阻塞性睡眠呼吸暂停低通气综合征患者亚临床右心室功能障碍的肺动脉硬化度

目的:研究阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者发生亚临床的右心室功能障碍时其肺动脉硬化度(PAS)的变化.方法:实验组选取的是经多导睡眠监测仪(PSG)确诊的80例OSAHS患者,根据AHI的不同分成3组,对照组选取的是同一时间段的35例健康者.使用二维超声收集所需常规超声参数,使用速度向量成像(VVI)技...     

血脂异常与勃起功能障碍

目的：探讨血脂异常与勃起功能障碍（ED）的相关性。方法：本文应用临床流行病学研究方法。比较120例伴有血脂异常的ED和120位正常勃起功能男性的空腹甘油三酯（TG）、总胆固醇（TC）、低密度脂蛋白（LDL）和高密度脂蛋白（HDL）。结果：病人组与对照组之间的TC、LDL和HDL比较,统计学处理有显著差异（P〈0．05,P〈0．05,P〈0．05）,而TG则无显著差异（P〉0．05）。高胆固醇血症的OR值为1．58,高低密度脂蛋白血症的OR值为1．78。结论：研究结果显示,血清高TC、高LDL和低HDL与ED密切相关,血脂异常是血管型ED的主要致病因素之一。     

都江堰友爱学校地震伤员康复状况调查分析

目的分析全国首家无障碍学校——四川省都江堰友爱学校地震伤员的伤情、功能障碍、康复现状及需求,为下一步康复医疗提供依据。方法对105例在校伤员进行现场功能评估,采用截肢身体意象评估量表(AB IS),对40名截肢伤员进行问卷调查。结果 105例伤员中,骨折44例(41.9%)、截肢40例(39%)、挤压伤15例(14.2%)、脑外伤6例(5.7%);大都存在的不同程度、多种功能障碍问题,其中肌力减退62例(59.1%),肌肉萎缩32例(30.2%),关节活动度(ROM)受限49例(46.7%),瘢痕粘连增生70例(66.7%),感觉障碍14例(13.3%),关节挛缩32例(30.5%),步态异常23例(21.9%),生活不能完全自理26例(24.8%)。结论 105例伤员均有不同程度的康复需求,需要进一步的康复指导与治疗;伤员的心理状况也需要关注。     

成都市女性性功能障碍的调查与相关因素的探析

目的:对成都市区FSD的患病情况进行调查,并探寻可能对其造成影响的相关因素。方法:以2015年7月至12月于四川大学华西医院健康体检中心进行体检的女性作为调查对象,应用中文版女性性功能指数量表(CVFSFI)及Beck抑郁问卷第二版(BDⅠ-Ⅱ)进行问卷调查,应用SPSS19.0建立数据库进行统计分析。结果:本次研究共发放问卷1237份,回收完整填写问卷1116份(回收率为90.2%)。女性性功能障碍(FSD)的发生率为26.1%,6个维度出现问题的比例由高到低依次为:性交疼痛23.4%,性满意度低22.6%,性高潮障碍21.5%,阴道润滑困难19.1%,性欲低下17.2%,性唤起困难15.9%。总体CVFSFI平均总分为(25.756±3.878)分。CVFSFI总分及6个维度的得分随着年龄的增长而减小。各个年龄组FSD发生率分别为:20~29岁组16.7%;30~39岁组21.9%;40~49岁组24.6%;≥50岁组64.7%。不同年龄组间,FSD发生率及各维度出现问题的比例差异均有统计学意义(P均<0.001),且随着年龄的增长有明显的增加。多因素Logistics回归分析显示,受教育(OR=0.654)是FSD的保护因素;年龄(OR=1.042)、BMI(OR=1.073)、绝经(OR=3.498)以及抑郁(OR=1.033)为FSD的危险因素。结论:成都市女性发生性功能障碍的比例约为26.1%,其中性交疼痛和性满意度低为主要表现。分析得出女性发生性功能障碍可能与年龄、BMI较大,受教育水平较低,以及处于绝经、抑郁状态有关。     

High Salt Intake Impairs Erectile Function in Salt-Sensitive Rats Through Mineralocorticoid Receptor Pathway Beyond Its Effect on Blood Pressure

