八髎穴温针灸治疗阳痿32例

目的:观察八髎穴温针灸治疗阳痿的临床疗效。方法:选取2011年1月—2014年6月本院门诊收治的阳痿患者32例,均采用八髎穴温针灸治疗。结果:32例患者中,治愈25例,好转6例,无效1例,有效率96.9%。结论:八髎穴温针灸治疗阳痿疗效显著。     

张杰运用“肝脾建中”思想临床治验浅析

[目的]浅析张杰教授运用"肝脾建中"思想辨治疾病的经验。[方法]通过跟随张杰教授门诊,选取张师运用"肝脾建中"思想辨治的肝积、呕吐、痫病、痿证之验案4则,并结合历代名家的相关论述,从病因病机、治则治法、用药特点等方面对验案进行分析,进一步研讨"肝脾建中"思想。[结果]张师认为,肝脾在生理上同居中焦,关系密切,为后天之源泉,人身之枢机,病理上则每易相兼为病,独创"肝脾建中"思想指导临床。"肝脾建中"思想是将肝脾作为一个矛盾的整体纳入杂病的辨治过程,其指导下的治法即是肝脾同治、调和气血、健运中焦,以协调上下,通达内外,临证用于辨治肝郁脾虚、痰毒瘀阻之肝积,肝气犯胃、胃阴不足之呕吐,肝脾两虚、风痰上扰之痫病,阳气不足、络脉瘀阻之痿证等,疗效显著。[结论]张师临证运用"肝脾建中"思想辨治疾病,旨在突显肝脾二脏的相关性及"肝脾建中"的重要性,经验特色鲜明,值得学习和推广。     

基于数据挖掘的中医治疗阳痿用药规律分析

目的:探讨中医治疗阳痿病的用药规律。方法:收集古籍以及全国名老中医药专家治疗阳痿病处方,基于中医传承辅助系统软件构建数据库,采用关联规则Apriori算法和复杂系统熵聚类方法,确定处方中各药物和药物组合的使用频数及药物之间的关联规则等。结果:高频药物包括菟丝子、熟地黄、当归、枸杞子、淫羊藿等;高频药物组合包括"枸杞子、菟丝子","肉苁蓉、菟丝子","枸杞子、淫羊藿"等;置信度为0.6以上的关联规则包括"茯苓-菟丝子","熟地黄-枸杞子","柴胡-当归"等。结论:中医治疗阳痿多用温补肾阳、益气养血之品。     

Medical treatment of erectile dysfunction

Erectile dysfunction (ED) is defined as the consistent inability to obtain or maintain an erection for satisfactory sexual relations. Data from the Massachusetts Male Aging Study have indicated that the prevalence of erectile dysfunction of any degree is 39% in 40-year old men, and 67% in those aged 70 years. Effective therapy has been available for some time, but it has commonly involved surgery, external devices or penile self-injection. For many men, these represent unacceptable barriers to seeking therapy. Recently, however, an effective oral medication has become available. This article reviews the physiology and pharmacology of ED. The literature currently available on the effectiveness and safety of various drugs used for ED is summarized, with particular attention to newly available oral agents. Guidelines for work-up and drug treatment of patients with ED are given. Detailed history and physical examination are crucial to the safe and effective treatment of men with erectile impotence. An extensive review of the literature shows that based on safety, effectiveness and ease of use, oral sildenafil citrate is an excellent choice for first-line therapy. Patients who use organic nitrates of any kind in any capacity should not be offered sildenafil. Based solely on effectiveness intra-cavernosal injection therapy remains the golden standard and should also be offered as an option for first-line therapy for the appropriate patients. Many alternatives are available for men who cannot use sildenafil or injection therapy. A thorough knowledge of existing medications is essential for proper treatment of ED.     

三维彩色能量血管造影成像在中老年动脉性阳痿中的应用

目的 探讨三维彩色能量血管造影成像在中老年阳痿患者诊断中的实用价值。方法 应用三维彩色能量血管造影成像于注射前列腺素E1前及注药后5min，对398例中老年阳痿患者及15例正常对照者的阴茎动脉进行检查。结果 注射药物后5min对照组阴茎动脉走行较直，空间结构清楚；阳痿患者的阴茎动脉走行纡曲，增宽，呈串珠状，且空间结构紊乱。结论 三维彩色能量血管造影成像能较清楚地显示阴茎动脉的走行情况，立体反映阴茎动脉分布特点，对阳痿的诊断及鉴别诊断有益。     

