Active Men Research Articles

Cold hypersensitivity in the hands and feet is associated with erectile dysfunction in young Taiwanese men

Cold hypersensitivity in the hands and feet (CHHF) is a protective or predisposing factor for many diseases; however, the relationship between CHHF and erectile dysfunction (ED) remains unclear. We aimed to investigate associations between CHHF and ED among young men of Southeast Asian origin. In this cross-sectional study, sexually active Taiwanese men aged 20–40 years were enrolled via an online questionnaire comprising general demographic information, comorbidities, subjective thermal sensations of their hands and feet in the past 6 months, and their erectile function using the International Index of Erectile Function-5 (IIEF-5). Participants who reported cold sensation of hands and feet were classified to have CHHF; those with IIEF-5 score ≤ 21 were considered to have ED. Total 54.2% and 27.9% of participants had ED and CHHF, respectively. Men with CHHF were significantly younger, had lower body mass index and IIEF-5 scores (p < 0.001), and a lower prevalence of diabetes mellitus (p = 0.033) along with higher prevalence of ED, psychiatric disorders, and insomnia (p < 0.001). After adjusting for predisposing factors of ED, CHHF (odds ratio 1.410, 95% confidence interval 1.159–1.714; p = 0.001) remained an independent predictor of ED. Thus, CHHF is independently associated with ED, affecting more than a quarter of young Taiwanese men. Autonomic dysregulation and subclinical endothelial dysfunction may be common pathophysiologies of CHHF and ED.

Unawareness of partner risk factors thwarts implementation of USPSTF recommendations for HIV pre-exposure prophylaxis in primary care

ABSTRACT The United States Preventive Services Task Force recommends pre-exposure chemoprophylaxis for persons at high risk of HIV exposure. The optimal screening strategy for at-risk individuals in primary care is not known. We evaluated the strategy of universal screening and discussed challenges to the implementation of this recommendation in primary care. Around 430 of 500 (86%) screening surveys were completed. Mutual monogamy was common but monogamous partners with recent negative HIV testing were uncommon. Likewise, among heterosexually active men and women, inconsistent condom use was common. Such individuals would be on guideline for HIV pre-exposure prophylaxis (PrEP) if their partner was at risk for HIV exposure. None of these potentially at-risk individuals met the criteria for PrEP, but 13% lacked knowledge of their partners' sexual and behavioral risk factors, preventing a clear decision on whether PrEP should be used. Our screen identified no individuals who clearly met the guideline criteria for HIV PrEP. We conclude that universal screening for HIV PrEP in primary care is unlikely to be an efficient strategy; targeted screening is likely more appropriate. Moreover, the 2019 guidelines for heterosexually active men and women rely on information that is often unknown to the patient, which makes these guidelines difficult to implement. Future guidelines should address these problems.

Repeated bout effect and muscle damage at variable eccentric exercise intensities in active young men: a longitudinal repeated measures investigation

Abstract Exercise-induced muscle damage (EIMD) and repeated bout effect (RBE) are widely researched across various populations and at various intensities. Despite the existence of vast literature, there is lack of comparison of low versus submaximal versus maximal intensity required for preconditioning. The aim of the study was to compare the muscle damage and RBE at various intensities of eccentric exercise in active young men. Thirty-six healthy, physically active men were recruited and randomly assigned to three different groups low-high (L-H, n = 12), submaximal-high (M-H, n = 12) and maximal-high (H-H, n = 12). All participants performed 2 exercise bouts separated by 14 days. L-H, M-H and H-H groups performed low (10% of 1RM), moderate (50% of 1RM) and high (90% of 1RM) intensity eccentric exercise for knee extensors, respectively, in the 1st bout followed by high (100% of 1RM) intensity in the second bout. Muscle soreness (SOR), thigh circumference (CIR), maximal voluntary isometric contraction (MVIC), range of motion (ROM) and blood lactate (Bl Lac) were measured before, immediately, at 24 h, at 48 h and at 72 h after exercise. A significant effect of time appeared for MVIC (), CIR (), ROM () and Bl Lac (). The bout × time interaction, as well as bout × time × group interaction was also found significant indicating changes in muscle strength and ROM. Circumference changed significantly with a significant bout × group interaction effect . SOR () was significant between the bouts. Therefore, exhibiting attenuation of muscle damage markers after the second bout. Findings of the present study showed that muscle damage was evident at all three intensities. Moreover, it was greater after moderate and high intensity as compared to low intensity eccentric exercise. RBE was elicited after three intensities indicating their role in preconditioning the muscles of active men.

