Are we ready to use new endoscopic scores for ulcerative colitis?

For ulcerative colitis(UC),the variability in inflammatory activity along the colon poses a challenge in management.The focus on achieving endoscopic healing in UC is evident,where the UC Endoscopic Index of Severity and Mayo Endoscopic Subscore are commonly used for evaluation.However,these indices primarily consider the most severely affected region.Liu et al recent study validates the Toronto Inflammatory Bowel Disease Global Endoscopic Reporting(TIGER)score offering a comprehensive assessment of inflammatory activity across diverse segments of the colon and rectum and a reliable index correlating strongly with UC Endoscopic Index of Severity and moderately with Mayo Endoscopic Subscore(MES).Despite recommendation,certain aspects warrant further invest-igation.Fecal calprotectin,an intermediate target,correlates with TIGER and should be explored.Determining TIGER scores defining endoscopic remission and response,evaluating agreement with histological activity,and assessing inter-endoscopist agreement for TIGER require scrutiny.Exploring the correlation between TIGER and intestinal ultrasound,akin to MES,adds value.

Score System Study for Hand-Extended Noodle Quality Based on HMW-GS Index in Wheat Flour

Hand-extended noodle, a special kind of noodle, requires particular quality flour to make it. High molecular weight glutenin subunits （HMW-GS） in wheat are important protein subunits, which affect flour quality. To improve breeding and selection efficiency of wheat varieties which are used in making hand-extended noodle, 100 spring wheat varieties were selected to study the importance of HMW-GS on noodle quality score indexes such as color, appearance, taste agreeability, toughness, stickiness, smoothness, taste, and total score, through methods of quantity theory and statistic evaluation. It was shown that the hand-extended noodle quality score of HMW-GS 1, 2°, N, 7, 7 ＋ 8, 17 ＋ 18, 22, 2 ＋ 10, 2 ＋ 11, 2＋ 12, 5 ＋ 10, and 10 was 5.40, 5.35, 0, 2.55, 2.56, 9.19, 0.05, 0.15, 1.49, 1.14, 10.00, and 5.14, respectively. The score system for hand-extended noodle quality based on HMW-GS index included eight multiple linear regression equations （R^2 〉 0.98）. Hence, using the HMW-GS composition, the eight hand-extended noodle quality indexes would be forecasted exactly. Results indicated that ideal subunit compositions of HMW-GS for this special usage were composition 1, 17 ＋ 18, 5 ＋ 10, or composition 2°, 17 ＋ 18, 5 ＋ 10. This standard could be used on variety selection in the early generation of breeding crosses. HMW-GS 2 ＋ 10, 2 ＋ 11, and 2 ＋ 12 were the least desirable subunits for hand-extended noodle, which should be avoided in wheat variety selection aimed for hand-extended noodle flour use.

Investigation on the Long Term Operational Stability of Underground Energy Storage in Salt Rock

Underground energy storage is an important function of all energy supply systems,and especially concerning the seemingly eternal imbalance between production and demand.Salt rock underground energy storage,for one,is widely applied in both traditional and renewable energy fields;and this particular technique can be used to store natural gas,hydrogen,and compressed air.However,resource diversification and structural complexity make the supply system increasingly uncertain with the passing years,leading to great challenges for energy storage facilities in the present,and perhaps going into the future as well.Hence,it is necessary to research the operation stability of underground energy storage further.In this paper,a stability evaluation index system of Underground Gas Storage(UGS)is constructed with natural gas as the main medium,according to FLAC 3D cavity creep simulation software,along with fuzzy membership function to comprehensively determine the impact factor scoring model;the subjective weight is calculated based on the improved Analytic Hierarchy Process(AHP),the objective weight is calculated by the Entropy Weight Method(EWM),the combined constant weight is obtained by combining the variance maximization theory,and introducing the variable weight theory to obtain a more accurate combined variable weight.Finally,with this all being considered and accounted for,and with the four different conditions designed for UGS deployment case analysis and verification taken into consideration,the combined variable weight evaluation achieved excellent results;compared with the traditional constant weight method,in fact,the new evaluation results are more rigorous and objective.

