Dermal extracellular matrix gelatin delivering Prussian blue nanoparticles to relieve skin flap ischemia

The survival rate of flap is a crucial factor for determining the success of tissue repair and reconstruction. Flap transplantation surgery often leads to ischemic and reperfusion injury, causing apoptosis and tissue necrosis, which significantly reduces the survival rate of flap. To address this issue, we developed a porcine skin decellularized matrix gel nanocomplex loaded with alprostadil (Alp) in Prussian blue nanoparticles (PB NPs) called Alp@PB-Gel. This gel not only maintained the cell affinity of the extracellular scaffold but also exhibited a high degree of plasticity. In vitro assays demonstrated that Alp@PB-Gel possessed antioxidant activity, scavenging ROS ability, and effectively promoted the angiogenesis and migration of human vascular endothelial cells (HUVECs) by stimulating the proliferation of vascular epithelial cells and fibroblasts. In vivo assays further confirmed that Alp@PB-Gel could effectively alleviate necrosis in the early and late stages after surgery, downregulate the levels of NLRP3 and CD68 to inhibit apoptosis and attenuate inflammation, while upregulate the levels of VEGF and CD31 to promote vascular tissue regeneration. Moreover, Alp@PB-Gel exhibited excellent cell affinity and biocompatibility, highlighting its potential for clinical application.

Outcomes of Alprostadil as an Adjuvant Therapy with Indirect Angiosomal Revascularization in Patients with Critical Limb Ischemia after Failure of Direct Revascularization

OBJECTIVES

this study was carried out to assess the effectiveness of Alprostadil (Prostaglandin E1) when used as an adjuvant therapy with indirect revascularization in patients with critical limb ischemia after the failure of direct revascularization.

PATIENTS AND METHODS

At our centers, 120 patients suffering from infrainguinal peripheral arterial disease with critical limb ischemia underwent a failed trial of direct revascularization procedure, all revascularization procedures were endovascular. Median follow-up was two years and 2.5 years for patients with and without DM. In the Alprostadil group mean age was 63.41±12.52; 36 (60%) for males and 24 (40%) for females. Post-endovascular intervention Alprostadil was administrated immediately postoperatively by intravenous infusion of 40μg Alprostadil diluted in 100 ml of normal saline, over 2 hours every 12 hours for six days.

RESULTS

In Alprostadil group, the mean ± SD of the baseline ABI was 0.45±0.175, while the Mean ± SD of ABI at the end of our study was 0.65±0.216 with a difference from the baseline of 0.2±0.041 (P-Value = 0.08, <0.05 meaning that it is significant). Our 1-month primary patency rate was 93.3%, while our 3 and 6-month patency rate was 92.9%. In the control group, the mean ± SD of the baseline ABI was 0.68±0.22, while the Mean ± SD of ABI at the end of our study was 0.69±0.23 with a difference from the baseline of 0.01±0.01 (P-Value > 0.05 meaning that it is non-significant) 1-month patency rate was 89%, while 3-month and 6-month patency rate was 75%. When we compared the patient's leg vessels before and after our intervention, we found that the percentage of the no-runoff-vessels group decreased from 10 (16.7%) to 4 (6.67%). One-runoff-vessel group percentage dropped from 40 (66.7%) to 36 (60%), whereas, in the two-runoff-vessel group, the percentage increased from 10 (16.7%) to 20 (33.3%). We evaluate leg arteries; we do no pedal arch intervention. in the Alpostradil group. Out of the total of 60 patients, limb salvage occurred in 58 (96.7%) patients, and 2 (3.3%) patients underwent below-the-knee amputation (BKA) before the study ended.

CONCLUSION

Our results show the efficacy and safety of Alprostadil as an adjuvant therapy with indirect angiosomal revascularization in patients with tissue loss due to critical limb ischemia.

Clinical evaluation of Alprostadil combined with Nimodipine in treatment of Cerebral Vasospasm after Subarachnoid Hemorrhage in elderly patients

Objective

To analyze the clinical efficacy of alprostadil combined with nimodipine in the treatment of cerebral vasospasm (CVS) after subarachnoid hemorrhage (SAH) in elderly patients.

Methods

This is a retrospective study. According to different treatment methods, the elderly 100 patients with CVS after SAH hospitalized in Baoding First Central Hospital from March 2020 to May 2021 were randomly divided into control group and observation group, with 50 patients in each group. The control group was treated with nimodipine, while the observation group was additionally combined with alprostadil. The levels of inflammatory factors and hemorheological indexes were measured before and after treatment. The clinical efficacy was compared and the adverse reactions were observed of the two groups.

Results

The overall clinical efficacy in the observation group (95.00%) was significantly higher than that in the control group (74.00%) (p<0.05). After treatment, serum tumor necrosis factor-α (TNF-α), interleukin-8 (IL-8), high-sensitivity C-reactive protein (hs-CRP) and hemorheological indexes such as plasma viscosity, whole blood viscosity at high shear, whole blood viscosity at low shear, hematocrit and platelet adhesion decreased significantly compared with those before treatment (p<0.05), which were more obvious in the observation group (p<0.05). During treatment, the rate of adverse reactions in the observation group was 12.00%, and that in the control group was 8.00%, without statistically significant difference between the two groups (p> 0.05).

Conclusion

Alprostadil combined with nimodipine is markedly effective in the treatment of CVS after SAH in elderly patients. It can effectively reduce inflammatory factor levels and improve hemorheological indexes in patients, which is conducive to the repair of neurological function.

Effects of alprostadil combined with tanshinone IIa injection on microcirculation disorder, outcomes, and cardiac function in AMI patients after PCI

BACKGROUND

Alprostadil can effectively dilate blood vessels, improve cardiac microcirculation, and reduce cardiac load. Tanshinone IIa injection can protect against atherosclerosis and reduce myocardial oxygen consumption. However, the effects of alprostadil combined with tanshinone IIa injection on microcirculation disorder, outcomes, and cardiac function in patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI) are still not fully clear.

