Soil salinization is a major abiotic stress limiting wheat production. Although transcriptional responses to salt stress are well-studied, the role of posttranscriptional regulation, particularly through RNA modifications, remains unclear in wheat (Triticum aestivum L.). Here, we present an integrated analysis of the early salt stress response using Nanopore direct RNA sequencing and quantitative proteomics. We generated genome-wide maps of N6-methyladenosine (m6A) modifications, concurrently profiling alternative polyadenylation events and poly(A) tail length dynamics. This multiomics approach characterizes coordinated epitranscriptomic reprogramming and enabled the construction of a regulatory network linking m6A marks to proteomic changes. Furthermore, we identified and functionally validated the putative m6A reader protein EVOLUTIONARILY CONSERVED C-TERMINAL REGION 5 (TaECT5) as a positive regulator of wheat salt tolerance. Our study provides a systems-level view of posttranscriptional regulation during salt stress in wheat and identifies potential targets for enhancing salt tolerance.

BACKGROUND:Acquired premature ejaculation (APE) is a prevalent male sexual dysfunction that significantly impairs quality of life. Although APE is associated with various risk factors, its underlying etiology remains poorly understood. AIM:This research investigates the potential connection between chronotype and APE. Particular emphasis is placed on the mediating associations involving health-promoting lifestyle (HPL) -self-initiated activities that maintain or improve health-and the moderating role of illness perception. METHODS:A total of 516 men diagnosed with APE and 495 healthy controls were recruited from our hospital for this study. Participants completed paper-based questionnaires, including sociodemographic information, the Premature Ejaculation Diagnostic Tool, the Health-Promoting Lifestyle Profile II, and the Morningness-Eveningness Questionnaire. Furthermore, patients with APE completed the Brief Illness Perception Questionnaire. Among APE patients, moderated mediation analysis was conducted to explore the underlying mechanisms. OUTCOMES:The main finding was that an evening chronotype was associated with both the presence and greater severity of APE, and the association between chronotype and APE severity was partly mediated by HPL and further moderated by illness perception. RESULTS:Chronotype was associated with the presence of APE (adjusted odds ratio = 0.99, 95% confidence interval [CI], 0.98-1.00, P < .001). Among men with APE, chronotype was associated with APE severity (β = -0.42, P < .01), with HPL mediating this association (β = -0.46, P < .01). Illness perception significantly moderated both the association between chronotype and HPL (β = -0.18, 95% CI, -0.24 to -0.11) and the link between HPL and APE (β = 0.11, 95% CI, 0.03-0.20). CLINICAL IMPLICATIONS:These findings suggest that considering chronotype, HPL, and illness perception may inform clinical approaches to improving ejaculatory regulation in individuals with APE. STRENGTHS AND LIMITATIONS:This study is the first to investigate the association between chronotype and APE, providing new insights that may inform future clinical considerations. However, the single-center design may limit the generalizability of the results. CONCLUSION:Chronotype was associated with both the presence and severity of APE, with the chronotype-severity link partly mediated by HPL and further moderated by illness perception. Integrating chronotype, lifestyle patterns, and illness perception into clinical assessment may improve understanding of ejaculatory control in men with APE.

