The mechanistic study on Wa medicine Niang-Mu-Liang medicinal liquor mitigating diabetes mellitus erectile dysfunction in rats by inhibiting ferroptosis

Background:This study aims to investigate the therapeutic effect of Wa medicine Niang-Mu-Liang medicinal liquor(NML)on rats with diabetes mellitus erectile dysfunction(DMED)and its impact on the ferroptosis signaling pathway.Methods:Thirty Sprague-Dawley rats were randomly divided into three groups:Control,DMED,and NML.After establishing the DMED model,treatments were administered for 8 weeks.After the administration,apomorphine hydrochloride tests were conducted to measure the mass and organ index of testes and epididymides,sperm concentration and viability in each group.Penile corpus cavernosum tissues were stained with hematoxylin and eosin.Nitric oxide and cyclic guanosine monophosphate levels in the penile corpus cavernosum tissues were determined using biochemical kits and enzyme-linked immunosorbent assay,while the expression of proteins related to the ferroptosis signaling pathway was measured by Western blot.Results:Compared to the DMED group,the DMED rats treated with NML showed significantly increased erection frequency,testicular and epididymal mass and index,sperm count and viability,along with noticeable improvement in the pathological morphology of penile corpus cavernosum.The content of nitric oxide and cyclic guanosine monophosphate,and the expression of ferritin heavy chain,ferritin light chain,and glutathione peroxidase 4 proteins in penile corpus cavernosum tissue were elevated,while the expression of transferrin and STEAP3 proteins was reduced.Conclusion:NML can improve erectile function in DMED rats by inhibiting the ferroptosis signaling pathway.

Pathogenesis and treatment of diabetes mellitus-related erectile dysfunction: current therapies and potential challenges

Erectile dysfunction(ED)is one of the important complications of diabetes,which is very common in diabetic patients,affecting more than half of male patients,and the incidence of the disease is about 3.5 times that of the normal population.The pathogenesis of diabetic erectile dysfunction(DMED)is complex,involving nerve,vascular,endocrine,muscular and psychological aspects.At present,the therapeutic approaches of DMED include drug therapy,surgery,physical therapy and so on.This article provides a review of current research on the pathogenesis and treatment of DMED.Further elucidation of the pathogenesis of DMED and the development of new therapeutic approaches are of great significance for the prevention and treatment of DMED.

Mechanism of the Xuefu Zhuyu decoction in treating diabetes mellitus erectile dysfunction based on the CaSR/Gq-PLC-PKC pathway

Background:To investigate the mechanism of Xuefu Zhuyu decoction in the treatment of diabetes mellitus erectile dysfunction.Methods:Rats with diabetes mellitus erectile dysfunction were developed using streptozocin and randomly assigned into model,low-dose herbal,and high-dose herbal groups.All rats were administered normal saline or the corresponding drugs by oral gavage for 4 weeks.The related indices were detected using enzyme-linked immunosorbent assays,immunohistochemistry,western blotting,and transmission electron microscopy.Results:The levels of lectin-like oxidized low-density protein receptor-1,endothelin-1,NADH oxidase,vascular cell adhesion molecule-1,and intercellular adhesion molecule-1 in the model group were significantly higher than they were in the mock group but lower than they were in the herbal treatment group.The level of nitric oxide was lower in the model group than was in the mock group but higher than the level in the herbal treatment group.The calcium-sensitive receptor,phospho-protein kinase Cδ/protein kinase Cδ,phosphorylated c-Jun amino-terminal kinase/c-Jun amino-terminal kinase,and phospho-P38 mitogen-activated protein kinase/P38 mitogen-activated protein kinase expression levels in the model group were higher than were in the mock group but lower than were in the herbal treatment group.The structures of the Corpus cavernosum penis endothelial cells were significantly improved in the herbal treatment group than they did in the model group.Conclusion:Xuefu Zhuyu decoction can decrease injury to the endothelium,improve vascular endothelial diastolic and contractive function,and inhibit vascular fibrosis in rats with diabetes mellitus erectile dysfunction.This mechanism may be related to the CaSR/Gq-PLC-PKC pathway.

