万艾可对促排卵期子宫发育不良患者内膜容受性的影响

目的:探讨万艾可在促排卵过程中对子宫内膜过薄患者内膜厚度及血流动力学的影响。方法:122例既往促排卵周期中子宫内膜生长不良的不孕症患者随机分为两组,A组(65例):于克罗米芬(CC)/人绒毛膜促性腺激素(hCG)促排卵第8天阴道放置万艾可(100 mg/d)至排卵,B组(57例)单纯CC/hCG促排卵。检测用药前后两组患者子宫内膜厚度、内膜形态学变化、子宫动脉血流搏动指数(PI)和血流阻力指数(RI)、以及妊娠率。结果:A组子宫内膜明显增厚,子宫内膜三线征发生率明显增高(P<0.05),PI和RI值显著降低(P<0.01),妊娠率(26.2%)也显著高于B组(10.5%)(P<0.05)。结论:万艾可能促进子宫内膜生长、改善子宫内膜容受性,有助于胚胎着床,提高妊娠率。     

性感集中训练法联合西地那非治疗早泄的临床观察

目的 观察应用性感集中训练法联合西地那非治疗早泄的疗效.方法 32例早泄患者应用性感集中训练法治疗4周,并于性交前0.5～1 h口服西地那非50 mg,观察患者治疗前后、停药后4周及8周的阴道内射精潜伏期时间、阴道内射精潜伏期评分、患者性生活满意度、配偶性生活满意度.结果 治疗后,阴道内射精潜伏期时间及其评分、患者性生活满意度、配偶性生活满意度与治疗前比较,差异有统计学意义[(3.84±0.42)min比(0.72 ±0.20) min,(1.86±0.28)分比(2.52±0.21)分,(9.8±1.3)分比(4.8±1.5)分,(9.5±1.2)分比(4.6±1.3)分,P＜0.01或P＜0.05],停药后4、8周上述指标与治疗后比较,差异均无统计学意义(P＞0.05).结论 性感集中训练法联合西地那非对早泄有较好的治疗效果,能延长阴道内射精潜伏期、提高患者夫妻双方性生活满意度,且治疗效果稳定、复发率低.     

The anatomical characteristics of the stria terminalis in the human brain: a diffusion tensor tractography study

The role played by spinal adrenergic and cholinergic receptors in the antinociceptive effects of intrathecal sildenafil in formalin-induced nociception was examined. Intrathecal catheters were inserted into the subarachnoid space of male Sprague-Dawley rats, and nociception was assessed using the formalin test, consisting of a subcutaneous injection of 50 μL of 5% formalin solution into the hind paw. We examined the effects of an alpha 1 adrenergic receptor antagonist (prazosin), an alpha 2 adrenergic receptor antagonist (yohimbine), a muscarinic acetylcholine receptor antagonist (atropine), and a nicotinic acetylcholine receptor antagonist (mecamylamine) on sildenafil-induced antinociception. Intrathecal sildenafil (3, 10, and 30 μg) suppressed, in a dose-dependent manner, formalin-induced flinching during phases 1 and 2 of the test. Intrathecal sildenafil (30 μg) could not show any effects against intrathecal prazosin (3 μg), yohimbine (10 μg), atropine (10 μg), and mecamylamine (10 μg) pretreatment during both phases of the formalin test. These results suggest that intrathecal sildenafil effectively attenuated the pain evoked by formalin injection. Additionally, spinal alpha 1, alpha 2, muscarinic and nicotinic receptors might play a role in sildenafil-induced antinociception.     

西地那非在干预男性肾移植受者移植前后勃起功能时的安全性及有效性研究

目的 评价西地那非在干预男性肾移植受者手术前后勃起功能时的有效性及安全性.方法 选取年龄23～58岁、移植肾存活1年以上、血肌酐在移植后1年内维持在150 μmol/L以下的成年男性肾移植受者41人,所有患者在血液透析期间及移植后均口服两地那非两月,对患者血液透析期间、移植后6月及1年的勃起功能进行调查(依据国际问卷表IIEF-5),记录其各个时段的环孢素浓度、血压及血肌酐.结果 肾移植前与移植后6月及1年患者的ED发生率相比,有显著性差异(P<0.05);不论血液透析期间还是移植后,西地那非治疗后的勃起功能与服药前勃起功能相比,有显著性差异(P<0.05);不论血液透析期间还是移植后,西地那非治疗后的环孢素浓度、血压及肌酐与服药前组相比,无显著性差异(P>0.05).结论 肾移植后,患者的勃起功能得到了改善:不论对于尿毒症血液透析患者,还是肾移植受者,西地那非都可以改善患者的勃起功能,而且两地那非的应用具有安全性.     

