阴茎勃起功能障碍药物治疗

勃起功能障碍是中老年男性常见多发病,近几年来其治疗的进展比较快,也引起了广泛关注。目前常用的一线口服治疗药物包括西地那非、伐地那非和他达拉非,临床效果相似但各有其特点。二线治疗包括阴茎海绵体血管注射疗法和尿道内用药,但因使用时有侵袭性而受限。目前所有的治疗方法都存在着不同程度的不良反应,基因治疗可能是未来ED治疗的发展方向。     

Viagra for temporary erectile dysfunction during treatments with assisted reproductive technologies.

During treatments with assisted reproductive technologies (ART), some men may have difficulties in producing spermatozoa on demand at the time of insemination, either for intrauterine insemination (IUI) or for in-vitro fertilization (IVF). This situation imposes tremendous stress on the couple and may cause cancellation of the treatment. Here we describe, for the first time, the use of sildenafil citrate (ViagraTM) for temporary erectile dysfunction in couples undergoing ART. The first case was a man who could not produce spermatozoa for the first IVF treatment after an exhausting trial for 12 h, despite the fact that he never had problems in providing sperm samples during previous IUI cycles. Using Viagra enabled him to provide spermatozoa, but the delay in oocyte insemination resulted in no embryonic development. This prompted us to be more alert to this option and to suggest the use of Viagra to men who had a history of erectile dysfunction during previous ART cycles. In these cases, the use of Viagra was planned in advance and it successfully solved any unpredictable erectile dysfunction on the day of insemination. Such cases emphasize the need to think in advance of this potential use of Viagra during ART.     

单纯治疗慢性前列腺炎对其合并ED的影响

目的探讨单纯治疗慢性前列腺炎对其合并阴茎勃起功能障碍(ED)的影响。方法选择415例前列腺炎继发ED的患者进行单纯针对前列腺炎的治疗,通过前列腺炎症状评分(NIH-CPSI)、前列腺液常规评价前列腺炎的治疗效果,采用国际勃起功能评分问卷(IIEF-5)评分评价ED的治疗效果。结果慢性前列腺炎经综合治疗2个月后,患者的NIH-CPSI评分及前列腺液白细胞计数均显著降低(P0.05)。前列腺炎治愈或好转后,IIEF-5评分显著增加,部分患者勃起恢复正常,中、重度ED患者显著减少,性欲下降患者明显减少,少数有射精障碍的患者得到改善。其差异均具有显著性(P0.05)。结论单纯治疗慢性前列腺炎可使大部分患者并发的ED明显改善,而对少数前列腺炎好转后ED症状改善不明显者,可联合应用PDE5i等药物治疗。     

IkB激酶在糖尿病性大鼠ED中的作用

目的探讨IkB激酶(Ik kinases,IKK)在糖尿病(diabetes mellitus,DM)性阴茎勃起功能障碍(erectiledy sfunction,ED)中的可能作用。方法注射链脲佐菌素建立糖尿病大鼠模型,分别在注射8周和12周后观察阴茎勃起次数,取大鼠阴茎,Western Blot方法检测IKK蛋白量的变化,ABC免疫组织化学方法检测阴茎IKK的分布和表达。结果 Dm大鼠的阴茎勃起次数明显低于对照组(P0.01),随病程延长降低;Western Blotting结果显示,DM组阴茎IKK蛋白量明显高于正常对照组(P0.01),12周DM组明显高于8周DM组(P0.05);IKK主要分布于阴茎血管、阴茎背神经,与对照组比较,DM组平均光密度值明显上调并随病程延长而上调。结论 DM大鼠阴茎IKK蛋白量的上调可能通过作用于阴茎内的血管、神经参与了糖尿病性ED发病。     

Prevalence and risk factors of erectile dysfunction in Niger delta region, Nigeria

Background

Erectile Dysfunction (ED) is one of the major social problems causing significant distress in men. Despite the increasing difficulty in management, knowledge, and understanding of factors responsible for its development are important for prevention and care.

Objectives

To assess the prevalence and risk factors for ED among men in Niger Delta Region of Nigeria, in order to determine its contextual variables.

Methods

Subjects included 400 male patients attending the general outpatients'' clinic (GOPC) of the University of Uyo Teaching Hospital. Respondents completed the abridged version of the International Index of Erectile Function (IIEF-5).

Results

A total of 166 (41.5%) subjects had ED; 66 (16.5%) had mild; 32 (8.0%) mild to moderate; 24 (6.0%) moderate; while 45 (11.3%) had severe 37 (9.2%) resulted from hypertension and its medications; 29 (7.3%) from diabetes; 49 (12.2%) from a combination of both and their therapies (P=0.044); 24 (6.0%) had history of previous surgery; while for 27 (6.8%) it was from undiagnosed medical conditions (p=0.001). The ED increases with age and is more among married and educated men.