Neurovascular Evaluation in Eugonadal Men with Type 2 Diabetes Mellitus and Erectile Disfunction:A Comparative Study between Responders and Not Responders to Phosphodiesterase 5 Inhibitors

The aim of our study was to evaluate functional alterations of the corpus cavernusum and its correlation with the lack of response to treatment with PDE5i in eugonadal patients with Type 2 Diabetes Mellitus and Erectile Dysfunction. In this prospective randomized study we included 157 patients. All were treated with 5 mg tadalafil daily and 100 mg sildenafil on demand and the response to treatment was assessed in 6 month by dividing them into 2 groups: G1: Good response. Significative improvement of erectile function according to IIEF-5, and G2: There was not an improvement with the treatment. At the end of the treatment we performed neurological and vascular studies to both groups. Also we performed CC-EMG in order to evaluate penile autonomic neuropathy. 82 patients were included in G1 and 75 in G2. The time evolution of the ED was 1.5 years for G1 and 5 years for G2. Average fasting glucose and glycosilated hemoglobin values were significantly higher in G2 than in G1. Also we observed significant differences in penile vascular parameters between both groups. Peripheral neuropathy parameters did not show differences between both groups. Cavernous smooth muscle electromyography showed asynchronous and asymetric potentials in G1 (minimal autonomic neuropathy) and denervation potentials in G2 characteristic of severe CC damage. It is concluded that vascular and autonomic alterations are causes of severe CC damage and lack of response to treatment with PDE5i in this population. Peripheral neuropathy is not part of this process.

Stem cell therapy and diabetic erectile dysfunction:A critical review

Erectile dysfunction(ED)has been identified as one of the most frequent chronic complications of diabetes mellitus(DM).The prevalence of ED is estimated to be about 67.4%in all DM cases worldwide.The pathophysiological process leading to ED involves endothelial,neurological,hormonal,and psychological factors.In DM,endothelial and neurological factors play a crucial role.Damages in the blood vessels and erectile tissue due to insulin resistance are the hallmark of ED in DM.The current treatments for ED include phosphodiesterase-5 inhibitors and penile prosthesis surgery.However,these treatments are limited in terms of just relieving the symptoms,but not resolving the cause of the problem.The use of stem cells for treating ED is currently being studied mostly in experimental animals.The stem cells used are derived from adipose tissue,bone,or human urine.Most of the studies observed an improvement in erectile quality in the experimental animals as well as an improvement in erectile tissue.However,research on stem cell therapy for ED in humans remains to be limited.Nevertheless,significant findings from studies using animal models indicate a potential use of stem cells in the treatment of ED.

Relationship between Gut Microbiota and Type 2 Diabetic Erectile Dysfunction in Sprague-Dawley Rats

In order to investigate the relationship between gut microbiota and type 2 diabetic erectile dysfunction(T2DED), we analyzed the characteristics of gut microbiota in the Sprague-Dawley(SD) rats with T2DED. Thirty-five SD rats were randomly divided into two groups: control group(n=15) with normal diet, and experimental group(n=20) with construction of T2D model. Faecal and serum samples were collected at 2nd and 8th week after establishment of T2D model, respectively. Faecal samples were used for analysis of gut microbiota, and serum samples for detection of trimethylamine N-oxide(TMAO), lipopolysaccharide(LPS), and inflammatory factors like interleukin-1(IL-1), IL-2, IL-10, and monocyte chemoattractantprotein-1(MCP-1). The main compositions of gut microbiota were Bacteroidetes, Proteobacteria and Firmicutes at the phylum level, and Oscillospira, Allobaculum, Bacteroides, Ruminococcus, SMB53, Prevotella, Coprococcus, Sutterella and Blautia at the genus level with relatively higher abundance in all SD rats. The relative abundance of Enterococcus, Corynebacterium, Aerococcus, Facklamia(opportunistic pathogens in most case) increased, and that of Allobaculum, Bifidobacterium, Eubacterium, Anaerotruncus(beneficial bacteria) decreased in T2DED group as compared with that at 2nd week after establishment of T2D model(T2D2 group). The serum contents of TMAO, LPS, IL-1, IL-2, IL-10 and MCP-1 in T2DED group were significantly higher than those in control group. The gut microbiota of T2DED rats was inhibited. The gut microbiota of T2DED rats had changed, as the relative abundance of beneficial bacterium was decreased while that of opportunistic pathogens was increased. The variations of gut microbiota might lead to inflammation and prompt the emergence of erectile dysfunction in the rats with T2D. TMAO might play an important role in the formation of T2DED.

