It is reported that plenty of men,especially the aged,have been bothering in penile erectile dysfunction(ED).There are series of treatments for ED.Oral erectogenic agents have become the first-line treatment options,including drugs that act on the central and peripheral nervous systems,testosterone,traditional Chinese medicine and so on.Sidenafil,apomorphine and yohimbine are the only three oral therapies currently available for the treatment of this disorder.The second therapy includes intracavernosum injection,transurethral medications,transdermal medications etc.Intracavernosum injection of PGE 1 is an effective approach at the present.With the rapid understanding of erectile physiology and etiology of ED and the introduction of new effective oral agents,the future of pharmacotherapy for ED will extend.In this review,we have highlighted the advances in current treatments and therapeutic approaches in male erectile dysfunction.

Objective To explore the gene diagnosis of Gitelman syndrome.Methods The clinical data of a child with Gitelman syndrome were retrospectively analyzed along with gene detection results of his elder sister and parents.Results A 6-year-old boy was hospitalized for fever and hypokalemia.Gene detection of SLC12A found a new locus mutation of EXON21 c.2522A＞G p.(Asp841Gly) and a heterozygosis of EXON16 c.1946C＞T p.(Thr649Met).The diagnosis of Gitelman syndrome was confirmed.His mother carried a heterozygosis mutation of EXON21 c.2522A＞G p.(Asp841Gly),while his father and elder sister carried a heterozygosis mutation of EXON16 c.1946C＞T p.(Thr649Met).Conclusion Gene detection of SLC12A is helpful in the diagnosis of Gitelman syndrome.The newly discovered mutation of SLC12A3 gene has enriched the mutation spectrum of Gitelman syndrome.

Objective The purpose of this study is to define the pollution level of CO2 pneumoperitoneum in operation room and its influence on the health of medical personnel,and put forward certain countermeasures.Methods This research consisted of four groups of experiments,and gradually proved that the use of pneumoperitoneum machine would lead to air pollution in the operation room,and the health of medical staff were influenced too.The four experiments were:the maximum CO2 gas leakage experiment;laparotomy and pneumoperitoneum surgery in the operating room CO2 gas concentration control experiment;CO2 gas concentration increase on the influence of the medical staff experiment; long-time pneumoperitoneum surgery operating room CO2 gas concentration change experiment.Results The maximum CO2gas leakage situation could cause the operation room CO2 gas concentration to increase(＞ l 000× 104); pneumoperitoneum machine in actual use process,could cause the increase of CO2 gas concentration in operation room; increase of CO2 gas concentration had an impact on the vital signs of the medical staff,the heart rate and blood pressure were statistically different before and after the operation; during pneumoperitoneum surgery for a long time,indoor CO2 gas concentration increased (＞1000× 10-6)and reduced quickly postoperation.Conclusions The use of C02 pneumoperitoneum machine in operation room influence the health of medical personnel.Effective protective measures dealing with gas pollution should be taken to reduce the chronic injury to medical staff.

Objective To assess the clinical application value of color Doppler ultrasound guided puncture in peripherally inserted central catheter (PICC). Methods Thirty-two patients needed long-term intravenous infusion underwent PICC. Color Doppler ultrasound was used to select the puncture vascular,the best puncture point and angle, and the entire process was monitored and guided dynamically, and the initial position of the catheter tip was located. Results Color Doppler ultrasound-guided puncture was successful in all 32 patients, and the successful rate was 100%. The guided puncture time was 22 s to 19 min, and the first puncture succeeded in 30 patients (93.75%). Conclusion Color Doppler ultrasound-guided puncture in PICC can obviously raise the success rate of puncture, shorten puncture time and reduce the complications. It is an easy, safe and certain method.

Objective To discuss the aged people N-terminal pro-B-type natriuretic peptide (NT-proBNP)changes in thyroid function disorder and its correlation.Methods With electrochemical luminescence analyzer,detected serum NT-proBNP lev-el 38 patients with hyperthyroid heart disease,68 patients with hyperthyroidism,31 patients with hypothyroidism,and 43 ca-ses of healthy controls.Compared each groupserum NT-proBNP level of older population with middle-aged people,and anal-ysied the correlation.Results The serum NT-proBNP level of Hyperthyroidism heart group,hyperthyroidism,hypothyroid-ism group and normal control group were 827.61±626.13,107.18±54.46,162.94±134.14,68.76±39.21 pg/ml,respec-tively.The serum level of HT-pro BNP.Hyperthyroidism group,hyperthyroidism,hypothyroidism group compared with nor-mal control group,there were statistically significan(t = 7.458,4.312,3.794,P = 0.000,0.000,0.001).Hyperthyroidism heart,hypothyroidism with hyperthyroidism group serum level of NT-proBNP comparison there was statistical significance(t=7.078,2.232;P = 0.000,0.032).Hyperthyroidism heartgroup,hypothyroidism group and normal control group older population was higher than the level of serum NT-proBNP middle-aged,difference was statistically significant (t=-3.216,-2.510,-2.653;P =0.007,0.016,0.014).Hyperthyroidism group of elderly serum NT-proBNP level higher than that of middle-aged people,but there was no statistically significant difference (t=-0.140,P =0.890).Multiple regression analy-sis in hyperthyroidism group serum levels of NT-proBNP and FT4 had positive correlation (r=0.224,P =0.033)and hypo-thyroidismgroup serum levels of NT-proBNP and T3 had negative correlation (r=-0.363,P =0.022).Conclusion Thy-roid dysfunction in elderly people for the level of serum NT-proBNP had significant influence.Auxiliary disgnosis and cura-tive effect observation of the serum level of NT-proBNP in people with different thyroid functional status has certain clinical value.