Expanding role of capsule endoscopy in inflammatory bowel disease

Capsule endoscopy has been shown to detect small bowel inflammatory changes better than any other imaging modality. Selection criteria have been optimized to increase the yield of capsule endoscopy in patients suspected to have Crohn's disease. Capsule endoscopy allows for earlier diagnosis of Crohn's disease of the small bowel and improved diagnosis of colitis in patients where it is unclear if they suffer from Crohn's or ulcerative colitis. A test capsule is available to assess for small bowel strictures and thus avoid capsule retention. A common language has been developed and a new scoring index will be added to capsule software. It is envisioned that the manner in which we treat Crohn's disease in the future will change, based on earlier diagnosis and treatment aimed at mucosal healing rather than symptom improvement.

Golgi protein-73:A biomarker for assessing cirrhosis and prognosis of liver disease patients

BACKGROUND Reliable biomarkers of cirrhosis,hepatocellular carcinoma(HCC),or progression of chronic liver diseases are missing.In this context,Golgi protein-73(GP73)also called Golgi phosphoprotein-2,was originally defined as a resident Golgi type II transmembrane protein expressed in epithelial cells.As a result,GP73 expression was found primarily in biliary epithelial cells,with only slight detection in hepatocytes.However,in patients with acute or chronic liver diseases and especially in HCC,the expression of GP73 is significantly up-regulated in hepatocytes.So far,few studies have assessed GP73 as a diagnostic or prognostic marker of liver fibrosis and disease progression.AIM To assess serum GP73 efficacy as a diagnostic marker of cirrhosis and/or HCC or as predictor of liver disease progression.METHODS GP73 serum levels were retrospectively determined by a novel GP73 ELISA(QUANTA Lite®GP73,Inova Diagnostics,Inc.,Research Use Only)in a large cohort of 632 consecutive patients with chronic viral and non-viral liver diseases collected from two tertiary Academic centers in Larissa,Greece(n=366)and Debrecen,Hungary(n=266).Aspartate aminotransferase(AST)/Platelets(PLT)ratio index(APRI)was also calculated at the relevant time points in all patients.Two hundred and three patients had chronic hepatitis B,183 chronic hepatitis C,198 alcoholic liver disease,28 autoimmune cholestatic liver diseases,15 autoimmune hepatitis,and 5 with other liver-related disorders.The duration of follow-up was 50(57)mo[median(interquartile range)].The development of cirrhosis,liver decompensation and/or HCC during follow-up were assessed according to internationally accepted guidelines.In particular,the surveillance for the development of HCC was performed regularly with ultrasound imaging and alpha-fetoprotein(AFP)determination every 6 mo in cirrhotic and every 12 mo in non-cirrhotic patients.RESULTS Increased serum levels of GP73(>20 units)were detected at initial evaluation in 277 out of 632 patients(43.8%).GP73-seropositivity correlated at baseline with the presence of cirrhosis(96.4%vs 51.5%,P<0.001),decompensation of cirrhosis(60.3%vs 35.5%,P<0.001),presence of HCC(18.4%vs 7.9%,P<0.001)and advanced HCC stage(52.9%vs 14.8%,P=0.002).GP73 had higher diagnostic accuracy for the presence of cirrhosis compared to APRI score[Area under the curve(AUC)(95%CI):0.909(0.885-0.934)vs 0.849(0.813-0.886),P=0.003].Combination of GP73 with APRI improved further the accuracy(AUC:0.925)compared to GP73(AUC:0.909,P=0.005)or APRI alone(AUC:0.849,P<0.001).GP73 levels were significantly higher in HCC patients compared to non-HCC[22.5(29.2)vs 16(20.3)units,P<0.001)and positively associated with BCLC stage[stage 0:13.9(10.8);stage A:17.1(16.8);stage B:19.6(22.3);stage C:32.2(30.8);stage D:45.3(86.6)units,P<0.001]and tumor dimensions[very early:13.9(10.8);intermediate:19.6(18.4);advanced:29.1(33.6)units,P=0.004].However,the discriminative ability for HCC diagnosis was relatively low[AUC(95%CI):0.623(0.570-0.675)].Kaplan-Meier analysis showed that the detection of GP73 in patients with compensated cirrhosis at baseline,was prognostic of higher rates of decompensation(P=0.036),HCC development(P=0.08),and liver-related deaths(P<0.001)during follow-up.CONCLUSION GP73 alone appears efficient for detecting cirrhosis and superior to APRI determination.In combination with APRI,its diagnostic performance can be further improved.Most importantly,the simple GP73 measurement proved promising for predicting a worse outcome of patients with both viral and nonviral chronic liver diseases.