Effect of icarisid II on diabetic rats with erectile dysfunction and its potential mechanism via assessment of AGEs, autophagy, roTOR and the NO-cGMP pathway

可勃起的机能障碍(编辑) 是糖尿病 mellitus 的主要复杂并发症。Icariin 被显示了通过它的 bioactive 形式提高可勃起的功能， icarisid II。这研究经由对先进 glycosylation 结束的评价与编辑和它的潜在的机制在糖尿病的老鼠上调查 icarisid II 的效果产品(年龄) ， autophagy， mTOR 和 NO-cGMP 小径。Icarisid II 被一个酶的方法从 icariin 提取。在控制和糖尿病的编辑组，老鼠被管理正常盐；在 icarisid II 组，老鼠 intragastrically 是管理 icarisid II。可勃起的功能被测量 intracavernosal 压力 / 平均数评估动脉的压力(ICP/MAP ) 。年龄集中，氮的氧化物 synthase (NOS ) 活动和 cGMP 集中被酶免疫分析估计。房间增长被分析使用甲基 thiazolyl tetrazolium 试金和流动 cytometry。Autophagosomes 被传播电子显微镜学， monodansylcadaverine 染色和 GFP-LC3 本地化观察。在 autophagy 的 NOS isoforms 和关键蛋白质的表示被西方的污点检验。我们的结果证明了 Icarisid II 增加了 ICP/MAP 价值，光滑的肌肉房间(SMC ) 生长曲线， S 阶段和 SMC/collagen 纤丝(SMC/CF ) 比例和减少的 Beclin 1 (P&#x0003c； 0.05 ) 。Icarisid II 显著地增加了 proliferative 索引和 p-p70S6K (Thr389 ) 层次并且减少 autophagosomes 的数字和 LC3-II 的层次(P&#x0003c； 0.01 ) 。Icarisid II 减少了年龄集中和增加的 cGMP 集中， NOS 活动(P&#x0003c； 0.05 ) 并且 cNOS 层次(P&#x0003c； 0.01 ) 在糖尿病的编辑组。因此， Icarisid II 组成有希望的混合物因为糖尿病的编辑和力量涉及 SMC 增长和 NO-cGMP 小径和年龄， autophagy 和 mTOR 小径的 downregulation 的 upregulation。

Magnitude and Factors Contributing to Erectile Dysfunction among Diabetic Men Attending the Diabetic Clinic at Debre Tabor Comprehensive and Specialized, Hospital in North West, Ethiopia 2020, Institutional Based Cross-Sectional Study

Background: Erectile dysfunction, which is defined as difficult to attain and maintain an erectile function enough to permit sufficient sexual performance, is accepted to be a big problem especially among diabetic patients. Objective To assess the Magnitude and factors contributing to Erectile Dysfunction Among Diabetic men attending the diabetic clinic in Debre Tabor Comprehensive and Specialized hospital, North West Ethiopia. Methods: Hospital based cross-sectional study was conducted on 362 participants in Debre Tabor Comprehensive and Specialized Hospital from August - December 2020 using systematic random sampling technique. Data were analyzed with SPSS Version 23. Binary and multivariable logistic regressions were done to identify factors which were contributing to erectile dysfunction. P-value < 0.05 and the corresponding 95% CI of odds ratios were considered to declare the result as statistically significant. Results: Three hundred sixty-two diabetes patients participating in the study with the mean age being 44.4 ± 14.47 (range: 18 - 78) years were interviewed. The majority (59.7% with CI: 54.4:64.6) of the diabetes patients suffered from erectile dysfunction and 13.3% (95% CI 17.8% - 26.8%) were found to have severe erectile dysfunction. Bi-variable analysis showed duration of diabetes (>10 years), type of diabetes (type II), physical exercise, drinking alcohol, BMI, blood glucose, and blood pressure were associated with erectile dysfunction at 5% level (p ≤ 0.05). Multiple logistic regression analysis revealed that duration of diabetes 10 years (AOR = 6.2, 95% CI: 2.78 - 13.85, p = 0.001), co-existing hypertension (AOR: 3.59, 95% CI: 1.58 - 8.19, p = 0.002), physically inactive (AOR = 2.87, 95% CI: 1.53 - 8.31, p = 0.003), unsafe level alcohol intake (AOR: 3.09;95% CI 1.45 - 6.59*, p = 0.003) and raised blood glucose (AOR: 15.26, 95% CI: 7.82 - 29.77, p = 0.004) were independent risk factors but no association was found with other variables. Conclusion: The magnitude of erectile dysfunction in this study population was 59.7% and associated with the type of diabetes;duration of diabetic, physical exercise, alcohol drinking, increase in blood pressure, and elevated blood glucose level were independently correlated with erectile dysfunction.