Underreporting Supplements: A Case of Drug-induced Liver Injury Due to a Testosterone Booster.

Acute liver injuries (ALIs) are caused by a wide range of etiologies, and determining the cause can often be challenging. Detailed history taking is essential in patients with liver injuries to promptly determine the underlying source of injury and for timely treatment and prognosis. A 27-year-old active duty man presented to the emergency department (ED) with jaundice. On medication reconciliation, he only reported taking acetaminophen for a recent upper respiratory infection. The patient had an ALI and was treated with N-acetyl cysteine for presumed acetaminophen toxicity. Initially, his liver-associated enzymes (LAEs) improved, but 2 weeks after discharge, he returned to the ED upon referral from ship medical for jaundice and worsening liver injury. Repeated query into the patient's history revealed that he was using a testosterone booster supplement for 6 months preceding initial hospitalization. After evaluation of other etiologies for liver injury returned negative, drug-induced liver injury from the testosterone booster was determined to be the underlying etiology. With discontinuation of the supplement, his liver injury improved. Hepatotoxicity is a major concern in supplement use; however, it is largely underreported. Supplements are often not recognized or reported as medications by patients, leading to failure to identify them as potential toxicants. This case highlights the importance of including supplement education and questioning in the evaluation of ALI and maintaining a high index of suspicion when other common etiologies of liver disease are negative.

Exercise-induced increase in muscle insulin sensitivity in men is amplified when assessed using a meal test.

Exercise has a profound effect on insulin sensitivity in skeletal muscle. The euglycaemic-hyperinsulinaemic clamp (EHC) is the gold standard for assessment of insulin sensitivity but it does not reflect the hyperglycaemia that occurs after eating a meal. In previous EHC investigations, it has been shown that the interstitial glucose concentration in muscle is decreased to a larger extent in previously exercised muscle than in rested muscle. This suggests that previously exercised muscle may increase its glucose uptake more than rested muscle if glucose supply is increased by hyperglycaemia. Therefore, we hypothesised that the exercise-induced increase in muscle insulin sensitivitywould appear greater after eating a meal than previously observed with the EHC. Ten recreationally active men performed dynamic one-legged knee extensor exercise for 1 h. Following this, both femoral veins and one femoral artery were cannulated. Subsequently, 4 h after exercise, a solid meal followed by two liquid meals were ingested over 1 h and glucose uptake in the two legs was measured for 3 h. Muscle biopsies from both legs were obtained before the meal test and 90 min after the meal test was initiated. Data obtained in previous studies using the EHC (n=106 participants from 13 EHC studies) were used for comparison with the meal-test data obtained in this study. Plasma glucose and insulin peaked 45 min after initiation of the meal test. Following the meal test, leg glucose uptake and glucose clearance increased twice as much in the exercised leg than in the rested leg; this difference is twice as big as that observed in previous investigations using EHCs. Glucose uptake in the rested leg plateaued after 15 min, alongside elevated muscle glucose 6-phosphate levels, suggestive of compromised muscle glucose metabolism. In contrast, glucose uptake in the exercised leg plateaued 45 min after initiation of the meal test and there were no signs of compromised glucose metabolism. Phosphorylation of the TBC1 domain family member 4 (TBC1D4; p-TBC1D4Ser704) and glycogen synthase activity were greater in the exercised leg compared with the rested leg. Muscle interstitial glucose concentration increased with ingestion of meals, although it was 16% lower in the exercised leg than in the rested leg. Hyperglycaemia after meal ingestion results in larger differences in muscle glucose uptake between rested and exercised muscle than previously observed during EHCs. These findings indicate that the ability of exercise to increase insulin-stimulated muscle glucose uptake is even greater when evaluated with a meal test than has previously been shown with EHCs.

CAN DARK CHOCOLATE ACUTE SUPPLEMENTATION IMPROVE CYCLOERGOMETER PERFORMANCE TEST?

