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Both comorbidity burden and low testosterone can explain symptoms and signs of testosterone deficiency in men consulting for sexual dysfunction

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Asian Journal of Andrology 2020年第3期22卷 265-273页

作者： giulia rastrelli Giovanni Corona Mario Maggi Sexual Medicine and Andrology Unit Department of Experimental and Clinical Biomedical SciencesUniversity of FlorenceViale Pieraccini 6Florence 50139Italy Endocrinology Unit Medical DepartmentMaggiore-Bellaria HospitalLargo Nigrisoli 2Bologna 40133Italy I.N.B.B. Biostructures and Biosystems National InstituteViale delle Medaglie d'Oro 305Rome(X)136Italy Endocrinology Unit Department of Experimental Clinical and Biomedical Sciences**Mario Serio"University of FlorenceViale Pieraccini 6Florence 50139Italy.

Low testosterone(T)is frequent in men with chronic illnesses.The clinical features of T deficiency(TD)overlap with those of chronic diseases.The aim of this study is to evaluate the relative contribution of chronic disease score(CDS)and low T to the presenee of TD symptoms.A consecutive series of 3862 men(aged 52.1±13.1 years)consulting for sexual dysfunction were studied.Several clinical and biochemical parameters were collected,in eluding the structured interview,ANDROTEST,for the assessme nt of TD symptoms.Penile color Doppler ultrasound(PCDU)was also performed.Based on the medications taken,the CDS was calculated.For a subset of 1687 men,information on mortality was collected(follow-up of 4.3±2.6 years).Higher CDS was associated with lower free and total T(TT)as well as with higher ANDROTEST score.When introducing CDS and TT in multivariable models adjusted for age,severe erectile dysfunctio n and impaired morning erectio ns were associated with both CDS(odds ratio and 95%confide nee interaval,OR[95%Cl]=1.25[1.13;1.37]and 1.38[1.29;1.48],respectively)and low TT(OR[95%Cl]=1.11[1.00;1.23]and 1.13[1.06;1.21],respectively).Similar results were obtained for PCDU parameters.Hypoactive sexual desire was associated with low TT(OR[95%Cl]=1.21[1.13;1.30]),whereas it was inversely related with CDS(OR[95%Cl]=0.91[0.84;0.97]).When considering mortality for major cardiovascular events,TT<8 nmol I1,but not CDS,was a significant predictor(hazard ratio[95%Cl]=5.57[1.51;20.63]).Chronic illnesses are associated with an overt TD.Both chronic diseases and low T can be invoIved in determining symptoms present in subjects complaining for sexual dysfunction.This should be considered in the diagnostic workup for TD.

关键词： chronic diseases erectile dysfunction sexual symptoms testosterone deficiency

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Women health and microbiota:Different aspects of well-being

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World Journal of Gastroenterology 2024年第10期30卷 1287-1290页

作者： giulia Nannini Amedeo Amedei Department of Experimental and Clinical Medicine University of FlorenceFlorence 50134Italy Network of Immunity in Infection Malignancy and Autoimmunity(NIIMA)Universal Scientific Education and Research Network(USERN)Florence 50134Italy

In this editorial,we comment on the article by Marano et al recently published in the World Journal of Gastroenterology 2023;29(45):5945-5952.We focus on the role of gut microbiota(GM)in women’s health,highlighting the need to thoroughly comprehend the sex differences in microbiota.Together,the host and GM support the host’s health.The microbiota components consist of viruses,bacteria,fungi,and archaea.This complex is an essential part of the host and is involved in neu-rological development,metabolic control,immune system dynamics,and host dynamic homeostasis.It has been shown that differences in the GM of males and females can contribute to chronic diseases,such as gastrointestinal,metabolic,neurological,cardiovascular,and respiratory illnesses.These differences can also result in some sex-specific changes in immunity.Every day,research on GM reveals new and more expansive frontiers,offering a wealth of innovative oppor-tunities for preventive and precision medicine.

关键词： Gut microbiota Women Immune system Well-being Hormones Sexdifferences

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Probing the endoplasmic reticulummitochondria interaction in Alzheimer's disease:searching far and wide

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Neural Regeneration Research 2024年第10期19卷 2103-2104页

作者： giulia Dematteis Laura Tapella Dmitry Lim Department of Pharmaceutical Sciences Universitàdel Piemonte Orientale“Amedeo Avogadro”NovaraItaly

Alzheimer's disease(AD)is the most frequent,form of dementia in elderly people and is an incurable disease with an exponentially growing number of cases.Extracellular deposition of amyloid-β(Aβ)plaques and intraneur... 详细信息

关键词： Alzheimer Aβ reticulum

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Testosterone therapy: a friend or a foe for the aging men with benign prostatic hyperplasia?

