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Zihao W, Kaifeng L, Shengmin Z, Yongzhan G, Pengjie L. Accurate diagnosis and effective treatment of abnormal meridians in erectile dysfunction patients based on infrared thermography: an electrophysiological technique study. Int J Impot Res 2024:10.1038/s41443-024-00859-w. [PMID: 38509346 DOI: 10.1038/s41443-024-00859-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 02/02/2024] [Accepted: 02/21/2024] [Indexed: 03/22/2024]
Abstract
An increasing body of research has demonstrated that appropriate stimulation of the meridians and acupoints in the human body can play a preventative and therapeutic role in diseases. This study combines the use of infrared thermography with intelligent electrophysiological diagnostic system (iEDS) to accurately diagnose and apply transdermal low-frequency electrical stimulation to treat abnormal meridians in patients with erectile dysfunction (ED). The treatment protocol included 6 treatments (each lasting 30 min and performed twice a week). The International Index of Erectile Function-5 (IIEF-5), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and Erection Hardness Scale were used to assess treatment results. A total of 62 patients were included in this study, with 31 patients in the treatment group and 31 patients in the sham therapy group. After six treatments, the treatment group improved significantly in IIEF-5 (15.52 ± 2.06 vs. 18.84 ± 2.67, p < 0.001), PHQ-9 (8.32 ± 6.33 vs. 4.87 ± 4.41, p < 0.001), GAD-7 (5.32 ± 5.08 vs. 2.94 ± 3.31, p = 0.003), and EHS (2.48 (2.00, 3.00) vs. 2.90 (2.00, 3.00), p = 0.007). After six sham treatment sessions, no improvements in any of the scores were reported in the sham therapy group. Following that, this group had an additional six treatments of regular therapy, which resulted in statistically significant improvements in IIEF-5 (16.65 ± 1.96 VS. 19.16 ± 2.40, p < 0.001), PHQ-9 (8.81 ± 6.25 VS. 4.97 ± 4.36, p < 0.001), GAD-7 (5.74 ± 5.18 VS. 3.68 ± 3.42, p < 0.001), and EHS (2.61 (2.00, 3.00) VS. 3.03 (2.00, 4.00), p = 0.003). No adverse events were reported regarding penile discomfort, pain, injury, or deformity. CLINICAL TRIALS: The study protocol is registered in the Clinical Trials Registry with the identification number ChiCTR2300070262.
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Affiliation(s)
- Wang Zihao
- The Yangzhou School of Clinical Medicine of Dalian Medical University, Yangzhou, China
| | - Liu Kaifeng
- The Yangzhou School of Clinical Medicine of Dalian Medical University, Yangzhou, China.
- Northern Jiangsu People's Hospital of Jiangsu Province, Yangzhou, China.
- Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, China.
- The Yangzhou Clinical Medical College of Xuzhou Medical University, Yangzhou, China.
| | - Zhang Shengmin
- Northern Jiangsu People's Hospital of Jiangsu Province, Yangzhou, China
| | - Gong Yongzhan
- Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, China
| | - Lu Pengjie
- The Yangzhou School of Clinical Medicine of Dalian Medical University, Yangzhou, China
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Albarakati M, El-Tholoth HS, Alzahrani A, Alghamdi OS, Alquliti A, Alnuami M, Althobity A, Almardawi A, Bedaiwi K. Predictors of Phosphodiesterase Type 5 Inhibitor Treatment Failure in Patients Diagnosed With Erectile Dysfunction. Cureus 2023; 15:e50515. [PMID: 38222149 PMCID: PMC10787576 DOI: 10.7759/cureus.50515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2023] [Indexed: 01/16/2024] Open
Abstract
INTRODUCTION Erectile dysfunction (ED) is a prevalent condition, especially in aging populations, with significant implications for quality of life. While phosphodiesterase type 5 inhibitors (PDE5Is) are the first-line treatment, a substantial percentage of patients do not respond satisfactorily. This study aimed to identify predictors of PDE5I treatment failure in ED patients. METHODS Data from January 2016 to January 2022 was reviewed for patients with ED who either failed PDE5I treatment or had a successful outcome. Demographic, medical, and laboratory data were collected and analyzed. Patients with contraindications or who did not complete the treatment were excluded. RESULTS The treatment failure group comprised 288 patients, while 225 age-matched patients formed the control responder group. There were no significant differences in marriage duration, comorbidities, smoking, or BMI. However, HbA1c levels, free testosterone, and SHBG were significantly different between the two groups. CONCLUSION This study found that high HbA1c levels, low free testosterone, and high sex hormone-binding globulin (SHBG) were associated with PDE5I treatment failure. Managing high HbA1c levels and addressing hormonal imbalances may enhance PDE5I treatment effectiveness in ED patients. However, further research is needed to explore other factors contributing to treatment outcomes.