Prevalence studies of dark chocolate may produce results similar to those observed after resistance exercise. The results examining the effects of dark chocolate ingestion on aerobic exercise performance are controversial. In addition, there is a choice in experiments with chronically consumed chocolate components (40 to 80 g) and large amounts of dark chocolate in studies to improve athletic performance. Therefore, the purpose of this study to verify the effect of acute supplementation of 80 g dark chocolate (70% cocoa) on performance on cycle ergometer test. Eleven healthy, physically active, but untrained men participated in the study. Two incremental cycle ergometer tests were performed to determine the peak power output (Ppeak) without chocolate supplementation (control condition, C) and with supplementation of 80 g of dark chocolate 70% cocoa (C70%) ingested orally two hours before the test. Variables such as heart rate (HR), blood glucose concentration [GLI], blood pressure (SBP/DBP), and rating of perceived exertion (RPE) were monitored. Data normality was verified by the Shapiro-Wilk test, and the results are presented as mean ± standard deviation (SD). The performance data of the tests and physiological variables were compared using Student's t-test for paired samples, adopting a significance level of P &lt; 0.05. No statistical differences were found for Ppeak (238.0 ± 35.1 vs 250.9 ± 42.7 W) between conditions (C and C70%, respectively), as well as in the other variables. Therefore, we concluded that although the ingestion of 80 g of dark chocolate (70% cocoa) 2 hours prior the cycle ergometer test did not modify the peak power output, physiological and psychophysiological variables analyzed when presenting the average results, individual analysis demonstrated that this supplementation could be used to enhance peak power, which support individual as opposed to group analysis to evaluate performance responses to supplementation protocols.

The Ethnogeomorphological Vision of Artisan Fishermen from the Guriú Community, Camocim-Ceará

Ethnogeomorphology, which is the understanding of relief through the knowledge of traditional communities, has been increasingly required within geographic science when the approach takes into account man's dialectical action on his environment. In the search for an understanding of coastal ethnogeomorphology, we chose to research the coast of Ceará which, among its morphological features, contains river mouths, fixed and mobile dunes, cliffs, lake environments, fluviomarine plains and all interconnected inan interaction of landscape dynamics. All the compartmentalizations expressed in the relief make the coastal landscape a space of great natural expressiveness within the space of Ceará. Added to these is anthropic action, forming geographic space, the object of study in Geography, which is formed by the dialectical interaction between man and the space that surrounds him. The present work is the result of qualitative research carried out on Guriú beach located in the municipality of Camocim-Ceará. This work aims to survey the traditional knowledge of artisanal fishing workers in the Guriú district about the local relief and the way they interact with the environment.

Orthorexia Nervosa and Healthy Orthorexia in a Physically Active North American Population.

The Teruel Orthorexia Scale (TOS) defines two related but distinct constructs: Orthorexia Nervosa (OrNe), a pathological fixation on a healthy diet, and Healthy Orthorexia (HeOr), an interest in a healthy diet independent of psychopathology. Here, we (a) assessed both types of Orthorexia in a large North American sample using the TOS and (b) explored if engaging in regular physical activity was associated with a greater risk of Orthorexia. A cohort of physically active adults (n = 927; 41% men) completed the TOS, as well as the Rapid Assessment of Physical Activity (RAPA), to broadly assess aerobic physical activity level and participation in strength and/or flexibility training. As expected, scores for HeOr and OrNe differed between participants, with lower scores for Orthorexia Nervosa in our physically active non-clinical sample. Higher HeOr scores were associated with lower BMI, and this was true for both men and women. We also found that measures of Orthorexia were associated with self-reported physical activity: active adults reporting more aerobic physical activity had higher HeOr scores, with the most active men having the highest scores. Notably, adults who reported regular strength training had higher scores for both HeOr and OrNe, with men who strength trained showing higher OrNe scores than women. Here, those who participate in regular strength training are more likely to exhibit orthorexic behaviors, and this effect was more pronounced for men than women. Prior work has validated the TOS in young, primarily female samples of non-English speakers outside the United States: present data from an age-diverse, physically active, gender balanced sample support the use of TOS for measurement of Orthorexia Nervosa and Healthy Orthorexia in English speakers and suggest that more work is needed to assess potential gender differences in these constructs.

The effect of combination treatment with low-intensity shockwave therapy and daily tadalafil on severe erectile dysfunction: a double-blind, randomized, sham-controlled clinical trial.