BackgroundHigh salt intake is a risk factor for hypertension, which can potentially lead to erectile dysfunction (ED); however, the underlying pathological mechanisms remain unclear.AimTo investigate whether erectile function is directly impaired by high salt intake and whether selective inhibition of mineralocorticoid receptor (MR) could provide protection from ED.Methods6-week-old male Dahl salt-sensitive rats were randomly divided into 3 groups: normal diet (0.3% NaCl; control, n = 8), high-salt diet (8% NaCl; HS, n = 8), and high-salt diet plus eplerenone (HS + EPL, n = 11). HS + EPL rats were orally administered daily doses of EPL (75 mg/kg) for 6 weeks; control and HS rats received purified water on the same schedule.OutcomesAt the end of the study period, erectile function was evaluated by measuring intracavernosal pressure and mean arterial pressure after cavernous nerve stimulation. Serum levels of asymmetric dimethylarginine and L-arginine were determined using ultraperformance liquid chromatography–tandem mass spectrometry. Quantitative PCR was used to assess the expression of MR, inflammation, and oxidative stress markers (nicotinamide adenine dinucleotide phosphate oxidase-1/4, p22^phox, interleukin-6, and superoxide dismutase-1), and protein arginine N-methyltransferase-1.ResultsThe intracavernosal pressure/mean arterial pressure ratio was significantly lower, whereas systolic blood pressure, MR expression, serum asymmetric dimethylarginine levels, oxidative stress, and levels of inflammatory biomarkers were significantly higher in HS rats than in control rats (P < .05). EPL administration significantly improved each of these parameters except systolic blood pressure and MR expression. No significant intergroup differences were observed for L-arginine and superoxide dismutase-1 levels.Clinical TranslationOur results provide a rationale for the need of salt restriction and the use of selective MR inhibitors in prophylaxis or treatment of ED in men consuming a high-salt diet.Strengths & LimitationsWe are the first to report that the adverse impact of high salt intake on erectile function is mediated via MR activation, independent of its effect on blood pressure. A major limitation of this study is that responses of salt-resistant rats were not studied.ConclusionsHigh salt intake directly impaired erectile function in Dahl salt-sensitive rats, whereas selective MR inhibition ameliorated this effect.Kishimoto T, Kataoka T, Yamamoto Y, et al. High Salt Intake Impairs Erectile Function in Salt-Sensitive Rats Through Mineralocorticoid Receptor Pathway Beyond Its Effect on Blood Pressure. J Sex Med 2020;17:1280–1287.     

An Internally Validated Nomogram for Predicting the Likelihood of Improvement of Clinical Global Impression in Patients With Lifelong Premature Ejaculation Treated With Dapoxetine

BackgroundAlthough the introduction of dapoxetine has ushered in a new era in the treatment of premature ejaculation, many patients with lifelong premature ejaculation (LPE) exhibit an unimproved clinical global impression even after treatment with dapoxetine.AimTo investigate independent predictors of the improvement of Clinical Global Impression (iCGI) in patients with LPE treated with dapoxetine and develop a nomogram to predict a patient's likelihood of achieving iCGI.MethodsData of 243 patients with LPE diagnosed at Xijing Hospital (Xi'an, China) and Northwest Women's and Children's Hospital (Xi'an, China) from January 2019 to May 2020 were analyzed. Independent predictors of iCGI were identified, and a nomogram was developed using R software based on a multivariate logistic regression model. The predictive accuracy of the nomogram was measured using the area under the receiver operating characteristic curve. The nomogram was calibrated by comparing predictions with observations.Main Outcome MeasuresThe primary outcome was the patient-rated Clinical Global Impression of Change scale score after a 4-week course of dapoxetine treatment, which was collected via an online questionnaire. A Clinical Global Impression of Change score of ≥1 was defined as iCGI in this study.ResultsPatients with LPE with at least a bachelor's degree, a self-reported intravaginal ejaculation latency time of >1 minute, and an International Index of Erectile Function question 5 score of ≥3 were independent factors associated with achieving iCGI, whereas a Premature Ejaculation Diagnostic Tool question 1 score of ≥2 was an independent factor negatively associated with achieving iCGI. The predictive accuracy of the nomogram, which was developed by integrating all variables with independent predictive significance, was 0.710 (95% confidence interval: 0.702–0.718). In addition, the calibration plot demonstrated excellent agreement between predictions and observations.Clinical ImplicationsIf the predictive performance of our nomogram is further proven in multiple external validations, it can be used to select suitable patients for dapoxetine treatment, thereby reducing the number of patients discontinuing treatment.Strengths & LimitationsThis study developed the first nomogram for predicting the likelihood of achieving iCGI in patients with LPE treated with dapoxetine. However, our nomogram was not externally validated using independent cohorts from other institutions.ConclusionThis study identified several independent predictors of iCGI in patients with LPE treated with dapoxetine. An effective nomogram was developed to predict their likelihood of achieving iCGI. External validations using data of Western patients with LPE are required to test the broader applicability of this Chinese patient-based tool.Hou G, Gao M, Zhang L, et al. An Internally Validated Nomogram for Predicting the Likelihood of Improvement of Clinical Global Impression in Patients With Lifelong Premature Ejaculation Treated With Dapoxetine. J Sex Med 2020;17:2341–2350.     