METHODS

A total of 300 AMI patients who underwent PCI in our hospital from January 2013 to June 2018 were randomly selected and divided into group A, B, C by using the random number table method, with 100 patients in each group. The group A was treated with alprostadil, the group B was treated with tanshinone IIa injection, and the group C was treated with alprostadil combined with tanshinone IIa injection. 7 days after treatment, the cardiac functions of all patients were observed by ultrasonic Doppler, as were the microcirculations by myocardial contrast echocardiography (MCE). The major adverse cardiac events (MACEs) in both groups were observed in the 12-month follow-up.

RESULTS

After treatment, the left ventricular end-diastolic diameter (LVEDD), end-diastolic left ventricular posterior wall thickness (LVPWD), left ventricular ejection fraction (LVEF), left ventricular end-systolic diameter (LVESD), interventricular septum thickness (IVST), and ratio of maximal early to late diastolic filling velocities (E/A) in the group C were superior to those in the group A and B, the differences were statistically significant (PP<0.05). After treatment, MCE showed that the Aβ value of the group aC was higher than that of the group A and B, the difference was statistically significant (P<0.05). The thrombolysis in myocardial infarction myocardial perfusion grade classification showed that the patients with grades 2‒3 were more abundant in the group C than the group A and B, the difference was statistically significant (PP<0.05). The incidences of MACEs, such as malignant arrhythmia, recurrent heart failure (HF), recurrent myocardial infarction, and death, in the group C were significantly lower than those in the group A and B (PP<0.05).

CONCLUSIONS

For AMI patients after PCI, alprostadil combined with tanshinone IIa injection can effectively improve microcirculation and ventricular remodeling, improve cardiac function and reduce the occurrence of MACEs. This combination can be widely used in clinical practice.

The prophylactic effect of alprostadil on contrast-induced nephropathy in renal insufficiency patients after percutaneous coronary intervention

OBJECTIVES

This study explored and analyzed the prophylactic effect of Alprostadil on contrast-induced nephropathy (CIN) after percutaneous coronary intervention (PCI) in patients with renal insufficiency.

METHODS

From June 2014 to June 2017, 156 patients with coronary artery disease and renal insufficiency who electively underwent PCI in our hospital were enrolled and randomly divided into Alprostadil group (n=77) and placebo control group (n=79) by random number table. The control group was given hydration and placebo, while the observation group received hydration and Alprostadil. The alprostadil and placebo were infused intravenously 30-90 minutes before operation until four hours after surgery. The changes of biochemical indicators, serum creatinine (Scr), glomerular filtration rate (GFR), the level of neutrophil gelatinase-associated lipocalin (NGAL) in urinary neutrophils, and the incidence of CIN were compared between the two groups of patients before and after PCI surgery.

RESULTS

The difference of SCr and GFR between the two groups of patients was statistical insignificant before and after PCI surgery (P>0.05), while the level of NGAL in both groups 12 h and 24 h after operation were critically higher than those prior-operation (P<0.05), and the increase in the control group was more obvious (P<0.05). The serum CysC, Hcy, and hs-CRP levels of the two groups 24 h after surgery were remarkably higher than those before surgery (P<0.05), and the indicators in observation group were superior to those in control group after surgery (P<0.05). The difference between the two groups of patients in incidence of CIN primary endpoint was statistically insignificant (P>0.05), while the incidence of secondary endpoint of CIN ≥ 0.3 mg/dL in Alprostadil group was significantly lower than that in control group (P<0.05).

CONCLUSION

For renal insufficiency patients undergoing PCI, the associative usage of Alpromazil with routine treatment can effectively prevent CIN and is worthy of clinical promotion.

Physical compatibility of alprostadil with selected drugs commonly used in the neonatal intensive care units

This study aimed to determine the physical compatibility of alprostadil with 17 continuous infusion drugs commonly administered in neonatal intensive care units. Test samples were prepared in a laminar airflow hood. Alprostadil 20 mcg/ml was mixed with each drug in a 1:1 ratio, in two orders of mixing. Physical stability of the admixtures was assessed by visual examination and by measuring turbidity. Visual examination was conducted by two observers by two methods: visual examination against a black and white background under normal fluorescent light and using a high-intensity monodirectional light. pH was measured as chemical stability predictor. Evaluations were performed immediately and 4 h after mixing. An additional visual control was performed at 24 h. Visual examination was positive or doubtful for the four drug combinations not considered compatible. Turbidity values were under 0.5 NTU throughout the study in all samples. No modifications of one pH unit or more was detected in any drug pair over time.Conclusion: Alprostadil was considered physical compatible with 13 drugs (adrenalin, amiodarone, calcium gluconate, dobutamine, dopamine, fentanyl, flecainide, furosemide, heparin, ketamine, midazolam, milrinone and morphine). Incompatibility could not be ruled out for 3 drugs (cisatracurium, dexmedetomidine and noradrenalin), and insulin was considered incompatible with alprostadil. What is Known: • Y-site administration is common in neonatal intensive care units, and volume of diluents and rate of infusions in newborns were lower than in adults which might result in high concentrations and prolonged contact time at Y-site administration. • Available data about compatibility of alprostadil with other drugs was scarce. What is New: • Alprostadil was compatible with 13 drugs commonly used in neonatal intensive care units. • Insulin was considered incompatible with alprostadil, and incompatibility cannot be ruled out for cisatracurium, dexmedetomidine and noradrenalin with alprostadil.

Effect of alprostadil in the treatment of intensive care unit patients with acute renal injury

BACKGROUND

Acute kidney injury (AKI) is a sudden or rapid decline in the filtration function of the kidneys which is marked by increased serum creatinine or blood urea nitrogen.

AIM

To examine the value of alprostadil-assisted continuous venous-venous hemofiltration (CVVH) in the treatment of severe AKI in severely ill patients.

METHODS

This was a retrospective study and the inclusion criteria were as follows: (1) Age of patients (≥ 18 years); (2) Admission to intensive care unit due to non-renal primary disease, APACHE II score (≥ 18 points); (3) The diagnostic criteria of AKI guidelines were formulated with reference to the Global Organization for the Improvement of Prognosis in Kidney Diseases, with AKI grades of II-III; (4) All patients were treated with CVVH; and (5) Complete basic data were obtained for all patients.