Patients with severe erectile dysfunction (ED) remain the most challenging group in terms of available noninvasive treatment modalities. The study sought to assess the role of combination therapy with low-intensity shockwave therapy (LiST) and daily tadalafil 5mg in a highly select group of patients with severe vasculogenic ED through a double-blind, randomized trial. Forty-eight sexually active men were randomly assigned to 12 sessions of LiST 3 times weekly and tadalafil 5mg once daily (n = 34) or sham therapy and tadalafil (n = 17) for 4 weeks. Patients were assessed at 1 and 3 months after completion of treatment. Improvement of erectile function was evaluated through the International Index of Erectile Function-Erectile Function domain (IIEF-EF) or 6-item IIEF and the Sexual Encounter Profile (SEP) diary. The primary outcome was the difference between the groups in the IIEF-EF at 3 months after completion of treatment. Secondary outcomes comprised (1) the difference between the groups in the IIEF-EF at 1 month after completion of treatment, (2) the difference between the groups in the "yes" responses to question 3 of the SEP diary at 1 and 3 months, and (3) the treatment-related adverse events. The number of patients attaining a minimal clinically important difference in the IIEF-EF (improvement of at least 7 points) was also assessed. After treatment, the absolute scores in the IIEF-EF were higher in patients receiving LiST and tadalafil vs sham therapy and tadalafil both at the 1-month (12.1 ± 2.4 vs 10.2 ± 1.7; P = .002) and at the 3-month (12.9 ± 2.1 vs 10.8 ± 1.8; P < .001) evaluation. Between the 2 groups, the proportion of "yes" responses to question 3 of the SEP diary was not statistically significant, whereas the number of patients attaining a minimal clinically important difference in the IIEF-EF was statistically significant only at the 3-month evaluation. No adverse events occurred. Application of LiST in patients with severe vasculogenic ED receiving daily dose tadalafil may further improve erectile function compared with tadalafil as a stand-alone treatment on the short term. Although we provided the first study in the field, severe vasculogenic ED was defined based on medical history and clinical examination and not based on penile ultrasound measures. The combination of 12 sessions LiST 3 times weekly and daily tadalafil for 4 weeks led to a 2-point difference in the IIEF-EF compared with sham therapy and daily tadalafil among patients with severe vasculogenic ED after 1 and 3 months from completion of treatment.

PDE5is-naïve versus non-naïve patients at first investigation for erectile dysfunction-findings from a long-term, real-life cross-sectional study.

Phosphodiesterase 5 inhibitors (PDE5is) represent a first-line pharmacological therapy for erectile dysfunction (ED). Men could obtain PDE5is for recreational purposes without any proper medical prescription. We aimed to analyze clinical characteristics of patients who already used any PDE5i for ED without previous formal medical prescription. Data from 2012 heterosexual, sexually active men seeking first medical help for ED at our outpatient clinic between 2005 and 2022 were analyzed. All patients were assessed with a comprehensive sexual and medical history and completed the International Index of Erectile Function (IIEF) at baseline. Comorbidities were scored with the Charlson comorbidity index (CCI). Thereof, according to exposure to any PDE5i before their first visit, patients were subdivided into: PDE5i-naïve and non-PDE5i-naïve patients. Descriptive statistics tested the sociodemographic and clinical characteristics of both groups. A logistic regression model predicted the likelihood of being PDE5i-naïve at the baseline. Linear regression analysis (LRA) estimated the likelihood of being PDE5i-naïve versus non-PDE5i-naïve over the analyzed timeframe. Lastly, local polynomial regression models graphically explored the likelihood of being PDE5i-naïve at the first clinical assessment over the analyzed timeframe, and the sensitivity analyses tested the probability of being PDE5i-naïve at baseline. Overall, 1,491 (70.9%) patients were PDE5i-naïve and 611 (29.1%) were non-PDE5i-naïve at the first assessment. PDE5is-naïve patients were younger, with a lower prevalence of CCI ≥ 1 and of normal erectile function (EF) than non-PDE5i-naïve men (all p<0.05). Multivariable logistic regression found that patients with lower BMI (OR: 0.99), higher IIEF-EF scores (OR: 1.02), lower rates of severe ED (OR: 0.94), and who had been assessed earlier throughout the study timeframe (OR: 1.27) were less likely to be PDE5i-naïve at baseline. Univariate LRA revealed that younger patients (Coeff: -0.02), with lower CCI (Coeff: -0.29) and higher alcohol intake per week (Coeff: 0.52) were more likely to be PDE5i-naïve over the analyzed timeframe. Moreover, for the same IIEF-EF score, patients with higher CCI had lower probability of being PDE5i-naïve. Self-prescription of PDE5is is an attitude presents in the general population, despite this phenomenon has decreased overtime. Current data outline the importance to keep promoting educational campaigns to promote PDE5is as effective and safe medicinal products, while avoiding their improper use.