PURPOSE:Previous neuroimaging studies have found abnormalities in the brain structure or functional connectivity of patients with lifelong premature ejaculation (LPE), but the differences in neurotransmitters in relevant brain regions remain unclear. This study aimed to explore the correlation between the central main excitatory neurotransmitter glutamate (Glu) and inhibitory neurotransmitter gamma-aminobutyric acid (GABA) with LPE. MATERIALS AND METHODS:This cross-sectional study recruited 50 LPE patients and 50 healthy controls (HCs). Proton magnetic resonance spectroscopy measured Glu, GABA, and creatine levels in the right thalamus and prefrontal cortex. Premature ejaculation symptoms were assessed using the premature ejaculation diagnostic tool (PEDT). RESULTS:After excluding invalid data, 42 LPE patients and 42 HCs were included. LPE patients showed elevated Glu levels (thalamus: 10.32 vs. 8.59, p<0.001; prefrontal cortex: 9.33 vs. 8.02, p<0.01) and Glu/GABA ratios (thalamus: 4.75 vs. 3.25, p<0.001; prefrontal cortex: 5.45 vs. 4.27, p<0.001), along with reduced thalamic GABA (2.28 vs. 2.27, p<0.001). Glu levels and Glu/GABA ratios positively correlated with PEDT scores, while GABA levels negatively correlated with PEDT. Additionally, GABA levels were higher in LPE patients with good sleep quality than in those with poor sleep (thalamus: 2.50 vs. 2.24, p=0.014; prefrontal cortex: 1.84 vs. 1.63, p<0.01). CONCLUSIONS:This study reveals differences in Glu and GABA levels in the thalamus and prefrontal cortex between LPE patients and HCs. The imbalance in Glu/GABA may be a contributing factor to increased central excitability and rapid ejaculation in LPE patients. These findings provide new potential targets for the etiological exploration and treatment of LPE.

BACKGROUND:Poor sleep quality is associated with erectile dysfunction (ED), but the underlying mechanisms remain unclear. Given that systemic inflammation and testosterone levels are key factors in vascular health, this study investigates whether inflammatory biomarkers (high-sensitivity C-reactive protein [hs-CRP], interleukin-6 [IL-6], neutrophil-to-lymphocyte ratio [NLR], and platelet-to-lymphocyte ratio [PLR]) and total testosterone (TT) mediate the relationship between sleep quality and erectile function in vasculogenic ED patients. METHODS:A total of 167 vasculogenic ED patients and 112 age-matched controls were recruited. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), and erectile function was evaluated using the International Index of Erectile Function-5 (IIEF-5). Inflammatory biomarkers and TT levels were measured, and principal component analysis (PCA) was applied to derive an inflammatory load score. Serial mediation analysis (PROCESS Model 6) was performed to examine whether inflammation and testosterone mediate the effect of sleep quality on erectile function, adjusting for potential confounders, including age, body mass index (BMI), smoking, triglycerides (TG), and total cholesterol (TC). RESULTS:Patients with vasculogenic ED had poorer sleep quality (p < 0.001), lower TT levels (p < 0.01), and higher inflammatory biomarker levels (p < 0.01) than controls. Correlation analysis showed PSQI was positively correlated with inflammation (β = 0.371, p < 0.001) and negatively correlated with TT (β = -0.206, p < 0.01) and IIEF-5 (r = -0.437, p < 0.001). Mediation analysis revealed: Inflammatory biomarkers (hs-CRP, IL-6, NLR, and PLR) significantly mediated the association between sleep quality and ED, with hs-CRP showing the highest effect (β = -0.133, p < 0.001), accounting for 21.73% of the total effect. Testosterone also played a mediating role (β = -0.055, p < 0.01), contributing to 8.99% of the total effect. After combining inflammatory biomarkers into a PCA-derived score, the mediation effect of inflammation increased to 38.60%, whereas the testosterone pathway weakened. CONCLUSIONS:This study provides novel evidence that inflammation is a key mediator linking poor sleep quality to vasculogenic ED, while decreased testosterone levels play a secondary but still significant role.

Background Cancer-associated fibroblasts (CAFs) are key components of the bladder cancer microenvironment, but how specific CAF subpopulations drive malignant progression remains unclear. This study aimed to identify CAF driver genes and elucidate the role of caveolin-1 (CAV1) in CAF-mediated bladder cancer progression. Methods Single-cell RNA sequencing and public bladder cancer datasets were integrated to identify fibroblast-associated candidate genes and evaluate the clinical significance of CAV1. Clinical samples were analyzed by immunofluorescence. The biological functions of CAV1 were further evaluated through CAF–bladder cancer cell co-culture systems, gain- and loss-of-function experiments, and comprehensive molecular analyses. The downstream mechanism was explored through LIF stimulation, STAT3 silencing, and validated in a subcutaneous xenograft model. Results Single-cell analysis identified CAV1 as a fibroblast-associated gene linked to stemness- and ferroptosis-related signatures. High CAV1 expression predicted poor prognosis and was independently associated with unfavorable survival. CAV1 expression positively correlated with fibroblast infiltration and was enriched in a subset of ACTA2-positive CAFs. CAFs markedly promoted multiple malignant behaviors of bladder cancer cells, whereas silencing CAV1 effectively counteracted these pro-tumorigenic effects. Mechanistically, CAV1 enhanced LIF expression in CAFs, thereby activating JAK2/STAT3 signaling in tumor cells. Pharmacological inhibition of STAT3 abolished the tumor-promoting effects of CAFs both in vitro and in vivo. Conclusions CAF-derived CAV1 promotes bladder cancer progression by activating the LIF-STAT3 signaling axis. Targeting stromal CAV1-mediated STAT3 signaling may represent a promising therapeutic strategy for bladder cancer.