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Affiliation(s)
| | | | | | | | | | - Musa Alnuami
- Urology, Prince Sultan Military Medical City, Riyadh, SAU
| | | | | | - Khaled Bedaiwi
- Urology, Prince Sultan Military Medical City, Riyadh, SAU
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Romano D, Zemon V, Foley FW. Age-related differences in the severity of sexual dysfunction symptoms and psychological distress in individuals with multiple sclerosis. Mult Scler Relat Disord 2023; 79:105011. [PMID: 37734187 DOI: 10.1016/j.msard.2023.105011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 08/29/2023] [Accepted: 09/13/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND Sexual dysfunction (SD) is a common symptom for many with multiple sclerosis (MS). However, SD research in general appears to often overlook young adults within their samples, which can be a major issue for better understanding and treatment for the MS population. Few studies have compared age-related differences in distress in response to physical disability. Research has also found that many people diagnosed with MS do not discuss any SD struggles with their providers. The present study hopes to see whether age-related differences exist in the reporting of the levels of primary, secondary, and tertiary SD, as defined by subscale scores of the Multiple Sclerosis Intimacy and Sexuality Questionnaire-19 (MSISQ-19), and amount of distress, as defined by the 12-Item Short Form Health Survey (SF-12)'s Mental Component Summary (MCS-12). Additionally, we hope to determine if there are any age-related or sex-related differences in help-seeking behaviors for SD. METHODS Study participants were recruited from the North American Research Committee on Multiple Sclerosis (NARCOMS) Registry. Participants completed the MSISQ-19, SF-12, and Patient Determined Disease Steps (PDDS), provided demographic information, and responded if they received medical or psychological treatment for SD. Study participants were 5815 respondents (Mage = 51 years, SD = 9.63, 75 % female, 30 % having attained a high school diploma, 35 % scoring "advanced disability" on the PDDS). Young adult (19-39 years), middle adult (40-64 years), and mature adult (65-older) were compared on SD. RESULTS Linear mixed effects modeling revealed that the MSISQ-19 subscale scores were significantly predicted by secondary SD (t = 2.48, p < .13). Young adult participants had the lowest primary SD (M = 13.87, 95 % CI [13.13, 14.61]) when compared to mature adult (M = 14.12, 95 % CI [13.27, 14.97]) and middle adult participants (M = 14.44, 95 % CI [14.21, 14.66]), though none were statistically significant. Mature adults had the lowest secondary SD (M = 16.50, 95 % CI [15.65, 17.35]), a statistically significant difference from the middle adults (M = 18.20, 95 % CI [17.97, 18.42]) and young adults (M = 18.91, 95 % CI [18.17, 19.65]). Mature adults had the lowest tertiary symptoms (M = 10.12, 95 % CI [9.27, 10.96]), followed by young adults (M = 12.23, 95 % CI [11.48, 12.97]), and middle adults (M = 11.65, 95 % CI [11.43, 11.88]), though none were statistically significant. Hierarchical multiple regressions found that age had the most significant impact on SD. When SF-12 MCS-12 was added, linear mixed effects did not reveal any statistically significant results between the age groups and SD levels. In contrast, hierarchical multiple regressions found that SF-12 MCS-12 scores had the most significant impact on SD. There were significant age-related and sex-related differences in help-seeking behaviors in those who sought psychological counseling as opposed to medical treatment for SD. CONCLUSION Our study has highlighted the importance of clinicians assessing for SD and psychological distress within their patients and to consider potential differences in symptom presentations of age groups to better address their unique needs.
