BACKGROUND:Cavernous nerve injury-induced erectile dysfunction (CNI-ED) is a common postoperative complication of pelvic surgery that currently lacks effective treatments. Oxidative stress (OS) plays a central role in its pathogenesis. Although epigallocatechin gallate (EGCG) has demonstrated antioxidant properties, its clinical application is limited by poor stability and bioavailability. Iron-EGCG nanozymes (Fe-EGCG), which integrate the enzymatic properties of nanoparticles with the antioxidant characteristics of EGCG through metal-polyphenol coordination, may provide a superior solution for restoring oxidative stress balance. OBJECTIVE:To investigate the therapeutic effects and underlying mechanisms of Fe-EGCG in ameliorating CNI-ED. MATERIALS AND METHODS:Fe-EGCG was synthesized via metal-polyphenol coordination and characterized for morphology and catalytic activity. Its reactive oxygen species (ROS) scavenging capacity was verified in vitro using PC-12 cells. Twenty-four rats were randomly assigned to four groups: sham-operated, bilateral cavernous nerve injury (BCNI), BCNI + EGCG, and BCNI + Fe-EGCG. EGCG and Fe-EGCG (100 µL, 2 mg/mL) were locally injected at the cavernous nerve injury site. Three weeks post-treatment, erectile function was evaluated. Cavernous nerves and penile tissues were collected for ultrastructural, histological, and molecular biological analyses. RESULTS:Fe-EGCG nanozymes were successfully synthesized and characterized. In vitro experiments demonstrated that Fe-EGCG exhibited significantly stronger superoxide dismutase (SOD) and catalase (CAT) activities, as well as superior ROS scavenging capacity, compared to EGCG. In vivo studies further revealed that Fe-EGCG achieved better therapeutic outcomes than EGCG. Compared with the BCNI group, both EGCG and Fe-EGCG treatments significantly alleviated neural damage. This effect was evidenced by increased axonal density, enhanced Schwann cell proliferation, and restoration of neuronal nitric oxide synthase (nNOS) expression. Additionally, erectile function was significantly improved in both treatment groups. The BCNI rats exhibited decreased smooth muscle content, increased collagen deposition in the corpus cavernosum, and upregulated fibrosis markers, all of which were significantly attenuated following EGCG and Fe-EGCG administration. Mechanistically, both treatments reduced oxidative stress levels and were associated with upregulation of the Nrf2/HO-1 pathway and downregulation of NLRP3 inflammasome activity. DISCUSSION AND CONCLUSION:Fe-EGCG ameliorates CNI-ED by attenuating oxidative stress, protecting nerves, and inhibiting penile fibrosis. This study establishes Fe-EGCG as a novel and promising therapeutic strategy for CNI-ED. As a nanozyme self-assembled from metal ions and natural organic ligands, it enhances the efficacy of traditional antioxidants through synergistic effects.

Background and Objective:Erectile dysfunction (ED) is common and closely linked to cardiometabolic disease, psychological distress, and relationship problems. Although effective treatments are available, outcomes depend on sustained post-discharge follow-up to assess response, adherence, adverse effects, and psychosocial needs. In practice, ED follow-up is often hindered by stigma, embarrassment, limited access, and fragmented communication. This narrative review examines the potential role, risks, and implementation requirements of large language model (LLM)-assisted follow-up in ED care. Methods:We conducted a targeted literature search in PubMed and Embase up to 15 January 2026, supplemented by Google Scholar for citation tracking. We selected clinically relevant evidence and conceptual work on ED follow-up, conversational artificial intelligence (AI), and safety governance, and synthesized findings thematically. Key Content and Findings:Among 280 included sources, only 10 were ED-specific, while 270 provided transferable evidence from chronic disease, oncology, and mental health follow-up settings. LLMs may reduce communication barriers, enable low-threshold symptom check-ins, reinforce discharge education, and collect patient-reported outcomes more frequently than traditional follow-up. Potential clinical value is greatest for structured, low-risk tasks such as education reinforcement, adherence support, and routine symptom monitoring. However, ED follow-up includes medication safety, nuanced counseling, mental health and relationship contexts, and sensitive data governance. Key risks include inaccurate or unsafe recommendations, privacy breaches, inappropriate handling of mental health red flags, and unclear accountability. A risk-stratified, human-in-the-loop implementation model can balance feasibility and safety by reserving autonomous LLM interactions for low-risk content while triggering clinician review and escalation for predefined high-risk scenarios. Conclusions:LLM-assisted follow-up could become a useful adjunct in ED care if implemented with clear boundaries, auditability, privacy protection, and robust human oversight. A nurse-supervised, trigger-based governance model, which aligns with current follow-up workflows, may enhance continuity and responsiveness without compromising clinical accountability. Prospective evaluations should prioritize patient acceptability, safety outcomes, workload impact, and implementation feasibility.

