Dietary calcium, phosphorus, and potassium intake associated with erectile dysfunction in the National Health and Nutrition Examination Survey (NHANES) 2001 to 2004.

BACKGROUND: Erectile dysfunction is now a common disorder of sexual function, and its relationship to dietary calcium, phosphorus, and potassium has not been well studied. We set out to determine if dietary intakes of calcium, phosphorus, and potassium are related to erectile dysfunction in U.S. men. METHODS: For this cross-sectional investigation, we used data from NHANES 2001-2004. To investigate the connection of dietary calcium, phosphorus, and potassium intake with erectile dysfunction, we employed multivariate logistic regression, smoothed curve fitting, and subgroup analysis. RESULTS: This cross-sectional study comprised 3,556 eligible male subjects in total, with a weighted mean age of 49.93±18.13 years. After controlling for race and age, the greatest tertile of calcium consumption was found to have a 34% lower risk of erectile dysfunction than the lowest tertile (OR = 0.66; 95% CI = 0.52-0.84; p = 0.0006). The risk of erectile dysfunction was found to be reduced by 33% (OR = 0.67; 95% CI = 0.52-0.87; p = 0.0024) for the highest tertile of phosphorus intake compared to the lowest tertile of phosphorus intake and by 35% (OR = 0.65; 95% CI = 0.50-0.83; p = 0.0006) for the highest tertile of potassium intake compared to the lowest tertile of potassium intake in the fully adjusted model. CONCLUSION: Erectile dysfunction and dietary consumption of calcium, phosphorus, and potassium are inversely associated with the U.S. population. To confirm the accuracy of our findings, additional prospective studies are necessary. Furthermore, it is imperative to do further fundamental research at the molecular level to gain a deeper understanding of the underlying mechanisms.

Pentaclethra macrophylla leaves reduce blood glucose level, improve sexual behavior and modulate critical enzymes associated with diabetes-erectile dysfunction morbidity in rats.

OBJECTIVES: This research work studied the phenolic composition of Pentaclethra macrophylla (PM), the inclusion of dietary supplementation of PM leaves on sexual functions and its connection to inhibit enzymes (arginase and phosphodiesterase-5) and nitric oxide level, linked to type 2 diabetes-induced erectile dysfunction in rats. METHODS: Gallic acid, chlorogenic and ellagic acids, Kaempferol, and epicatechin etc. was spotted with High performance liquid chromatography-diode array detector from PM extract. Twenty-five (25) rats were used for the study. Five rats were placed with basal diet; diets not supplemented with PM leaves (normal rat group) while twenty rats were made diabetic by feeding them with high fat diet for two weeks, prior to single injection with 35 mg/kg of streptozotocin (STZ). After checking with glucometer, experimental animals with blood glucose level >250 mg/dL were accepted as diabetic. The diabetic rats were subsequently divided into four groups of five rats each (n=5). The diabetic rats were placed on basal diet, or diets supplemented with PM leaves (10 % or 5 % inclusion) or sildenafil citrate (SC). RESULTS: The result revealed that PM supplemented diets caused significant (p<0.05) reduction in blood glucose level, and augmented erectile function by inhibiting arginase and PDE5 activities as well as enhancing nitric oxide level. CONCLUSIONS: In conclusion, dietary inclusion of PM leaves could serve as a potent nutraceutical source in hyperglycemia induced erectile dysfunction management.

Antihyperglycemic and aphrodisiac effect of West African Albizia (Albizia zygia) leaves-inclusive diet in diabetes-induced erectile dysfunctional rats.