Conclusion

ED is a common problem among men in Niger Delta region. Therefore, efforts must be made to reduce the incidence by dealing with the factors responsible for its development.     

氧化应激与诱导性一氧化氮合酶在糖尿病性阴茎勃起功能障碍中的作用

目的:探讨氧化应激与诱导性一氧化氮合酶(iNOS)在糖尿病性阳茎勃起功能障碍(ED)中的可能作用。方法:注射链脲佐菌素建立糖尿病大鼠模型,分别在注射8周和12周后观察阴茎勃起次数、取大鼠阴茎和血浆,测定血清丙二醛(MDA)水平、总抗氧化能力(T-AOC)、一氧化氮合酶(NOS)和iNOS活力以及用免疫组织化学ABC方法检测阴茎iNOS的表达。结果:糖尿病大鼠的阴茎勃起次数明显低于对照组,并随病程延长降低;糖尿病大鼠血清MDA、iNOS水平明显高于对照组;糖尿病大鼠T-AOC水平明显低于对照组;与对照组比较,糖尿病组阴茎内iNOS阳性细胞数和平均光密度值随病程延长而升高。结论:糖尿病性阴茎勃起功能障碍与氧化应激水平、血清iNOS活性以及阴茎iNOS的表达升高相关。     

前列腺癌近距离治疗后勃起功能障碍相关的研究进展

前列腺癌近距离治疗与前列腺癌根治行切除术都能对早期前列腺癌患者起到根治的疗效,但前者发生勃起功能障碍的发生率较低。勃起功能障碍(ED)的定义为持续或反复不能达到并维持阴茎勃起状态而影响性生活,常使用国际勃起功能评分。其发生的原因可分为血管源性及非血管源性。前列腺癌近距离治疗后勃起功能障碍的治疗,是药物治疗、物理治疗及心理咨询相结合的综合性治疗。5型磷酸二酯酶抑制剂(PDE5)抑制剂和前列地尔是目前治疗前列腺近距离治疗后ED的一线用药。     

糖尿病大鼠神经生长因子的表达与阴茎勃起功能障碍的关系

目的：探讨糖尿病(DM)大鼠神经系统中 NGF 的表达与阴茎勃起功能障碍(ED)的相关性。方法：建立糖尿病大鼠模型,分别于造模1～4月注射阿扑吗啡(APO)作阴茎勃起功能试验,然后取大鼠的大脑、胸腰段交感干、阴茎和前列腺,用免疫组织化学法和荧光免疫组化法显示 NGF 阳性神经元或神经纤维,并作图像分析。结果：糖尿病1个月时尚无 ED 出现,但各处的 NGF 阳性神经元及纤维开始下降,与对照组相比有显著性差异,随着病程延长差异更明显;2个月时 DM 大鼠阴茎勃起次数与对照组已有显著差异3个月和4个月时差异非常显著。结论：糖尿病性早期中枢和周围神经系统内 NGF 减少,NGF 的减少与糖尿病性 ED 的发生发展密切相关。     

Cardiac autonomic regulation during sleep in idiopathic REM sleep behavior disorder

OBJECTIVE: To assess cardiac autonomic and respiratory changes from stage 2 non-rapid eye movement sleep (NREM) to rapid eye movement (REM) sleep in subjects with idiopathic REM sleep behavior disorder (RBD) and controls. We tested the hypothesis that REM-related cardiorespiratory activation is altered in subjects with RBD. DESIGN: Retrospective case-control study. SETTING: University hospital-based sleep research laboratory. PATIENTS: Ten subjects with idiopathic RBD (2 women, mean age 63.4 +/- 6.2 years) and 10 sex- and age-matched controls (mean age 63.9 +/- 6.3 years). INTERVENTION: One-night polysomnography was used to assess R-R variability during NREM and REM sleep. MEASUREMENTS AND RESULTS: Spectral analysis of R-R interval and respiration were performed. Mean R-R interval, low-frequency (LF) and high-frequency (HF) components in both absolute and normalized units (LFnu and HFnu), and the LF/HF ratio were obtained from 5-minute electrocardiogram segments selected during NREM and REM sleep under stable conditions (stable breathing pattern, no microarousals or leg movements). Respiratory frequency was also assessed. Values obtained were then averaged for each stage and analyzed by 2 x 2 analysis of variance with group (RBD subjects and controls) as factor and state (NREM and REM) as repeated measures. RR interval, HF, and HFnu components decreased from NREM to REM in controls but did not change in RBD subjects (Interaction P < 0.05). LFnu (interaction P < 0. 001), LF/HF (interaction P < 0. 001), and respiratory frequency (interaction P < 0. 05) increased from NREM to REM sleep in controls but remained stable in RBD subjects. CONCLUSION: REM-related cardiac and respiratory responses are absent in subjects with idiopathic RBD.     