Background: Mitochondrial dysfunction is implicated in the pathogenesis of erectile dysfunction (ED); establishing a causal relationship remains a challenge. This study employed a two‐sample Mendelian randomization (MR) approach to investigate the potential causal associations between mitochondria‐associated proteins and ED. Methods: Association data on mitochondria‐associated proteins from the IEU OpenGWAS database were used for exposure, whereas ED association data from the UK Biobank and FinnGen databases served as the outcome. MR analyses were conducted separately, primarily employing the inverse‐variance weighted (IVW) method and supplemented by the MR‐Egger, weighted median, simple mode, and weighted mode methods. Sensitivity analyses included Cochran’s Q test, MR‐Egger test, leave‐one‐out analysis, and MR‐PRESSO. A meta‐analysis of both databases was conducted to enhance the credibility of the results. Results: Meta‐analysis revealed a significant causal relationship between five mitochondria‐related proteins and ED: 39S ribosomal protein L33 (RPL33; p = 0.013; odds ratio [OR] = 0.94; 95% confidence interval [CI]: 0.90–0.99), mitochondrial ubiquitin ligase activator of NFKB‐1 (MULAN1; p = 0.039; OR = 1.08; 95% CI: 1.00–1.16), nucleoside diphosphate‐linked moiety X motif ‐8 (NUDT8; p = 0.035; OR = 0.92; 95% CI: 0.84–0.99), pyruvate dehydrogenase (acetyl‐transferring) kinase isozyme‐1 (PDK1; p = 0.047; OR = 1.07; 95% CI: 1.00–1.14), and serine‐tRNA ligase (SerRS; p = 0.005; OR = 1.18; 95% CI: 1.05–1.33). Sensitivity analyses revealed no abnormalities. Conclusion: RPL33 and NUDT8 exhibited potential protective effects against ED, whereas MULAN1, PDK1, and SerRS may increase the risk of developing ED. These findings offer new insights into the role of mitochondrial dysfunction in ED pathogenesis and may guide the development of future therapeutic strategies.

BackgroundErectile dysfunction (ED) is characterized by a persistent inability to achieve and maintain sufficient penile erection for satisfactory sexual performance persisting for at least six months. Low-intensity pulsed ultrasound (LIPUS), a noninvasive therapy, has shown potential in improving ED by promoting the regeneration of connective tissue, blood vessels, and cavernous nerves, as well as reducing inflammation. This study aims to evaluate the clinical efficacy and histological changes in the corpus cavernosum of patients with ED treated with tadalafil combined with LIPUS through a randomized controlled trial.MethodsThis study will enroll 114 patients diagnosed with ED who will be randomly assigned to either the treatment group or the control group in a 1:1 ratio using simple random sampling. The treatment group will first receive 5 mg of tadalafil daily combined with twice-weekly LIPUS therapy for 4 weeks. Following a 4-week interval with daily 5 mg tadalafil alone (no LIPUS treatment), the same combined treatment regimen will be repeated. The control group will receive only 5 mg of tadalafil daily. The primary outcome will be assessed using the minimal clinically important difference (MCID) based on the International Index of Erectile Function-5 (IIEF-5) at each follow-up visit. Additional assessments will include the Erection Hardness Score (EHS), penile blood flow parameters, and elasticity values for a comprehensive evaluation.DiscussionThe study aims to evaluate the efficacy of tadalafil combined with LIPUS for treating ED and to improve the evaluation of treatment response in erectile dysfunction by integrating blood flow parameters and two-dimensional shear wave elastography.Trial registrationTrial registration: ClinicalTrials.gov, NCT06543628. Registered 5th August 2024, https://clinicaltrials.gov/study/NCT06543628.