Characteristics of Changes in Contractile Properties of Muscle after Anaerobic Exercise

Tensiomyography (TMG) has been described as an effective method for identifying differences in muscle response to athletic training stimuli. However, there is a lack of studies that evaluated changes in muscle contractile properties in response to anaerobic effort and related these changes to Wingate test parameters in more than one lower limb superficial muscle. The main contribution of this work is to evaluate changes in the contractile properties of muscles in response to anaerobic exercise. In a group of 20 physically active men, the body composition analysis was performed using a Tanita DC-360 device. The anaerobic effort was assessed by a Wingate test (30 s), and the contractile properties of muscles were measured using a TMG S2 device. The TMG parameters were measured in selected superficial muscles of the dominant lower limb. The study also calculated indices of the differences (d) and the size of the effect (r). An anaerobic effort in the form of the Wingate test resulted in greater stiffness (Dm) in the vastus lateralis muscle (p = 0.0365; r = 0.47) and a delayed response to stimulus (Td) in the vastus lateralis (p = 0.0239; r = 0.51) and vastus medialis (p = 0.0031; r = 0.66) muscles. The half relaxation time (Tr) (p = 0.0478; r = 0.44) and sustained contraction time (Ts) (p = 0.0276; r = 0.49) in the rectus femoris muscle were also increased. In contrast, a prolonged stimulus-response time (Td) with a decrease in sustained contraction time (Ts) was observed in the gastrocnemius lateralis (Td: p = 0.0054; r = 0.64 and Ts: p = 0.0012; r = 0.74) and gastrocnemius medialis (Td: p = 0.0229; r = 0.52 and Ts: p = 0.0054; r = 0.64) muscles. A significant decrease in contraction time (Tc) (p = 0.0051; r = 0.63) occurred only in the soleus muscle. In addition, significant correlations were shown between selected changes in contractile properties of muscle and parameters of the Wingate anaerobic test. Anaerobic exercise has a significant effect on changes in skeletal muscle contractility parameters. TMG is an effective method for identifying differences in muscle response to sports training stimuli.

Near-InfraRed Spectroscopy Provides a Reproducible Estimate of Muscle Aerobic Capacity, but Not Whole-Body Aerobic Power.

Near-infrared spectroscopy (NIRS) during repeated limb occlusions is a noninvasive tool for assessing muscle oxidative capacity. However, the method's reliability and validity remain under investigation. This study aimed to determine the reliability of the NIRS-derived mitochondrial power of the musculus vastus lateralis and its correlation with whole-body (cycling) aerobic power (V̇O2 peak). Eleven healthy active men (28 ± 10 y) twice (2 days apart) underwent repeated arterial occlusions to induce changes in muscle oxygen delivery after 15 s of electrical muscle stimulation. The muscle oxygen consumption (mV̇O2) recovery time and rate (k) constants were calculated from the NIRS O2Hb signal. We assessed the reliability (coefficient of variation and intraclass coefficient of correlation [ICC]) and equivalency (t-test) between visits. The results showed high reproducibility for the mV̇O2 recovery time constant (ICC = 0.859) and moderate reproducibility for the k value (ICC = 0.674), with no significant differences between visits (p > 0.05). NIRS-derived k did not correlate with the V̇O2 peak relative to body mass (r = 0.441, p = 0.17) or the absolute V̇O2 peak (r = 0.366, p = 0.26). In conclusion, NIRS provides a reproducible estimate of muscle mitochondrial power, which, however, was not correlated with whole-body aerobic capacity in the current study, suggesting that even if somewhat overlapping, not the same set of factors underpin these distinct indices of aerobic capacity at the different (peripheral and whole-body systemic) levels.

The effect of physical activity on cytokine levels in adults living with type 1 diabetes-a preliminary study.