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Affiliation(s)
- Danielle Romano
- Ferkauf Graduate School of Psychology, 165 Morris Park Ave, Bronx, NY 10461, United States.
| | - Vance Zemon
- Ferkauf Graduate School of Psychology, 165 Morris Park Ave, Bronx, NY 10461, United States
| | - Frederick W Foley
- Ferkauf Graduate School of Psychology, 165 Morris Park Ave, Bronx, NY 10461, United States
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Walther A, Rice T, Eggenberger L. Precarious Manhood Beliefs Are Positively Associated with Erectile Dysfunction in Cisgender Men. ARCHIVES OF SEXUAL BEHAVIOR 2023; 52:3123-3138. [PMID: 37351710 PMCID: PMC10684399 DOI: 10.1007/s10508-023-02640-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 05/22/2023] [Accepted: 05/31/2023] [Indexed: 06/24/2023]
Abstract
The notions that manhood is hard to attain, easy to lose, and needs to be proven via public action constitute precarious manhood beliefs (PMB). PMB is a new concept and it remains unclear whether and how PMB relate to erectile dysfunction (ED) in cisgender men. The ability to achieve an erection remains considered as a cornerstone of masculinity and sexual performance can be conceived as a proof of one's masculinity. In this context, ED can be received as sexual failure and a threat to a man's masculinity and sense of adequacy. For these reasons, the hypothesis that PMB are associated with ED warranted empirical testing. In an anonymous online survey focusing on men's mental health conducted in German-speaking countries of Europe, 507 cisgender men (Mage = 44.2, SDage = 15.2) completed measures on PMB, sexual function, self-stigma, social desirability, and conformity to traditional masculinity ideology (TMI). Multilinear regression analysis with stepwise introduction of relevant covariates evaluated potential associations between PMB and ED. Of a 507 cisgendered male sample, 63.1% reported an increased risk for ED based on previously established cutoff points. Elevated levels of PMB endorsement among the men predicted reduced sexual and erectile function in all models, even when accounting for relevant control variables such as age, education, self-stigma, social desirability, or conformity to TMI. Group comparisons revealed that the men suffering from ED showed higher levels of PMB endorsement but not self-stigma nor TMI relative to men without ED. PMB are significantly associated with ED. While determining causality will require further study, our results may support the hypothesis that higher levels of PMB endorsement may lead to increased tension to perform sexually, resulting in increased psychological pressure and a higher risk to develop ED.
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Affiliation(s)
- Andreas Walther
- Department of Clinical Psychology and Psychotherapy, Psychological Institute, University of Zurich, Binzmühlestrasse 14, 8050, Zurich, Switzerland.
| | - Timothy Rice
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Lukas Eggenberger
- Department of Clinical Psychology and Psychotherapy, Psychological Institute, University of Zurich, Binzmühlestrasse 14, 8050, Zurich, Switzerland
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Xu J, Chen Y, Gu L, Liu X, Yang J, Li M, Rao K, Dong X, Yang S, Huang B, Jin L, Wang T, Liu J, Wang S, Bai J. Hypothalamic-pituitary-adrenal axis activity and its relationship to the autonomic nervous system in patients with psychogenic erectile dysfunction. Front Endocrinol (Lausanne) 2023; 14:1103621. [PMID: 36936153 PMCID: PMC10020360 DOI: 10.3389/fendo.2023.1103621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 02/14/2023] [Indexed: 03/06/2023] Open
Abstract
BACKGROUND Psychological stress and its two stress response systems, the hypothalamic-pituitary-adrenal (HPA) axis and the autonomic nervous system (ANS), are closely related to psychogenic erectile dysfunction (pED). However, the analyses of perceived stress and stress systems in pED patients need to be more in-depth, especially the interactions between them. METHODS Our study included 75 patients with pEDs and 75 healthy men. The International Index of Erectile Function-5 (IIEF-5) and the 10-item Perceived Stress Scale (PSS-10) were used for assessing the severity of ED and perceived stress. All participants collected saliva samples on three consecutive days at eight specific times with strict reference to the time of morning awakening for measuring cortisol parameters and wore electrocardiography for 24 h to derive heart rate variability (HRV). RESULTS The PSS-10 scores of pED patients were significantly higher than the control group (p<0.001). Although PSS-10 and IIEF-5 scores were negatively correlated in pED patients, there was no statistical significance between them (r=-0.049, p=0.677). Compared with the control group, the HRV parameters of pED patients were significantly increased in LF/HF ratio (p=0.014) but significantly decreased in LF, HF, and pNN50 (p<0.001). However, the two groups had no statistically significant differences in cortisol variables (all p>0.05). The interaction between sympathovagal modulation (HF, rMSSD) and cortisol awakening response (CAR AUCi) explained significantly greater variance in perceived stress than either stress system alone. Higher parasympathetic activity combined with a higher cortisol awakening response was associated with greater perceived stress. CONCLUSION Our results suggested that the interrelation between ANS and HPA axis activity might enhance our comprehension of how stress affected the physical and mental health of pED patients.