Background:The development of neurogenic erectile dysfunction (NED) is closely associated with apoptosis and fibrosis of corpus cavernosum smooth muscle cells (CCSMCs) following cavernous nerve injury (CNI). This study aimed to examine the preventative effects of fisetin on CCSMC apoptosis and fibrosis, as well as its ameliorative effects on NED, using a rat model of CNI. Methods:Twenty-four male Sprague-Dawley rats were randomly assigned into three groups: a control group (n=8), a model group (CNI; n=8), and a fisetin group [2.5 mg/(kg·day) of fisetin administered via gavage; n=8]. The animal model was established through clamping of the bilateral cavernous nerves. The control and model groups were given an equivalent volume of saline. Erectile function (EF) was evaluated as the ratio of intracavernous pressure to mean arterial pressure (ICP/MAP). Penile tissue samples were collected for Western blotting, Real-time polymerase chain reaction (RT-qPCR), and fluorescence analysis to assess the expression levels of apoptotic proteins, messenger RNA (mRNA), collagen types I (Col-1) and III (Col-3), and peroxisome proliferator-activated receptor gamma (PPAR-γ). Apoptosis in CCSMCs was evaluated using TUNEL staining, while the collagen content in corporal tissue was assessed using Masson staining. Results:Compared to the control group, the model group's ICP:MAP ratio decreased. The model group also exhibited increased levels of apoptotic proteins and their RNA, including caspase 3, caspase 9, and Bax, while those of Bcl-2 were decreased. TUNEL staining indicated the presence of apoptosis in CCSMCs. The expression of the Col-1 and Col-3 proteins was elevated, and Masson staining indicated that the smooth muscle-to-collagen ratio was decreased. Moreover, RT-qPCR and immunofluorescence staining indicated a decrease in PPAR-γ content in corporal tissue. Treatment with fisetin for 4 weeks reversed these changes. In vitro experiments showed that the addition of the PPAR-γ inhibitor T0070907 negated the effects of fisetin in reducing the apoptosis rate and collagen deposition in CCSMCs. Conclusions:Fisetin may exert a protective effect against CNI-induced apoptosis in CCSMCs, ameliorate the fibrosis of the corporal tissue, and enhance EF, primarily through the upregulation of PPAR-γ expression.

BackgroundChronic prostatitis type IIIb/chronic pelvic pain syndrome (CP/CPPS) poses significant therapeutic challenges. This study aimed to investigate and compare the clinical efficacy and safety of low-intensity pulsed ultrasound (LIPUS) versus tamsulosin for treating CP/CPPS.MethodsIn this randomized controlled trial, 65 patients with CP/CPPS were allocated to two groups. Group A (n = 35) received LIPUS treatment twice weekly, while Group B (n = 30) received tamsulosin sustained-release capsules (0.2 mg, once nightly). The treatment duration was four weeks for all patients. Outcomes were assessed using the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI), Self-Rating Anxiety Scale (SAS), and International Index of Erectile Function-5 (IIEF-5) at baseline and 4 weeks post-intervention.ResultsAfter 4 weeks, both groups showed significant improvements in all NIH-CPSI domains (pain, urinary, quality of life), SAS, and IIEF-5 scores compared to baseline (all P < 0.05). Group A demonstrated significantly greater improvement in pain symptoms than Group B (P < 0.05), whereas Group B showed superior improvement in urinary symptoms compared to Group A (P < 0.05). No statistically significant differences were found between the groups for the remaining symptom domains (P > 0.05).ConclusionBoth LIPUS and tamsulosin significantly alleviated CP/CPPS-related symptoms with a favorable safety profile. LIPUS was more effective for pain relief, while tamsulosin was superior for urinary symptoms. Combination therapy may represent a promising approach for managing CP/CPPS.