RESULTS

The clinical effect of alprostadil administered in the treatment group was better than that observed in the control group (P < 0.05). The urine output of patients in the alprostadil group returned to normal time (9.1 ± 2.0 d) and was lower than that in the control group (10.6 ± 2.5 d), the difference was statistically significant (P < 0.05); adverse reactions occurred in the alprostadil group compared with the control group, but the difference was not statistically significant (P > 0.05).

CONCLUSION

Alprostadil-assisted CVVH in the treatment of severely ill patients with AKI can effectively improve the renal resistance index and partial pressure of urine oxygen, and has a positive effect on improving renal function.

Frequency and anatomic distribution of arterial obstructions in patients with vasculogenic erectile dysfunction not responding to intracavernous prostaglandin

Background: The extent of arterial disease in patients with erectile dysfunction (ED) non-responsive to intracavernosal injection of Alprostadil is of importance for therapeutic options. However, published evidence, in particular angiographically validated is scarce. Here we investigated arterial lesion patterns in this specific patient cohort by selective angiography. Patients and methods: A cohort of 239 patients received a clinical and duplex-sonographic workup for ED of suspected vascular origin. Duplex ultrasound of the cavernosal arteries was performed after intracavernosal injection of 10 μg Alprostadil. Consequently, standardized workup included grading of the erectile and determination of peak systolic velocity (PSV) and end-diastolic velocity (EDV) in both cavernosal arteries. PSV-values below 30 cm/sec indicated reduced arterial flow, whereas EDV-values above 15 cm/sec indicated a venous leak of the pudendal veins. All patients with suspected arterial ED based on duplex sonography underwent contrast-enhanced computed tomography. Endovascular therapy was carried out in ED patients not responsive or with significant side effects to PDE-5-inhibitors or Alprostadil by selective angiographic depiction of erection-related arteries. Results: 54 patients with a mean age of 61.2 (±9.8) years underwent angioplasty of erectionr elated arteries. Out of these 48/54 (89%) patients presented with an erection considered insufficient for penetration (E0-E3) subsequent to intracavernous application of 10 μg Alprostadil. 14/48 (29%) patients had bilateral arterial obstructions and 34/48 (71%) had unilateral disease. Commonly affected was the internal pudendal artery (n = 31, 65%), followed closely by the common penile artery (n = 30, 64%). The least affected arteries were the dorsal penile (n = 6, 13%), hypogastric (n = 4, 8%), common iliac (n = 4, 8%), cavernosal (n = 4, 8%), and inferior gluteal (n = 1, 2%) arteries. Conclusions: Arterial obstructions amenable to endovascular revascularization are frequent in patients non-responsive to intracavernosal prostaglandin administration. Therapeutic strategies in ED patients non-responsive to conservative measures should therefore consider endovascular treatment opportunities.

[Effects of alprostadil in β-aminopropanitrile induced aortic dissection in a murine model]

Objective: To investigate the protective role of alprostadil on aortic dissection. Methods: 26 C57BL6 male mice were divided into control group (normal drinking water, n=13) and model group (1 g·kg^-1·d^-1 BAPN via drinking water, n=13). On day 14, mRNA expression of inflammatory-related genes as well as EP receptor families were detected by RT-PCR (n=6 each) and EP4 protein levels were determined by Western blot (n=7 each). Another 88 mice were divided into 3 groups: control group (n=22), model group (n=33) and treatment group (n=33). The mice in model group and treatment group were applied with BAPN (1 g·kg^-1·d^-1) via drinking water. The mice in treatment group received additional intraperitoneal injection with alprostadil (80 μg·kg^-1·d^-1) for 28 days. The mice in the control and model group received equal volume intraperitoneal injection with 0.9% saline respectively. The body weight and systolic blood pressure, the mortality and morbidity were monitored from the beginning until the designed end of the study. On day 28, the mice were sacrificed and aorta were fixed, embedded and sliced, followed by staining with HE and Victoria Blue. The distribution of EP4 was determined by immunohistochemistry in control (n=6) and model group (n=6). Furthermore, the concentration of PGE1 were tested among model (n=3) and treatment group (n=4). EP4 protein expression was determined in model group (n=7) and treatment group (n=6). Results: On day 14, mRNA expression level of MCP-1 ((2.74±1.55) vs. (1.00±0.49),<0.05) and MMP2((1.38±0.42) vs. (1.00±0.27), P<0.05) was significantly upregulated in model group compared with control group. Protein expression of EP4 receptor also increased in aorta in model group compared with control group (1.48±0.51 vs. 1.00±0.19, P<0.05). In the dissection area, the EP4 expression was also enriched compared with non-dissection area, particularly in endothelial cells and inflammatory cells on day 28. BAPN applied in drinking water (model and treatment groups) successfully induced the aortic dissection in mice, some mice died of the rupture. The elastic fibers were fractured, and the infiltrated immune cells were visible in dissected tissue. False lumen was formed. There was no dissection and death in the control group. Compared with control group, the morbidity and mortality rates were significantly increased in the model group (60.6%, 20/33, 30.3%, 10/33) and the treatment group (72.7%, 24/33, 24.2%, 8/33). The mortality and morbidity rates were similar between model and treatment groups. There is no difference in terms of SBP among three groups (P>0.05). Further study showed that after alprostadil injection, the blood concentration of PGE1 was increased in treatment group ((0.540±0.041 vs. 0.436±0.012)μmol/L, P<0.05). Besides, the EP4 receptor expression was downregulated in the treatment group compared to model group (0.60±0.30 vs. 1.00±0.20, P<0.05). Conclusion: EP4 expression is upregulated in BAPN induced aortic dissection mouse model. No protective effects are observed post alprostadil treatment in this model probably due to the reduced expression of EP4.