Value of quality of life analysis in liver cancer: A clinician's perspective

Health related quality of life(HRQOL) is increasingly recognized as an important clinical parameter and research endpoint in patients with hepatocellular carcinoma(HCC). HRQOL in HCC patients is multifaceted and affected by medical factor which encompasses HCC and its complications, oncological and palliative treatment for HCC, underlying liver disease, as well as the psychological, social or spiritual reaction to the disease. Many patients presented late with advanced disease and limited survival, plagued with multiple symptoms, rendering QOL a very important aspect in their general well being. Various instruments have been developed and validated to measure and report HRQOL in HCC patients, these included general HRQOL instruments, e.g., Short form(SF)-36, SF-12, Euro Qo L-5D, World Health Organization Quality of Life Assessment 100(WHOQOL-100), World Health Organization Quality of Life Assessment abbreviated version; general cancer HRQOL instruments, e.g., the European Organisation for Research and Treatment of Cancer(EORTC) QLQ-C30, Functional Assessment of Cancer Therapy(FACT)-General, Spitzer Quality of Life Index; and liver-cancer specific HRQOL instruments, e.g., EORTC QLQ-HCC18, FACT-Hepatobiliary(FACT-Hep), FACT-Hep Symptom Index, Trial Outcome Index. Important utilization of HRQOL in HCC patients included description of symptomatology and HRQOL of patients, treatment endpoint in clinical trial, prognostication of survival, benchmarking of palliative care service and health care valuation. In this review, difficulties regarding the use of HRQOL data in research and clinical practice, including choosing a suitable instrument, problems of missing data, data interpretation, analysis and presentation are examined. Potential solutions are also discussed.

Effect of Dehulling and Hydrothermal Treatment on the Amino Acid Content of Soriz (<i>Sorghum oryzoidum</i>)

Cereals are the basic element in ensuring the food security of the population through the significant intake of carbohydrates, proteins, dietary fiber, vitamins and minerals. The processing of cereals leads to changes in their nutritional quality, which could lead to both reduced nutrients and anti-nutrients. Gluten-free cereal varieties attract attention as raw materials to improve the nutritional quality of food and to diversify the product range. Sorghum (Sorghum oryzoidum) is a hybrid of sorghum, obtained at the Institute for Scientific Research for Corn and Sorghum in the Republic of Moldova, by crossing Sudan grass (S. sudanense) and bicolor sorghum (S. bicolor). The research aimed to determine the impact of dehulling and hydrothermal treatment on the amino acid content of soriz. The obtained results reported that the dehulling and hydrothermal treatment led to the uneven modification of the amino acid content in the investigated samples. As a result of dehulling, the total amount of essential amino acids decreased by 19.8% compared to the native grain. Boiling whole grains without prior hydration led to 34% loss of essential amino acids compared to native grains, and pre-hydration of the grains and subsequent boiling reduced essential amino acid losses by 8% compared to cooked grains without hydration. Boiling grains with pre-hydration had a positive effect on the chemical index of lysine, methionine and cysteine, leucine and tryptophan. However, the nutritional quality of sorghum grain proteins and derivatives obtained, evaluated according to the chemical index, is low. The results obtained reported that dehulling and hydrothermal treatment unevenly altered the amino acid content, and the method of boiling grains with pre-hydration had a positive effect on the CSI of lysine, methionine and cysteine, leucine and tryptophan.