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Affiliation(s)
- Jinzhou Xu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yinwei Chen
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Longjie Gu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xiaming Liu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jun Yang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Mingchao Li
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Ke Rao
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xiyuan Dong
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Shulin Yang
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Bo Huang
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Lei Jin
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Tao Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jihong Liu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Shaogang Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jian Bai
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- *Correspondence: Jian Bai,
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Vartolomei L, Cotruș A, Tătaru SO, Vartolomei MD, Man A, Ferro M, Stanciu C, Sin AI, Shariat SF. Lower urinary tract symptoms are associated with clinically relevant depression, anxiety, and stress symptoms. Aging Male 2022; 25:62-66. [PMID: 35179090 DOI: 10.1080/13685538.2022.2040981] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
OBJECTIVES To investigate the correlation between lower urinary tract symptoms (LUTS), erectile dysfunction (ED), and testosterone deficiency (TD) with depressive, stress, and anxiety symptoms. MATERIAL AND METHODS From October 2019 to March 2020, 113 males were included. Inclusion criteria: age 40-75, no clinical suspicion of prostate cancer, no serious cardiovascular comorbidities. All patients completed a set of questionnaires: International Prostate Symptom Score (IPSS), International Index of Erectile Function (IIEF-5), and Depression Anxiety Stress Scales (DASS-21). RESULTS Median age was 62 years (range 40-74), mean IPSS score was 10.94 (SD 7.75), mean IIEF-5 score 13.12 (SD 7.08), and mean DASS-21 score 11.35 (SD 8.24). According to DASS-21 subscales, 28 (24.8%) patients had depressive symptoms, 25 (22.1%) anxiety symptoms, and 25 (22.1%) stress symptoms. Depression was associated with LUTS (14.5 vs. 8 score, p = .002). Similarly, stress symptoms were associated with LUTS (IPSS 15 vs. 7 score, p = .0001) and with ED (IIEF-5 5 vs. 15 score, p = .01). Positive Spearman's rho correlations between LUTS and all three, depression, anxiety, and stress symptoms were found (p values <.001). CONCLUSIONS LUTS is associated with depression, anxiety, and stress symptoms. Screening for these symptoms could help with individual counseling and management.