Promising role of medicinal plants in the regulation and management of male erectile dysfunction

Male erectile dysfunction (ED) refers to incompetency to reaching and retaining adequate penile tumescence for sexual intercourse. Over 152 million men globally suffer from ED and by 2025, the number of affected individuals is anticipated to be around 322 million. Pharmacological and nonpharmacological therapies such as phosphodiesterase (PDE) inhibitors, alprostadil, penile prosthesis surgery, and hormonal replacement are available for management and recuperation of ED. Nevertheless, such therapies are reported to have adverse effects as well as life-threatening. Accordingly, diversity of medicinal plant species and bioactive active compounds are preferred as therapeutic options because they are natural, abundant, available, low-cost and cause fewer or no side effects. This current review will emphasise the aetiology, risk factors, mechanisms underlying the pathophysiology of ED, treatments of ED as well as their side effects. It also provides medicinal plants that are proven effective in vivo and in vitro for the mitigation and treatment of male ED. This knowledge could be used in the future in drug discovery for the development of more natural drugs with no side effects.

[Effect of alprostadil in early wound healing of rats with deep partial-thickness scald]

Objective: To explore the effect of alprostadil in early wound healing of rats with deep partial-thickness scald. Methods: Ninety specific pathogen free healthy Sprague-Dawley rats (half males and half females) were divided into sham scald group, simple scald group, and alprostadil group using the random number table with 30 rats in each group. Rats in sham scald group were sham injured, and rats in the other 2 groups were inflicted with deep partial-thickness scald of 30% total body surface area on the back. Immediately after scald, rats in the 3 groups received anti-shock treatment. Two hours post scald, rats in sham scald group and simple scald group were injected intraperitoneally with 1 mL normal saline, and rats in alprostadil group were injected intraperitoneally with 1 mL alprostadil injection, once a day and continued for 14 days. On post scald day (PSD) 3, 7, and 14, 10 rats in each group were collected for observing the general wound conditions and the wound healing rates of rats in 2 scald groups were calculated, abdominal aortic blood of 2 mL from each rat were collected to detect serum thromboxane B2 by enzyme-linked immunosorbent assay, and wound tissue on the back was collected to examine pathomorphological change by hematoxylin-eosin staining and to detect wound microvessel density (MVD) by immunohistochemical staining. Data were statistically analyzed with analysis of variance of factorial design, t test, Kruskal-Wallis H test, Mann-Whitney U test, and Bonferroni correction. Results: (1) There was no scald wound in rats in sham scald group. On PSD 3, wounds of rats in simple scald group and alprostadil group formed dry eschar. On PSD 7 and 14, wound areas of rats in alprostadil group were significantly smaller than those of rats in simple scald group, and with less exudation. (2) On PSD 3, the wound healing rates of rats in simple scald group and alprostadil group were similar (t=1.167, P>0.05). On PSD 7 and 14, the wound healing rates of rats in alprostadil group were significantly higher than those in simple scald group (t=8.657, 33.050, P<0.01). (3) On PSD 3, 7, and 14, the levels of serum thromboxane B2 of rats in simple scald group and alprostadil group were (541±22), (607±47), (688±21), (326±25), (271±21), (135±27) pg/mL, significantly higher than (17±6), (16±4), (16±4) pg/mL of rats in sham scald group (t=72.977, 39.685, 102.076, 37.033, 37.253, 13.845, P<0.01). On PSD 3, 7, and 14, the levels of serum thromboxane B2 of rats in alprostadil group were significantly lower than those in simple scald group (t=20.637, 20.651, 51.680, P<0.01). (4) Normal epidermis and dermis were seen in rats in sham scald group. On PSD 3, a large number of necrotic tissue and inflammatory cells infiltration were seen in wounds of rats in simple scald group, while a little new epithelium formation and some inflammatory cells infiltration were seen in wounds of rats in alprostadil group. On PSD 7 and 14, the new epithelium of rats in alprostadil group was significantly thicker than that in simple scald group, and epidermis formed gradually in alprostadil group. (5) On PSD 3, 7, and 14, the wound MVD of rats in simple scald group and alprostadil group were significantly higher than those in sham scald group (Z=-3.780, -3.781, -3.780, -3.780, -3.781, -3.780, P<0.01). On PSD 3, the wound MVD of rats in simple scald group and alprostadil group were similar (Z=-1.965, P>0.05). On PSD 7 and 14, the wound MVD of rats in alprostadil group were significantly higher than those in simple scald group (Z=-3.780, -3.780, P<0.01). Conclusions: The early intervention with alprostadil can significantly improve microcirculation of deep partial-thickness scald wound, reduce inflammatory cell infiltration, promote the formation of new blood vessels, thus promoting wound healing.

Sildenafil corrects the increased contractility of rat detrusor muscle induced by alprostadil in vitro

BACKGROUND

Sildenafil (PDE5-inhibitor) and alprostadil (PGE₁) are used in combination clinically for the management of some cases of erectile dysfunction. Despite the roles of prostaglandins (PG) and nitric oxide (NO) pathways in contractility of bladder smooth muscle are frequently studied, the effect of sildenafil/alprostadil combination and the crosstalk between NO/cGMP and PG pathways on bladder activity is not documented.

METHODS

Organ-bath experiments were performed using isolated rat detrusor muscle. Direct and neurogenic contractions were induced using ACh and electric stimulation (EFS, 4Hz, 80V, 1ms), respectively. The contractile responses in absence and presence of the tested drugs at different concentrations were compared. Results are expressed as mean ± SEM (n = 5-7).

RESULTS

Alprostadil (0.01-10 μM) concentration-dependently potentiated ACh (100μM)- and EFS (4 Hz)- induced contraction. Maximum potentiation of ACh-contraction in presence of alprostadil was 40 ± 5%. Sildenafil potentiated ACh-induced contraction at low concentrations (0.01-1 μM), but inhibited it at higher ones (10-100 μM). IBMX (non-selective PDE-inhibitor, 0.01-100μM) and SNP (NO-donor, 1nM-1 mM) produced the same biphasic pattern. The potentiatory phase of sildenafil was inhibited by atropine (0.1μM), L-NAME (non-selective NOS-inhibitor, 100μM), N-PLA (nNOS-inhibitor, 30μM) or MB (nonselective GC-inhibitor, 10μM). In presence of sildenafil (0.1μM), the concentration-response curve of alprostadil (0.01-10μM) on both ACh and EFS-induced contraction was clearly shifted downward.