STUDY ON HEMODYNAMICS OF ERECTION IN DIABETIC ERECTILE DYSFUNCTION

To study the cavernosa hemodynamics in diabetic erectile dysfunction (ED).Methods 22 diabetic and 35 psychic ED patients were studied by intracavernosum injection of a mixture papaverine and phentolamine ( 30/ l mg ) to assess the hemodynamics changes of the corpus cavernosum by means of colour duplex ultrasonography. Results The average hemodynamics data of the diabetic ED patients vs that of the psychogenic ED patients in terms of peak flow velocity ( PFV) : 20. 06 + 7. 15cm/s vs 35. 82 +9.41cmfs, end diastolic velocity (EDV) : 8. 82 + 0. 35cmf s vs 5.51 + 0. 42cm/s, artery diameter (Ad) : 0. 78 + 0. 25cm vs 1. 01 + 0. 42cm,vein diameter (Vd) : 1.05 +0. 32mm vs 1.21 +0.45mm, resistance index(R1) : 0. 72 +0. 28 vs 0. 98 +0. 31 ,mean velocity of artery ( MV) :6. 71 +0. 27cm/s vs 10. 31 +3.32cmfs, dorsal deep vein flow( DDVF) ： 28. 81 +6. 32cm!s vs 25. 74 + 0. 58cm/s. Stasticstical differences existed in PFV, Ad,R1 and MV( P <0.01 ). The arterial wall is thick and rigid in diabetic ED patients. Conclusion Atheroscleorsis and veno-occlusive dysfunction of the corpus cavernosum are essential to the development of diabetic ED.

Peyronie's disease:a silent consequence of diabetes mellitus

瞄准：与 Peyronie 的疾病(PD ) 和糖尿病(DM ) 调查病人的临床的特征。方法：在一个 8 年的时期期间，在我们的门诊病人诊所看见的 307 个人的一个总数与 PD 被诊断。临床的特征，阴茎畸形和有 PD 和 DM 的病人的可勃起的地位一起(n=102 ) 回顾地被分析并且与有没有为全身的脉管的疾病(n=97 ) 的风险因素独自一个的 PD 的病人相比。结果：在有 DM 和性机能障碍的人之中的 PD 的流行是 10.7% 。有 PD 的糖尿病的病人的吝啬的年龄是(55.9+/-8.9 ) 年；在里面它是的没有风险因素组(48.5+/-9.0 ) 年(P 【 0.05 ) 。DM 的中部的持续时间是 5 年。有 PD (56.0%) 的糖尿病的病人的多数在长期的阶段介绍了(P 【 0.05 ) ，并且他们是更可能的有严重阴茎畸形(】60 度) 比没有风险因素组(P 【 0.05 ) 。在糖尿病的组，最普通的主要症状是阴茎弯曲(81.4%) ，随勃起(14.7%) 在阴茎(22.5%) 和阴茎疼痛的柄上由一个摸得出的小瘤列在后面。19.6% 病人的一个总数不知道他们在糖尿病的组的阴茎畸形。如果由历史并且响应 intracavernosal 注射和刺激测试，可勃起的功能显著地与 PD 和 DM 在病人被减少(P 【 0.05 ) 。结论：DM 可能在 PD 夸大纤维变性过程。有 PD 的糖尿病的病人有严重畸形和可勃起的机能障碍(编辑) 的更高的风险。PD 似乎是 DM 的沉默后果并且应该活跃地在糖尿病的男人被寻求。

Erectile dysfunction in chronic kidney disease:From pathophysiology to management

Chronic kidney disease(CKD) is encountered in millions of people worldwide,with continuously rising incidence during the past decades,affecting their quality of life despite the increase of life expectancy in these patients.Disturbance of sexual function is common among men with CKD,as both conditions share common pathophysiological causes,such as vascular or hormonal abnormalities and are both affected by similar coexisting comorbid conditions such as cardiovascular disease,hypertension and diabetes mellitus.The estimated prevalence of erectile dysfunction reaches 70% in end stage renal disease patients.Nevertheless,sexual dysfunction remains under-recognized and under-treated in a high proportion of these patients,a fact which should raise awareness among clinicians.A multifactorial approach in management and treatment is undoubtedly required in order to improve patients' quality of life and cardiovascular outcomes.