糖尿病性勃起功能障碍大鼠阴茎和脊髓nNOS及AchE表达的变化

目的：观察大鼠糖尿病性勃起功能障碍（ED）与腰骶段脊髓和阴茎神经源性一氧化氮合酶（nNOS）和乙酰胆碱酯酶（AchE）阳性神经元或神经纤维变化的相关性。方法：注射链脲佐菌素建立糖尿病大鼠模型,4周和12周后注射阿扑吗啡（APO）进行大鼠阴茎勃起功能实验,取大鼠阴茎和腰骶段脊髓,用ABC免疫组织化学法和组织化学法分别显示nNOS和AchE阳性神经元或神经纤维。结果：与对照组相比,糖尿病4周时,大鼠阴茎勃起次数无显著性差异;12周时显著性减少;糖尿病4周时,脊髓和阴茎nNOS和AchE阳性神经元或神经纤维均无显著变化,而12周时均显著减少。结论：糖尿病性ED的出现伴随脊髓和阴茎内NO和乙酰胆碱的减少。     

Asymmetrical dimethylarginine and severity of erectile dysfunction and their impact on cardiovascular events in patients with acute coronary syndrome

Introduction

Coronary artery disease (CAD) and vascular erectile dysfunction (ED) are related to endothelial dysfunction. Elevated asymmetrical dimethylarginine (ADMA) levels and ED are common in patients with increased cardiovascular risk. Our aim was to investigate whether ADMA has a predictive role for major adverse cardiovascular events (MACE) in acute coronary syndrome (ACS). The secondary aim of this study was to investigate whether severity of ED predicts MACE in these patients.

Material and methods

Follow-up data were available for severity of ED in 71 patients with ACS. Plasma ADMA levels were determined by ELISA in 57 patients. Erectile dysfunction was assessed by the International Index of Erectile Function-6 (IIEF-6) score. Major adverse cardiovascular events (reinfarction, all-cause hospitalisation, stroke and all-cause death) was evaluated after a median of 10 months.

Results

Severe ED had no significantly increased hazard ratio for cardiovascular events compared with mild, mild to moderate, and moderate ED (0.259 [95% CI 0.041–1.6], p = 0.147; 0.605 [95% CI 0.095–3.8], p = 0.594; 0.980 [95% CI 0.233–4.1], p = 0.978; and 0.473 [95% CI 0.052–1.3], p = 0.508). The patients who had ADMA levels ≥ 0.32 µmol/l had no significantly increased hazard ratio for cardiovascular events compared with patients who had ADMA levels < 0.32 µmol/l (2.018 [95% CI 0.615–6.6], p = 0.247).

Conclusions

Severity of ED and ADMA did not increase the risk of cardiovascular events in follow-up patients with ACS in our study. Larger prospective studies are necessary to evaluate whether ADMA predicts cardiovascular events in patients with ACS.     

一氧化氮合酶与阴茎勃起功能障碍相关研究进展

勃起功能障(erectile dysfunctio,ED)是指阴茎不能达到和(或)维持足够的勃起以完成满意的性交,且病程至少持续6个月以上[1].     

Cardiac autonomic dynamics during sleep are lost in patients with TIA and stroke

Ischaemic stroke is accompanied by important alterations of cardiac autonomic control, which have an impact on stroke outcome. In sleep, cardiac autonomic control oscillates with a predominant sympathetic modulation during REM sleep. We aimed to assess cardiac autonomic control in different sleep stages in patients with ischaemic stroke. Forty‐five patients enrolled in the prospective, multicentre SAS‐CARE study but without significant sleep‐disordered breathing (apnea–hypopnea index < 15/hr) and without atrial fibrillation were included in this analysis. The mean age was 56 years, 68% were male, 76% had a stroke (n = 34, mean National Institutes of Health Stroke Scale [NIHSS] score of 5, 11 involving the insula) and 24% (n = 11) had a transitory ischaemic attack. Cardiac autonomic control was evaluated using three different tools (spectral, symbolic and entropy analysis) according to sleep stages on short segments of 250 beats in all patients. Polysomnographic studies were performed within 7 days and 3 months after the ischaemic event. No significant differences in cardiac autonomic control between sleep stages were observed in the acute phase and after 3 months. Predominant vagal modulation and decreased sympathetic modulation were observed across all sleep stages in ischaemic stroke involving the insula. Patients with ischaemic stroke and transitory ischaemic attack present a loss of cardiac autonomic dynamics during sleep in the first 3 months after the ischaemic event. This change could represent an adaptive phenomenon, protecting the cardiovascular system from the instabilities of autonomic control, or a risk factor for stroke, which precedes the ischaemic event.     

