法舒地尔对高血压大鼠勃起功能的影响

目的:探讨Rho激酶抑制剂法舒地尔对高血压大鼠勃起功能的影响及其机制。方法:12周龄雄性SD大鼠随机分成对照组(A组)、高血压组(B组)、法舒地尔治疗组(C组),建立高血压大鼠模型后,C组给予法舒地尔[30 mg/(kg.d)]腹腔注射,A组、B组给予等量生理盐水腹腔注射,术后10周测量大鼠阴茎海绵体内压/平均颈动脉压(ICPmax/MAP),Western印迹法测定ROCK1、ROCK2蛋白在阴茎海绵体的表达水平。结果:B组收缩压(mmHg)、ROCK1、ROCK2蛋白表达(190.39±5.07、0.048±0.002、0.143±0.011)较A组(124.81±4.01、0.036±0.001、0.101±0.011)显著增加(P<0.05),C组收缩压(mmHg)、ROCK1、ROCK2蛋白表达(182.03±4.32、0.044±0.001、0.126±0.007)较B组显著降低(P<0.05),B组ICPmax/MAP(36.82±5.47)较A组(59.99±5.69)显著降低(P<0.05),C组(51.1±5.63)较B组显著提高(P<0.05)。结论:法舒地尔可通过抑制RhoA/Rho激酶信号高表达及可能的降血压作用而改善高血压大鼠勃起功能。     

RhoA/Rho激酶在阴茎勃起中的作用

阴茎海绵体血管的张力受血管收缩和舒张因子的调控。通常认为NO舒张阴茎小动脉和海绵体平滑肌在阴茎勃起中具有重要作用。最近研究发现,RhoA/Rho激酶参与收缩因子去甲肾上腺素(NE)和内皮素1(ET-1)介导的阴茎小动脉和海绵体平滑肌收缩过程,与NO介导的海绵体平滑肌舒张过程有相互作用,NO的勃起效应可能与阻断RhoA/Rho激酶介导的阴茎海绵体血管平滑肌收缩有关。RhoA/Rho激酶抑制剂在ED的治疗中有广阔的应用前景。     

RhoA/Rho激酶信号通路与阴茎勃起功能关系

ED为男性常见疾病,全球40～70岁男子中患病率达52%。近年来已认识到RhoA/Rho激酶信号通路在维持阴茎萎软与导致ED中发挥重要作用,本文总结了近年来对RhoA/Rho激酶信号通路的研究进展,并阐明其在阴茎勃起中的作用机制,以及NO/cGMP/PKG信号通路与RhoA/Rho激酶信号通路之间的相互关系,为进一步研究阴茎勃起过程中分子信号通路奠定基础。     

阴茎夜间勃起监测系统NEVA在勃起功能障碍诊断中的应用

目的 探讨夜间阴茎勃起监测系统对勃起功能障碍(ED)诊断的应用价值.方法 应用国产伟力NEVA夜间阴茎勃起监测系统对正常志愿者(32例)、心理性ED患者(63例),动脉性ED患者(61例)和静脉性ED患者(28例),检查阴茎血容积变化率、阴茎勃起次数、每次勃起持续时间、阴茎长度变化率及阴茎周径变化率.结果 正常志愿者组及心理性ED组的阴茎血容积变化率为231.5±112.5及221.8±96.7,每次勃起持续时间分别为(27.2±12.5)min及(25.9±11.1)min,这两项指标两组比较,差异均无统计学意义,P均＞0.05.而动脉性ED组及静脉性ED组的以上两项指标为172.8±56.8及130.6±22.1,(20.1±8.6)min及(18.1±10.5)min,这两项指标两组比较,差异均无统计学意义,P均＞0.05.NEVA对动脉性及静脉性ED诊断的准确率分别为91.8%和96.4%.结论 NEVA夜间阴茎勃起监测系统在ED筛选和血管性ED诊断中是有效的、易于接受的方法.     

平滑肌收缩机制及其与勃起功能障碍的关系

阴茎勃起功能障碍(ED)与平滑肌细胞的收缩与舒张失衡相关。ED发生过程中,除舒张功能减弱外,另一重要原因为平滑肌细胞的收缩功能上调。其中,收缩相关性信号通路、胞膜离子通道、平滑肌细胞表型都参与了平滑肌细胞收缩的调节,其功能变化可引起多种平滑肌细胞相关疾病。收缩相关性信号通路Raf/MEK/ERK1/2与Rho A/Rock通路之间存在交互作用,抑制Rho A蛋白表达或降低Rock2磷酸化水平都可能成为ED的治疗途径。电压依赖性钙通道(VDCCs)、瞬时受体电位(TRP)通道功能失调是高血压、糖尿病ED发病的主要原因之一,多种病理因素上调Ca V1.2、TRPC1及TRPC4表达可使平滑肌收缩功能加强,进而导致ED的发生;阴茎海绵体表型转化也与ED的发生发展有关。本文就近年平滑肌收缩机制与ED关系研究的进展加以综述。     