ETHNOPHARMACOLOGICAL RELEVANCE: West African Albizia (Albizia zygia DC J. F. Macbr) leaves are a tropical plant that are frequently used in folkloric medicine to treat a number of illnesses, including type 2 diabetes (TY2D) and erectile dysfunction (ED), without having a complete scientific foundation. AIM OF THE STUDY: This investigation examined the effect of action of dietary augmentation of Albizia zygia leaves (AZL) on rat sexual functioning and important enzymes related to TY2D and ED. MATERIALS AND METHODS: Thirty matured adult Wistar rats of the weight 180-200 g were acclimatized in a lab environmental condition for two weeks prior to experiment given food and water to acclimate. Twenty-four of the rats got high fat diet (HFD) for periods of two weeks before receiving streptozotocin (STZ) intraperitoneally (i.p.), 35 mg/kg body weight single dose. Six rats got basal diets. Type 2 diabetes was identified in rats 72 h after STZ treatment. Rats were then used to evaluate the mounting number, mount delay, intromission number, and intromission latency. RESULTS: Following that, meals supplemented with AZL (5% or 10% inclusion) were given to diabetic-ED rats for 14 days. AZL was added. Therefore, in diabetic-ED rats, AZL supplementation could significantly (p0.05) lower blood glucose levels and the activities of alpha amylase, alpha glucosidase, phosphodiesterase-5, and arginase. In the case of diabetic-ED treated rats in consideration with diabetic-ED control group, nitric oxide levels were increased along with sexual function. CONCLUSION: Thus, experimental results of this study demonstrated rats that consumed AZL in their diets had less erectile dysfunction. In order to address ED caused by diabetes, AZL could be suggested as functional meals.

Intravenously engrafted human multilineage-differentiating stress-enduring (Muse) cells rescue erectile function after rat cavernous nerve injury.

OBJECTIVE: To evaluate the effect of intravenous administration of human multilineage-differentiating stress-enduring (Muse) cells on rat postoperative erectile dysfunction (ED) with cavernous nerve (CN) injury without an immunosuppressant. MATERIALS AND METHODS: Male Sprague-Dawley rats were randomised into three groups after CN crush injury. Either human-Muse cells, non-Muse mesenchymal stem cells (MSCs) (both 1.0 × 105 cells), or vehicle was infused intravenously at 3 h after CN injury without immunosuppressant. Erectile function was assessed by measuring intracavernous pressure (ICP) and arterial pressure (AP) during pelvic nerve electrostimulation 28 days after surgery. At 48 h and 28 days after intravenous infusion of Muse cells, the homing of Muse cells and non-Muse MSCs was evaluated in the major pelvic ganglion (MPG) after CN injury. In addition, expressions of C-X-C motif chemokine ligand (Cxcl12) and glial cell line-derived neurotrophic factor (Gdnf) in the MPG were examined by real-time polymerase chain reaction. Statistical analyses and comparisons among groups were performed using one-way analysis of variance followed by the Tukey test for parametric data and Kruskal-Wallis test followed by the Dunn-Bonferroni test for non-parametric data. RESULTS: The mean (SEM) ICP/AP values at 28 days were 0.51 (0.02) in the Muse cell group, 0.37 (0.03) in the non-Muse MSC group, and 0.36 (0.04) in the vehicle group, showing a significant positive response in the Muse cell group compared with the non-Muse and vehicle groups (P = 0.013 and P = 0.010, respectively). In the MPG, Muse cells were observed to be engrafted at 48 h and expressed Schwann cell markers S100 (~46%) and glial fibrillary acidic protein (~24%) at 28 days, while non-Muse MSCs were basically not engrafted at 48 h. Higher gene expression of Cxcl12 (P = 0.048) and Gdnf (P = 0.040) was found in the MPG of the Muse group than in the vehicle group 48 h after infusion. CONCLUSION: Intravenously engrafted human Muse cells recovered rat erectile function after CN injury in a rat model possibly by upregulating Cxcl12 and Gdnf.

[Erectile disfunction after treatment for prostate cancer]. / Erectiele disfunctie na behandeling van prostaatkanker.

Hasannejadsi et al. presented a predictive model for preserving erectile function after treatments for localized prostate cancer. However, the model has practical limitations and overestimates the chances of recovery. It focuses on the frequency of erections without considering important factors such as quality and patient satisfaction. The model did not include significant predictors like BMI and smoking. Additionally, it does not account for the extent of nerve sparing during surgery, limiting its usefulness for nerve-sparing prostatectomy patients. This comment emphasizes the importance of penile rehabilitation (PR) after prostate cancer treatment, highlighting the impact of penile inactivity on fibrosis of corporal cavernosal tissue. The author advocate for the implementation of PR during and after prostatecancer treatment and stress the role of healthcare professionals in providing information on rehabilitation options and sexual health in its totallity. The model can serve as a tool to initiate conversations about sexual function but should be complemented with comprehensive care tailored to individual patients.

Combining transcriptomic analysis and network pharmacology to explore the mechanism by which Shaofu Zhuyu decoction improves diabetes mellitus erectile dysfunction.