Patient preferences

Objective: To assess whether patients can weigh risk comparisons involving mortality and quality of life in an understandable manner based on their willingness to accept risks of complications. Design: Cross-sectional survey of patients. Setting: University-based Department of Veterans Affairs Medical Center. Participants: 230 men patients seen in a general medicine clinic. Measurements: Two survival graphs were used. Each graph contained survival curves for two alternative unidentified treatments for an unidentified medical condition. Graph 2 contained one curve that had a life expectancy that was 14% higher than the life expectancy of the corresponding curve in graph 1. Respondents were randomly assigned one of the two graphs and were asked to indicate which treatment they preferred and what risk of a change in their quality of life (urinary incontinence or impotence) they were willing to accept to achieve longer survival. Patients were also asked whether they had a history of urinary incontinence or impotence. Results and conclusions: Patients tended to be unwilling to accept worse quality of life to achieve increased survival over time. For both curve comparisons, significantly more (p<0.01) patients accepted a treatment associated with higher mortality to avoid a 100% chance of incontinence than to avoid a 100% chance of impotence. Of the 75% (172/230) of patients reporting willingness to accept risk of either urinary incontinence or total impotence or both, 62% reported having at least some symptoms related to urinary incontinence or impotence. Of the 58 patients not willing to accept the complication risks, only 11% reported a history of urinary incontinence or impotence. The results show that patients are able to make distinctions about severity of morbidity, men are less willing to accept the risk of urinary incontinence than that of total impotence, and men patients who are symptomatic with urinary incontinence or impotence are more willing to accept the risks of treatment than are asymptomatic patients. Received from the Department of Veterans Affairs Medical Center, Oregon Health Sciences University, Portland, Oregon.     

The effect of platelet-rich plasma on cavernous nerve regeneration in a rat model

The aim of this study was to investigate the effect of platelet-rich plasma (PRP) on cavernous nerve (CN) regeneration and functional status in a nerve-crush rat model. Twenty-four Sprague–Dawley male rats were randomly divided into three equal groups: eight had a sham operation, eight underwent bilateral nerve crushing with no further intervention and eight underwent bilateral nerve crushing with an immediate application of PRP on the site of injury. Erectile function was assessed by CN electrostimulation at 3 months and nerve regeneration was assessed by toluidine blue staining of CN and nicotinamide adenine dinucleotide phosphate (NADPH)-diaphorase staining of penile tissue. Three months after surgery, in the group that underwent bilateral nerve crushing with no further intervention, the functional evaluation showed a lower mean maximal intracavernous pressure (ICP) and maximal ICP per mean arterial pressure (MAP) with CN stimulation than those in the sham group. In the group with an immediate application of PRP, the mean maximal ICP and maximal ICP/MAP were significantly higher than those in the injured control group. Histologically, the group with the application of PRP had more myelinated axons of CNs and more NADPH-diaphorase-positive nerve fibres than the injured control group but fewer than the sham group. These results show that the application of PRP to the site of CN-crush injury facilitates nerve regeneration and recovery of erectile function. Our research indicates that clinical application of PRP has potential repairing effect on CN and peripheral nerves.     

Rauchen schädigt die männliche Zeugungsfähigkeit

It is concluded from a survey on the world literature: Smoking damages the male fertility. Smoker should therefore stop the smoking not only in respect to their own health but from sense of responsibility for the future generation too. The most important reasons for this conclusions are: Tobacco smoke contains numerous mutagenic substances. They reach the male gonads via the blood. They show their mutagenic action here openly much more stronger than on egg-cells because the spermatogenesis continues over the whole male reproductive period whereas the formation of eggs is already completed in the fetal phase. The majority of studies indicates to a damaging effect also on the number and/or the motility and morphology of spermatozoa by strong smoking during a longer time. Especially smoking husbands with infertile marriages the urgent advice therefore should be given to stop smoking. Weighty epidemiological and experimental results suggest a teratogenic action in the offspring by smoking of fathers too - independently for the smoking customs of the mother. A verification and extension of these results are very desirable.     

Factors related to sexual functioning in male patients undergoing hemodialysis and with kidney transplants

The sexual functioning of 13 male patients undergoing renal dialysis and 13 male patients who had received kidney transplants was compared. Standardized interviews were used to assess the frequency of intercourse before illness, during dialysis, and after transplantation and to assess sexual difficulties experienced during these periods. In addition, plethysmographic recordings of erection levels were obtained for three dialysis and three transplant patients at eight separate time periods corresponding to particular points in the dialysis cycle. Assessments of depression and anxiety (IDA scale) and renal functioning (Marital Patterns Test) were also carried out. Dialysis patients were less able to gain and maintain erections than transplant patients and intercourse was less frequent for couples where the husband was on dialysis. Dialysis patients were more depressed than transplant patients, although transplant patients showed greater levels of anxiety. More marital difficulties were experienced by patients on dialysis than patients who had received transplants. The implications of these findings for the treatment of sexual problems in these patients are discussed.