Efficacy and safety of low-intensity shockwave therapy plus tadalafil 5 mg once daily in men with type 2 diabetes mellitus and erectile dysfunction:a matched-pair comparison study

Low-intensity extracorporeal shockwave therapy(LiESWT)represents a promising treatment for patients with erectile dysfunction(ED).We investigated the efficacy of LiESWT combined with tadalafil 5 mg once daily in men with type 2 diabetes mellitus(T2DM)and ED and compared LiESWT protocols administering different number of shockwaves.We performed a retrospective matched-pair comparison using data from a prospectively maintained database.Seventy-eight patients who received tadalafil 5 mg once dai7ly for 12 weeks+LiESWT performed with an electrohydraulic source for 3 weeks(Group A)were matched 1:1 to patients who received tadalafil 5 mg once daily alone for 12 weeks(Group B).A subgroup analysis was performed according to the number of shockwaves delivered during each session(1500,1800,and 2400 in subgroup A1,A2,and A3,respectively).The mean International Index of Erectile Function-5(IIEF-5)score variations with respect to baseline recorded at 4,12,and 24 weeks after the end of the treatment were investigated as treatment outcomes.The mean IIEF-5 scores significantly improved in all groups and subgroups at 4-week follow-up without intergroup differences.At 12-and 24-week follow-up,the mean IIEF-5 improvement was significantly higher among patients in the A3 subgroup(+5.0±2.1[P<0.001]and+4.7±2.3[P<0.001],respectively).The combined approach with tadalafil 5 mg once daily and LiESWT with a protocol involving 2400 shockwaves provides significant advantages in terms of IIEF-5 improvement and durability compared to tadalafil 5 mg once daily alone in patients with T2DM and ED.

Transplantation of endothelial progenitor cells transfected with VEGF165 to restore erectile function in diabetic rats

现在的学习调查了移植 endothelial 祖先细胞(EPC ) 的效果有进有糖尿病的可勃起的机能障碍(编辑) 的老鼠的阴茎海绵体的脉管的 endothelial 生长因素基因(VEGF165 ) 的 transfected。糖尿病的编辑的一个老鼠模型经由 streptozotocin 的 intraperitoneal 注射被构造。在 streptozotocin 治疗以后，预先对待从每三组老鼠的 EPC 被移植进他们的阴茎海绵体。我们的结果，监视的后面的 intracavernosal 压力(ICP ) ，看了在试用组在老鼠之中显著地增加的那 ICP 什么时候在基础条件和电的刺激期间与从在 blank-plasmid 和控制的老鼠的结果相比组织(P < 0.01 为两比较) 。组织学的检查在试用组在老鼠的阴茎海绵体揭示了广泛的 neovascularisation。荧光显微镜学在熬过的试用组移植 EPC 显示了那许多，区分了房间进 endothelial 并且集成于 neovascularisation 的地点。基于这研究的结果，我们断定进有糖尿病的编辑的老鼠的阴茎海绵体的 VEGF165-transfected EPC 的移植恢复可勃起的功能。

Lipoxin A4 improves erectile dysfunction in rats with type I diabetes by inhibiting oxidative stress and corporal fibrosis

以前的研究证明了在老鼠的阴茎纸巾的氧化应力和肉体的纤维变性是糖尿病的 mellitus (DMED ) 导致的可勃起的机能障碍的关键病理学的因素。Lipoxin A4 (LXA4 ) 被报导禁止氧化压力和纤维变性疾病，当它是否能在可勃起的功能上施加一个保护的角色，是时，别变清。类型我糖尿病的 mellitus (DM ) 用 streptozotocin 在三十只男 10-week-old Sprague-Dawley 老鼠被导致。十个星期以后，有 apomorphine 测试证实的 DMED 的 22 只老鼠被划分成二个组：DMED 组(n = 11 ) 并且 DMED + LXA4 组(n = 11；为 4 个星期的 LXA4 注射日报) 。另外，另一十只匹配年龄的老鼠形成了控制组。我们发现那可勃起的功能显著地与控制组相比在 DMED 组被损害，但是在 DMED + LXA4 组被改进。同样，在 DMED 组的过去激活的氧化压力和损害 endothelial 功能是在 DMED + LXA4 组改进的两个。而且，给严肃的肉体的纤维变性看的 DMED 组，它是也在 DMED + LXA4 组由 LXA4 的处理禁止了。一起拿， LXA4 能在氧化应力和纤维变性上施加一个抑制角色有效地改进 DMED。