Background Erectile dysfunction (ED) is a prevalent condition that significantly impairs male sexual health and quality of life, yet the psychological pathways—specifically the potential roles of rumination as a mediator and resilience as a moderator—linking it to non-restorative sleep (NRS) remain unclear. To address this, we conducted a cross-sectional study of 880 men with ED recruited from the Andrology Clinic of the First Affiliated Hospital of Anhui Medical University between April 2024 and October 2025. Participants were evaluated using the NRS Scale (NRSS, lower scores indicate more severe NRS), Ruminative Responses Scale (RRS), 10-item Connor–Davidson Resilience Scale (CD-RISC-10), and the 5-item International Index of Erectile Function (IIEF-5); data were subsequently analyzed via Pearson correlations, bootstrapped mediation and moderated mediation modeling, and latent profile analysis (LPA) in Mplus to identify rumination subgroups and characterize variations in erectile function across these profiles. Results NRSS correlated positively with IIEF-5 ( r = 0.63) and negatively with rumination ( r = −0.54). Rumination partially mediated the NRSS–IIEF-5 association (NRSS→rumination: β = −0.54; rumination→IIEF-5: β = −0.22). LPA identified three rumination profiles (low 28.86%, moderate 43.18%, high 27.96%) with graded IIEF-5 scores (high vs low: 8.92±3.84 vs 14.95±5.03). Resilience moderated both the NRSS→rumination path (NRSS × Resilience β = −0.13) and the rumination→IIEF-5 path (Rumination × Resilience β = 0.14), indicating that the indirect association via rumination was conditional on resilience. (All P < 0.001). Conclusion Our findings support a cognitive–emotional pathway wherein subjective sleep non-restoration contributes to ED partially through the mediating role of rumination, while psychological resilience serves to buffer this adverse association. Although longitudinal studies are necessary to establish definitive causal directionality and ensure broader generalizability, these results suggest that integrating therapeutic strategies—specifically those targeting perceived sleep quality, maladaptive rumination, and psychological resilience—may significantly facilitate the development of more personalized and comprehensive clinical management for patients with ED.

BACKGROUND:Erectile dysfunction (ED) is a prevalent male health disorder and a recognized sentinel marker for cardiovascular disease. Current diagnostic reliance on subjective questionnaires or invasive examinations limits early screening. AIM:We aimed to develop and validate a machine learning model based on routine blood test data to predict ED risk to facilitate its early clinical screening. METHODS:Data from 4116 men in the NHANES database (2001-2004) formed the training/internal validation sets. An independent external validation set comprised 489 clinical patients with NPTR-confirmed ED. From 49 initial demographic and blood-based indicators, feature selection via univariate logistic, multivariate logistic, and LASSO regression identified nine key predictors. Seven machine learning models were constructed, optimized via grid search with fivefold cross-validation, and evaluated using ROC analysis, calibration curves, and decision curve analysis (DCA). The optimal model was interpreted via SHAP. RESULTS:The random forest model achieved superior performance, with an external validation AUC of 0.934, accuracy of 0.918, and specificity of 0.986, significantly outperforming logistic regression (AUC = 0.743). SHAP analysis identified age, sex hormone-binding globulin (SHBG), testosterone, glucose, cholesterol, and creatinine as the most influential predictors. DISCUSSION:The study established a concise, nine-feature blood test panel and validated a high-performing predictive model in an independent clinical cohort, demonstrating significant clinical net benefit. Meanwhile, this model provides an economical, non-invasive, and scalable screening tool suitable for health check-ups, facilitating early ED identification. CONCLUSION:A machine learning model based on routine blood tests can effectively evaluate ED risk, offering a novel foundation for early screening and precision management.