Background Peripheral nerve injury can result in penile cavernosal denervation muscle atrophy, a primary factor in nerve injury erectile dysfunction (NED). While acetylcholine (Ach) is integral to erectile function, its role and mechanisms in NED need further exploration. Objective To investigate the inhibition of CCMSCs Apoptosis and Protein Degradation Pathway by Ach in NED rat model. Methods We investigated changes in Ach secretion and receptor expression in an NED rat model, followed by the evaluation of apoptosis and ubiquitin proteasome activation in hypoxic Cavernous smooth muscle cells (CCMSCs) and their co-cultures with Schwann cells (SWCs), under Ach influence. Further, key pathways in NED were identified via high-throughput sequencing, focusing on the p38/MAPK signaling pathway. We examined gene alterations related to this pathway using hypoxic cell models and employed p38 inhibitors to verify protein changes. Our findings in vitro were then confirmed in the NED rat model. Results Nerve injury led to reduced Ach receptors and associated gene expression. Experimentally, Ach was shown to counteract CCMSC apoptosis and muscle protein degradation via the p38/MAPK pathway. Inhibition of the Ach degradation pathway demonstrated a capacity to slow NED progression in vivo. Discussion and conclusion Activation of Ach receptors may decelerate denervation-induced cavernosal muscle atrophy, suggesting a potential therapeutic approach for NED. This study highlights the crucial role of the Ach/p38/MAPK axis in the pathophysiology of penis smooth muscle atrophy and its broader implications in managing NED and male erectile dysfunction.

Background:It is difficult to diagnose hypogonadism because of the lack of objective assessments of erectile dysfunction (ED), which is caused by hypogonadism.Aim:To provide a new approach for diagnosing hypogonadism, this study evaluated the efficacy of nocturnal penile tumescence and rigidity (NPTR) testing with RigiScan for patients with ED with and without hypogonadism.Methods:From June 2021 to February 2023, 133 patients with ED (62 with hypogonadism and 71 without) underwent NPTR testing at the Department of Andrology. A detailed history of all participants was obtained. All participants also underwent a physical examination, sex hormone testing, and ultrasound examination of the cavernous vessels of the penis.Outcomes:Patient characteristics, sex hormone serum levels, and RigiScan Plus data of NPTR testing of patients with ED were obtained and evaluated.Results:Between the groups, there were no significant differences in age, body mass index, or erectile function score or in the prevalence of smoking, drinking, diabetes, hypertension, and hyperlipidemia. RigiScan data revealed differences in erection episodes per night, average event rigidity, erection durations, and percentage of tumescence greater than baseline, which were significantly lower in the testosterone-deficient group than in the normal testosterone group. The average event rigidity of the tip displayed the largest area under the curve value, with a sensitivity of 67.6%, a specificity of 85.5%, and a cutoff value of 52.50.Clinical Implications:Our findings may allow appropriate patients to receive testosterone replacement therapy, which has been shown to be an effective treatment for hypogonadism.Strengths and Limitations:This is the first study of its kind to perform a comprehensive review of the association between hypogonadism and RigiScan parameters. This study was limited by its small sample size.Conclusion:RigiScan parameters of patients with ED and testosterone deficiency were significantly lower than those of patients with normal testosterone; therefore, RigiScan is useful for the differential diagnosis of patients with ED caused by hypogonadism.

BACKGROUND:Erectile dysfunction (ED), defined as the inability to achieve or maintain a penile erection sufficient to satisfy sexual behavior, is prevalent worldwide. AIM:Using previous research, bioinformatics, and experimental confirmation, we aimed to discover genes that contribute to ED through regulating hypoxia in corpus cavernosum smooth muscle cells (CCSMCs). METHODS:We used the Gene Expression Omnibus to acquire the sequencing data of the corpus cavernosum transcriptome for diabetic ED and nerve injury type ED rats. We intersected the common differentially expressed genes. Further verification was performed using single cell sequencing. Real-time quantitative polymerase chain reaction and immunofluorescence were used to investigate whether the differentially expressed genes are found in the corpus cavernosum. We used induced hypoxia to assess cell viability changes, and we developed a lentivirus overexpressing Cldn4 for in vitro and in vivo experiments to measure changes in JNK signaling, fibrosis, hypoxia, and erectile function. OUTCOMES:Our results indicate that targeting the JNK pathway and decreasing local hypoxia may be better options for therapeutic intervention to improve erectile function. RESULTS:We identified Cldn4 and found its expression increased in the corpora cavernosa of the 2 datasets. In addition, we found that hypoxia can increase the expression of Cldn4, activate the JNK signaling pathway, and exacerbate fibrosis in CCSMCs. Cldn4 overexpression in CCSMCs activated the JNK signaling pathway and increased fibrotic protein expression. Last, rat corpus cavernosum overexpressing Cldn4 activated the JNK signaling pathway, increased local fibrosis, and impaired erectile function. CLINICAL IMPLICATIONS:Through bioinformatics and in vitro and in vivo experiments, we found that Cldn4 has a negative effect on ED, and targeting Cldn4 may provide new ideas for ED treatment. STRENGTHS AND LIMITATIONS:Although we have identified Cldn4 as a potential target for ED treatment, we have only conducted preliminary validation on CCMSCs, and we still need to further validate in other cell lines. CONCLUSION:CCSMC hypoxia leads to increased Cldn4, in both nerve injury and diabetic ED rat models, and promotes fibrosis by activating the JNK signaling pathway.