Objective: To study the effects of parathyroid hormone(PTH) on the calcification characters of cultured human dental papilla mesenchymal(DPM) cells.Methods: DPM cells were cultured up to 35 days in two groups. The control group was cultured in DMEM supplemented with 15% FCS,50 ?g/ml ascorbic acid and 10 mmol/L ?-glycerophosphate. The cells in experimental group were cultured in above mentionned medium containing 33.3 nmol/L of PTH. The medium was changed every 3 or 4 days. Osteocalcin secretion of the cells was measured by radioimmunoassay.Results: Addition of TPH in medium caused a significant increase of osteocalcin secretion from 21 to 35 days culture (P

Objective To summarize the experiences with early treatment of the wounded associated with 4 · 20 Lushan earthquake in army hospitals.Methods Emergency response programs were started and tent hospitals were set up.According to the basic principle of wartime wound treatment regulation,emergency triage,emergency medical care,transferring,specialized treatment and evacuation were performed for the wounded in this earthquake.Results After the earthquake,the emergency rescue programs were started in the hospital.Twenty minutes later,emergence medical team with full equipment were set out for the epicenter and the tent hospitals were set up.A total of 181 earthquake cases were admitted within two weeks,of which 68 (37.6％) were transferred from the scene of earthquake and 113 (62.4％) were transferred after the primary treatment (including cases evacuating from other hospitals).Forty-nine surgeries had been done,including 30 emergence ones.Thirty-four cases (including 14 severe wounded) were evacuated to superior hospitals as their vital signs turned stable.There was no death or surgical wound infection.Conclusions Peacetime complete emergence programs and materials reserves,unified and well-organized command as well as normative grading treatment system in army hospitals assure the standardized medical care with high efficiency and high quality for earthquake victims.However,more researches are needed over diagnosis methods and standards for wound severity,equipment improvement and standards for casualty evacuation.

Objective To investigate the clinical significance of Notch-1 expression in small cell lung cancer(SCLC) and non-small cell lung cancer(NSCLC),and analyze the role of it in prognosis.Methods SP immunohistochemistry was used to detect the expression of Notch-1 antibody in 43 of SCLC and 40 of NSCLC tissues.Further analysis was carried out to interpret the association of Notch-1 antibody expression with clinicopathological features,lymph node metastasis and prognosis in SCLC.Results The positive rate of Notch-1 expression was 20.93％ ( 9/43 ) in SCLC,while 65.00％ ( 26/40 ) in NSCLC.The expression of Notch-1 antibody was associated with clinical stage and lymph node metastasis ( x2 =5.42,P ＜ 0.05 ; x2 =4.88,P ＜ 0.05respectively),but was not associated with age,sex,tumor location,tumor size ( Ps ＞ 0.05 ).Compared with NSCLC,the expression rates of Notch-1 antibody were significantly higher in SCLC ( x2 =16.50,P ＜ 0.05 ).Kaplan-Meier survival analysis indicated that the survival time of patients with positive Notch-1 expression was significantly longer than that of patients with negative staining( x2 =19.87,P ＜ 0.05 ).Cox regression analysis showed that Notch-1 antibody could significantly reduce the risk of death in patients with SCLC.Conclusion The positive expressions of Notch-1 were significantly different in SCLC and NSCLC,which linked to the clinicalstage,lymph node metastasis and poor prognosis.Accordingly,the expression of Notch-1 may have good value in diagnosis and prognosis.

Objective To explore the influence of individualized nursing intervention on life quality of patients with rheumatoid arthritis. Methods 60 patients were divided into the intervention group and the control group with 30 cases in each group. The intervention group adopted individualized nursing projects according to the influencing factors of life quality based on routine nursing. The control group received routine nursing only. The life quality of the two groups was appraised by inventory before and after intervention. Results The status such as physiological function, mental function, social function and self-recognized health in the intervention group was greatly ameliorated and was statistically different from that in the control group(P＜0.05).Conclusion Individualized nursing intervention could dramatically improve the life quality of patients with rheumatoid arthritis

ObjectiveTo evaluate the role of galactomannan (GM) detection in bronchoalveolar lavage fluid (BALF) in the diagnosis of invasive pulmonary aspergillosis (IPA) in elderly patients with lung diseases.MethodsThe elderly patients with lung diseases and suspected of having IPA were enrolled. BALF for culture and GM detection, and serum samples for GM detection were obtained from all participants.According to European Organization for Research and Treatment of Cancer/Mycoses Study Group (EORTC/MSG) with host factors, clinical criteria, mycological evidence and histological or cytopathological evidence, all patients were categorized into the proven, probable,possible and no IPA patients. The IPA patients were considered as IPA group while no IPA was considered as control group. ResultsAmong 76 enrolled elderly patients, 18 cases were diagnosed with IPA (1 proven, 11 probable and 6 possible), the remained 58 patients were as control group.Based on a GM index cutoff value of ≥0. 5, the sensitivity, specificity, positive predictive value and negative predictive value for BALF were 83.3％, 82. 8％, 60.0％ and 94.1％, respectively; these variables in serum were 55.60％ , 91.4 ％, 66.7 ％ and 86.9％ , respectively. Using a GM index cutoff value of ≥1.0, the specificity and positive predictive value of both BALF GM and serum GM reached 100％, but the sensitivity and negative predictive value of BALF GM were higher than serum GM (66.7％ vs. 22.2％, 90.60％ vs. 80.60％, respectively). Receiver operating characteristic curve analysis yielded a sensitivity of 83.4％ and a specificity of 96.6％ at a BALF GM index cutoff value of ≥0.725. ConclusionsGM detection in BALF seems to be a useful tool in the diagnosis of IPA in elderly patients with lung diseases,and could be widely used in future.