Sexual reproduction in plants is a tightly coordinated process that underpins biodiversity, drives speciation, and serves as a foundation for modern crop improvement. Here, we synthesize recent advances in elucidating the molecular mechanisms governing major reproductive events in flowering plants, including male and female gametogenesis, pollen-pistil communication, double fertilization, embryogenesis, and endosperm-mediated seed development. We also discuss the integration of asexual propagation through protoplast regeneration, highlighting its emerging importance in plant biotechnology. Together, these insights deepen our understanding of fundamental reproductive biology and open new opportunities for the rational design of hybrid breeding systems and stress-resilient crops, with broad implications for global food security under changing climatic conditions.

The shoot apical meristem of vascular plants generates all the aboveground organs. During this process, the structure and function of the meristem are maintained by a group of regulatory genes, among which the WUSCHEL (WUS)-CLAVATA3 (CLV3) module plays the core role. To date, all of the insights into shoot meristem homeostasis have been derived from studies on herbaceous plants. The mechanism by which the shoot meristem is maintained in trees remains unknown. In this study, we analyzed the functions of the poplar genes PagWUS and PagCLV3, homologs of Arabidopsis WUS and CLV3, respectively, in the maintenance and regeneration of the shoot meristem. Our results reveal both conserved and divergent functions compared to those of their orthologs in herbaceous species. Similar to their herbaceous counterparts, PagWUS and PagCLV3 are specifically expressed in the organizing center and stem cells, respectively, and form a feedback loop that regulates shoot meristem maintenance. Overexpression of PagWUS promoted shoot regeneration. Compared with herbaceous species, poplar possesses a much larger stem cell niche. The function of the PagWUS-PagCLV3 module is consistent with the developmental characteristics of perennial trees in that it regulates the cessation of the shoot meristem and mediates the proper pattern of secondary growth. Disruption of PagCLV3 enhanced shoot regeneration capacity. Our results shed light on shoot meristem regulation in trees and pave the way for understanding the mechanisms of meristem activity and plant development.

BACKGROUND:Lifelong premature ejaculation (LPE) is a prevalent male sexual dysfunction with unclear neurobiological mechanisms. Despite its high prevalence, the etiology of LPE remains debated, often attributed to psychological or biological factors. Recent neuroimaging studies have highlighted the role of central nervous system dysregulation in sexual behavior. AIM:This study investigates abnormal brain functions and altered network connectivity in LPE patients after visual sexual stimuli (VSS) using functional magnetic resonance imaging. METHODS:Twenty-five LPE patients and 31 healthy controls (HCs) underwent resting-state and task-state functional magnetic resonance imaging (fMRI). Clinical data, including sexual history, self-reported intravaginal ejaculatory latency time, International Index of Erectile Function-5, the Chinese Index of Premature Ejaculation, anxiety/depression scores, and serum testosterone levels, were collected. Neuroimaging preprocessing and analysis focused on amplitude of low-frequency fluctuation, fractional ALFF, and regional homogeneity. Task-state fMRI compared brain activation patterns after VSS. Statistical analyses included voxel-based comparisons and network connectivity assessments using SPM12 and DPABI v3.0. OUTCOMES:LPE patients demonstrate distinct neurofunctional abnormalities after VSS, particularly hyperactivation in the precuneus. RESULTS:‌Clinical Data‌: LPE patients exhibited significantly lower International Index of Erectile Function-5 scores and higher depression rates compared to HCs, with no differences in age, BMI, or testosterone levels. Brain Activation‌: During VSS, LPE patients showed relative signal decrease in the middle cingulate cortex and left precentral gyrus compared to HCs. Regional homogeneity analysis revealed hyperactivation in the precuneus and fusiform gyrus post-stimulus. Network Connectivity‌: Altered connectivity in premature ejaculation patients involved the fusiform gyrus (linked to posterior cingulate, hippocampus, parahippocampus, and supplementary motor areas) and the superior parietal lobule (connected to the angular gyrus). CLINICAL IMPLICATIONS:These findings suggest that aberrant central nervous system processing of sexual stimuli contributes to premature ejaculation pathophysiology, offering potential targets for neuromodulatory therapies. STRENGTHS AND LIMITATIONS:The study focuses on the different activation patterns of patients with LPE from the perspective of sexual arousal. The methodological aspects of research, such as the use of images or videos in sexual stimulation, remain controversial. The findings of our network analysis only demonstrated a limited number of altered functional connections, and no established network metrics were provided to substantiate the claim of extensive network disruption. These factors collectively represent important limitations of the present study. CONCLUSION:The hyperactivity in this brain region observed in patients could represent a unique response to VSS among those with LPE, ultimately leading to alterations in their ejaculatory behavior.‌‌‌.