BACKGROUND: Erectile dysfunction is common among the complications of diabetes mellitus. Shaofu Zhuyu decoction (SFZYD) is commonly used to treat diabetic mellitus erectile dysfunction (DMED). However, its main active components and specific mechanism are still unknown. PURPOSE: To confirm the activity of SFZYD in improving DMED, explore the main active components of SFZYD, and clarify the underlying mechanism. METHODS: A diabetic rat model was induced with streptozotocin (STZ). After intragastric administration, erectile function was assessed by the maximum intracavernous pressure (ICPmax)/mean arterial pressure (MAP). Corpus cavernosum fibrosis was evaluated by Masson staining, and ELISA methods were used to determine the serum levels of IL-6, TNF-α, IL-10, IL-4 and IL-1ß to evaluate inflammation. Then, the main active components of SFZYD were identified by UPLC‒MS/MS. Finally, the target and biological mechanism of SFZYD in improving DMED were predicted by combined network pharmacology and transcriptomics, which was also validated by molecular docking and cellular thermal shift assay (CETSA) experiments. RESULTS: SFZYD significantly improved erectile dysfunction and inhibited inflammatory responses and local tissue fibrosis in diabetic rats. A total of 1846 active components were identified by UPLC‒MS/MS, and isorhamnetin was the main active component. The transcriptomic results were used to identify differentially expressed genes among the control, DM and SFZYD groups, and 1264 differentially expressed genes were obtained from the intersection. The network pharmacology results showed that SFZYD acts on core targets such as AKT1, ALB, HSP90AA1 and ESR1 through core components such as isorhamnetin, quercetin and chrysophanic acid. Further combined analysis revealed that multiple targets, such as CYP1B1, DPP4, NOS2 and LCN2, as well as the regulation of the PI3K-AKT signaling pathway, may be important mechanisms by which SFZYD improves DMED. Molecular docking verification showed that isorhamnetin, the key component of SFZYD, has good binding ability with several core targets, and its binding ability with CYP1B1 was the strongest. The CETSA results showed that isorhamnetin binds to CYP1B1 in CCECs. CONCLUSION: SFZYD improves DMED, inhibits the inflammatory response and alleviates local tissue fibrosis. The combined application of transcriptomic, network pharmacology, molecular docking and CETSA approaches was helpful for revealing the mechanism by which SFZYD improves DMED, which may be related to the regulation of CYP1B1 and the PI3K-Akt signaling pathway.

Sildenafil Vs. Tadalafil for The Treatment of Benign Prostatic Hyperplasia: A Single-arm Self-controlled Clinical Trial.

PURPOSE: To compare the efficacy and adverse events of sildenafil monotherapy for benign prostatic hyperplasia (BPH) with its FDA-approved counterpart, tadalafil. MATERIALS AND METHODS: In this single-arm self-controlled clinical trial, 33 patients were enrolled. All patients underwent a 6-week treatment with sildenafil, followed by a 4-week washout period and finally a 6-week treatment with tadalafil. Patients were examined on each appointment and post-void residual (PVR) urine, International Prostate Symptom Score (IPSS) and Quality of life index (IPSS-QoL index) were recorded subsequently. Efficacy of each drug regimen was then evaluated by comparing these outcome parameters. RESULTS: Both sildenafil and tadalafil were shown to improve PVR (both p < .001), IPSS (both p < .001) and IPSS- QoL index (both p < .001) significantly. Sildenafil was more effective than tadalafil in reducing PVR (mean difference (95%CI) = 9.91% (4.11, 15.72), p < .001) and ameliorating IPSS-QoL index (mean difference (95%CI) = 19.3% (4.47, 34.41), p = .027). Moreover, although not significant, sildenafil reduced IPSS more than tadalafil (mean difference (95%CI) = 3.33% (-0.22, 6.87), p = .065). Concurrent erectile dysfunction did not affect responsiveness to therapy with either sildenafil or tadalafil but age was inversely related to post-treatment IPSS in both sildenafil (B = 0.21 (0.04, 0.37), p = .015) and tadalafil (B = 0.14 (0.02, 0.26), p = .021) regimens with a more prominent role in responsiveness to sildenafil (ß = 0.31) compared to tadalafil (ß = 0.19). CONCLUSION: Considering the significantly better improvement of PVR and IPSS-Qol index with sildenafil, this drug can be nominated as a suitable alternative for tadalafil as a BPH treatment, especially in younger patients who don't have any contraindications.

