Phosphodiesterase-5 inhibitors (PDE5i) have been used as the first-line treatment for erectile dysfunction (ED) in recent years. However, with the increased clinical application of PDE5i, the incidence rate of PDE5i-induced adverse reactions is on the rise, which may involve the cardiovascular, digestive, nervous, respiratory, and reproductive systems. Most of the adverse reactions are mild to moderate, occasionally with serious or rare complications. The probability and severity of the adverse reactions are associated with the dosage and frequency of medication as well as with individual differences. Therefore individualized medication is necessitated and, for the patients with cardiovascular disease, epilepsy, psychosis, or anaphylactic conditions, PDE5i should be cautiously given or avoided. This review provides an overview of PDE5i-induced adverse reactions and countermeasures in the treatment of ED.
Erectile Dysfunction ; drug therapy ; Humans ; Male ; Phosphodiesterase 5 Inhibitors ; administration & dosage ; adverse effects

Objective To evaluate arterial reconstruction of traumatic iliac-femoral artery pseudoaneurysm in parenteral drug abusers.Methods Data of 21 consecutive patients who presented with iliac-femoral artery pseudoaneurysm with the diameter ranging from 3.0 cm～7.5 cm secondary to parenteral drug abuse from 2004 to 2007 were analyzed.Fifteen patients were male and the median age was 3 1.3 years.the aneurysm involved the common femoral artery and distal external iliac artery.Autologous greater saphenous vein was used as a graft for arterial reconstruction after iliac-femoral artery pseudoaneurysm excision through a single curved inguinal incision.Results The surgical procedure was successful in all 21 eases without intraoperative mortality and severe complications.All the 21 patients were free of postoperative claudication symptoms except 1 case with preoperative popliteal artery stenosis.Wound infection and tissue fistula developed in one ease.Ingunal incisional hematoma and cutaneous abnormal sensation developed in one each eases.Conclusions The use of autologous greater saphenous venous grafts for aaefial reconstruction after false aneurysm excision in drug abusers is safe and effective.The harvest of the greater saphenous vein is precondition of this precedure.These preliminary results indicate that the implementation of this technique offers advantages compared with the artery ligation alone without revascularization,that is frequently associated with later intermittent claudication.

Objective To observe the influence of electroacupuncure(EA) at different therapeutic time windows on the effects of inosine on neuronal apoptosis and expression of heat-shock-proteins-70 (HSP70)after focal cerebral ischemic reperfusion injury (CIRI) in rats.Methods The model was established by ligation of the artery for 2 hour.EA was delivered to “baihui” and “dazhui” through acupuncture needles 0.5 hr,2 hr,6 hr and 12 hr respectively following MCAO.The expression level of HSP70 and the number of apoptotic cells were examined by immunohistochemical technique and TUNEL,comparing the average optical density of HSP70 and the number of apoptotic positive cells of cortex penumbra and hippocampus CA1 area in rat brain.Results Compared with the model group,the average optical density of HSP70 in every EA group was increased in apoptotic positive cells of cortex penumbra and hippocampus CA1 area 0.5 h (89.98± 6.55),(128.73 ± 8.03),2 h (90.96±6.38),(132.25±8.78),6 h (93.71±6.12),(132.58±7.04),12 (96.19±7.30),(133.57±6.19)and the number of apoptotic positive cells of cortex penumbra in every EA group was decreased 0.5 h (1.80±0.84),2 h (3.40± 1.14),6 h (5.00± 1.00),12 h (5.00±2.45).The number of apoptotic cells of hippocampus CA1 area was decreased just in the EA group of 0.5 h (1.60± 1.89).Conclusion EA could increase the expression level of HSP70 and at the same time decrease the number of apoptotic cells,EA plays an important part in protecting the neuronal cells of brain after focal cerebral ischemic reperfusion injury.The acupuncture treatment should be taken as far as early.

AIM:To investigate retinal vascular endothelial growth factor(VEGF)level and retinal cells apoptosis in the early stage of diabetic NOD mouse retina.METHODS:Animals were divided into the control group(non-diabetes mice)(2,4,6,8,12 weeks group,n=30)and diabetes group(2,4,6,8,12 weeks group,n=30).EUSA(Enzyme-Linked Immunosorbent Assay)was performed to detect VEGF level in both serum and retina.Transmission electron microscope method was used to examine retinal cell apoptosis.RESULTS:Compared with the control group,VEGF levels in serum and retina were increased significantly in the NOD group(12 weeks:4.9±0.4μg/g versus 0.19±0.1μg/g in serum sample,P ＜ 0.01;165.0±9.0μg/g versus 18.0±4.0μg/g in retinal sample,P＜0.01).There exists a positive correlation between serum VEGF and retinal VEGF levels in the early diabetic NOD mice(γ=0.9902,P=0.001).The number of the cells apoptosis in the ganglion significantly in the NOD group(P＜0.01).CONCLUSION:The high VEGF expression may be contributed to increase retinal cells apoptosis.Many factors associated with retinal VEGF expression might involve in the early diabetes stage.

Diabetes is a complex and heterogeneous disorder presently affecting more than 100 million people worldwide and causing serious socio-economic problems. Spontaneous rodent models of diabetes mellitus have proved invaluable in understanding the pathogenesis, complications, and genetic or environmental influences that increase the risks of diabetes. We have reviewed here in the development and characterization of spontaneous rodent models that displayed most features commonly associated with diabetic retinopathy.