某三级甲等公立医院数字减影设备的成本效益分析

目的对公立医院数字减影血管造影(digital subtraction angiography,DSA)设备进行成本效益分析,结合社会效益评价,为设备采购和管理提供科学依据。方法采用投资回收期法、投资收益率法、量本利分析法和净现值法对数字减影设备进行成本效益分析,运用模糊数学法建模和指标评分法进行社会效益评价。结果公立医院数字减影设备包括DSA数字血管造影机、DSA全数字化平板探测器血管造影机、血管造影X线系统,其中:血管造影X线系统投资收益率最高为19.07%,投资回收期仅2.80年,运行效益评价为优秀;DSA全数字化平板探测器血管造影机A的经济指标最低,原因在于其业务量仅达保本工作量的83.91%,但其社会效益评分最高(C值为7.3)。结论公立医院在采购和管理数字减影等大型设备时需进行充分的成本效益分析论证,兼顾公立医院的公益性和科研属性,实行经济效益和社会效益双评价。

Endoscopic ultrasonography in the evaluation of condition and prognosis of ulcerative colitis

BACKGROUND Ulcerative colitis(UC)is usually diagnosed through histopathology,enteroscopy,clinical symptoms,and physical findings;however,it is difficult to accurately evaluate disease severity.AIM To investigate the value of endoscopic ultrasonography(EUS)in the evaluation of the severity and prognosis of UC.METHODS Patients with UC who were seen in our hospital from March 2019 to December 2020 were eligible,and disease severity was evaluated according to the modified Truelove and Witts and Mayo scores.We performed EUS,calculated the UC endoscopic index of severity(UCEIS)and EUS-UC scores,and administered appropriate treatment.The UCEIS and EUS-UC scores of patients were assessed in relation to disease severity,and the correlations between UCEIS and EUS-UC scores and disease severity was also analyzed.The UCEIS and EUS-UC scores before and after treatment were also compared.RESULTS A total of 79 patients were included in this study.According to the Mayo Index,23,32,and 24 patients had mild,moderate and severe UC,respectively.The UCEIS and EUS-UC scores were higher in moderate cases(4.98±1.04 and 5.01±0.99,respectively)than in mild cases(1.56±0.82 and 1.64±0.91,respectively,P<0.05).Furthermore,the UCEIS and EUS-UC scores(7.31±1.10 and 7.59±1.02,respectively)were higher in severe cases than in moderate cases(P<0.05).According to the modified Truelove and Witts scores,21,36,and 22 patients were classified as having mild,moderate and severe disease,respectively.The UCEIS and EUS-UC scores were significantly higher in moderate disease(4.79±1.11 and 4.96±1.23,respectively)than in mild disease(1.71±0.78 and 1.69±0.88,respectively,P<0.05).Additionally,the UCEIS and EUS-UC scores in severe disease(7.68±1.22 and 7.81±0.90,respectively)were significantly higher than in moderate disease(P<0.05).The UCEIS and EUSUC scores were significantly and positively correlated with disease severity according to the modified Truelove and Witts score and Mayo score(P<0.05).The UCEIS and EUS-UC scores after 2 mo of treatment(3.88±0.95 and 4.01±1.14,respectively)and after 6 mo of treatment(1.59±0.63 and 1.64±0.59,respectively)were lower than the respective scores before treatment(5.93±1.79 and 6.04±2.01)(P<0.05).CONCLUSION EUS can clarify the status of UC and accurately evaluate the treatment response,providing an objective basis for formulation and adjustment of the treatment plan.

Single-territory incomplete surgical revascularization improves regional wall motion of remote ventricular areas： results from a propensity-matched study

Objective Basic science studies demonstrated a general intramyocardial angiogenetic response potentially responsible for the creation of a microvascular neocapillaries network assisting myocardial function. We hypothesized that the benefit provided by the reperfusion of left anterior descending （LAD） territories and the biological angiogenetic drive triggered by the revascularization could translate in a global improvement in ventricular contractility, not restricted to the grafted area. Methods High-risk patients with multivessel coronary artery disease and preoperative wall motion abnormalities were retrospectively analyzed to compare outcomes and regional ventricular function of those who received optimal medical therapy （OMT） versus those who underwent off-pump coronary artery bypass grafting （OPCABG） and received an incomplete myocardial revascularization using left internal mammary artery （LIMA） on LAD （OPCABG group）. From January 2007 to December 2014, 206 patients （OMT, n = 136, OPCABG, n = 70） were propensity-score matched to have 70 matched pairs. Variables included in propensity score analyses were ejection fraction （EF）, left ventricular end diastolic volume （LVEDVi）, EuroSCORE II. Primary endpoint was the variation in the global wall motion score index （AWMSI） as evaluated by transthoracic echocardiography. Follow up was completed at 3 years from surgery or hospital discharge. Results Regional analysis of ventricular function revealed a regional WMSI improvement in the OPCABG group not only for LAD territories but also for non-LAD regions, associated with a reduction in the negative left ventricular ischemic remodeling, compared to patients discharged in optimal medical therapy. Global AWMSI was negative in OPCABG group （-3.4 ± 2.8%） and positive in the OMT group （5.9 ± 3.1%）, indicating a better wall motion score for OPCAB patients. Surprisingly, regional WMSI improved also in non-grafted territories in the off-pump CABG group with a delta value of -3.7 ± 5.3% for left circumflex artery （LCX） area and -3.5 ± 5.4% for right coronary artery （RCA） area. Conclusions In patients with multivessel coronary artery disease, LIMA-to-LAD grafting is associated with an improvement in the WMSI involving also the surrounding non-LAD ungrafted segments and with the attenuation of negative global and regional ischemic ventricular remodeling.