Quality of life of hypertensive men with erectile dysfunction in a tertiary health centre in southern Nigeria.

BACKGROUND: Erectile dysfunction (ED) is the most common disorder of sexual health seen in men in community studies. A man's sexual health has been found to be a key factor in determining the capacity for maintaining a healthy relationship. AIM: This study sought to determine the quality of life of hypertensive men with ED attending the out-patient clinics of Federal Medical Centre (FMC), Asaba, South-South, Nigeria. SETTING: This study was conducted in the Out Patients Clinics (OPC) of FMC, Asaba, Delta state, Nigeria. METHODS: After obtaining approval from the ethics and research committees in Asaba, 184 consenting hypertensive men who met the eligibility criteria were selected by systematic random sampling to participate in the study from October 2015 to January 2016. This study was a cross-sectional survey. Data were collected with a semi-structured interviewer-administered questionnaire adopted from the international index of Sexual Health Inventory for Men (SHIM) and the World Health Organization Quality of Life Scale (WHOQOL-BREF). The study complied with the principles of Helsinki and Good Clinical Practice. RESULTS: The results showed the mean score for physical domain (58.78 ± 24.37), the psychological domain (62.68 ± 25.93), the social domain (50.47 ± 29.09), and the environmental domain (62.25 ± 18.52). Over a fifth, 11 (22.0%), of the respondents with severe ED had poor quality of life. CONCLUSION: This study showed that ED is common in hypertensive men and their quality of life was more impaired than those with normal erectile function.Contribution: This study contributes to holistic approaches to patient care.

A novel approach using electroacupuncture for erectile dysfunction after radical prostatectomy: A case report.

INTRODUCTION: Research shows that electrical stimulation to damaged peripheral nerves has promising effects on nerve regeneration and recovery of function. DESCRIPTION: A 71 yr. old male, who was 12 months post left intrafacial and right incremental nerve sparing robotic radical prostatectomy received 6 sessions of sacral electroacupuncture/acupuncture at weekly intervals, commencing 12 months post operatively. METHODS: CARE guidelines informed the case study report. Positive changes in erectile function after electroacupuncture was recorded using validated scores (IIEF-5 and EHS). Qualitative information was collected via a feedback box. DISCUSSION: Given that current treatments for post radical prostatectomy erectile dysfunction are invasive and largely unsuccessful, further investigation into electroacupuncture for this population should be pursued.

[Governor vessel moxibustion combined with wenyang yiqi qiwei decoction for erectile dysfunction with spleen-kidney deficiency and its effect on testosterone and vascular endothelial function].

OBJECTIVE: To observe the therapeutic effect of governor vessel moxibustion combined with wenyang yiqi qiwei decoction on erectile dysfunction (ED) with spleen-kidney deficiency and to explore the possible mechanism. METHODS: A total of 130 ED patients with spleen-kidney deficiency were randomized into an observation group (65 cases, 2 cases dropped off) and a control group (65 cases, 3 cases dropped off). The control group was given wenyang yiqi qiwei decoction orally, one dose daily. On the basis of the treatment in the control group, governor vessel moxibustion was applied from Dazhui (GV 14) to Yaoshu (GV 2) in the observation group, 110 min a time, once a day. The treatment of 4 weeks was required in both groups. Before and after treatment, 5-question international index of erectile function (IIEF-5) score, erection quality scale (EQS) score, erectile hardness assessment (EHS) score, TCM syndrome score, serum testosterone (T) level and vascular endothelial function indexes (prostaglandin I2 [PGI2], endothelin-1 [ET-1] and nitric oxide [NO] levels) were observed respectively, and the clinical efficacy was evaluated in both groups. RESULTS: After treatment, the scores of IIEF-5, EQS, EHS and serum levels of T, PGI2, NO were increased compared before treatment (P<0.01), the TCM syndrome scores and serum ET-1 levels were decreased compared before treatment (P<0.01) in the two groups; the scores of IIEF-5, EQS, EHS and serum levels of T, PGI2, NO in the observation group were higher than those in the control group (P<0.01, P<0.05), the TCM syndrome score and serum ET-1 level were lower than those in the control group (P<0.01, P<0.05). The total effective rate was 88.9% (56/63) in the observation group, which was superior to 74.2% (46/62) in the control group (P<0.05). CONCLUSION: Governor vessel moxibustion combined with wenyang yiqi qiwei decoction can improve the erectile function and increase the erection hardness and quality in ED patients with spleen-kidney deficiency, its mechanism may relate to improving serum T level and vascular endothelial function.