Gastrointestinal Tract ; physiopathology ; Humans ; Infection ; physiopathology ; Sepsis ; physiopathology ; Shock, Septic ; physiopathology

Objective Repair of aortic arch aneurysm is technically demanding and usually requiring complex circulatory management. Operative morbidity and mortality may be prohibitive with traditional surgical intervention. We described our experience with 5 hybrid endovascular procedure for aorta repair with different kinds of bypass followed by concomitant placement of stent graft in the aorta. Methods We retrospectively reviewed the clinical data of 5 consecutive patients presenting with aortic aneurysm or dissection from 2007 to 2008 treated by the hybrid aorta repair. Complete surgical rerouting of the supra-aortic vessels was followed by endovascular repair of aortic arch aneurysm with a Zenith TX2 stent graft. Hybrid left carotid-subclavian bypass with Zenith stent graft deployment covering the ostium of the LSA was performed in a Debakey type Ⅲ aortic dissection case. Procedures were successfully completed with exclusion of the aortic aneurysm. All stent grafts were deployed retrograde from the femoral artery in these patients. Results Technical success with complete aneurysmal exclusion was achieved in all patients (100%). At a follow-up period of 2-10 months, there was no incidence of endoleak. Documented perioperative neurelogic events did not occurred in all patients. Postoperatively one patient suffered from ARDS and cardiac failure and recovered. One patient died of myocardial infarction. Conclusions Hybrid arch repair provides an alternative to patients otherwise considered prohibitively high risk for traditional open arch and thoracoabdominal aorta repair.

Objective To evaluate the gastroesophageal reflux symptom in patients who underwent continuous ambulatory peritoneal dialysis (CAPD) and the efficacy of proton pump inhibitor (PPI) in treating gastroesophageal reflux. Methods Fifty-eight CAPD patients with good clinical and complete dialyzed eondition,who was admitted to the hospital between Jan. 2008 and July 2008, were inquired about their gastroesophageal reflux symptoms using reflux disease questionnaire (RDQ). The patients who had RDQ≥6 and <12 were received esomeprazole 20 mg daily, while those with RDQ≥12 were received esomeparzole 20 mg twice daily. RDQ score was reevaluated 4 weeks after treatment.Results The common symptom was regurgitation (64.70%), followed by acid reflux (52.9 %), non-cardic chest pain (47.1. %) and heart burn (17. 6%). After 4-week treatment, the RDQ was significantly decreased (P< 0. 05). But there was no difference in outcome of treatment between patients with RDQ≥ 12 and RDQ< 12 (P=0. 059). Conclusion The gastroesophageal reflux symptom in CAPD patients can be relieved by PPI administration, but a larger clinical trial is needed to evaluate the course and efficacy of treatment.

Objective To investigate the effect of pregnancy on the potency of bupivacaine for spinal anesthesia in rats. Methods Female non-pregnant SD rats weighing 180-220 g and 17 day pregnant SD rats weighing 350-400 g were used in this study. The rats ( 18 non-pregnant, 18 pregnant) in which PE-10 catheter were successfully placed without complications were selected. The 18 non-pregnant rats were randomly divided into 3 groups (n =6 each): control group (group C), 2% bupivacaine group (group B2 ) and 4% bupivacaine group (group B4). The 18 pregnant rats were also randomly divided into 3 groups (n = 6 each): control group (group PC),2% bupivacaine group (group PB2 ) and 4% bupivacaine group (group PB4 ). Group C and PC received intrathecal (IT) normal saline 30 μl, and the other 4 groups received 2% or 4% bupivacaine 30 μl intrathecally. Analgesia was determined using the taifllick latency (TFL) before IT administration (baseline), and at 10 min, 20 min,30 min, 1 h, 2 h, 4 h, 1 d, 2 d, 3 d and 4 d after IT administtation. The percentage of the maximal possible effect (MPE) was calculated. Hind-limb motor function (MF) was also assessed. Results Compared with the baseline value, MPE at 10 min-2 h after administration and MF scores at 10 min-1 h after administration were significantly increased in group B2, MPE at 10 min-4 h after administration and MF scores at 10 min-1 h after administration were significantly increased in group B4;MPE at 10 min-1 d after administration and MF scores at 10 min2 h were significantly increased in group PB2 and MPE at 10 min-1 d after administration and MF scores at 10 min4 h were significantly increased in group PB4 ( P ＜ 0.05 ). Conclusion Pregnancy can enhance the potency of bupivacaine for spinal anesthesia in rats.

Objiective To evaluate the histocompatibility of gelatin-bletilla/Salvia-miltiorrhiza i material and to discuss the appropriate concentration of salvia-miltiorrhiza in the material. Method Salvia-miltiorrhiza together with gelatin and bletilla was used to make a kind of porous membranes. A total of 175 rats were divided randomly (random number) into 5 groups ( n = 35 in each). The porous membranes containing salvia-miltiorrhiza material in different concentrations of 1, 2, 4, and 5 mL/100 g were implanted subcutaneously into the rats of the four experimental groups, respectively. The gelatin-bletilla material without salvia-miltiorrhiza was implanted into the rats of control group. In 1, 3, 7, 14, 21, 28 and 56 days after implant, the materials were taken out of the bodies of the rats, separately. The material implanted for 1, 3, 7 and 14 days were observed with immunohistoche-mistry. Results In the area of implant, no noticeable inflammation or other was found. The implanted materials were degraded and entirely absorbed in vivo in 8 weeks. The salvia-miltiorrhiza in concentration of 2 mL/100 g in vivo promoted the angiogenesis most significantly. Conclusions The gelatin-bletilla/salvia-miltiorrhiza material has excellent histocompatibility and the appropriate concentration of salvia-miltiorrhiza in material is 2 mL/100 g.