CONCLUSIONS

A crosstalk between PGE₁ and NO/cGMP pathways may exist. At low concentrations only, the effect of sildenafil on bladder contractility is dependent on NO/cGMP. cGMP intracellularly-elevated by sildenafil, may inhibit the activity of PLC and hence the cascade of EP₁-receptors, thus masking the hyperactivity of bladder caused by alprostadil, which adds to the advantages of this combination.

Effect of Alprostadil on Colorectal Anastomoses Under Relative Ischemia

BACKGROUND

Anastomotic leak after colorectal surgery, which remains a serious clinical problem that causes augmented morbidity and mortality, is usually favored by ischemia. The aim of this study was to determine whether alprostadil may improve anastomotic wound healing under ischemic condition.

METHODS

Ninety-three adult Wistar rats were randomized into three groups: control, ischemia (by devascularization along the first 2 cm at each anastomotic end), and ischemia plus alprostadil. Resection of a colonic segment at the colorectal junction and an anastomosis was performed. Animals were euthanized at 8 d. Surgical site infection, anastomotic leak, and grade of intra-abdominal adhesions using a validated scale were determined. Bursting pressure and tension were calculated and histologic examination of the anastomosis was performed.

RESULTS

The ischemic group revealed an increased anastomotic leak rate (14/31 versus 3/31) and a lower bursting pressure and tension when compared to control group, validating therefore the experimental model. After intraperitoneal injection of alprostadil, anastomotic leak rate was significantly lower (5/31) and the bursting pressure and tension were significantly increased. Histologic examination revealed a lower presence of inflammatory cells, and a significantly higher neovascularization and a higher presence of fibroblasts in treated animals when compared with the ischemic group.

CONCLUSIONS

Alprostadil may have a positive effect on colonic anastomotic wound healing under relative ischemic condition. Alprostadil administration increases anastomotic bursting pressure, decreases leak rate, and reverses most of the histological changes caused by blood flow decrease. These protective effects could be caused by vasodilation, stimulation of neovascularization, and immunomodulatory properties.

[Assessment of the erectile function and patients' perception of improvement in Spanish patients with erectile dysfunction]

OBJECTIVE

This study has been carried out to assess the hardness of erection and the perception of improvement in erectile function with the treatments received during the last month.

MATERIAL AND METHOD

Descriptive, observational, multicenter, cross-sectional study carried out in 30 urology sites in Spain. Patients diagnosed of erectile dysfunction receiving treatment during at least the last month have been enrolled. Hardness of erection has been assessed with the erection hardness score and improvement perception has been estimated with the global assessment question.

RESULTS

A 63% of patients had a hardness of erection that was insufficient for penetration, but 75% of patients referred that their erectile function had improved with treatment. After adjustment for other factors, erection hardness score values were not significantly different among patients being treated with alprostadil topical cream, compared to patients being treated with the combination of phosphodiesterase 5 (PDE5) inhibitors plus alprostadil topical cream or with PDE5i other than sildenafil alone. However, patients treated with alprostadil topical cream had a significantly higher chance of referring an improvement in their erectile function compared to patients treated with PDE5i, despite the fact that they had received treatment for a shorter period of time.

CONCLUSION

Hardness of erection is just another factor of erectile function, but it is not the only one influencing improvement perception by patients.

[Effect of alprostadil on wound healing of scalded rats and the mechanism]

Objective: To explore effect of alprostadil on wound healing of scalded rats and the mechanism. Methods: According to random number table method, forty-eight Sprague Dawley rats were divided into sham scald group, simple scald group, lithium chloride group, and alprostadil group, with 12 rats in each group. Rats in sham injury group were sham injured on the back, and rats in the other three groups were inflicted with 30% total body surface area deep partial thickness scald on the back.Immediately after scald, rats in sham scald group and simple scald group were injected with 1 mL saline through caudal vein, and rats in lithium chloride group and alprostadil group were injected respectively with 1 mL lithium chloride and alprostadil through caudal vein. Saline, lithium chloride, and alprostadil were injected once in a day and lasted for 14 days. General wound appearance and wound healing rate on post scald day (PSD) 7, 10, 14 were observed and calculated. Expressions of protein and mRNA of Wnt1 and β-catenin on PSD 14 were detected. Data were processed with analysis of variance of factorial design, one-way analysis of variance, Student Newman Keuls q test, t test, and Bonferroni correction. Results: (1) On PSD 7, wounds of scalded rats in each group formed dry eschar and had little exudation. On PSD 10, wounds of rats in simple scald group were covered with eschar, with little exudation, and wounds of rats in lithium chloride group were covered with eschar, and partial wounds healed under the eschar. On PSD 10, partial eschar of rats in alprostadil group desquamated; partial wounds healed; newly burned skin was ruddy. On PSD 14, partial wounds of rats in simple scald group were healed under eschar with little exudation. On PSD 14, most of the eschar of rats in lithium chloride group were desquamated with patial wounds healed and little exudation. On PSD 14, wounds of rats in alprostadil group were basically healed with vigorously growing hair on the back. (2) On PSD 7, the wound healing rates of rats in simple scald group, lithium chloride group, and alprostadil group were close (F=0.41, P>0.05). On PSD 10 and 14, wound healing rate of rats in lithium chloride group and alprostadil group were significantly higher than that in simple scald group (q=5.73, 17.45, 26.30, 11.28, P<0.05), and wound healing rate of rats in alprostadil group was significantly higher than that in lithium chloride group (q=32.03, 28.73, P<0.05). (3) On PSD 14, the mRNA expressions of Wnt1 and β-catenin of rats in lithium chloride group and alprostadil group were significantly higher than those in simple scald group (q=65.40, 19.16, 66.79, 18.41, P<0.05), and the mRNA expressions of Wnt1 and β-catenin of rats in simple scald group was significantly higher than those in sham scald group (t=14.86, 4.46, P<0.05). (4) On PSD 14, the protein expressions of Wnt1 and β-catenin of rats in lithium chloride group and alprostadil group were 0.98±0.05, 0.98±0.06, 0.97±0.06, and 1.00±0.06, which were significantly higher than 0.49±0.04 and 0.66±0.04 of rats in simple scald group (q=34.62, 22.38, 33.61, 23.47, P<0.05). On PSD 14, the protein expressions of Wnt1 and β-catenin of rats in simple scald group was significantly higher than 0.29±0.03 and 0.31±0.03 of rats in sham scald group (q=14.73, 23.88, P<0.05). Conclusions: Alprostadil can accelerate wound healing through activating Wnt/β-catenin signal pathway and upregulating the expressions of Wnt1 and β-catenin.