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Asian Journal of Andrology 2020年第3期22卷 233-235页

作者： giulia rastrelli Linda Vignozzi Mario Maggi Sexual Medicine and Andrology Unit Department of Experimental and Clinical Biomedical SciencesUniversity of FlorenceViale PieracciniFlorence 61-50139Italy LN.B.B. Biostructures and Biosystems National InstituteViale delle Medaglie d'Oro305Rome 1-00136Italy Endocrinology Unit Department of Experimental Clinical and Biomedical Sciences"Mario Serio"University of FlorenceViale PieracciniFlorence 61-50139Italy.

One of the major concerns for the prescription of medications containing testosterone(T)in the aging men with T deficiency(TD)is prostate disorders(such as benign prostatic hyperplasia,BPH)and their related symptoms(lower urinary tract symptoms,LUTS).This is because prostate is an androgen-responsive gland;however,the androgen dependence of prostate growth,well demonstrated in earlier phases of life,has no clear evidence in late adulthood and senescence.In fact,after the age of 40 years,BPH becomes increasingly more prevalent.On the other hand,in men older than 40 year,a progressive decline in T is observed.These epidemiological data are a starting point for questioning a putative detrimental role of T on the prostate health in the ageing man.

关键词： prostatic BPH prescription

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Brain dysfunctions and neurotoxicity induced by psychostimulants in experimental models and humans:an overview of recent findings

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Neural Regeneration Research 2024年第9期19卷 1908-1918页

作者： Marcello Serra Nicola Simola Alexia E.Pollack giulia Costa Department of Biomedical Sciences Section of NeuroscienceUniversity of CagliariCagliariItaly Department of Biology University of Massachusetts-BostonBostonMAUSA

Preclinical and clinical studies indicate that psychostimulants,in addition to having abuse potential,may elicit brain dysfunctions and/or neurotoxic effects.Central toxicity induced by psychostimulants may pose serious health risks since the recreational use of these substances is on the rise among young people and adults.The present review provides an overview of recent research,conducted between 2018 and 2023,focusing on brain dysfunctions and neurotoxic effects elicited in experimental models and humans by amphetamine,cocaine,methamphetamine,3,4-methylenedioxymethamphetamine,methylphenidate,caffeine,and nicotine.Detailed elucidation of factors and mechanisms that underlie psychostimulant-induced brain dysfunction and neurotoxicity is crucial for understanding the acute and enduring noxious brain effects that may occur in individuals who use psychostimulants for recreational and/or therapeutic purposes.

关键词： 3,4-methylenedioxymethamphetamine amphetamine caffeine cell cultures cocaine methamphetamine methylphenidate neurotoxicity nicotine

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How to recognize late-onset hypogonadism in men wit sexual dysfunction

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Asian Journal of Andrology 2012年第2期14卷 251-259页

作者： Giovanni Corona giulia rastrelli Linda Vignozzi Edoardo Mannucci Mario Maggi Sexual Medicine and Andrology Unit Department of Clinical Physiopathology University of Florence Florence 50139 Italy Endocrinology Unit Maggiore-Bellaria Hospital Medical Department Azienda-Usl Bologna Bologna 40133 Italy Diabetes Section Geriatric Unit Department of Critical Care University of Florence Florence 50139 Italy

Late-onset hypogonadism （LOH） has been considered the most common form of male hypogonadism with a prevalence of approximately 1 in 100 men. Diagnosis of LOH should be made in symptomatic men with unequivocally low serum testosterone （T） levels. However, its clinical presentation is often insidious and difficult to recognize because it is characterized by nonspecific symptoms that make differential diagnosis with physiological ageing problematic. Sexual dysfunction is the most important determinant for medical consultation and the most specific symptom associated with low T. We therefore analysed a consecutive series of 1734 subjects who attended our unit for sexual dysfunction to investigate the associations between low T （different thresholds）, sexual parameters, medical history data （delayed puberty, pituitary disease or cryptorchidism） and their physical exam results. Metabolic parameters, in particular waist circumference, display the greatest accuracy in detecting low T. We found that only the association of several symptoms and signs could significantly raise the clinical suspicion of low T. Structured inventories, which cluster together symptoms and signs of hypogonadism, can help clinicians suspect androgen deficiency. In particular, structured interviews, such as ANDROTEST, have been demonstrated to have a greater accuracy when compared to self reported questionnaires in detecting low T levels.

