosa (neoangiogenesis) in patients affected by vasculogenic ED. Data from this study show, for the first time, that LI-ESWT treatment promotes neovascularisation of the functional arteries in patients affected by vasculogenic ED., (© 2021. The Author(s), under exclusive licence to Springer Nature Limited part of Springer Nature.)

Objective: To establish a standard location for examining penile cavernosal arteries (CAs) using dynamic duplex Doppler ultrasound (PDDU) examination in the diagnosis of non-arterial erectile dysfunction (ED) or arterial insufficiency., Patients and Methods: Two groups of 105 patients each were enrolled. The first group (age 56.3 ± 6.0 years) displayed clinical patterns of arterial insufficiency; the second group (age 35.2 ± 4.7 years) displayed clinical patterns of non-arterial ED. The patients had their peak systolic velocity (PSV), end-diastolic velocity (EDV), resistive index (RI = PSV - EDV/PSV × 100), and acceleration time of the CAs measured using PDDU at the crura and at the midpoint between the penoscrotal junction and the coronal sulcus (mid penis). Intra- and interoperator variability were assessed. The PSV, RI, acceleration time, and EDV data obtained from the penoscrotal junction or from the "mid penis" in group 1 and in group 2 were compared using analysis of variance., Results: The PSV, EDV, and acceleration time were significantly higher when measured at the crura penis than when measured at the "mid penis" in both groups, whereas the RI was higher at the "mid penis" than at the "crura." Thus, arterial ED was better diagnosed with the data from the mid penis, whereas non-arterial ED was better diagnosed at the "crura.", Conclusion: The location of the sampling site of the CAs using PDDU is critical for a correct diagnosis of ED., (Copyright © 2017. Published by Elsevier Inc.)

Aim of the Study: Alprostadil (A) induces smooth-muscle relaxation by stimulating the increasing of intracellular cAMP. Intra-urethral administration is an alternative to its intra-cavernose injection in inducing erection. In order to understand the functional and anatomical basis for drug transfer, the possible communications of the corpus spongiosum with the corpora cavernosa were studied., Material of Study: A "Spongiogram" (SP) was performed in 44patients (pt.) by injection of radiological contrast into the glans. The SP visualized drainage of the glans into the deep dorsal vein, as well as that of the spongiosum into the circumflex veins, which in turn drained into the deep dorsal vein., Results: In 34pt. (77,2%) filling of the corpora was also visualized; in 10pt.(22.8%), with ectasia of the deep dorsal vein, such a filling was not visualized., Discussion: Filling of the corpora cavernosa, in 34 pt. demonstrated the presence of "spongiosal-cavernosal" shunts., Conclusions: The presence of "spongiosal-cavernosal" shunts justified the efficacy of A in term of complete penile erection, regarding also corpora cavernosa; in the other cases an increased speed of venous discharge justified the drug's lack of local efficacy, with poor results in terms of erection., Key Words: Alprostadil, Erectile Dysfunction, Spongiosography.

Objectives: In 2013 the International Society for Sexual Medicine(ISSM) published the guidelines regarding the standard operating procedure (SOP) for penile duplex Doppler ultrasound (PDDU). Although ISSM-SOP have given important strides in reducing interobserver variability in PDDU by procedural protocol and parameters these guidelines do not address the anatomic location along the penis at which hemodynamic measurements have to be done. In our opinion a "double sampling" may be interesting to detect the arteriogenic or venogenic nature of the erectile dysfunction (ED). In particular sampling measurements at the "crus" (at the level of the peno-scrotal junction) may be significative for detection of veno-occlusive dysfunction (VOD),whereas an evaluation at "mid penis" (1/2 distance between peno-scrotal junction and coronal sulcus), may be useful to diagnose an arterial insufficiency (AI)., Material and Methods: We evalued 90 men, mean age 56.3, affected with ED of medium degree, responder to PDE5-I that urdergone to PDDU and also responder after pharmacologic intracavernosal injection (PII)of prostaglandin E1 20 mcg, with rigid erection and normal maintenance. We moreover evalued 90 men in youthful age (mean 35.2), in absence of vascular risk factors, no responder to PDE5-I that undergone to PDDU by PII at high dosage (bimix: prostaglandin E1 20 mcg, papaverine 20 mg)., Results: In the first pool the sampling at "mid penis" resulted significative for arterial insuffciency (AI) in 81% (73), in presence of normal or borderline end diastolic velocity (EDV). Sampling at the "crus" resulted negative for VOD in 90% (81). In the second pool, 66.6% (60) resulted responder with rigid erection and normal maintenance in presence of normal hemodynamic parameters: peak systolic velocity (PSV) and end diastolic velocity (EDV) both at the "crus" and at "mid penis" sampling. 33.4% (30) responded with a semirigid erection and manifested a constant deficit of maintenance; at the "crus"and at "mid penis" the hemodynamic arterial parameters resulted normal. At the "crus" the EDV resulted significantly augmented (VOD index) in 96.6% (29); at "mid penis" augmented EDV was founded in 50% (15)., Conclusions: These observational data would be able to confirm the utility of a routinary "double sampling" procedure, at the "crus" and at "md penis", during PDDU in order to better distinguish between VOD or AI or in any case to be useful to stimulate a future more precise standardization in execution of PDDU examination.