Sub-Chronic Restraint Stress Suppresses Sexual Potency and Erection Efficiency by Targeting the Hypothalamic-Pituitary-Testicular Axis and the Nitric Oxide/Cyclic Guanosine Monophosphate/Phosphodiesterase 5α Pathway in Adult Rats.

INTRODUCTION: Male sexual potency and vigor are a complex neuroendocrine process and an important component of well-being. Psychological stress is one of the leading causes of male impotence worldwide. Therefore, to better understand the effects of psychological stress on male sexual potency, vigor, and the physiology of erection, we used the rat restraint stress (RS) model, which can most aptly simulate psychological stress. METHODS: Adult male SD rats were exposed to RS for 1.5 or 3 h/day for 30 days. Neuromodulators and hormones of sexual potency and penile erection were quantified using ELISA kit. The histoarchitecture of the penis was examined using Masson trichrome staining. Immunoblotting and immunofluorescence were used to assess the expression and immunolocalization patterns of penile erection markers. To assess sexual potency and vigor, a noncontact erection and a copulatory test were performed. RESULTS: RS exposure decreased the circulatory levels of gonadotropins and testosterone while increasing the serum corticosterone level. RS exposure altered the histomorphology of the penis by decreasing the smooth muscle/collagen ratio and increasing oxidative stress in penile tissue. Furthermore, RS adversely affected NO availability for penile erection by decreasing the neurotransmitter acetylcholine and other erection facilitatory markers such as p-Akt, nNOS, eNOS, and cGMP, while increasing the inhibitory marker PDE5α in the penis. RS exposure significantly reduced the frequencies of mount, intromission, and ejaculation, whereas it prolonged sexual exhaustion by increasing latencies of postejaculatory mount, intromission, and ejaculation. CONCLUSION: The current findings suggest that psychological stressors, such as RS, cause erectile dysfunction in adult male rats by modulating the hypothalamic-pituitary-testicular axis, oxidative balance, penile fibrosis, and the NO/cGMP/PDE5α pathway of penile erection.

Paeonol ameliorates diabetic erectile dysfunction by inhibiting HMGB1/RAGE/NF-kB pathway.

BACKGROUND: The management of diabetes mellitus-induced erectile dysfunction (DMED) is progressively becoming tricky due to the surge in the number of patients and the poor efficiency of phosphodiesterase type 5 inhibitors in DMED. Paeonol (Pae), as a traditional Chinese medicine, has been more and more widely used in the treatment of diabetic complications. However, whether Pae could be a potential therapeutic drug of DMED needs to be further evaluated. OBJECTIVES: To investigate the pharmacological effect and possible mechanism of Pae in the treatment of DMED. METHODS: Intraperitoneal streptozotocin injection and an apomorphine test were used to construct the model of DMED. Seventeen DMED rats were divided into two groups: DMED group (n = 8) and DMED+Pae group (Pae; 100 mg/kg/d; oral administration; n = 9). In addition, there were still 10 normal age-matched male rats as control group. Four weeks later, the cavernous nerve electric stimulation was carried out to measure the erectile response. Moreover, the corpus cavernosum smooth muscle cells (CCSMCs) were primarily isolated and exposed to high glucose (HG) stimulation, Pae treatment and glycyrrhizin (GL; the selective inhibitor of HMGB1). After an incubation for 1 week, the CCSMCs were harvested for detection. RESULTS: The impairment of erectile function was observed in DMED rats compared with control samples, accompanied by the upregulation of HMGB1/RAGE/NF-κB Pathway. The lower nitric oxide and cGMP level and the higher level of inflammation, fibrosis, and apoptosis were also observed in DMED rats. It showed contrast that Pae treatment could improve the erectile function, as well as histologic alteration and related molecular changes. In addition, Pae could downregulate the HMGB1/RAGE/NF-κB pathway to regulate the apoptosis and inflammation levels of CCSMCs in high-glucose conditions, which is similar to the results of GL treatment. CONCLUSION: Pae alleviated ED in DMED rats, likely by inhibiting HMGB1/RAGE/NF-κB Pathway, inflammatory, apoptosis, and fibrotic activity, and moderating endothelial dysfunction. Our study provide evidence for a potential new therapy for DMED.