Impact of anticoagulation and vasoactive medication on regained radial artery patency after catheterization: a case-control study

Background

Radial artery access is the primary approach for coronary interventions due to higher safety profile in comparison to femoral access. Radial artery occlusion (RAO) is the main complication of transradial catheterization that can lead to severe symptoms and a permanent artery occlusion. The incidence of RAO after transradial access ranges from 5 to 38% and data regarding treatment is scarce. Whether anticoagulation and vasoactive medication provides an additional benefit in recovery of radial artery patency (RAP) after catheterization has not been investigated in detail.

Aim

The objective was to investigate the impact of anticoagulation and vasoactive medication on regained patency after documented RAO following transradial catheterization.

Patients and methods

Overall 2635 patients were screened. 2215 (84%) catheterizations were performed by femoral and 420 (16%) by radial access. In 30 patients RAO was observed. In case of RAO patients were classified in three groups: Anticoagulation, anticoagulation added with alprostadil and controls. Follow-up was conducted after 3 months with ultrasound and clinical examination.

Results

Eight patients received anticoagulation and 11 patients anticoagulation together with alprostadil. Eleven patients served as controls. Recovery of RAP after catheterization was higher following either treatment (79.5%) compared to controls (0%, p = 0.006). Subgroup analysis yielded a higher RAP recovery in patients treated with anticoagulation (62.5%) as compared to controls (0%, p = 0.002). No effect on regained RAP was found with additional alprostadil therapy (33.3%) compared to anticoagulation therapy (62.5%, p = 0.229).

Conclusion

RAO should be treated with anticoagulation to regain patency. Addition of vasoactive medication does not lead to further beneficial effects. Further research is needed regarding preventive and therapeutic strategies following RAO.

The protective effect of Papaverine and Alprostadil in rat testes after ischemia and reperfusion injury

OBJECTIVE

To investigate the effect of papaverine and alprostadil on testicular torsion-detorsion injury in rats.

MATERIALS AND METHODS

A total of 40 male Wistar-Albino rats were used in this study. Four hours of right testicular torsion was applied to each group, excluding sham operated group. The torsion-detorsion (T/D), T/D + papaverine and T/D + alprostadil groups received saline, papaverine and alprostadil at the same time as surgical detorsion, respectively. At 14 days after the surgical detorsion, ischaemic changes and the degree of damage were evaluated with Cosentino scoring and the Johnson tubular biopsy score (JTBS).

RESULTS

JTBS was determined as 8.8±2.7 in the Sham group, 5.08±1.9 in the T/ D+papaverine group, 5.29±2.3 in the T/D +alprostadil group and 2.86±1.9 in the TD group. The JTBS was determined to be statistically significantly high in both the T/D + papaverine group and the T/D + alprostadil group compared to the T/D group (p=0.01, p=0.009). In the T/D + papaverine group, 3 (43 %) testes were classified as Cosentino 2, 3 (43%) as Cosentino 3 and 1 (14 %) as Cosentino 4. In the T/D +alprostadil group, 5 (50 %) testes were classified as Cosentino 2, 3 (30 %) as Cosentino 3 and 2 (20%) as Cosentino 4.

CONCLUSION

The present study indicated that spermatic cord administration of alprostadil and papaverine showed a protective effect against ischemia/reperfusion injury after right-side testes torsion and histological changes were decreased after testicular ischemia reperfusion injury.

Alprostadil combined with somatostatin for treatment of severe acute pancreatitis: Clinical efficacy and impact on inflammatory factors

AIM

To observe the clinical efficacy of alprostadil combined with somatostatin in the treatment of severe pancreatitis (SAP) and the influence on inflammatory factors.

METHODS

Eighty two patients with SAP treated from April 2013 to May 2017 were enrolled in this study. They were randomly divided into either an observation group or a control group. Both groups were given routine treatments and alprostadil, and the observation group was additionally given somatostatin. After 2 wk of therapy, clinical efficacy, symptom remission time, serum inflammatory factor levels, adverse reaction rate, and mortality rate of the two groups were compared.

RESULTS

The total effective rate was 92.68% (38/41) in the observation group and 75.61% (31/41) in the control group, and there was a significant difference between them (χ² = 4.479, P < 0.05). Times to recovery of bowel pain, intestinal function, and blood amylase as well as hospital stay were significantly shorter in the observation group than in the control group (P < 0.05). The levels of white blood count (WBC), C-reactive protein (CRP), amylase (AMY), alanine transaminase (ALT), alanine transaminase (AST), and creatinine (Cr) in the observation group were significantly lower than those in the control group at 7 d and 14 d after treatment (P < 0.05). The levels of endotoxin, TNF-α, IL-6, and IL-1β in the observation group were significantly lower than those in the control group (P < 0.05). The mortality rate in the observation group (2.44%, 1/41) was significantly lower than that in the control group (17.07%, 7/41) (χ² = 4.986, P < 0.05).

CONCLUSION

Alprostadil combined with somatostatin in the treatment of severe pancreatitis has obvious efficacy and can reduce symptoms and the inflammatory response quickly.

Clinical Efficacy of Alprostadil Combined with α-lipoic Acid in the Treatment of Elderly Patients with Diabetic Nephropathy

Objective

To evaluate the effect and toxicity of alprostadil combined with thioctic acid injection in the treatment of patients with diabetic nephropathy (DN).