Bipolar disorder (BD) is a very common mental health disorder, whose etiology concerning aggressive styles and defense mechanisms is still poorly known despite the efforts dedicated to develop psychological and biological theories. After obtaining written signed informed consent, this study will recruit inpatients with a clinical diagnosis of BD, based on Structured Clinical Interview and the Diagnostic and Statistical Manual of Mental Disorders criteria, and their parents. The Bus-Perry Aggression Questionnaire, the Defense Style Questionnaire 40, the Symptom check list SCL-90-R, developed by DeRogatis will be administered to the participants, together with a semi-structured questionnaire concerning demographic data (age, gender, employment, education) and only for the patients clinical information (onset year of the disorder, presence of co-morbidities, alcohol and drug use, suicide tendencies, kind of treatment). All the questionnaires are in the Italian validated version. The successful completion of this study will shed light on the relationship between aggressive styles and defensive mechanisms in bipolar inpatients and in their parents, helping the clinicians to develop ad hoc psychological interventions.

The Aachener Aphasie Test (AAT) is the major German test for the diagnosis of aphasic disorders. The test is easy to use and is valid and reliable for the diagnosis of aphasia and its severity and to evaluate the recovery of the aphasic disorder after language rehabilitation. The AAT is, however, not sufficient to define cognitively sound logotherapeutic treatment. The use of tasks which are based on cognitive functional models allows the identification of specific processing levels that have been damaged by a cerebral lesion, and the definition of a focussed rehabilitation plan. In this paper, we will discuss the results of a cognitive neurolinguistic treatment in a patient who suffered of Broca's aphasia with agrammatism and phonological dyslexia.

A patient who developed a unilateral opercular syndrome following a cerebrovascular accident is described. Computed tomography showed that the lesion did not affect the opercular cortex, but involved deep white matter and the head of the caudate nucleus of the left hemisphere. Persistent hypophonia and transient aphasia were associated. Comparison with previous cases is discussed.

Doppler velocimetry enables three haemodynamic parameters that are extremely useful for the study of venous diseases to be evaluated: blood flow direction, the morphology of the velocity wave and venous pressure. These three parameters are used in association depending on the particular requirements of the diagnostic problem. In the case of suspected deep venous thrombosis, study of the morphology of the velocity wave and clinostatism pressure give good diagnostic possibilities for the iliaco-femoral axis but poor for the leg trunks. In post-thrombotic syndrome, Doppler velocimetry is not so useful because the patient has to remain immobile during the examination while this specific pathology features insufficiency of the muscular pump during walking. In varicose disease, the investigation offers a very high diagnostic capability by evidencing the site and extent of valvular incontinence in the saphena and perforating vessels. The only limitation is the presence of numerous incontinent perforating vessels, but this is infrequent. In this pathology, Doppler v. has almost completely supplanted phlebography because it responds to the needs of modern medicine to replace invasive diagnostic investigations with non-invasive techniques that are equally effective. Finally, two other fields of application are very important for this investigation: the study of a patient with varices prior to saphenic stripping and prior to sclerotherapy. Definition of the origin and course of the reflux ways makes an optimal result possible, even allowing for the evolution of varicosity.

A case series of 226 male patients, aged between 19 and 65 years, in whom a "venous-leakage" was probably the cause of impotence is reported. The Authors describe the complex diagnostic iter, the principles of medical and surgical treatments and the results. Finally the clinical conditions considered essentially proposing a surgical treatment are announced.