Comparative efficacy and safety of prostatic urethral lift vs prostatic artery embolization for benign prostatic hyperplasia: a systematic review and network meta-analysis.

OBJECTIVE: To assess and compare the clinical efficacy and safety of prostatic urethral lift (PUL) and prostatic artery embolization (PAE) for the treatment of lower urinary tract symptoms (LUTS) in patients with benign prostatic hyperplasia (BPH) by means of a systematic review and network meta-analysis. METHODS: A systematic literature search was performed using PubMed and Web of Science from inception to March 2021 to identify randomized controlled trials (RCTs) that compared PUL or PAE with either transurethral resection of the prostate (TURP) or sham procedures as control interventions. Qualitative and quantitative analyses were performed to pool the data on direct and indirect comparisons between interventions using STATA 14. RESULTS: Eight RCTs with 675 participants were included in our network meta-analysis. Quantitative synthesis revealed that TURP was the most efficacious intervention for clinical (International Prostate Symptoms Score and quality of life) and functional outcomes (maximum urinary flow rate and post-void residual urine volume), and was associated with a lower reintervention rate compared with PAE (risk ratio [RR] 2.08 with 95% confidence interval [CI] 0.96 to 4.51) and PUL (RR 2.33 with 95% CI 0.50 to 10.86), although the difference were not statistically significant. Indirect comparison indicated that PUL and PAE resulted in similar outcomes. PAE was associated with fewer minor adverse events (AEs; RR 0.75 with 95% CI 0.48 to 1.18) and PUL with fewer major AEs (RR 0.72 with 95% CI 0.17 to 3.13) when compared with TURP. Whilst PAE had a better ranking with regard to improvement of most clinical and functional outcomes, PUL was the best ranked procedure regarding erectile function, as measured by the International Index of Erectile Function 5, but no significant difference was observed. CONCLUSION: Current evidence suggests that PUL and PAE have similar clinical efficacy and safety profiles in the management of LUTS associated with BPH. However, the quality of evidence is relatively low because of the paucity of RCTs available, and results should be interpreted with caution.

An Evaluation of Sexual Function in the Treatment of Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia in Men Treated with the Temporarily Implanted Nitinol Device.

Purpose: To document the effect of the temporarily implanted nitinol device (iTind; Medi-Tate Ltd, Israel) on sexual function from a multicenter, randomized, single-blinded, sham-controlled trial. Materials and Methods: Men were randomized 2:1 between iTind and sham procedure arms. The iTind was placed for 5-7 days and an 18F Foley catheter was inserted and removed for the iTind and sham group, respectively. Patients were assessed at baseline, 3, and 12 months postoperatively using the Sexual Health Inventory for Men (SHIM) and International Index of Erectile Function (IIEF). Unblinding occurred at 3 months. Results: We studied 185 men with a mean age of 61.1 ± 6.5 years. There was no difference in SHIM or total IIEF between iTind and sham at 3 months or in the iTind arm at 12 months compared with baseline. Men in the iTind arm without erectile dysfunction at baseline showed an improvement in total IIEF score of +6.07 ± 21.17 points (p = 0.034) at 12 months, in addition to an improvement in ejaculatory function. SHIM scores remained unchanged in all groups, regardless of age, prostate volume, or baseline erectile function. Conclusion: No changes were observed in sexual and ejaculatory function of patients with iTind regardless of a man's age, prostate volume, and baseline sexual function. Clinicaltrials.gov: NCT02506465.

Biological activities of African medicinal plants in the treatment of erectile dysfunction: a mechanistic perspective.