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Affiliation(s)
- Liliana Vartolomei
- I.O.S.U.D., George Emil Palade University of Medicine, Pharmacy, Sciences and Technology from Târgu Mureș, Târgu Mureș, Romania
- Department of Urology, Medical University of Vienna, Vienna, Austria
- Department of Psychology, Dimitrie Cantemir University from Târgu Mureș, Târgu Mureș, Romania
| | - Andrei Cotruș
- Department of Psychology, Dimitrie Cantemir University from Târgu Mureș, Târgu Mureș, Romania
| | - Sabin Octavian Tătaru
- I.O.S.U.D., George Emil Palade University of Medicine, Pharmacy, Sciences and Technology from Târgu Mureș, Târgu Mureș, Romania
| | - Mihai Dorin Vartolomei
- I.O.S.U.D., George Emil Palade University of Medicine, Pharmacy, Sciences and Technology from Târgu Mureș, Târgu Mureș, Romania
- Department of Urology, Medical University of Vienna, Vienna, Austria
- Department of Cell and Molecular Biology, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology from Târgu Mureș, Târgu Mureș, Romania
| | - Adrian Man
- Department of Microbiology, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology from Târgu Mureș, Târgu Mureș, Romania
| | - Matteo Ferro
- Department of Urology, European Institute of Oncology, Milan, Italy
| | - Camelia Stanciu
- Department of Psychology, Dimitrie Cantemir University from Târgu Mureș, Târgu Mureș, Romania
| | - Anca Ileana Sin
- Department of Cell and Molecular Biology, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology from Târgu Mureș, Târgu Mureș, Romania
| | - Shahrokh F Shariat
- Department of Urology, Medical University of Vienna, Vienna, Austria
- Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
- Department of Urology, Weill Cornell Medical College, New York, NY, USA
- Department of Urology, University of Texas Southwestern, Dallas, TX, USA
- Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria
- Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic
- Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan
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Cannarella R, Calogero AE, Aversa A, Condorelli RA, La Vignera S. Differences in Penile Hemodynamic Profiles in Patients with Erectile Dysfunction and Anxiety. J Clin Med 2021; 10:jcm10030402. [PMID: 33494316 PMCID: PMC7864480 DOI: 10.3390/jcm10030402] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 01/17/2021] [Accepted: 01/20/2021] [Indexed: 01/23/2023] Open
Abstract
Background: Penile echo-color Doppler ultrasound (PCDU) is the gold standard for the diagnosis of arterial erectile dysfunction (ED). Its reliability in patients with anxiety was questioned, due to false-positive results. Aim: To assess the penile hemodynamic response to intracavernous injection (ICI) of alprostadil in patients with anxiety-related ED. Methods: Patients with non-organic ED and a 5-item International Index of Erectile Function (IIEF-5) score ranging between 5 and 7 were enrolled. They were asked to compile the 7-item Generalized Anxiety Disorder (GAD-7) questionnaire to assess the degree of anxiety and were divided according to the GAD-7 score in Group 1 with minimal level of anxiety (n = 20), Group 2 with mild anxiety (n = 20), Group 3 with moderate anxiety (n = 20), and Group 4 with severe anxiety (n = 20). Peak systolic velocity (PSV) and the end-diastolic velocity (EDV) were sampled in all patients, through PCDU in the flaccid state, and 5, 10, 15, and 20 min after ICI of alprostadil at the standard dose of 10 μg. Results: In penile flaccidity, the patients showed a mean PSV of 8.0 ± 4.0 cm/s. The degree of anxiety was found to significantly influence both PSV and EDV at all assessed time-points. Particularly, it was negatively associated with the PSV at time 5 (r = −0.9, p < 0.01), 10 (r = −0.9, p < 0.01), 15 (r = −0.9, p < 0.01), and 20 (r = −0.7, p < 0.01) minutes, and positively with the EDV at time 5 (r = 0.7, p < 0.01), 10 (r = 0.6, p < 0.01), 15 (r = 0.5, p < 0.01), and 20 (r = 0.3, p < 0.01) minutes. Although all patients showed a mean dynamic PSV > 25 cm/s (which excluded an arterial ED according to the current guidelines), a peculiar hemodynamic pattern was found in patients with severe anxiety. In these patients, normal PSV values were reached only after 20 min from ICI, suggesting a “late-responder” profile. Conclusion: If further studies confirm the existence of a distinct hemodynamic profile in patients with severe anxiety, sampling the PSV and the EDV values could be proposed, for detecting patients with severe anxiety-related ED. Dynamic PCDU could be considered an accurate diagnostic test in patients with non-organic ED, since zero false-positive results were found in the present study. PSV in the flaccid state is not able to discriminate between arterial- or non-organic ED.
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Affiliation(s)
- Rossella Cannarella
- Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy; (R.C.); (A.E.C.); (R.A.C.); (S.L.V.)
| | - Aldo E. Calogero
- Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy; (R.C.); (A.E.C.); (R.A.C.); (S.L.V.)
| | - Antonio Aversa
- Department of Experimental and Clinical Medicine, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy
- Correspondence:
| | - Rosita A. Condorelli
- Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy; (R.C.); (A.E.C.); (R.A.C.); (S.L.V.)
| | - Sandro La Vignera
- Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy; (R.C.); (A.E.C.); (R.A.C.); (S.L.V.)
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