The aim of this study is to investigate whether physical activity and the level of body fat are factors reducing the level of pro-inflammatory cytokines in people with T1DM. Twenty-five men (27.8 ± 9.4 years old; 178.9 ± 6.9 cm; 80.6 ± 12 kg) and 18 women (28.1 ± 12.5 years old; 162.4 ± 5.5; 63.1 ± 9.9 kg) were divided into four groups based on body fat percentage and level of physical activity (AN-active people with normal body fat; IAN-inactive people with normal body fat; AO-active people with excessive body fat, IAO-inactive people with excessive body fat). The level of cytokines in the blood serum was assessed. The level of IL-8 was higher (measurable) in inactive men, regardless of adiposity degree and in women, only in the inactive group with normal body fat. IL-6 was found only in active men with excessive adiposity. In conclusion, the findings from this study allow to indicate that moderate level of physical activity may contribute to a reduction in the development of systemic low-grade inflammation in patients with T1DM, and thus, may reduce the risk of CVD.

Effect of repeated prolonged exercise on liver fat content and visceral adipose tissue in well-trained older men.

Liver fat (LF) and visceral adipose tissue (VAT) content decreases with training, however, this has mainly been investigated in sedentary obese or healthy participants. The aim of this study was to investigate the effects of repeated prolonged exercise on LF and VAT content in well-trained older men and to compare baseline LF and VAT content to recreationally active older men. A group of five well-trained older men were tested before and after cycling a total distance of 2558 km in 16 consecutive days. VAT content and body composition was measured using DXA before a bicycle ergometer test was performed to determine maximal fat oxidation (MFO), maximal oxygen consumption ( ), and the relative intensity at which MFO occurred (Fatmax). LFcontent was measured on a separate day using MRI. For comparison of baseline values, a control group of eight healthy age- and BMI-matched recreationally active men were recruited. The well-trained older men had lower VAT (p = 0.02), and a tendency toward lower LF content (p = 0.06) compared with the control group. The intervention resulted in decreased LF content (p = 0.02), but VAT, fat mass, and lean mass remained unchanged. , MFO, and Fatmax were not affected by the intervention. The study found that repeated prolonged exercise reduced LF content, but VAT and remained unchanged. Aerobic capacity was aligned with lower LF and VAT in older active men.

No difference in fat oxidation, postexercise energy expenditure or energy intake following ingestion of a protein-based breakfast compared to carbohydrate breakfast.

Background: Manipulation of macronutrient intake and exercise can alter overall energy consumption and potentially body composition. Aim: The purpose of this study was to manipulate the macronutrient content of breakfast before exercise to investigate the impact on exercise energy expenditure and postexercise energy intake (EI). Methods: Twelve active men were recruited, 11 finished the study protocol (age: 28 ± 9 years; VO2max: 56 ± 5 ml·kg-1·min-1). In a randomized crossover design, each participant completed 4 trials, 3 consisting of a specific breakfast (protein, PRO; carbohydrate, CHO; noncaloric; NON-CAL) followed in 1 h by a 45 minutes moderate intensity treadmill exercise protocol. The fourth trial consisted of breakfast and no exercise (CON). An ad-libitum lunch and food for the rest of the day were provided and assessed for EI. Measures included resting metabolic rate pre- and postbreakfast along with oxygen uptake (VO2) during and after exercise, along with hunger scales, and blood measures of glucose, insulin and plasma-PYY prebreakfast, pre-exercise, postexercise, and 60 minutes postexercise. Results: Fat oxidation was highest during exercise in the NON-CAL (0.57 g·min-1) trial with similar levels of fat oxidation between PRO (0.50 g·min-1) and CHO trials (0.48 g·min-1). Hunger was not affected by PRO intake or exercise, nor was appetite hormones and glucose. EI at lunch and dinner was not significantly different between trials. Conclusion: Pre-exercise PRO intake did not modify fat oxidation during exercise, did not lead to a larger VO2 versus CHO, nor did it attenuate EI postexercise.