宫血净口服液治疗崩漏的止血机理研究

目的:探讨宫血净口服液治疗崩漏的止血机理.方法:通过宫血净口服液与血康口服液对气虚血淤动物模型作用的相关指标的测定,采用单因素方差分析的统计学方法来分析宫血净口服液治疗崩漏的止血机理.结果:宫血净口服液能降低大鼠全血粘度比、血浆粘度、全血低切还原粘度、全血低切相对粘度,宫血净大剂量组与模型组对照,全血低切相对粘度、全血低切还原粘度数数值有极显著差异(P＜0.01),全血粘度比(高低切)、血浆粘度有显著性差异(P＜0.05);其中全血粘度比(低切)与血康组比较有显著性差异(P＜0.05);宫血净小剂量组与模型组对照全血低切相对粘度、全血低切还原粘度值有极显著性差异(P＜0.01),全血粘度比(高、低切)、血浆粘度有显著性差异(P＜0.05),与血康组比较,全血粘度比(高、低切)有显著性差异(P＜0.05);明显延长BT、CT,以小剂量组明显(P＜0.01);宫血净口服液大剂量组使E2上升,与模型组E2对照,有显著性差异(P＜0.05);宫血净口服液小剂量组有增强大鼠子宫收缩力的作用,使子宫平滑肌收缩幅度提高,活动力增强;阳性对照组有抑制子宫收缩幅度及收缩活动力的作用.结论;宫血净口服液治疗崩漏的止血机理上是一综合作用.     

Angiotensin-Receptor Blockade Improves Inflammation and Endothelial Dysfunction in Ankylosing Spondylitis: ARB-AS Study

Cardiovascular (CV) disease is the leading cause of premature death in ankylosing spondylitis (AS). Atherosclerosis and AS share similar pathogenic mechanisms. The proven benefits of angiotensin-receptor blockers (ARBs) in atherosclerotic cardiovascular disease and their role in immune mediation provide strong rationale to investigate its impact with olmesartan on inflammation and endothelial dysfunction in AS. To investigate the effect of olmesartan on inflammation and endothelial dysfunction in AS. 40 AS patients were randomized to receive 24 weeks of treatment with olmesartan (10 mg/day, n  = 20) and placebo ( n  = 20) as an adjunct to existing stable antirheumatic drugs. Markers of endothelial function included the following: flow-mediated dilation (FMD) assessed by AngioDefender, endothelial progenitor cells (EPCs) estimated by flow cytometry, nitrite (nitric oxide surrogate), intracellular adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule-1 (VCAM-1) and inflammatory measures including Bath ankylosing spondylitis disease activity index (BASDAI), ankylosing spondylitis disease activity score (ASDAS) and bath ankylosing spondylitis functional index (BASFI); erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP); proinflammatory cytokines (interleukin-1 [IL-1], IL-6, tumor necrosis factor-α [TNF-α]) and marker of oxidative stress– thiobarbituric acid reactive substances (TBARS) estimated at baseline and after treatment. Health assessment questionnaire disability index (HAQDI), 36-item short form survey (SF-36), and systematic coronary risk evaluation (SCORE) were estimated using standard tools. FMD improved significantly in the olmesartan group (5.83 ± 0.31% to 7.68 ± 0.27%, p  ≤  0.05) as compared with placebo (5.89 ± 0.35% to 6.04 ± 0.32%, p  = 0.33). EPC population, nitrite, VCAM-1, and TBARS levels improved significantly in olmesartan group as compared with placebo ( p ≤ 0.05). Olmesartan significantly decreased ASDAS, BASDAI, BASFI, ESR, CRP, IL-6, TNF-α, and SCORE as compared with placebo. HAQDI and SF-36 (PH) scores improved significantly in olmesartan group as compared with placebo. Olmesartan reduces inflammatory disease activity, improves quality of life (QOL), and decreases CV risk demonstrating the immunomodulatory, vasculoprotective, and cardioprotective potential of this drug in AS.     

Effects of interventions on cerebral perfusion in the Alzheimer's disease spectrum: A systematic review

Cerebral perfusion dysfunctions are seen in the early stages of Alzheimer's disease (AD). We systematically reviewed the literature to investigate the effect of pharmacological and non-pharmacological interventions on cerebral hemodynamics in randomized controlled trials involving AD patients or Mild Cognitive Impairment (MCI) due to AD. Studies involving other dementia types were excluded. Data was searched in April 2021 on MEDLINE, Embase, and Web of Science. Risk of bias was assessed using Cochrane Risk of Bias Tool. A meta-synthesis was performed separating results from MCI and AD studies. 31 studies were included and involved 310 MCI and 792 CE patients. The MCI studies (n = 8) included physical, cognitive, dietary, and pharmacological interventions. The AD studies (n = 23) included pharmacological, physical interventions, and phytotherapy. Cerebral perfusion was assessed with PET, ASL, Doppler, fNIRS, DSC-MRI, Xe-CT, and SPECT. Randomization and allocation concealment methods and subject characteristics such as AD-onset, education, and ethnicity were missing in several papers. Positive effects on hemodynamics were seen in 75 % of the MCI studies, and 52 % of the AD studies. Inserting cerebral perfusion outcome measures, together with established AD biomarkers, is fundamental to target all disease mechanisms and understand the role of cerebral perfusion in AD.