Methods

Sixty two patients with DN were included in this study and randomly divided into control group (n=32) and experiment group (n=30). Patients in the control group were given alprostadil 20ug+NS 100ml ivgtt, qd and patients in the experiment group were given alprostadil 20ug+NS 100ml ivgtt combined with thioctic acid injection of 0.45g+100ml ivgtt, qd for 14 days. After treatment, the renal function and serum level of CRP, IL-6 and TNF-α were compared between the two groups.

Results

After two weeks of treatment, the serum level of CysC and UAER significant decreased for both control and experiment group with statistical difference of p<0.05. After treatment, the serum level of CysC were 1.40 ±0.46 mg/L and 1.02±0.33 for control and experiment group respectively (p<0.05). The post-treatment UAER in experiment group was significantly lower than those of control group with statistical difference (81.02±0.33 vs112.45±20.32, p<0.05) ug/min. The serum level of CRP, IL-6 and TNF-α were significantly decreased after treatment for both control and experiment group (p<0.05). And the post-treatment serum CRP, IL-6 and TNF-α in experiment group were significantly lower than those of control group with statistical difference (p<0.05). No significant side effects were found for the two groupsin the course of treatment.

Conclusion

Alprostadil combined with α-lipoic acid may improve renal function in patients with diabetic nephropathy by decreasing the levels of serum inflammatory factors.

Topical alprostadil (Vitaros©) in the treatment of erectile dysfunction after non-nerve-sparing robot-assisted radical prostatectomy

OBJECTIVE

The aim of the study is the evaluation of the efficacy and safety of the treatment with topical alprostadil (Vitaros^©) in post-robot assisted radical prostatectomy (RARP) rehabilitation therapy of patients with erectile dysfunction (ED).

METHODS

Seventy-four patients were enrolled and underwent non-nerve-sparing RARP.

INCLUSION CRITERIA

age <75, preoperatively International Index of Erectile Function (IIEF-5) >16, erection hardness score (EHS) ⩾2, weekly sexual intercourse ⩾1, affirmative answers to Sexual Encounter Profile Question (SEP-Q) 2 and SEP-Q3, Charlson Comorbidity Index (CCI) ⩽5, Eastern Cooperative Oncology Group (ECOG) performance status ⩽1, no moderate/severe cardiovascular disease.

RESULTS

Vitaros was administered ⩾2 twice a week. At month 6, the IIEF-5 decreased from 20.5 preoperative to 18.1 post-treatment. EHS score decreased from a mean of 3.3 to a mean of 3.0. The quality of life score decreased from an average of 5.1 to 2.3. Weekly sexual intercourse decreased from an average of 2.1 to 1.7. Six patients dropped out; 89.7% patients showed a positive SEP-Q2 and 77.8% a positive SEP-Q3. All patients responded positively to Global Assessment Questions (GAQ)-1 and 97% to GAQ-2. Of all 68 analyzed patients, 13 (17.6%) switched to intracavernous injection therapy.

CONCLUSIONS

In conclusion, Vitaros may become a viable alternative to common injective therapies in well-selected patients after RARP.

Satisfaction and treatment adherence in erectile dysfunction in the medium and long term

INTRODUCTION

The aim of this study was to show the satisfaction and treatment adherence in erectile dysfunction (ED) in the medium and long term.

MATERIAL AND METHODS

A descriptive, comparative study was conducted in 2 centres through telephone interviews with patients who came for an initial visit between 2012 and 2014 for ED. A complete case history review was conducted on the use of and withdrawal from treatment. For current use, the Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) and the Global Assessment Questionnaire (GAQ) were filled out; for past use, only the GAQ was filled out. For the statistical analysis, we employed Fisher's exact test for comparisons of percentages and the Kruskal-Wallis test to compare means.

RESULTS

The study included 250 patients; 20.8% were prescribed intraurethral alprostadil (ALP-IU), 17.2% were prescribed intracavernous alprostadil (ALP-IC), 92.8% were prescribed a first IPD5, and 24.8% were prescribed at least a second IPD5. The treatment withdrawal rate was 62.07% for the first IPD5, 41.94% for the last IPD5, 69.23% for the ALP-IU and 65.11% for the ALP-IC (P=.007). The main reason for withdrawal for the IPD5 was a lack of response (32.76% of those who took IPD5). In addition to withdrawal, there were adverse reactions for ALP-IU and ALP-IC (28.85% and 11.63%, respectively). The mean duration of use until withdrawal was 4.3 months for IPD5, 2.2 months for ALP-IU and 5.5 months for ALP-IC (P=.064). The most favourable GAQ and EDITS scores were observed for IPD5 (EDITS score of 74). Sildenafil and tadalafil had the longest usage times (mean >5 months).

CONCLUSIONS

The withdrawal rate for treating ED is high, with short usage times of a few months. A lack of response and adverse reactions were the main causes for withdrawal. The drugs that provide greater satisfaction are the IPD5, although there are no significant differences in the mean usage time between the different types and in aspects such as the mean usage time to withdrawal or the withdrawal rates.

Meta-analysis of effectiveness and safety of octreotide combined with alprostadil for acute pancreatitis

AIM: To systematically evaluate the effectiveness and safety of octreotide combined with alprostadil in the treatment of acute pancreatitis (AP).

METHODS: Relevant randomized controlled trials (RCTs) were searched via databases including PubMed, CBM, VIP, CNKI and WanFang Data from their inception to October 2015, and the references of the included studies were also screened. Two reviewers screened the literature, assessed the quality of studies and extracted the data. RevMan 5.2 software was used to complete the meta-analysis.

RESULTS: Eighteen trials involving 1277 participants were included. The results of the systematic review showed that compared with the control group, the experimental group was superior with regard to clinical effective rate (RR = 1.20, 95%CI: 1.15-1.26), time to relief of bellyache [SMD = -2.68, 95%CI: -3.11-(-2.25)], time to relief of signs of abdominal tenderness [SMD = -2.54, 95%CI: -2.79-(-2.30)], time to recovery of blood amylase [SMD = -1.95, 95%CI: -2.15-(-1.76)], incidence of AP complications (RR = 0.30, 95%CI: 0.13-0.69), and average length of hospital stay [SMD = -8.95, 95%CI: -13.61-(-4.29)].