Background and Objective:The treatment of prostate cancer (PCa) often comes with the risk of erectile dysfunction (ED). As therapeutic technologies continue to advance, the incidence of ED and its treatment methods are also evolving. This paper aimed to provide a comprehensive analysis of the latest developments in PCa treatment, with a particular focus on its relationship with ED, and to review current innovative strategies for ED treatment. Methods:This study conducted a literature search in databases including PubMed, Excerpta Medica, Web of Science, Scopus, and the Cochrane Library, using keywords including "prostate cancer", "active surveillance", "radiation therapy", "cryotherapy", "radical prostatectomy", "immunotherapy", "chemotherapy", "androgen deprivation therapy", "erectile dysfunction", and "therapeutic advances", to collect English-language literature published from 1966 to June 2024. Key Content and Findings:Active surveillance (AS) strategies have significantly reduced the incidence of ED. Technological advancements such as radiation therapy (RT), precise delineation techniques, and improvements in cryotherapy equipment are all dedicated to reducing the risk of ED. Intraoperative nerve monitoring combined with robot-assisted radical prostatectomy (RP) plays a key role in protecting the cavernous nerves and improving postoperative erectile function (EF) recovery. The impact of immunotherapy and chemotherapy on the risk of ED still needs to be clarified with additional clinical data. Androgen deprivation therapy (ADT) is often carried out as part of a combined treatment or through novel administration modalities to reduce its side effects. Given the limitations of traditional ED treatment methods, emerging treatments such as physical energy therapy, stem cell and platelet-rich plasma (PRP) therapy, gene and targeted therapies, tissue engineering and nerve transplantation, and traditional Chinese medicine (TCM) represent novel solutions for ED treatment. Conclusions:With the innovation of PCa treatment technologies, the incidence of ED has declined, and emerging ED treatment methods have benefited the recovery of sexual function in patients with PCa. These advances may form the basis from which further innovations in PCa treatment strategies can be developed.

BackgroundHJIG is a potential treatment for erectile dysfunction (ED) that has been used in China for over 20 years. We conducted a multi-center, double-blind, randomized, placebo-controlled trial to evaluate the effectiveness and safety of the Chinese Herbal Medicine, Hongjing I granule (HJIG), in patients with mild to moderate erectile dysfunction (ED).MethodsThis study is structured as a randomized, double-blind, placebo-controlled trial, executed across multiple centers. The recruitment strategy is primarily oriented towards patients demonstrating a pronounced preference for solely leveraging traditional Chinese medicine (TCM) interventions, a preference that is widely observed within TCM healthcare settings. A total of 100 patients, presenting with mild to moderate ED, specifically linked to the traditional diagnostic criteria of qi deficiency and blood stasis, will be enrolled. These participants will be randomly distributed between the HJIG (N = 50) and placebo (N = 50) arms. The designated treatment period is set at 8 weeks. Primary outcome measures encompass the International Index of Erectile Function-Erectile Function domain (IIEF-EF) score, the Sexual Encounter Profile (SEP), and scores derived from the traditional Chinese medicine symptom evaluation.ResultsOf the 122 men enrolled, the baseline IIEF-EF score averaged 16.00 [IQR: 13.00, 18.00]. Eight weeks post-randomization, the HJIG group demonstrated a mean change in IIEF-EF scores of 7.80 (±3.25), compared to 3.33 (±3.90) in the placebo group, signifying a marked difference (P < 0.001). The median alterations in SEP3 scores were 0.50 [IQR: 0.36, 0.75] for the HJIG group and 0.50 [0.20, 0.67] for the placebo group, revealing a statistically relevant distinction (P = 0.05). In both primary outcomes, HJIG proved superior to the placebo. Additionally, improvements in TCM symptom scores were notably greater in the HJIG group relative to the placebo, with no adverse events reported across both groups.ConclusionThe Hongjing I granule significantly improved symptoms in patients with mild to moderate ED. However, to validate these findings, further extended randomized trials are warranted.Clinical Trial RegistrationThe study has been registered in the Chinese Clinical Trial Registry (ChiCTR) and the registration number was ChiCTR2000041127.