Global population aging is shifting healthcare priorities from merely extending life to enhancing quality of life, yet sexuality remains a neglected dimension of healthy aging. Prevailing approaches focus on discrete sexual dysfunctions such as erectile dysfunction, menopause-related dyspareunia, or late-onset hypogonadism, overlooking the multidimensional and dyadic nature of sexual aging. This review reframes successful sexual aging (SSA) as a biopsychosocial process evaluated in the light of the new systems sexology, integrating decline and adaptation, and introducing the paradigm of SSA grounded in acceptance, adaptation, and activation. We conducted a narrative review of literature across sexual medicine, geriatrics, endocrinology, urology, gynecology, psychiatric, psychology, sociology, and regenerative medicine. We critically examined central theoretical constructs of CouplePause and DoublePause along with validated assessment instruments and a proposed conceptual framework, the Sexual Aging Index (SAI), intended to guide future multidimensional assessment of sexual aging. Evidence synthesized from gender-specific and cross-cultural perspectives illuminated key conceptual voids, translational barriers, and novel opportunities to advance the field of sexual aging research. Sexual aging is shaped by endocrine decline, neurovascular changes, psychological resilience, sociocultural norms, and relational dynamics. Men commonly experience gradual androgen and vascular decline, while women face abrupt transitions linked to menopause and genitourinary syndrome of menopause (GSM), yet both trajectories are strongly moderated by adaptation and couple dynamics. Current assessment instruments fail to adequately capture aging-specific, dyadic dimensions, highlighting the need for multidimensional tools like the SAI. Interventions extend beyond pharmacology to include translational Chinese medicine (TCM), functional nutrition, low intensity extracorporeal shock wave therapy (Li-ESWT), platelet-rich plasm (PRP), stem cell therapies, and vaginal energy-based devices, though evidence remains heterogeneous. The SSA framework reframes it as a positive, process-oriented phenomenon linked to quality of life and relational health, while challenging sexual ageism at individual, clinical, and policy levels. Sexual aging represents an emerging frontier in sexual medicine, demanding a shift from deficit-based models to an integrative, couple-centered, and culturally inclusive paradigm. Advancing this field will require international consensus on definitions and frameworks, the development of validated multidimensional assessment tools, the implementation of rigorous multimodal clinical trials, and societal initiatives to dismantle sexual ageism. Embedding sexual health into healthy aging policies, healthcare delivery, and medical education will be critical to ensure that intimacy, dignity, and sexual vitality remain integral to longevity in the twenty-first century.