The global incidence of erectile dysfunction is increasingly becoming a significant health concern, as its frequency demonstrates a consistent upward trajectory each year. In recent years, FDA-approved drugs like sildenafil among others has been approved to treat this disorder however the drug is not without its own side effects. In a bid to develop alternative therapeutic option, scientists have now turned to traditional medicine in search of a treatment regimen. Africa is blessed with numerous medicinal plants used in the treatment and management of several diseases including erectile dysfunction. Due to limited access to modern medicine and high-quality medical facilities, a significant number of individuals in Africa continue to depend on traditional medicine as a means of addressing critical health issues. Perhaps one of the grossly explored medicinal properties of plants in Africa is for erectile function. Through years of extensive research in medicinal plants, several plants indigenous to Africa have been identified to show profound ability to mitigate erectile dysfunction. While previous reports have indeed corroborated the ability of this plant to abate erectile dysfunction, there is still a dearth of information regarding the mechanistic aspect of these plants. Hence, the current review aims to provide a comprehensive mechanistic perspective to the major African medicinal plant which have been reported to be effective in the treatment of erectile dysfunction.

[Analysis of traditional Chinese medicine diagnosis and treatment for erectile dysfunction related to COVID-19 infection].

The incidence of erectile dysfunction (ED) has been reported to increase after COVID-19 infection, and it is common in COVID-19 patients during recovery. This paper presents a summary of the latest research progress on COVID-19-induced ED and explores the traditional Chinese medicine (TCM) diagnosis and treatment approach based on TCM theory and clinical experience. COVID-19 infection may lead to ED through endothelial dysfunction, testicular injury, hormonal imbalance, and psychological factors. The pathogenesis of COVID-19-related ED is mainly characterized by deficiency of the body's essence and excess of pathogenic factors. In the early stage, it is dominated by deficiency of qi and yin, while in the middle stage, it is mainly due to deficiency of qi and blood stasis. In the long-term, ED is based on the imbalance of yin and yang, with liver stagnation and qi stagnation often co-existing. Clinical manifestations of ED vary, and treatment should focus on tonifying qi and nourishing yin, promoting blood circulation, regulating yin and yang, and soothing liver depression according to TCM diagnosis and treatment principles.

[To evaluate the efficacy of Yishen Tongluo decoction combined with low-dose tadalafil in the treatment of diabetic erectile dysfunction with kidney deficiency and blood stasis syndrome].

OBJECTIVE: To observe the clinical efficacy of the combined treatment of Yishen Tongluo formula and low-dose tadalafil in diabetic erectile dysfunction. METHODS: A total of 80 patients with diabetic erectile dysfunction were randomly divided into two groups. The control group given tadalafil treatment, observation group in the control group given Yishen Tongluo Formula on the basis of treatment. The treatment period was 8 weeks. Erectile function were observed before and after treatment in the two groups patients-5 international questionnaire (IIEF - 5) score, erection quality scale (EQS) score, erectile hardness (EHS) score, TCM syndrome integral, content of serum homocysteine (HCY), endothelial function index ï¼»serum levels of prostaglandin I2 (PGI2)ï¼½ and endothelin (ET) content, a The changes of nitrogen oxide (NO), glucose and lipid metabolism indexes ï¼»triglyceride (TC), total cholesterol (TG)ï¼½ and oxidative stress related factors ï¼»total antioxidant capacity (T-AOC), glutathione peroxidase (GSH-Px)ï¼½ were evaluated, and the clinical efficacy of the two groups was evaluated. RESULTS: In terms of overall efficacy rate, the observation group (79.4%) outperformed that of the control (48.7%, P< 0.01).After treatment, the IIEF-5 score, EQS score, EHS score, and serum levels of PGI2, NO, T-AOC and GSH-Px were higher than those before treatment in the two groups (P< 0.05). The TCM syndrome score and serum HCY, ET-1, TC and TG were lower than those before treatment (P< 0.05), and the comparison group's consequence was comparatively worse than the group under observation (P< 0.01). CONCLUSIONS: Yishen Tongluo Formula can dramatically enhance the erectile dysfunction andimprovement of glucose-lipid metabolism when adopted in together with low-dose tadalafil.

Aqueous extract of Massularia acuminata exerts erectogenic effect by modulating critical enzymes and hormones in streptozotocin-induced erectile dysfunction in rats.