Isolating higher yielding and more stable rice genotypes in stress environments: fine-tuning a selection method using production and resilience score indices

In Asia, the rice crop sustains millions of people. However, growing demand for this crop needs to be met while simultaneously reducing its water consumption to cope with the effects of climate change. Lowland cropping systems are the most common and productive but have particularly high water requirements. High-yielding rice genotypes adapted to drier environments(such as rainfed or aerobic rice ecosystems) are needed to increase the water use efficiency of cropping. Identifying these genotypes requires fast and more accurate selection methods. It is hypothesized that applying a new quantitative selection method(the score index selection method), can usefully compare rice yield responses over different years and stress intensities to select genotypes more rapidly and efficiently. Applying the score index to previously published rice yield data for 39 genotypes grown in no-stress and two stress environments, identified three genotypes(ARB 8, IR55419-04 and ARB 7) with higher and stable yield under moderate to severe stress conditions. These genotypes are postulated to be better adapted to stress environment such as upland and aerobic environments. Importantly, the score index selection method offers improved precision than the conventional breeding selection method in identifying genotypes that are well-suited to a range of stress levels within the target environment.

Serum vitamin E concentration is negatively associated with body mass index change in girls not boys during adolescence

Background Vitamin E is the most abundant lipid-soluble antioxidants present in plasma;however,the relationship between serum vitamin E and change in body mass index(BMI)-for-age Z scores in adolescents has not been well described.Methods This study is a cross-sectional study.Data were analyzed from 4014 adolescents who participated in the National Health and Nutrition Examination Survey.The nutritional status was calculated by BMI Z scores and was classifed into nor-mal weight,overweight,and obese.Multivariable-adjusted logistic regression was used to examine the association between serum vitamin E levels with overweight/obesity.Besides,the interaction effects between potential confounders and vitamin E on obesity were further evaluated.Results After adjusting potential confounders,serum vitamin E levels were negatively associated with overweight/obesity in girls but not in boys.Per standard deviation increment in vitamin E concentrations was associated with a 92%decreased risk of obesity in females.Besides,lower quartiles of serum vitamin E were associated with a higher risk of overweight/obesity in girls.Moreover,the inverse association between serum vitamin E levels and obesity was also found in most subgroups through subgroup analysis.Conclusions Our study supports the negative association between serum vitamin E levels and overweight/obesity in ado-lescents.A higher serum vitamin E level may be associated with a reduced probability of obesity in girls,but not in boys.

Laryngopharyngeal reflux disease, prevalence and clinical characteristics in ENT department of a tertiary hospital Tanzania