保护阴茎血管内皮功能:勃起功能障碍治疗新途径

阴茎勃起是典型的神经血管过程。越来越多证据表明,阴茎血管内皮功能异常是勃起功能障碍发生的重要机制。保护阴茎血管内皮功能可以改善勃起功能,血管内皮保护剂通过减轻氧化应激损伤、保护勃起递质的功能活性,改善阴茎海绵体血管内皮功能,从而治疗勃起功能障碍。保护阴茎血管内皮功能,将成为勃起功能障碍治疗的新途径。     

下尿路症状与勃起功能障碍之间诊断与治疗的关系

近年来，大量的流行病学研究结果证实了下尿路症状（LUTS）与阴茎勃起障碍（ED）有着很强的相关性。这一发现为两者的临床诊疗和机制研究提供了新的思路，揭示了LUTS和ED发病机制上的相关性，并提示在两种疾病的个体化诊疗中应考虑到这种相关性。Ponholzer A等人进行了一项研究[Int J Impot Res，2007，19（6）：544—550]，提出LUTS和ED的相关性可能有以下五种机制：①Rho-激酶的活性增加；     

应用Rho激酶抑制剂对大鼠阴茎勃起的作用

目的 :探讨将RhoA/Rho激酶抑制剂Y 2 76 32涂抹于阴茎白膜表面以及阴茎龟头皮肤表面有无促进阴茎勃起的作用及其对体循环的影响。　方法 :2 0只成年雄性SD大鼠 ,体重为 2 5 0～ 30 0g ,随机分为实验组和对照组。全身麻醉后颈动脉和海绵体插管连续监测平均动脉压 (MAP)和阴茎海绵体内压 (CCP)的变化。寻找盆腔星状神经节(MPG)并以系列电刺激诱发勃起。向海绵体白膜表面及阴茎龟头皮肤表面涂抹Y 2 76 32 ,观察用药前后阴茎勃起的改变及MAP的改变。　结果 :将Rho激酶抑制剂Y 2 76 32涂抹于大鼠阴茎白膜表面和阴茎龟头皮肤表面均可促进在无阴茎支配神经电刺激下发生勃起 (ICP/MAP明显升高 ) ,在系列电刺激MPG时用药后发生的勃起反应较用药前亦明显增强。表面用药后还发现大鼠体循环血压有不同程度的降低。　结论 :阴茎皮肤表面应用Rho激酶抑制剂是一种安全有效的ED治疗方法 ,其临床应用价值仍有待于进一步探索     

国产低能冲击波设备治疗勃起功能障碍的多中心随机对照研究

目的评估国产线性低能冲击波设备(E100)治疗勃起功能障(ED)的安全性和有效性。方法本研究为一多中心、随机双盲对照研究。病史、国际勃起功能评分(IIEF-6)及夜间阴茎勃起监测确诊的ED患者,按照2︰1的顺序随机分为治疗组及对照组,接受低能冲击波治疗每周1次,共4周,能量0.09mJ/mm2;分4个部位,每部位冲击900次,共3600次,对照组在探头内置铁片阻挡冲击波输出,其余与治疗组完全相同。治疗结束后12周随访,内容包括IIEF-6及夜间阴茎勃起监测。结果治疗组40例中的35例,对照组20例中的16例完成治疗及随访。治疗组与对照组在基线年龄、身高、IIEF-6等均无显著差异;治疗组IIEF-6随访结果显著优于对照组(17.60±6.18 vs.14.00±6.13);治疗组有效率显著高于对照组(68.6%vs.12.5%)。两组均无副作用报告。结论国产低能冲击波设备(E100)治疗勃起功能障碍安全、有效。     

勃起功能障碍患者夜间阴茎勃起监测的临床分析

近年来国内外越来越多的采用夜间阴茎勃起现象(NPT)监测,作为勃起功能障碍(ED)临床诊断的一个重要手段.我院采用YJZ-204A型阳痿检测仪对108例ED患者进行监测,其结果如下.     

Calcium Independent Contraction of Bladder Smooth Muscle

Background Recently, it has been suggested that in vascular smooth muscle a Ca²⁺-independent mechanism or Ca²⁺-sensitization of contractile elements may participate in smooth muscle contraction. In this study, we evaluate this mechanism in detrusor muscle.
Methods Strips of smooth muscle from rabbit aorta, rabbit bladder and human bladder were evaluated by in vitro contraction studies.
Results The results show that (1) in Ca²⁺-free solution containing ethyleneglycol bis (-aminothylether)-N,N,-tetraacetic acid (ECTA), carbachol and phorbol ester produced sustained contractions in detrusor muscle (Ca²⁺-free contraction); (2) depletion of Ca²⁺ stores by caffeine did not affect Ca²⁺-free contraction induced by carbachol; and (3) VV-7 (calmodulin inhibitor) and ML-9 (myosin light chain kinase [MLCK] inhibitor) did not show inhibitory effects on Ca²⁺-free contraction, while H-7 (protein kinase C [PKC] inhibitor) abolished this contraction.
Conclusions These results suggest that neither stored Ca²⁺ nor the Ca²⁺-calmodulin-MLCK system is involved in the carbachol-induced Ca²⁺-free contraction of detrusor muscle. This Ca²⁺-independent contraction seems to be mediated by the activation of PKC coupled with agonist stimulation of the muscarinic receptor.     