HPLC-紫外检测法测定保健食品中违禁药品西地那非含量

目的建立高效液相色谱（HPLC）测定保健食品中违禁药品西地那非方法。方法采用C18柱,250mm×4．6mm×5μm;流动相：0．05mol／L磷酸三乙胺溶液（pH=3）：甲醇：乙腈：58：25：17,在291nm波长处检测其含量。结果获得理想的分离效果,本方法最低检出浓度为0．18μg／ml,线性范围为0．584～292μg/ml,方法平均回收率为95．0％,RDS〈10％。结论该方法适用于保健食品中违禁药品西地那非含量的测定。     

A Placebo-Controlled, Multicenter, Randomized, Double-Blind, Flexible-Dose, Two-Way Crossover Study to Evaluate the Efficacy and Safety of Sildenafil in Men With Traumatic Spinal Cord Injury and Erectile Dysfunction

Background/Objective:     

Sildenafil improves endometrial blood flow in patients with recurrent implantation failure

Successful embryo implantation depends on a well-functioning endometrium and high-grade quality embryos. An increasing body of evidence suggests that sildenafil citrate plays an important role in endometrial receptivity and implantation. However, few studies have investigated the effects of oral sildenafil citrate on the clinical outcomes of patients with recurrent implantation failure (RIF). In the present study, we aimed to determine the impact of sildenafil citrate on improving the endometrial blood flow and pregnancy rate in RIF patients. A total of 346 frozen-thawed transfer cycles from 305 RIF patients undergoing IVF at the Center for Reproductive Medicine of Peking University Third Hospital from June 2013 to December 2017 were enrolled. Oral sildenafil citrate was given to the patients, and the related effects on endometrial blood flow, endometrial thickness, and clinical outcomes were investigated. In the 346 transferred cases, the proportion of three groups (A: undetectable blood flow; B: sub-endometrial blood flow; C: endometrial and sub-endometrial blood flow) before and after oral administration of sildenafil citrate was as follows: group A: 36.7% ( n = 127) vs. 7.5% ( n = 26); group B: 42.8% ( n = 148) vs. 24.0% ( n = 83); group C: 20.5% ( n = 71) vs. 68.5% ( n = 237). Moreover, the endometrial blood flow in 137 FET cycles was improved (61.8%). Besides, the implantation rate was 19.47% (132/678), and the clinical pregnancy rate reached 32.66% (113/346), while the endometrial blood flow of the pregnancy group was better compared with the non-pregnancy group. This study explored the improving effects of sildenafil citrate on the endometrial receptivity and clinical outcomes of RIF patients, confirming the crucial role of good endometrial blood flow in a successful pregnancy. Meanwhile, the low incidence of adverse events also supported the security and feasibility of sildenafil citrate in the clinical therapy of RIF patients.     

Appearance of antidepressant-like effect by sildenafil in rats after central muscarinic receptor blockade: evidence from behavioural and neuro-receptor studies