Massularia acuminata stem is often used in folkloric medicine in the management of erectile dysfunction (ED), without full scientific basis for its action. Thus, the effects of aqueous extract of M. acuminata stem (MAS) on sexual activity, hormonal action, enzymatic activity and levels of molecules associated with erectile function were assessed. ED was induced by single intraperitoneal injection of 50 mg/kg body weight of streptozotocin in rats and treated with sildenafil citrate or MAS (50 or 100 mg/kg) orally for 2 weeks. The results revealed that there was significant (p < 0.05) reduction in mounting and intromission frequencies, testosterone, luteinizing hormone, and nitric oxide levels, as well as elevation in mounting and intromission latencies, phosphodiesterase 5, arginase, acetylcholinesterase, adenosine triphosphatidase, and adenosine deaminase activities, nitric oxide, thiobarbituric acid reactive species, and glycated haemoglobin levels were observed in ED rats in comparison with the control rats. Treatment with MAS or sildenafil citrate significantly (p < 0.05) modulated the sexual behaviour, biochemical parameters and histological architecture, with 100 mg/kg of MAS having the best erectogenic effects. Furthermore, phenolic characterization revealed that catechin and kaempferol as the main phenolic compounds present in MAS, that can act in synergistically or additively with other phytochemicals to confer erectogenic effect.

Nutraceutical potential of almond fruits in managing diabetes-related erectile dysfunction: Effect on Nrf-2 level and smooth muscle/collagen ratio.

Oxidative stress is one of the major crosstalk between diabetes and erectile dysfunction. Tropical almond is a natural antioxidant that works in a way to neutralize the effect of reactive oxygen species in disease management. This study therefore aimed to evaluate the effects of tropical almond on the nuclear factor erythroid-2-related factor-2 (nrf-2) level and smooth muscle/collagen ratio, as well as other biochemical indices in the penile tissue of diabetic rats. Six non-diabetic male rats (control) and 36 diabetic male rats were divided into six groups (n = 6). The diabetic male rats were placed on almond-supplemented diets except for the diabetic control group. Thereafter, the rats were sacrificed penile tissues were excised for nrf-2, smooth muscle/collagen ratio, and other biochemical analyses. The results revealed a significant (p < 0.05) decrease in nrf-2 level, smooth muscle/collagen ratio, and total thiol level, with a concomitant increase in acetylcholinesterase activity in comparison to the control group. Interestingly, therapy with diets high in almond fruits significantly enhances the nrf-2 level, smooth muscle/collagen ratio, and total thiol level in comparison with the untreated diabetic group. In addition, dietary inclusion of almond fruits significantly reduced acetylcholinesterase activity in diabetic male rats. Therefore, the preventive management with almond fruits could be beneficial in combating erectile dysfunction associated with diabetes. The activities of almond fruits reported in this study could be due to their antioxidant property and the inherent phytoconstituents (amino acids, phenolic compounds, and flavonoids).

Continuous Psychological Nursing Based on Grey Clustering Algorithm in Patients after Transurethral Resection of Prostate.

Objective: To explore the effect of continuous psychological nursing based on the grey clustering algorithm on erectile function, bad psychological emotion, and complications in patients after transurethral resection of prostate (TURP). Methods: 98 patients who underwent TURP were randomly divided into observation and control groups (routine nursing). The observation group first used the grey clustering algorithm to evaluate the psychological intelligence, found patients with abnormal psychological behavior, and then implemented continuous psychological nursing combined with pelvic floor muscle exercise. The patients were followed up for 4 months. The International Index of Erectile Function-5 (IIEF-5), the incidence of complications, the Hamilton Depression Scale (HAMD), the Hamilton Anxiety Scale (HAMA) scores, and the nursing satisfaction were analyzed and compared between these two groups. Results: The grey clustering algorithm can accurately reflect the characteristics of patients' psychological changes. After targeted nursing, compared with the control group, the IIEF-5 in the observation group was higher [(24.87 ± 1.85) vs. (22.24 ± 1.47), P < 0.05], the incidence of total complications was lower (10.20% vs. 26.53%, P < 0.05), the score of HAMA was lower [(6.11 ± 2.57) vs. (10.98 ± 2.29), P < 0.05], the score of HAMD was lower [(6.97 ± 2.85) vs. (11.35 ± 2.19), P < 0.05], and the nursing satisfaction was higher (100% vs. 85.71%, P < 0.05). Conclusion: Mental intelligence evaluation based on the grey clustering algorithm combined with pelvic floor muscle exercise can significantly improve the rehabilitation effect of erectile function in patients after TURP, reduce the incidence of postoperative complications, and alleviate patients' anxiety and depression.