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 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 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 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

Objective To explore influences of the fistula's location on the procedure and outcome of a transvaginal vesicovaginal (VVF) repair.Methods The medical data of patients undertaken transvaginal VVF repairs in Peking University First Hospital between Janurary 2009 and Auguest 2016 were retrospectively collected,including age,past history,causes of the fistula,disease course,past treatment,outcomes of the cystoscopy and imaging test and surgical information.The follow-ups were performed.Patients who had incomplete clinical data and lost to follow-up were not included.The present study included 68 VVF subjects with the median age of 46 years (range:24-64 years).The univariate analysis was performed to figure out potential risk factors for the VVF repair outcome.The duration and blood loss of VVF repairs were compared among the subjects with the fistulae located at bladder neck,trigone and supra-trigone region.Results There were 5,23 and 40 cases having VVFs located at bladder neck,trigone and supratrigone region respectively.The overall repair success rate was 88.2％ (60/68).According to results of the univariate analysis,subjects with more past repair times had significantly lower success rates.There were no significant differences in success rates of surgical repairs for VVFs located at bladder neck (80.0％,4/5),trigone (91.3％,21/23) and supra-trigone region (87.5％,35/40).And the location of VVFs had no significant association with the duration and blood loss during the VVF repair.Conclusions The location of VVFs had no influences on the procedure and outcomes of the transvaginal repairs.The VVF repair approach may not be determined based on the fistula's location alone.

Objective To assess the safety and efficacy of a novel technology referred to as percutaneous ureteroscopic laser deroofing in the management of renal cysts.Methods From November 2014 to August 2016,59 patients having surgical indications with renal cysts were enrolled and evaluated by ultrasound and CT scan.Of all the 59 patients,36 were males and 23 were females.Their mean age was 46 years (ranging 35-64 years).41 patients complained about the reported flank and abdominal pain.18 patients were found by imaging examination.Their mean diameter of cyst was 6.3cm(ranging 4.9-9.1cm).In regards to the 59 patients,include 6 patients suffered with parapelvic cysts and 4 patients suffered with renal cyst complicated with ipsilateral renal calculi.Their mean stone surface area was 5.7 cm2 (ranging 3.4-9.8 cm2).All of the patients received combined spinal and epidural analgesia or paravertebral nerve block anesthesia.Patients were placed in the prone position for percutaneous puncture and tract dilation.Under ultrasound guidance,an eighteen gauge needle was placed inside the cyst cavity percutaneously,a metal guidewire was introduced followed by sequential dilation up to F26-28.9.8F rigid ureteroscope was inserted through the Amplazt access sheath and advanced into the cyst cavity.Then sheath and ureteroscope both returned to the exterior cyst together.Cyst wall was dissociated from perirenal adipose tissue by used ureteroscope.A majority of the collapsed cyst wall was grasped and gently pulled towards the Amplazt sheath interior using grasping forceps and incised using either Thulium (Power 40 ～50W) or Holmium laser(Power 60 ～70W) and was taken for pathological examination.Nephrostomy tube was left in place for 2-3 days and removed before discharge.For parapelvic cysts patients,ureter stent was inserted into the renal pelvis i n the dorsal lithotomy position firstly.Patients were then placed in the prone position for percutaneous puncture and tract dilation.Laser was used to incise cyst wall towards identified pelvis to create a permanent communication between the cyst and adjacent renal collecting system.F6 double-J stent was inserted into the cyst cavity at the end to prevent auto-closure for at most two months.F22 nephrostomy tube was left in renal pelvis for two weeks.For renal cyst complicated with ipsilateral renal calculi patients,a puncture was created targeting the stone through the cyst,after fragmenting and extracting the stone,the same laser was used to deroof the cyst.More than 50％ reduction in cyst volume was considered a success.The perioperative complications,hospitalization days and the effective rate of surgery were evaluated.Results All operations were conducted without intraoperative complications such as bleeding,urinary leakage or injury of the renal parenchyma and the adjacent organs.The hospital stay after the surgery was 2-4 days (mean 2.5 days).After 3-12 months follow-up (mean 8.1 months),patients underwent imaging examinations.42 out of 59 cases were completely resolved,15 were reduced to less than 50％,the total effective rate for the operation is 96.6％ (57/59).4 patients with ipsilateral renal calculi were completely clear.However,two cases failed probably due to incomplete resection and follow treated with laparoscopic renal cyst deroofing.Conclusions Percutaneous ureteroscopy renal cyst laser deroofing is a safe,effective,less invasive,which can be performed in any endourological center without the need of special instruments and training.

Objective To study the indication of pelvic autonomic nerve preservation(PANP)for patients undergoing rectal carcinoma resection and evaluate the operative procedure and post-operative urine function.Methods Materials of 18 cases of middle and lower rectum carcinoma,receiving PANP radical resection from Jan. 2000 to Nov. 2002 were reviewed. The perioperative urodynamic index and postoperative long-term sexual function were analyzed.Result Pelvic autonomic nerve was preserved in all 18 patients and they have normal urine function and satisfactory long-term sexual function.Conclusion Male patients aged younger than 60 yrs., with rectal carcinoma of Ducks A to C are suitable for receiving PANP radical resection for better maintenance of the urinal and sexual function.