Authentication, Authorization, Access Control, and Key Exchange in Internet of Things

The Internet of Things (IoT) is a dynamic network of devices and infrastructure supporting instances composed to platforms being based on cloud/fog and blockchain technologies. Its intervention in more and more sensitive areas requires IoT entities (devices and platform instances) to communicate with each other via secure channels generally established by using cryptographical methods. This needs an authentic key exchange, which in turn requires an authentication process. Moreover, it has to be ensured that client entities can access only authorized services provided by authorized server entities. Additionally, requirements specifically introduced by IoT complicate realizing these security goals even more. This article introduces a novel approach providing authentication, authorization, access control, and key exchange in instance-to-instance, device-to-instance, and device-to-device communications to handle cloud/fog-based and blockchain-based platforms. In contrast to related work, realizations of these security goals are not disjunct processes and are integrated with each other in our approach combining zero-knowledge and identity-based schemes while meeting the IoT security requirements. Thus, it does not require any public data pre-distribution or secret pre-sharing between communicating entities, and no entity has to hold any device-specific or instance-specific data to be used for authentication or authorization. While supporting the autonomous character of IoT, our approach is independent of application and platform types without requiring additional components or procedures. Moreover, it is resistant to active man-in-the-middle attacks and does not include costly cryptographic operations. This article also demonstrates the high performance of our approach with regard to multiple affecting factors.

Intralesional injection of hyaluronic acid compared with verapamil in acute phase of Peyronie’s disease: A prospective randomized clinical trial

ABSTRACT Purpose The aim of this work was to analyze and contrast the effectiveness and safety of intralesional HA in the acute stage of PD with that of verapamil injection. Methods In this prospective, randomized clinical trial, 42 PD-affected, sexually active men between the ages of >18 and 70 participated. Two groups of patients were recruited; group A obtained weekly intralesional treatment with HA for 12 weeks, whereas group B obtained weekly intralesional therapy with verapamil for 12 weeks. Physical examinations and Duplex Doppler ultrasound were performed on all patients. Results The penile curvature was significantly decreased at 12 weeks after therapy in contrast to baseline in group A (34.1 ± 6.77° vs. 24.7 ± 9.72°, p = 0.005), and was significantly decreased at 12 weeks after therapy compared to baseline in group B (36.2 ± 7.43° vs. 30.8 ± 8.63 °, p = 0.047). The decrease in penile curvature at 12 weeks after therapy was noticeably better in group A in contrast to group B (24.7 ± 9.72° vs. 30.8 ± 8.63°, p = 0.038). Conclusion HA is emerging as a valid choice for the treatment of PD in terms of resolution of the acute phase of the disease, and it is plausible to posit that the use of HA may contribute to the stabilization of the disease and decrease the need for the subsequent choice of a possible surgical strategy, with the ability to reduce penile pain and have a stronger impact on penile curvature and patient satisfaction.

Ketone Monoester Followed by Carbohydrate Ingestion after Glycogen-Lowering Exercise Does Not Improve Subsequent Endurance Cycle Time Trial Performance.

Relative to carbohydrate (CHO) alone, exogenous ketones followed by CHO supplementation during recovery from glycogen-lowering exercise have been shown to increase muscle glycogen resynthesis. However, whether this strategy improves subsequent exercise performance is unknown. The objective of this study was to assess the efficacy of ketone monoester (KME) followed by CHO ingestion after glycogen-lowering exercise on subsequent 20 km (TT20km) and 5 km (TT5km) best-effort time trials. Nine recreationally active men (175.6 ± 5.3 cm, 72.9 ± 7.7 kg, 28 ± 5 y, 12.2 ± 3.2% body fat, VO2max = 56.2 ± 5.8 mL· kg BM-1·min-1; mean ± SD) completed a glycogen-lowering exercise session, followed by 4 h of recovery and subsequent TT20km and TT5km. During the first 2 h of recovery, participants ingested either KME (25 g) followed by CHO at a rate of 1.2 g·kg-1·h-1 (KME + CHO) or an iso-energetic placebo (dextrose) followed by CHO (PLAC + CHO). Blood metabolites during recovery and performance during the subsequent two-time trials were measured. In comparison to PLAC + CHO, KME + CHO displayed greater (p < 0.05) blood beta-hydroxybutyrate concentration during the first 2 h, lower (p < 0.05) blood glucose concentrations at 30 and 60 min, as well as greater (p < 0.05) blood insulin concentration 2 h following ingestion. However, no treatment differences (p > 0.05) in power output nor time to complete either time trial were observed vs. PLAC + CHO. These data indicate that the metabolic changes induced by KME + CHO ingestion following glycogen-lowering exercise are insufficient to enhance subsequent endurance time trial performance.