Introduction: Erectile dysfunction (ED) is a prevalent condition in urology, primarily managed with PDE5 inhibitors (PDE5Is). However, approximately 20% of patients do not experience improvement in overall sexual satisfaction (OS) after taking PDE5Is. Among these, traditional Chinese medicine (TCM) has emerged as a complementary approach, with formulas like Hongjing I granules (HJIG) showing promise in preliminary studies. This study aims to rigorously evaluate the effectiveness and safety of HJIG in mild to moderate ED cases, assessing improvement in both sexual function and TCM pattern alignment.Methods: This study is a randomized, double-blind, placebo-controlled multicentre trial. Recruitment will be conducted from patients who have a strong willingness to try using only traditional Chinese medicine treatment (This is very common in traditional Chinese medicine hospitals.). A total of 100 patients diagnosed with mild to moderate ED caused by qi deficiency and blood stasis will be recruited and randomly assigned to receive one of two treatments: HJIG (N = 50) or placebo (N = 50). Patients will receive 8 weeks of treatment and a 16-week follow-up starting from the fourth week of treatment. Outcome measures, including the International Index of Erectile Function-Erectile Function domain (IIEF-EF) score, Sexual Encounter Profile (SEP), and Traditional Chinese Medicine symptom score, will be evaluated.Discussion: The expected outcome of this trial is that the use of the herbal formula HIJG alone can improve overall sexual satisfaction (OS) in patients with mild to moderate ED, while also improving their traditional Chinese medicine symptom scores. This will provide evidence-based support for the use of Chinese medicine in the treatment of ED in China.Trial Registration: Chinese Clinical Trial Registry, ChiCTR2000041127, Registered on 19 December 2020, https://www.chictr.org. cn/showproj.html?proj=46469.Trial Status: Recruitment began in March 2021, therefore 80 patients have been recruited. It is expected to finish recruiting in December 2023.

RationalePrimary renal parenchymal squamous cell carcinoma (SCC) is an extremely rare tumor that is difficult to diagnose by hematology and imaging studies and is often diagnosed later than other primary renal cancers. DiagnosisA 52-year-old male patient was found to have cysts in both kidneys for 1 week. No urgency and frequency of urination, no dysuria, no gross hematuria, and no significant changes in recent body weight were reported. InterventionsThe upper pole of the right kidney is a cystic and solid mass (8.3 cm * 8.2 cm * 8.1 cm), the cystic part has long T1 and long T2 signals, the solid part has mixed signals, and some parts have limited diffusion. There were nodular long T1 and short T2 calcification signals. An enhanced scan of the solid part showed uneven enhancement and continuous enhancement of the mass capsule. Cystic renal cancer was considered because of the multiple cysts in both kidneys. Surgical treatment was performed. Postoperative pathology revealed well-differentiated squamous cell carcinoma of the right kidney with cystic degeneration, 8.5 cm * 6 cm in size, infiltrating the renal parenchyma, and the cutting edge was negative. The pathological stage was pT2bN0M0. OutcomeAt the follow-up 5 months after the operation, no metastasis was found. ConclusionRenal SCC is rare and easily misdiagnosed and missed. Pathological diagnosis is still the gold standard for its diagnosis. However, with active surgical treatment, the short-term prognosis of the patient is good.