BACKGROUND:Chronic kidney disease (CKD) frequently coexists with hypothalamic-pituitary-gonadal dysfunction, yet the exposure-response shape linking kidney function, testosterone, and outcomes remains unclear. METHODS:Based on data from five cycles of the National Health and Nutrition Examination Survey (NHANES) and the UK Biobank (UKBB), we used multivariate logistic regression models and linear regression models to explore the associations between total testosterone levels and CKD as well as estimated glomerular filtration rate (eGFR). Subsequently, we plotted restricted cubic splines (RCS) of testosterone levels against the risk of CKD and the eGFR. Finally, we further verified the association between total testosterone levels and eGFR based on the kidney transplant cohort. RESULTS:Across both populations, lower eGFR was revealed to be associated with lower total testosterone in an approximately linear fashion. RCS identified an inflection around the "borderline low" range of about 300-400 ng/dL; below that, CKD risk rose steeply, indicating a nonlinear, threshold-like risk pattern. The logistic regression analysis based on the public databases also indicated that CKD would reduce testosterone levels (NHANES: β = -17.98, 95% CI: -29.54, -6.420, p-value = 3.4 × 10-3; UKBB: β = -12.25, 95% CI: -14.84, -9.661, p-value = 1.9 × 10-20), but it had no effect on estradiol. In the validation cohort of kidney transplant recipients, total testosterone increased significantly after transplantation, whereas estradiol showed no parallel rise. CONCLUSION:Our findings demonstrate a clear linear-threshold relationship between declining eGFR and reduced testosterone levels, and show that testosterone significantly increases after renal function recovery in kidney transplant recipients.

AIMS:Artificial light exposure at night and irregular light schedules are increasingly prevalent environmental stressors in modern society and have been implicated in male reproductive disorders. This study aimed to determine how distinct patterns of circadian rhythm disruption differentially affect male reproductive function and to elucidate the underlying mechanisms. MATERIALS AND METHODS:Three groups of male rats were subjected to standard 12-h light/12-h dark cycles (LD), fixed inverted light-dark cycles (DL), and a dynamic alternating light-dark-dark-light cycle (LDDL) designed to induce circadian rhythm instability. Reproductive outcomes including body weight, testicular index, serum testosterone levels, and sperm parameters were assessed. Testicular oxidative status was evaluated by measuring NOX4/5, HO-1, SOD, and MDA levels, while apoptosis was examined using Bax/Bcl-2 ratio, cleaved caspase-3 expression, and TUNEL staining. KEY FINDINGS:Male rats exposed to the LDDL cycle exhibited significant reproductive dysfunction, manifested as markedly reduced testicular index, decreased serum testosterone concentration, and impaired sperm motility. Mechanistically, LDDL conditions enhanced testicular oxidative stress, manifested by NOX4/5 upregulation and HO-1/SOD suppression. This redox imbalance was accompanied by germ cell apoptosis activation, evidenced by elevated Bax/Bcl-2 ratios, increased cleaved caspase-3 expression, and a higher proportion of TUNEL-positive cells. Notably, reproductive damage was more pronounced under dynamic circadian rhythm disruption than under fixed light-dark reversal conditions. SIGNIFICANCE:By linking dynamically light-induced circadian disruption to testicular oxidative stress and apoptotic signaling pathways, it elucidates potential mechanisms by which modern lighting environments impair male fertility and provides strategies for circadian rhythm intervention and environmental mitigation.

TaDJA-6D boosts wheat regeneration and transformation efficiency across genotypes, offering a new molecular breeding resource. As a key member of the heat shock protein 40 family, the co-chaperone DnaJ proteins play a crucial role in plant growth, development, and stress responses. However, very few studies have focused on the function of DnaJ protein in wheat (Triticum aestivum L.). Here, we characterized a DnaJ family gene from wheat, TaDJA-6D, (TraesCS6D02G232600) and analyzed its spatiotemporal expression pattern. During wheat regeneration, the transcriptional expression level of the TaDJA-6D gene was continuously upregulated with the extension of tissue culture time; in situ hybridization revealed that the genes were highly expressed in the vigorously dividing regions of wheat calli. Functional analysis demonstrated that, compared with the control vector, overexpression of TaDJA-6D significantly improved the wheat regeneration and transformation efficiency across diverse wheat genotypes, including Fielder, Kenong 199, Yanda 1817 and Xiaoyan 6. Our findings suggest that TaDJA-6D plays an important role in the process of wheat regeneration and genetic transformation. This study deepens our understanding of the functions of wheat co-chaperone proteins and provides novel genetic resources for efficient wheat transformation.