Chronic intermittent hypoxia induces cardiac inflammation and dysfunction in a rat obstructive sleep apnea model

Chronic intermittent hypoxia is considered to play an important role in cardiovascular pathogenesis during the development of obstructive sleep apnea (OSA). We used a well-described OSA rat model induced with simultaneous intermittent hypoxia. Male Sprague Dawley rats were individually placed into plexiglass chambers with air pressure and components were electronically controlled. The rats were exposed to intermittent hypoxia 8 hours daily for 5 weeks. The changes of cardiac structure and function were examined by ultrasound. The cardiac pathology, apoptosis, and fibrosis were analyzed by H&E staining, TUNNEL assay, and picosirius staining, respectively. The expression of inflammation and fibrosis marker genes was analyzed by quantitative real-time PCR and Western blot. Chronic intermittent hypoxia/low pressure resulted in significant increase of left ventricular internal diameters (LVIDs), endsystolic volume (ESV), end-diastolic volume (EDV), and blood lactate level and marked reduction in ejection fraction and fractional shortening. Chronic intermittent hypoxia increased TUNNEL-positive myocytes, disrupted normal arrangement of cardiac fibers, and increased Sirius stained collagen fibers. The expression levels of hypoxia induced factor (HIF)-1α, NF-kB, IL-6, and matrix metallopeptidase 2 (MMP-2) were significantly increased in the heart of rats exposed to chronic intermittent hypoxia. In conclusion, the left ventricular function was adversely affected by chronic intermittent hypoxia, which is associated with increased expression of HIF-1α and NF-kB signaling molecules and development of cardiac inflammation, apoptosis and fibrosis.     

Complementary and alternative medicine (CAM) for sexual dysfunction and erectile dysfunction in older men and women: an overview of systematic reviews

Older patients with sexual dysfunction (SD) and/or erectile dysfunction (ED) often use complementary and alternative medicine (CAM). The aim of this overview of systematic reviews is to critically evaluate the evidence for or against the effectiveness of CAM. Six electronic databases were searched to identify all relevant systematic reviews (SRs). Their methodological quality was assessed independently by two reviewers using the Oxman score. Four SRs met our inclusion criteria. They evaluated: acupuncture, ginseng, maca and yohimbine. The methodological quality of all of the SRs was good. However, the primary studies were often associated with considerable risk of bias. Cautiously positive conclusions were drawn for yohimbine and ginseng as treatment options for ED. For acupuncture and maca the evidence was insufficient for ED and SD respectively. It is concluded that there is some encouraging evidence but more and better studies are required to establish the value of CAM for SD and ED.     

Cardiac autonomic nervous system activity during presleep wakefulness and Stage 2 NREM sleep

Previous research has found that cardiac parasympathetic nervous system (PNS) activity increases and cardiac sympathetic nervous system (SNS) activity decreases during night-time sleep. This study aimed to examine in greater detail the time course of these changes in cardiac autonomic nervous system (ANS) activity. In the week prior to the experimental night, nine subjects maintained a constant sleep-wake schedule and experienced an adaptation night. Each subject's experimental night consisted of 2 h of presleep wakefulness, followed by a night of sleep, commencing at each subject's normal sleep onset time. One hundred and twenty beat blocks of presleep wakefulness and stable Stage 2 non-rapid eye movement (NREM) sleep across the night were selected. SNS activity was assessed using pre-ejection period, the amplitude of the T-wave in the ECG and the 0.1 Hz peak from the spectral analysis of the ECG. PNS activity was assessed using respiratory sinus arrhythmia (spectral analysis). Heart rate and respiratory rate were also measured. The results indicated a progressive decrease in SNS activity throughout sleep and a rise in PNS activity during the first half of the normal sleep period. The changes in PNS activity were similar, while the changes in SNS activity were altered, compared with a previous study in which stage of sleep was not controlled. This indicates a likely sleep stage influence on SNS activity, but not on cardiac PNS activity. These results are consistent with the concept of a primarily circadian, but not sleep, influence on PNS activity, and primarily a sleep, but not circadian, influence on SNS activity.