Summary. The phosphodiesterase (PDE) 5 inhibitor sildenafil has been shown to display psychotropic actions in humans and animals, and has been used for the treatment of antidepressant-associated erectile dysfunction. However, its effects on the neurobiology of depression are unknown. Nitric oxide (NO)-cyclic guanosine monophosphate (cGMP) inhibition is anti-depressant in animals, and increasing cGMP with sildenafil is anxiogenic in rodents. Substantial cholinergic-nitrergic interaction exists in the brain, while sildenafil shows modulatory actions on cholinergic transmission. Depression is also associated with increased cholinergic drive. Here we report that sildenafil increases muscarinic acetylcholine receptor (mAChR) signaling in human neuroblastoma cells. We also show that fluoxetine (20 mg/kg/day × 7 days), as well as a combination of sildenafil (10 mg/kg/day × 7 days) plus the antimuscarinic atropine (1 mg/kg/day × 7 days) demonstrates significant, comparable antidepressant-like effects in the rat forced swim test (FST) and also reduces cortical β-adrenergic receptor (β-AR) density, while sildenafil or atropine alone did not. Importantly, sildenafil did not modify fluoxetine’s response. Sildenafil thus demonstrates antidepressant-like effects but only after central muscarinic receptor blockade, providing evidence for cholinergic-nitrergic interactions in the neurobiology of depression. Correspondence: Christiaan B. Brink, Division of Pharmacology, North-West University (PUK), Internal Box 16, Potchefstroom 2520, South Africa     

西地那非治疗肺动脉高压的临床疗效研究

目的 观察西地那非对肺动脉高压(PH)的临床治疗效果,为PH的临床治疗提供更多的理论依据.方法 选择80例PH患者,按随机数字表法分为常规治疗组和西地那非治疗组,每组40例.观察比较两组治疗前后6 min步行试验距离、Brog呼吸困难评分、肺动脉收缩压(SPAP)、心率、体循环收缩压(cSBP)、体循环舒张压(cDBP)、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、血尿素氮(BUN)、血肌酐(SCr)及其临床疗效.结果 治疗前常规治疗组和西地那非治疗组6 min步行试验距离分别为(258.62±58.34)、(260.22±54.33)m,Brog呼吸困难评分分别为(3.2±1.1)、(3.3±1.2)分,SPAP分别为(70.66±6.52)、(71.09±6.61) mm Hg(1 mm Hg=0.133 kPa),两组比较差异无统计学意义(P＞0.05)；治疗后常规治疗组和西地那非治疗组6 min步行试验距离分别为(332.67±63.51)、(411.47 ±75.86)m,均较治疗前显著增加(P＜0.05)；Brog呼吸困难评分分别为(2.6±0.8)、(2.0±0.6)分,SPAP分别为(61.43±5.27)、(47.84 ±5.15) mm Hg,均较治疗前显著减低(P＜0.05)；西地那非治疗组6 min步行试验距离、Brog呼吸困难评分、SPAP改善情况显著优于常规治疗组(P＜0.05).常规治疗组和西地那非治疗组治疗前后心率、cSBP、cDBP、ALT、AST、BUN、SCr比较差异均无统计学意义(P＞0.05).西地那非治疗组总有效率为77.5％(31/40),显著优于常规治疗组的57.5％(23/40),差异有统计学意义(P＜0.05).西地那非治疗组的不良反应主要为头痛、颜面潮红和消化不良.结论 西地那非治疗PH患者临床疗效显著,不良反应轻微,值得临床推广和应用.     

Sildenafil citrate (Viagra) and erectile dysfunction following external beam radiotherapy for prostate cancer: a randomized, double-blind, placebo-controlled, cross-over study

Purpose: To determine the efficacy of sildenafil citrate (Viagra) in patients with erectile dysfunction after three-dimensional conformal external beam radiotherapy (3D-CRT) for prostate cancer.

Methods and Materials: 406 patients with complaints of erectile dysfunction and who completed radiation at least 6 months before the study were approached by mail. 3D-CRT had been delivered (mean dose 68 Gy). Sixty patients were included and entered a double-blind, placebo-controlled, cross-over study lasting 12 weeks. They received during 2 weeks 50 mg of sildenafil or placebo; at Week 2 the dose was increased to 100 mg in case of unsatisfactory erectile response. At Week 6, patients crossed over to the alternative treatment. Data were collected using the International Index of Erectile Function (IIEF) questionnaire, and side effects were recorded.

Results: Mean age was 68 years. All patients completed the study. For most questions of the IIEF questionnaire there was a significant increase in mean scores from baseline with sildenafil, but not with placebo. Ninety percent of the patients needed a dose adjustment to 100 mg sildenafil. Side effects were mild or moderate.

Conclusion: Sildenafil is well tolerated and effective in improving erectile function of patients with ED after 3D-CRT for prostate cancer.