Introduction Erectile dysfunction (ED) has a high incidence and complex etiology. Traditional assessments, based on intercourse scenarios, often neglect erectile function during masturbation, possibly leading to misdiagnosis. This study aimed to comprehensively assess ED based on erection during masturbation. Method A single‐center cross‐sectional study was conducted at the First Affiliated Hospital of Anhui Medical University, with the study period spanning from June 2024 to June 2025. The International Index of Erectile Function‐5 (IIEF‐5) scale (which was administered separately for intercourse and masturbation to capture scenario‐specific function) and nocturnal penile tumescence and rigidity (NPTR) monitoring were adopted to classify the ED subtype (Group A: NPTR (abnormal) + ED during masturbation; Group B: NPTR (abnormal) + no ED during masturbation; Group C: NPTR (normal) + ED during masturbation; Group D: NPTR (normal) + no ED during masturbation). A structured questionnaire survey was implemented to gather information on potential risk factors of the study participants, followed by statistical analysis of the association. Results Among the 525 participants we studied, 371 suffered from ED. These patients were generally older, had a higher body mass index (BMI), a higher smoking rate, and lower physical activity levels. Subtypes differed in IIEF‐5 scores, comorbidities, and related factors: Group A represents the most severe ED, and its IIEF‐5 score is also the lowest (8.16 ± 3.87). Group A was associated with organic diseases; Group B with sexual desire disorder; Groups C and D with psychological disorders. Conclusion This is the first study to use masturbation erection to classify ED types, each with unique characteristics and causes, providing a basis for personalized diagnosis and treatment.

Tadalafil administration and low-intensity extracorporeal shockwave therapy (Li-ESWT) are both effective treatments for erectile dysfunction (ED), but the option of monotherapy or combination therapy for patients with varying severities of ED remains uncertain. This study aimed to compare the efficacy of Li-ESWT monotherapy versus Li-ESWT combined with daily tadalafil across different ED severity subgroups. A total of 188 men aged 18–60 years with ED were enrolled from three clinical centers between June 2018 and March 2020. Demographic data, International Index of Erectile Function-5 (IIEF-5), erectile hardness score (EHS), Clinical Global Impression scale (CGI), and minimal clinically important difference (MCID) were collected. Li-ESWT was delivered using the Renova system with standardized parameters (once weekly for a total of four sessions). Patients in the combination therapy group received 5 mg of tadalafil daily for one continuous month during the Li-ESWT treatment period. Statistical analyses compared pre- and post-treatment outcomes within and between groups. The study population comprised 53 patients in the Li-ESWT monotherapy group and 135 in the combination therapy group. Compared to baseline, IIEF-5 scores improved by 2.92 ± 2.57 points with Li-ESWT monotherapy and by 4.60 ± 4.24 points with combination therapy. In patients with moderate to severe (Mo-Se) ED, combination therapy yielded significantly higher IIEF-5 scores (13.26 ± 5.59 vs. 9.65 ± 3.38, p = 0.001) and higher EHS scores (2.70 ± 0.78 vs. 2.30 ± 0.73, p = 0.042) compared to monotherapy at the 3-month follow-up. Compared with Li-ESWT group, the combination group demonstrated significantly higher “improved” response rates in both CGI (58.3% vs. 40.0%, p = 0.045) and MCID (56.2% vs. 20.0%, p = 0.004) assessments in Mo-Se ED patients. Both Li-ESWT monotherapy and combination therapy with tadalafil are effective treatments for ED. The combination strategy appears to offer superior clinical benefits for patients with Mo-Se ED, whereas monotherapy may be sufficient for those with mild ED. Future large-scale, long-term studies are needed to further validate the value of tailoring treatment selection based on ED severity.