G protein-coupled receptor kinase 2 inhibition improves erectile function through amelioration of endothelial dysfunction and oxidative stress in a rat model of type 2 diabetes

Type 2 diabetes mellitus (T2DM)is a common cause of erectile dysfunction (ED).It has been demonstrated that G protein-coupled receptor kinase 2 (GRK2)overexpression contributes to diabetic endothelial dysfunction and oxidative stress,which also underlies ED in T2DM.We hypothesized that GRK2 overexpressed and attenuated endothelial function of the cavernosal tissue in a rat model of T2DM.T2DM rats were established by feeding with a high-fat diet (HFD)for 2 weeks and then administering two intraperitoneal (IP) injections of a low dose of streptozotocin (STZ),followed by continuous feeding with a HFD for 6 weeks.GRK2 was inhibited by IP injection of paroxetine,a selective GRK2 inhibitor,after STZ injection.Insulin challenge tests,intracavernous pressure (ICP), GRK2 expression,the protein kinase B (Akt)/endothelial nitric oxide synthase (eNOS)pathway,nicotinamide adenine dinucleotide phosphate (NADPH)oxidase subunit gp91phox,nitric oxide (NO),reactive oxygen species (ROS)production,and apoptosis in cavernosal tissue were examined.Less response to insulin injection was observed in T2DM rats 2 weeks after HFD.Markedly increased GRK2 expression,along with impaired Akt/eNOS pathway,reduced NO production,increased gp91phox expression and ROS generation,increased apoptosis and impaired erectile function were found in T2DM rats.inhibition of GRK2 with paroxetine ameliorated Akt/eNOS signaling,restored NO production,downregulated NADPH oxidase,subsequently inhibited ROS generation and apoptosis,and ultimately preserved erectile function.These results indicated that GRK2 upregulation may be an important mechanism underlying T2DM ED,and GRK2 inhibition may be a potential therapeutic strategy for T2DM ED.

针药并用治疗气阴两虚兼瘀型糖尿病性勃起功能障碍的疗效观察及对血管内皮功能及相关生长因子的影响

目的 观察针刺联合益气养阴活血方治疗气阴两虚兼瘀型糖尿病性勃起功能障碍的临床疗效及对血管内皮功能及相关生长因子的影响。方法 将90例气阴两虚兼瘀型糖尿病性勃起功能障碍患者随机分为治疗组和对照组,每组45例。对照组予糖尿病基础治疗及他达拉非片口服治疗,治疗组在对照组基础上采用针刺联合益气养阴活血方。比较两组国际勃起功能指数-5(international index of erectile function-5, IIEF-5)评分和中医证候积分变化,比较两组血清内皮素-1(endothelin-1, ET-1)、血管紧张素-Ⅱ(angiotensin Ⅱ, Ang-Ⅱ)、一氧化氮(nitric oxide, NO)和血管活性肠肽(vasoactive intestinal peptide, VIP)含量变化,比较两组血清内皮生长因子(vascular endothelial growth factor, VEGF)、转化生长因子-β(transforming growth factor-β, TGF-β)、成纤维细胞生长因子-21(fibroblast growth factor 21, FGF-21)和胰岛素样生长因子-1(insulin-like growth factor 1, IGF-1)含量变化,并比较两组临床疗效。结果 治疗后,两组IIEF-5评分高于治疗前(P<0.05),对照组勃起无力、腰膝酸软、阴部刺痛及中医证候积分总分低于治疗前(P<0.05),治疗组中医证候各项积分及总分低于治疗前(P<0.05);且治疗组IIEF-5评分高于对照组(P<0.05),治疗组中医证候各项积分及总分低于对照组(P<0.05)。治疗后,两组血清ET-1和AngⅡ低于治疗前,NO和VIP高于治疗前(P<0.05);且治疗组血清ET-1和AngⅡ低于对照组,NO和VIP高于对照组(P<0.05)。治疗后,两组血清VEGF和IGF-1高于治疗前,TGF-β和FGF-21低于治疗前(P<0.05);且治疗组血清VEGF和IGF-1高于对照组,TGF-β和FGF-21低于对照组(P<0.05)。治疗组总有效率为90.7%,高于对照组的73.8%(P<0.05)。结论 在西药治疗的基础上,针刺联合益气养阴活血方能够改善气阴两虚兼瘀型糖尿病性勃起功能障碍患者临床症状,提高治疗效果,可能与改善血管内皮功能、调节相关生长因子有关。