Background:Laryngopharyngeal reflux disease(LPRD)is a condition with nonspecific symptoms and most of times patients present late with advanced disease which may pre-dispose to malignancy.The magnitude and clinical characteristics of this condition are not well known among patients attending Otorhinolaryngology services in Tanzania.Materials and methods:This was a hospital based descriptive cross sectional study,conducted in the wards and clinics of Otorhinolaryngology department of Muhimbili National Hospital.Patients with symptoms of Laryngopharyngeal reflux disease were included in the study.Data was collected using questionnaires and clinical examination forms,were processed and analysed by using SPSS.Results presented in frequency tables,cross tabulations and figures.Results:This study recruited 256 participants among them males were 131(51.2%).The mean age was(41.38±13.94)years.Prevalence of Laryngopharyngeal reflux disease was 18.4%without gender predilection.The commonest symptoms were globus sensation,hoarseness of voice and excessive urge to clear the throat with 95.7%,88.1%and 83.0%respectively while the most observed signs were thick endolaryngeal mucus,Vocal cord oedema and partial ventricular obliteration with 90.9%,88.6%and 72.7%respectively.Lying down less than two hours after meal and spices foods consumption were the leading risk factors.Hypertension and Diabetes Mellitus type 2 were the most prevalent co morbid conditions associated with Laryngopharyngeal reflux disease.Conclusion:The prevalence of Laryngopharyngeal reflux disease is high among patients attending Otorhinolaryngology services at Muhimbili national hospital.All patients with Laryngopharyngeal reflux disease related symptoms should get thorough evaluation for early diagnosis and treatment.

Attenuation of tumor necrosis factor-a elevation and improved heart function by postconditioning for 60 seconds in patients with acute myocardial infarction

Background Postconditioning has been shown to reduce infarct size, ischemic/reperfusion injury and myocardial injury in patients with acute myocardial infarction （AMI） undergoing percutaneous coronary intervention （PCI）. This study tested the hypothesis that postconditioning attenuates the elevation of tumor necrosis factor-a （TNF-a） and improves heart function in patients with AMI after PCI. Methods A total of 75 patients were randomly assigned to 1 of 3 groups： the routine group （n=-26）, in which no intervention was given at the onset of reperfusion; and the Postcon-30s （n=25） or Postcon-60 s （n=24） groups, in which 3 cycles of 30- or 60-second balloon deflation and inflation were repetitively performed. TNF-a serum concentration was measured by ELISA. Global and regional left ventricular systolic function was determined by echocardiography at 1 year. Thirty-four normal controls （NC） were enrolled in the study. Results The TNF-a concentration in patients with AMI was significantly elevated at baseline compared to controls （P 〈0.01）. Concentration levels increased in the routine and Postcon-30s, but not in Postcon-60s group at 7 days （P 〈0.05）. As for linear associations among the three groups, left ventricular ejection fraction （LVEF） and wall motion score index （WMSI） were ranked as follows： Postcon-60s 〉Postcon-30s〉routine （P values all 〈0.05, 65% vs. 57% vs. 52% and 1.10 vs. 1.27 vs. 1.53） after 1 year. More importantly, there was a significant relevance between the soluble TNF-a serum concentration at 7 days and LVEF or WMSI after 1 year （Pvalues all 〈0.0001）. Conclusions Postconditioning, in particular Postcon-60s was associated with long-term cardioprotective effects for inhibition of the inflammatory response and reperfusion injury. The soluble TNF-a serum concentration provided powerful prognostic information of global and regional left ventricular systolic function in patients with AMI.

Evaluation of Depression and Quality of Life in Patients With Psoriasis

Objective:To measure the prevalence of depression in patients with psoriasis and to evaluate the relationship between the severity of psoriasis and depression and its effect on patients’quality of life.Methods:A total of 154 patients with a confirmed diagnosis of psoriasis were assessed to determine the severity of psoriasis based on the psoriasis area and severity index score,presence,and severity of depression using the patient health questionnaire 9,and quality of life using the dermatology life quality index 10.Pearson correlation coefficient was used to demonstrate the relationship between continuous variables with 95%confidence intervals(CIs);P<0.00001 was taken to indicate statistical significance.Results:The severity of psoriasis was mild in 36.36%of patients,moderate in 25.97%,severe in 32.47%,and very severe in 5.20%.Of the 154 patients,139(90.3%)had depression;the severity of depression was mild in most affected patients(46.7%)and severe in 2.6%of patients.Psoriasis had a moderate effect on the quality of life in 37.01%of patients and a very large effect in 33.77%of patients.The severity of psoriasis was positively correlated with depression(Pearson correlation coefficient,r=0.42,P<0.00001,95%CI:0.28–0.54)and quality of life(r=0.43,P<0.00001,95%CI:0.29–0.55).Conclusion:Depression is a common comorbidity in patients with psoriasis.The severity of psoriasis is positively correlated with the severity of depression and is associated with poor quality of life.

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).