Introduction:Arteriogenic erectile dysfunction (AED) is the vascular subtype of erectile dysfunction and is closely linked to endothelial dysfunction. The Endothelial Activation and Stress Index (EASIX), calculated from lactate dehydrogenase (LDH), creatinine, and platelet count, has been recognized as a surrogate marker of endothelial injury in several vascular-related conditions. The aim of this study is to explore the association between EASIX and AED. Methods:In this cross-sectional study, 193 men were enrolled, including 94 patients diagnosed with AED and 99 controls. Erectile function was assessed using the International Index of Erectile Function-5 (IIEF-5), nocturnal penile tumescence and rigidity, and color duplex Doppler ultrasonography. EASIX was calculated as LDH × creatinine/platelet count. Multivariate logistic regression analysis was performed to evaluate the association between EASIX and AED after adjusting for potential confounders. Receiver operating characteristic (ROC) curve analysis was conducted to assess diagnostic performance. Results:EASIX levels were significantly higher in the AED group compared to controls (1.13 [0.72-1.55] vs. 0.79 [0.58-1.01], P < .001). In multivariate logistic regression analysis adjusting for age, body mass index, smoking status, metabolic parameters, testosterone levels, and comorbidities, EASIX remained independently associated with AED (OR 1.339, 95% CI 1.239-1.448, P < .001). When analyzed by quartiles, participants in the highest EASIX quartile had a significantly increased likelihood of AED compared with the lowest quartile (P < .001). A significant negative correlation was observed between EASIX and IIEF-5 score (r = -0.291, P = .004). ROC analysis demonstrated that EASIX had moderate diagnostic performance for identifying AED (AUC 0.728, 95% CI 0.656-0.799), which was higher than LDH (AUC 0.680) and creatinine (AUC 0.689). Conclusion:EASIX was significantly associated with AED and demonstrated moderate diagnostic performance. Prospective studies are warranted to validate its clinical applicability.

Penile cancer is rare, and patients increasingly rely on the internet for health information. On April 1, 2025, we conducted a cross-sectional evaluation of the quality and readability of the top 100 Google search results; 71 websites were included in the analysis. Overall quality was fair, with a mean DISCERN score of 41.01 ± 13.67, and transparency was limited, with a mean Journal of the American Medical Association (JAMA) benchmark score of 1.69 ± 1.02. Readability was generally suboptimal: the mean Flesch Reading Ease (FRE) score was 52.06 ± 12.05 (fairly difficult), and the Gunning Fog Index and Simplified Measure of Gobbledygook (SMOG) scores (8.48 ± 2.43 and 7.19 ± 2.02, respectively) indicated reading demands above the recommended sixth-grade level. Kruskal-Wallis and Dunn's post hoc tests showed significant differences in DISCERN scores across affiliations, with non-profit websites scoring higher than commercial websites. FRE also differed by affiliation (p = 0.016), although post hoc comparisons were not significant, and sensitivity analyses supported the robustness of these findings. Correlation analysis demonstrated a strong association between DISCERN and JAMA scores (r = 0.662; p < 0.001). These findings support improved disclosure of authorship and update dates and simplification of language for patient education.

The FAcilitates Chromatin Transcription (FACT) complex, comprising structure-specific recognition protein 1 (SSRP1) and suppressor of Ty 16 (SPT16), plays a key role in regulating gene transcription by facilitating ATP-independent nucleosome assembly. SSRP1 contains an HMG domain that binds to DNA and regulates cell proliferation, apoptosis, and DNA repair. However, its role in plant development remains poorly understood. In this study, we identified a mutant, small kernel 301 (smk301), characterized by reduced kernel size and semi-dwarfism. Map-based cloning revealed that the mutation affects ZmSSRP1 on chromosome 8, which is expressed throughout maize (Zea mays L.) tissues. ZmSSRP1 localizes to the nucleus and interacts with ZmSPT16 to form the FACT complex. Using RNA-seq and ATAC-seq analyses, we identified 3 candidate target genes involved in hormone pathways, all of which show a significant positive correlation with ZmSSRP1 expression. Notably, ZmSSRP1 was enriched in the chromatin open region of brassinosteroid-deficient dwarf 1 (ZmBRD1), which encodes a Brassinosteroid C-6 Oxidase. This indicates that ZmSSRP1 affects maize development by regulating the transcription of ZmBRD1, thereby influencing the brassinosteroid content in maize. Our findings shed light on how the FACT complex influences maize development by modulating the expression of brassinosteroid-related genes, offering insights into the molecular mechanisms underlying plant growth.