Abstract Background Erectile dysfunction (ED) is a common disease in male urology, and there is a single class of drugs used for its first-line treatment. Approximately 20% of patients do not experience improvement in overall sexual satisfaction (OS) after taking tadalafil. Currently, traditional Chinese medicine (TCM) is widely used as a complementary and alternative medicine (CAM) approach for ED patients. The Hongjing I granule (HJIG) herbal formula has shown good therapeutic effects on ED in preclinical studies. However, further evidence is needed to demonstrate its clinical efficacy and safety.Methods This study is a randomized, double-blind, placebo-controlled multicentre trial. A total of 100 patients diagnosed with mild to moderate ED caused by qi deficiency and blood stasis will be recruited and randomly assigned to receive one of two treatments: HJIG (N = 50) or placebo (N = 50). Patients will receive 8 weeks of treatment and a 16-week follow-up starting from the fourth week of treatment. Outcome measures, including the International Index of Erectile Function-Erectile Function domain (IIEF-EF) score, Sexual Encounter Profile (SEP), and Traditional Chinese Medicine symptom score, will be evaluated.Discussion This study is the first multicentre study to compare traditional Chinese herbal formulas with placebos in the treatment of ED. It aims to verify the improvement of TCM syndrome differentiation, erectile function, and sexual experience and to further broaden the treatment options for ED. The hypothesis is that HJIG can improve the erectile function score and sexual experiences of patients diagnosed with qi deficiency and blood stasis–type mild to moderate ED. This study may establish a new treatment for ED, distinct from other drugs used for similar clinical indications in clinical practice, and may provide high-quality reference evidence for its use as a complementary or substitute drug.Trial registration: Chinese Clinical Trial Registry, ChiCTR2000041127.

Diabetic erectile dysfunction (DED) is one of the most common complications of diabetes mellitus. However, current therapeutics have no satisfactory effect on DED. In recent years, traditional Chinese medicine (TCM) has shown good effects against DED. By now, several clinical trials have been conducted to study the effect of TCM in treating DED; yet, the underlying mechanism is not fully investigated. Therefore, in this review, we briefly summarized the pathophysiological mechanism of DED and reviewed the published clinical trials on the treatment of DED by TCM. Then, the therapeutic potential of TCM and the underlying mechanisms whereby TCM exerts protective effects were summarized. We concluded that TCM is more effective than chemical drugs in treating DED by targeting multiple signaling pathways, including those involved in oxidation, apoptosis, atherosclerosis, and endothelial function. However, the major limitation in the application of TCM against DED is the lack of a large-scale, multicenter, randomized, and controlled clinical trial on the therapeutic effect, and the underlying pharmaceutical mechanisms also need further investigation. Despite these limitations, clinical trials and further experimental studies will enhance our understanding of the mechanisms modulated by TCM and promote the widespread application of TCM to treat DED.

男科疾病位在下焦,病程日久则易出现多虚多瘀的病理变化,加之久病及肾、久病入络的最终转归,故现代医家认为肾虚血瘀是男性不育症、良性前列腺增生症、慢性前列腺炎、勃起功能障碍、迟发型性腺功能减退症等多种男科疾病的共同病理基础和必然趋势,常贯穿于疾病发生发展的不同阶段.临床上基于肾虚血瘀理论,补肾活血法在男科疾病的诊疗中得以广泛运用,并取得了令人满意的疗效.鉴于上述,文章还提出肾虚血瘀是男科疾病异病同治的重要桥梁,但运用补肾活血法"异病同治"男科疾病的相关研究尚待进一步开展.