腺病毒介导PDE5A1反义核酸改善糖尿病兔阴茎勃起功能的实验研究

目的探讨腺病毒介导PDE5A1反义核酸对海绵体平滑肌PDE5基因表达的抑制作用及对兔阴茎勃起功能的影响.方法25只成年雄性新西兰兔随机分为5组1组为正常对照组,4组静脉注射四氧嘧啶建立糖尿病性勃起功能障碍(ED)动物模型,分别将携带反义基因腺病毒载体、携带β-半乳糖苷酶基因腺病毒载体(β-gal组)、空载体及0.9%NaCl转染模型组阴茎海绵体.转染后第7天,电刺激盆神经测定各组阴茎海绵体内压(NSICP),评价阴茎勃起功能,ELISA法测定海绵体组织cGMP浓度,Western blot法分析海绵体组织中β-gal表达水平.结果反义核酸组海绵体组织cGMP浓度(25.6±2.5)fmol/mg蛋白,明显高于β-gal组(8.8±0.9)fmol/mg蛋白、空载体组(8.3±1.1)fmol/mg蛋白和糖尿病对照组(7.4±0.8)fmol/mg蛋白,差异有统计学意义(P＜0.05);反义核酸组NSICP增加幅度(66.2±3.6)mmHg,明显高于β-gal组(38.2±2.5)mmHg、空载体组(35.2±2.2)mmHg及糖尿病对照组(36.6±2.7)mmHg,差异有统计学意义(P＜0.05);与正常对照组(65.2±3.2)mmHg比较差异无统计学意义(P＞0.05);β-gal组海绵体组织β-gal表达水平明显高于其他组.结论腺病毒介导PDE5A1反义基因能改善糖尿病兔阴茎勃起功能,PDE5A1可作为ED基因治疗的重要靶基因.     

Relaxation degree of cavernous smooth muscle: a novel parameter to predict postoperative success in penile revascularization

Objective To investigate the role of a new preoperative parameter, relaxation degree (RD), in the prediction of postoperative success after deep dorsal vein arterialization operations. Patients and methods Chart reviews and electromyographic recordings were evaluated in 52 patients on whom deep dorsal vein arterialization was carried out for pure caverno-occlusive dysfunction. The efficiacy of the operation was assessed as improvement or failure according to the five-item version of international index of erectile function (IIEF). RD was defined as the percentage decrease in cavernous electrical activity (CEA) after intracavernous papaverine injection. Preoperative RD measurements were statistically compared between the improvement and the failure groups. Results The mean age of patients was 34.2 ± 8.1 years (range 25–49) with a mean follow-up of 32 ± 8 months. Improvement was observed in 39 (75%) and failure in 13 (25%) patients. The mean RD values were 60% and 32% for surgical improvement and failure groups respectively (P < 0.01). In patients with mild ED, the mean RD value was 70.3% whereas it was 28.7% in patients with severe ED. The RD value of greater than 40% predicts surgical success with a specifity of 75% and a sensitivity of 90%. Conclusion The RD value of cavernous muscle seems to decrease as the severity of ED increases. In addition, RD may predict the outcome of penile revascularization operations and it may be a useful preoperative indicator for surgical success.     

Pectoralis Major Muscle Flap: A New Support Approach to Mammaplasty, Personal Technique

Despite the significant evolution of mammaplasty techniques, some undesirable changes on the operated breasts result in evident dissatisfaction for both patients and doctors. The main reason is that the breast has a tendency to resume its previous shape months after the operation. In pursuit of a procedure that would avoid this untoward morphologic evolution, we set to work on the development of a new approach of broad fixation to maintain the breast shape and to avoid ptosis by using the inferior third of the pectoralis major muscle. The authors report their experience with 46 consecutive cases of breast reduction and mastopexy operated between March 1994 and November 1995, studying the surgical procedure employed, its advantages, limitations, and possible complications.     

Evaluation and Treatment of Erectile Dysfunction Following Spinal Cord Injury: A Review

ABSTRACT

The majority of spinal cord injured (SCI) men with upper motor neuron lesions have reflex erections. However, these erections are often not adequately sustained making it difficult if not impossible to have intercourse. The majority of SCI men with lower motor neuron lesions do not have erections. Penile implants are effective in producing erections following SCI. However, they have the disadvantages of being a surgical procedure and of having the risk of infections and erosion of the implant through the skin. Intracavernous injections of papaverine and phentolamine and vacuum erection devices have recently been added to our armamentarium of ways to treat erectile dysfunction. A major concern particularly in SCI men is that papaverine and phentolamine may cause prolonged erections in SCI men. We presently have little data on the use of vacuum devices in SCI men, but preliminary reports on those who are using FDA-approved devices appear promising. (J Am Paraplegia Soc 1991; 14: 43–51)