关键词： late-onset hypogonadism （LOH） male hypogonadism testosterone sexual dysfunction

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Autoimmune pancreatitis:Cornerstones and future perspectives

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World Journal of Gastroenterology 2024年第8期30卷 817-832页

作者： Camilla Gallo giulia Dispinzieri Nicola Zucchini Pietro Invernizzi Sara Massironi Division of Gastroenterology and Center for Autoimmune Liver Diseases Department of Medicine and SurgeryFondazione IRCCS San Gerardo dei TintoriUniversity of Milano-BicoccaMonza 20900Italy Department of Pathology Fondazione IRCCS San Gerardo dei TintoriMonza 20900Italy

Autoimmune pancreatitis(AIP)is an autoimmune subtype of chronic pancreatitis resulting from the aberrant immune response against the pancreas,leading to inflammation and fibrosis.Although AIP is rare,its incidence is increasing and is often misdiagnosed as other pancreatic diseases.AIP is commonly classified into two types.Type 1 AIP(AIP-1)is typically associated with elevated serum immunoglobulin G4(IgG4)levels and systemic manifestations,while type 2 AIP is typically a more localized form of the disease,and may coexist with other autoimmune disorders,especially inflammatory bowel diseases.Additionally,there is emerging recognition of a third type(type 3 AIP),which refers to immunotherapy-triggered AIP,although this classification is still gaining acceptance in medical literature.The clinical manifestations of AIP mainly include painless jaundice and weight loss.Elevated serum IgG4 levels are particularly characteristic of AIP-1.Diagnosis relies on a combination of clinical,laboratory,radiological,and histological findings,given the similarity of AIP symptoms to other pancreatic disorders.The mainstay of treatment for AIP is steroid therapy,which is effective in most cases.Severe cases might require additional imm-unosuppressive agents.This review aims to summarize the current knowledge of AIP,encompassing its epidemiology,etiology,clinical presentation,diagnosis,and treatment options.We also address the challenges and controversies in diagnosing and treating AIP,such as distinguishing it from pancreatic cancer and managing long-term treatment,highlighting the need for increased awareness and knowledge of this complex disease.

关键词： Autoimmunity Pancreatitis Autoimmune pancreatitis Immunoglobulin G4 Steroids Relapse

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Economic Risk Assessment of Future Debris Flows by Machine Learning Method

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International Journal of Disaster Risk Science 2024年第1期15卷 149-164页

作者： Chenchen Qiu Lijun Su Alessandro Pasuto giulia Bossi Xueyu Geng School of Engineering University of WarwickCoventry CV47ALUK Key Laboratory of Mountain Hazards and Earth Surface Process Institute of Mountain Hazards and EnvironmentChinese Academy of SciencesChengdu 610041China Research Institute for Geo-Hydrological Protection(IRPI-CNR) National Research Council of ItalyPadova 35127Italy

A reliable economic risk map is critical for effective debris-flow mitigation.However,the uncertainties surrounding future scenarios in debris-flow frequency and magnitude restrict its application.To estimate the economic risks caused by future debris flows,a machine learning-based method was proposed to generate an economic risk map by multiplying a debris-flow hazard map and an economic vulnerability map.We selected the Gyirong Zangbo Basin as the study area because frequent severe debris flows impact the area every year.The debris-flow hazard map was developed through the multiplication of the annual probability of spatial impact,temporal probability,and annual susceptibility.We employed a hybrid machine learning model-certainty factor-genetic algorithm-support vector classification-to calculate susceptibilities.Simultaneously,a Poisson model was applied for temporal probabilities,while the determination of annual probability of spatial impact relied on statistical results.Additionally,four major elements at risk were selected for the generation of an economic loss map:roads,vegetation-covered land,residential buildings,and farmland.The economic loss of elements at risk was calculated based on physical vulnerabilities and their economic values.Therefore,we proposed a physical vulnerability matrix for residential buildings,factoring in impact pressure on buildings and their horizontal distance and vertical distance to debrisflow channels.In this context,an ensemble model(XGBoost) was used to predict debris-flow volumes to calculate impact pressures on buildings.The results show that residential buildings occupy 76.7% of the total economic risk,while roadcovered areas contribute approximately 6.85%.Vegetation-covered land and farmland collectively represent 16.45% of the entire risk.These findings can provide a scientific support for the effective mitigation of future debris flows.