OBJECTIVE:To explore the mechanism of Salidroside regulating the phenotypic transformation of cavernous smooth muscle cells (CCSMCs) in rats. METHODS:Primary CCSMCs were isolated from male SD rats, cultured in hypoxic environment for 24 hours, and treated with Salidroside at 30 μg/mL. Then the expressions of HIF-1α, platelet-derived growth factor receptor (PDGFR) and phenotypic transformation-related proteins α-SMA and Collagen I were detected by Western blot. The culture system of the CCSMCs was treated with exogenous PDGF-BB at 20 ng/mL for 24 hours, and the effects of Salidroside or PDGFR inhibitor Crenolanib (100 nmol/L) were observed. The expressions of PDGFR, phosphorylated PDGFR, phenotypic transformation-related proteins α-SMA and Collagen I, STAT3, phosphorylated STAT3, STAT5 and phosphorylated STAT5 were determined by Western blot. The intervention effects of Salidroside and/or the overexpression of STAT3 were observed after stimulation of the CCSMCs by exogenous PDGF-BB, followed by detection of the expressions of phenotypic transformation-related proteins α-SMA and Collagen I, STAT3 and phosphorylated STAT3 proteins. RESULTS:The expression of HIF-1α in the CCSMCs was significantly upregulated after cultured in hypoxic environment for 24 hours (P < 0.05), suggesting the successful construction of the hypoxia model of CCSMCs. Meanwhile, the expressions of PDGFRα, PDGFRβ and Collagen I were remarkably increased (all P < 0.05), and that of α-SMA markedly decreased (P < 0.05) in the CCSMCs. However, the expressions of the all the proteins above were significantly inhibited by Salidroside intervention (all P < 0.05). After stimulated by exogenous PDGF-BB for 24 hours, the phosphorylation ratios of PDGFRα, PDGFRβ and STAT3 and the expression of Collagen I were significantly elevated (all P < 0.05), that of α-SMA remarkably reduced (P < 0.05), and all were inhibited by intervention with crenolanib or Salidroside (all P < 0.05). No statistically significant difference was observed in the STAT5 phosphorylation ratio between different groups (P > 0.05). Overexpression of STAT3 in the CCSMCs treated with exogenous PDGF-BB and Salidroside significantly decreased the expression of α-SMA (P < 0.05) and increased that of Collagen I (P < 0.05). CONCLUSION:Salidroside could improve the phenotypic transformation of CCSMCs in male rats through the PDGFR/STAT3 signaling pathway, which needs further exploration and verification.

目的 探讨复方利多卡因乳膏联合盐酸达泊西汀治疗原发性早泄的临床疗效.方法 60例原发性早泄患者随机分为A、B、C三组,每组各20例.A组给予复方利多卡因乳膏于性交前15?min外用,B组于性交前1～3?h给予盐酸达泊西汀片口服,C组予以复方利多卡因乳膏外用联合盐酸达泊西汀口服治疗.比较治疗前、治疗后4周三组患者的阴道内射精潜伏期(IELT)、早泄诊断量表(PEDT)评分、患者及其伴侣的性生活满意度和不良事件发生情况.结果 治疗4周后,三组患者的IELT较治疗前均有大幅度提高,差异有统计学意义(P<0.05);C组的IELT提高程度明显高于A、B两组,差异有统计学意义(P<0.05);A、B两组的IELT提高程度比较,差异无统计学意义(P>0.05).治疗4周后,三组患者的PEDT评分较治疗前明显降低,差异有统计学意义(P<0.05);C组的PEDT评分下降程度明显高于A、B两组,差异有统计学意义(P<0.05),A、B两组的PEDT评分下降程度比较,差异无统计学意义(P>0.05).治疗4周后,三组患者及其性伴侣的性生活满意度均有提升,差异有统计学意义(P<0.05);B、C组患者及其性伴侣的性生活满意度高于A组,差异有统计学意义(P<0.05);C组患者及其性伴侣的性生活满意度高于B组,差异有统计学意义(P<0.05).结论 复方利多卡因乳膏联合达泊西汀治疗能够明显增加IELT、降低PEDT评分、提高患者及其性伴侣的性生活满意度,增强控制射精的能力,缓解患者负面情绪,增强信心,且不良反应少.

Circular RNAs (circRNAs) are a class of noncoding RNAs with closed-loop of single-stranded RNA structure. Although most of the circRNAs do not directly encode proteins, emerging evidence suggests that circRNAs play a pivotal and complex role in multiple biological processes by regulating gene expression. As one of the most popular circRNAs, circular homeodomain-interacting protein kinase 3 (circHIPK3) has frequently gained the interest of researchers in recent years. Accumulating studies have demonstrated the significant impacts on the occurrence and development of multiple human diseases including cancers, cardiovascular diseases, diabetes mellitus, inflammatory diseases, and others. The present review aims to provide a detailed description of the functions of circHIPK3 and comprehensively overview the diagnostic and therapeutic value of circHIPK3 in these certain diseases.