Is Li-ESWT effective in diabetic patients with severe erectile dysfunction?

Noninvasive low-intensity extracorporeal shockwave treatment(Li-ESWT)has been widely used to treat erection disorders.There is no clear information regarding either the selection of patients for the treatment or the treatment protocol.In this study,we aimed to investigate the efficacy of extracorporeal shockwave therapy in diabetic patients with severe erectile dysfunction(International Index of Erectile Function-5[IIEF-5]scores of 5 to 7).Sixty-three diabetes mellitus patients with erectile dysfunction having IIEF-5 scores of 5 to 7 and not showing a recovery of potency despite phosphodiesterase type 5 inhibitor therapy for the past 6 months were included in the study.The patients were evaluated based on their IIEF-5 scores and Erection Hardness Scale scores.The IIEF-5 score(mean±standard deviation[s.d.])increased from 5.29±1.67 to 5.56±1.85,with a difference of 0.27±0.18(P>0.05).The Erection Hardness Scale scores(mean±s.d.),on the other hand,increased from 1.46±0.50 to 1.48±0.50,with a difference of 0.02±0(P>0.05).In conclusion,the response to phosphodiesterase type 5 inhibitors did not change after extracorporeal shockwave treatment in diabetes mellitus patients with severe erectile dysfunction(IIEF-5 scores of 5 to 7).

GPR120激动剂通过β-Arrestin2途径改善高糖诱导的海绵体内皮细胞功能障碍

目的探讨激活G蛋白偶联受体(GPR)120对高糖诱导的人类阴茎海绵体内皮损伤修复的影响,以期为寻找糖尿病性勃起功能障碍(DMED)新的药物开发靶点提供理论依据。方法收集海绵体植入手术患者术中废弃海绵体组织提取海绵体内皮细胞进行原代培养,用高浓度葡萄糖诱导内皮细胞损伤,再以GPR120激动剂治疗,观察对比不同处理的细胞一氧化氮(NO)释放量、细胞迁移、血管生成等功能。结果成功提取人类海绵体内皮细胞进行原代培养并鉴定;发现GPR120在人类海绵体内皮细胞中稳定表达,且与内皮型一氧化氮合酶(eNOS)存在共定位;与高糖损伤组相比,GPR120激动剂治疗组NO释放量、划痕愈合率和血管生成率均显著增加(P<0.05);沉默β-Arrestin2后GPR120激动剂失去原有的治疗效果。结论高糖培养可诱导海绵体内皮细胞功能障碍,GPR120激动剂能够治疗海绵体内皮功能障碍,沉默β-Arrestin2后GPR120激动剂无法改善内皮功能。

糖尿病对大鼠性功能及阴茎海绵体组织形态学、α-SMA表达的影响

目的观察糖尿病模型大鼠的性功能情况,探索高血糖继发性功能减退的可能机制。方法实验大鼠随机分为空白组(5只)和糖尿病组(15只),糖尿病动物模型构建成功后,评估2组的性功能;观察2组睾丸组织学特征;测定2组阴茎组织α-平滑肌肌动蛋白(α-smooth muscle actin,α-SMA)的表达情况。结果血清性激素水平显著降低(P<0.01);组织形态学观察显示糖尿病组睾丸组织间质紊乱,阴茎组织平滑肌细胞较空白组减少,而纤维化程度加重;糖尿病组α-SMA的阳性细胞表达显著降低(P<0.01)。结论糖尿病大鼠性激素水平降低、阴茎海绵体平滑肌细胞数减少、阴茎海绵体α-SMA表达量下降、睾丸间质结构紊乱,平滑肌细胞形态的转变以及纤维化程度的加重是本病的重要表型特征,探索针对该表型特征的诊疗将具有重要意义。