关键词： Economic risk Future debris fows Gyirong Zangbo Basin Machine learning model Physical vulnerability matrix Southwest Tibet,China

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Erectile dysfunction and central obesity： an Italian perspective

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Asian Journal of Andrology 2014年第4期16卷 581-591页

作者： Giovanni Corona giulia rastrelli Sandra Filippi Linda Vignozzi Edoardo Mannucci Mario Maggi Endocrinology Unit Maggiore-Bellaria Hospital Azienda-Usl Bologna Bologna Sexual Medicine and Andrology Unit Department of Experimental Clinical and Biomedical Sciences University of Florence Florence Diabetes Agency Careggi Hospital Florence Italy.

Erectile dysfunction （ED） is a frequent complication of obesity. The aim of this review is to critically analyze the framework of obesity and ED, dissecting the connections between the two pathological entities. Current clinical evidence shows that obesity, and in particular central obesity, is associated with both arteriogenic ED and reduced testosterone （T） levels. It is conceivable that obesity-associated hypogonadism and increased cardiovascular risk might partially justify the higher prevalence of ED in overweight and obese individuals. Conversely, the psychological disturbances related to obesity do not seem to play a major role in the pathogenesis of obesity-related ED. However, both clinical and preclinical data show that the association between ED and visceral fat accumulation is independent from known obesity-associated comorbidities. Therefore, how visceral fat could impair penile microcirculation still remains unknown. This point is particularly relevant since central obesity in ED subjects categorizes individuals at high cardiovascular risk, especially in the youngest ones. The presence of ED in obese subjects might help healthcare professionals in convincing them to initiate a virtuous cycle, where the correction of sexual dysfunction will be the reward for improved lifestyle behavior. Unsatisfying sexual activity represents a meaningful, straightforward motivation for consulting healthcare professionals, who, in turn, should take advantage of the opportunity to encourage obese patients to treat, besides ED, the underlying unfavorable conditions, thus not only restoring erectile function, but also overall health.

关键词： androgens erectile dysfunction impotence vasculogenic

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Application of ultrasonography-elastography score to suspect porto-sinusoidal vascular disease in patients with portal vein thrombosis

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Hepatobiliary & Pancreatic Diseases International 2024年第1期23卷 20-24页

作者： Stefania Gioia Adriano De Santis giulia d’Amati Silvia Nardelli Alessandra Spagnoli Arianna Di Rocco Lorenzo Ridola Oliviero Riggio Department of Translational and Precision Medicine Sapienza University of RomeRomeItaly Department of Radiological Oncologicaland Pathological SciencesSapienza University of RomeRomeItaly Department of Public Health and Infectious Diseases Sapienza University of RomeRomeItaly

Background:Porto-sinusoidal vascular disease(PSVD)and portal vein thrombosis(PVT)are causes of portal hypertension characterized respectively by an intrahepatic and a pre-hepatic obstacle to the flow in the portal system.As PVT may be a consequence of PSVD,in PVT patients at presentation,a pre-existing PSVD should be suspected.In these patients the identification of an underlying PSVD would have relevant implication regarding follow-up and therapeutic management,but it could be challenging.In this setting ultrasonography may be valuable in differential diagnosis.The aim of the study was to use ultrasonography to identify parameters to discriminate between PSVD and“pure”PVT and then to suspect PVT secondary to a pre-existing PSVD.Methods:Fifty-three patients with histologically proven PSVD and forty-eight patients affected by chronic PVT were enrolled and submitted to abdominal ultrasonography with elastography by acoustic radiation force impulse(ARFI).Results:ARFI was higher and superior mesenteric vein(SMV)diameter was wider in PSVD patients than in PVT patients.Thus,a prognostic score was obtained as linear combinations of the two parameters with a good discrimination capacity between PSVD and PVT(the area under the curve=0.780;95%confidence interval:0.690-0.869).Conclusions:A score based on ARFI and SMV diameter may be useful to suspect an underlying PSVD in patients with PVT and to identify a subgroup of patients to be submitted to liver biopsy.

关键词： Non-cirrhotic portal hypertension Porto-sinusoidal vascular disease Chronic portal vein thrombosis Liver stiffness Portal hypertension Acoustic radiation force impulse

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