Muscle Oxygen Extraction during Vascular Occlusion Test in Physically Very Active versus Inactive Healthy Men: A Comparative Study.

An increase in the delivery and use of oxygen to the musculature in physically active subjects are determinants of improving health-related aerobic capacity. Additional health benefits, such as an increase in the muscle mass and a decrease in fat mass, principally in the legs, could be achieved with weekly global physical activity levels of more than 300 min. The objective was to compare the muscle vascular and metabolic profiles of physically very active and inactive subjects. Twenty healthy men participated in the study; ten were assigned to the physically very active group (25.5 ± 4.2 years; 72.7 ± 8.1 kg; 173.7 ± 7.6 cm) and ten to the physically inactive group (30.0 ± 7.4 years; 74.9 ± 11.8 kg; 173.0 ± 6.4 cm). The level of physical activity was determined by the Global Physical Activity Questionnaire (GPAQ). A resting vascular occlusion test (5 min of an ischemic phase and 3 min of a reperfusion phase) was used, whereas a near-field infrared spectroscopy (NIRS) device was used to evaluate the muscle oxygenation in the right vastus lateralis of the quadriceps muscle. The area under the curve of the deoxyhemoglobin (HHb) during the ischemic phase and above the curve of the tissue saturation index (TSI) during the reperfusion phase were obtained to determine muscle metabolic and vascular responses, respectively. Physically very active group showed a higher absolute HHb (3331.9 ± 995.7 vs. 6182.7 ± 1632.5 mmol/s) and lower TSI (7615.0 ± 1111.9 vs. 5420.0 ± 781.4 %/s) and relative to body weight (46.3 ± 14.6 vs. 84.4 ± 27.1 mmol/s/kg and 106.0 ± 20.6 vs. 73.6 ± 13.8 %/s/kg, respectively), muscle mass (369.9 ± 122.2 vs. 707.5 ± 225.8 mmol/kg and 829.7 ± 163.4 vs. 611.9 ± 154.2 %/s/kg) and fat mass (1760.8 ± 522.9 vs. 2981.0 ± 1239.9 mmol/s/kg and 4160.0 ± 1257.3 vs. ±2638.4 ± 994.3 %/s/kg, respectively) than physically inactive subjects. A negative correlation was observed between HHb levels and TSI (r = -0.6; p < 0.05). Physically very active men (>300 min/week) present better muscle oxidative metabolism and perfusion and perform significantly more physical activity than physically inactive subjects. Extra benefits for vascular health and muscle oxidative metabolism are achieved when a subject becomes physically very active, as recommended by the World Health Organization. In addition, a higher level of physical activity determined by GPAQ is related to better vascular function and oxidative metabolism of the main locomotor musculature, i.e., the quadriceps.

Overactive bladder negatively affects erectile function and promotes premature ejaculation: findings from large representative population-level study.

The effect of overactive bladder (OAB) on sexual health has been evaluated extensively for women but much less for men. Therefore, the aim of this study was to evaluate the relationship between OAB and men's sexual activity and the effect of OAB on erectile dysfunction (ED) and premature ejaculation (PE) in a large representative cohort of men at the population level. This study was based on computer-assisted web interviews that used validated questionnaires. The most recent census and the sample size estimation calculations were employed to produce a population-representative pool. The study included 3001 men, representative of the population in terms of age and place of residence. The frequency of sexual intercourse was higher for respondents without OAB symptoms compared with persons who had OAB (p = 0.001), but there was no association between OAB symptoms and number of sexual partners (p = 0.754). Regression models did not confirm the effect of OAB on sexual activity (odds ratio 0.993, CI 0.974-1.013, p = 0.511). Both ED and PE were more prevalent in respondents with OAB symptoms compared with persons who lacked those symptoms (p < 0.001). Importantly, the effect of OAB on ED or PE was independent of age, comorbidities, and lifestyle habits (regression coefficients of 0.13 and 0.158 for ED and PE, respectively). Overactive bladder did not significantly affect men's sexual activity, but it significantly correlated with ED and PE. Our results suggest a need in daily clinical practice to screen for OAB symptoms for persons who report ED or PE.