CONCLUSION: Octreotide combined with alprostadil for treating AP is superior to octreotide alone. Due to the limited quality of the included studies, our conclusion needs to be verified by more high quality studies.

Peripheral Female Genital Arousal as Assessed by Thermography Following Topical Genital Application of Alprostadil vs Placebo Arousal Gel: A Proof-of-Principle Study Without Visual Sexual Stimulation

Introduction

Female sexual arousal disorder is a pathophysiologic state characterized clinically by persistent or recurrent inability to attain or maintain an adequate lubrication-swelling response of sexual excitement until completion of sexual activity. Prior clinical experience with alprostadil products for men with erectile dysfunction supports its use in women with female sexual arousal disorder.

Aim

To compare the effect of topical alprostadil with over-the-counter (OTC) lubricant on female genital arousal in the absence of visual sexual stimuli.

Methods

Healthy premenopausal women without sexual dysfunction were recruited from the community to participate in the study. Of 17 women who consented, 10 were enrolled and completed the trial. The mean age of subjects was 32 years (range = 27–43). Study drug or placebo was applied topically to the genitals. Continuous temperature monitoring was performed. Participants completed questionnaires assessing genital sensation, effect, intensity, and duration.

Main Outcome Measures

Change in temperature from baseline in vestibule, clitoris and vulva.

Results

In all 10 subjects, topical alprostadil induced a statistically significant increase in temperature of the vestibule, clitoris, and vulva compared with the OTC lubricant. The most rapid difference in genital temperature between placebo and alprostadil was seen on the vulva, which demonstrated a significant difference at approximately 9 minutes. There was a significant difference in temperature seen for the vestibule and clitoris at 11 and 19 minutes, respectively. Sixty percent of women reported being aware or conscious of genital sensations with topical alprostadil, but not with OTC lubricant. Discordance was noted in 30% of subjects who reported being aware or conscious of genital sensations with the two treatments and 10% who reported not being aware or conscious of genital sensations with either treatment.

Conclusion

Topical alprostadil administered to healthy premenopausal women induced statistically significant, sustained increases in genital temperatures of the vestibule, clitoris, and vulva within 20 minutes compared with OTC lubricant.

Assessment of penile erection methods in rhesus macaques to model pharmacokinetics of antiretroviral drugs and penile infection with simian immunodeficiency virus

BACKGROUND

An established macaque model to assess HIV interventions against penile transmission is currently not available. Physiological changes during penile erections may affect susceptibility to infection and drug pharmacokinetics (PK). Here, we identify methods to establish erections in macaques to evaluate penile transmission, PK, and efficacy under physiologic conditions.

METHODS

Penile rigidity and length were evaluated in eight rhesus macaques following rectal electrostimulation (RES), vibratory stimulation (VS), or pharmacological treatment with Sildenafil Citrate (Viagra) or Alprostadil.

RESULTS

Rectal electrostimulation treatment increased penile rigidity (>82%) and length (2.5 ± 0.58 cm), albeit the response was transient. In contrast, VS alone or coupled with Viagra or Alprostadil failed to elicit an erection response.

CONCLUSION

Rectal electrostimulation treatment elicits transient but consistent penile erections in macaques. High rigidity following RES treatment demonstrates increased blood flow and may provide a functional model for penile PK evaluations and possibly simian immunodeficiency virus (SIV) transmission under erect conditions.

Safety and efficacy of intraurethral alprostadil in patients with erectile dysfunction refractory to treatment using phosphodiesterase-5 inhibitors

INTRODUCTION

Phosphodiesterase-5 inhibitors (PDE5i) are the first choice for treating erectile dysfunction (ED) but are not always effective. The aim of this study was to present our experience in treating patients with ED, refractory to treatment with PDE5i, using intraurethral alprostadil (MUSE).

MATERIAL AND METHODS

We conducted a review of 82 patients with ED and no response to PDE5i, from March 2013 to October 2014. Forty-seven patients (57%) had hypertension (AHT), 24 (29%) had diabetes (DM) and 20 (24%) had AHT and DM. Additionally, 19 (23%) had undergone radical prostatic (RP) surgery. The patients were evaluated after the treatment was applied and at 4 weeks using the following validated questionnaires: International Index of Erectile Function (IIEF-5/SHIM), Global Assessment Questionnaire (GAQ), Sexual Encounter Profile (SEP) and Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS).

RESULTS

The mean patient age was 60.5 years (40-80), and the mean follow-up was 11.3 months (1-20). Sixty-eight percent of the treated patients responded to MUSE(®) (74% in the AHT group, 65% in the AHT+DM group, 62.5% in the DM group and 58% in the RP group). The mean IIEF-5 score was 11.7±4.7, which increased to 18.6±4.9 after MUSE was administered (P=.027). The mean EDITS score at 4 weeks was 61.6 (6-81.9). The most common adverse effect was urethral burning, which occurred in 24 patients (29%). There were no cases of urinary tract infection, syncope or priapism.

CONCLUSIONS

Intraurethral alprostadil is an effective treatment and has a broad safety profile for treating patients with erectile dysfunction refractory to oral treatment with PDE5i.

Comparison of Prostaglandin E1 and Sildenafil Citrate Administration on Skin Flap Survival in Rats

Background

Alprostadil and sildenafil are known vasodilators used independently to improve flap survival in animal models. In this study, we investigate whether these agents act synergistically to decrease flap necrosis in rat models.

Methods

After acclimation period, 4 groups of 10 male white rats were given a modified McFarlane skin flap. The postoperative treatment included saline control (Group A), sildenafil citrate-only (Group B), alprostadil-only (Group C), and both sildenafil and alprostadil (Group D). The flaps were observed on postoperative days 1, 3, 5 and 7. The animals were euthenized on postoperative day 7, and the flaps were evaluated for inflammation and neovascularization.

Results

At each observation, the mean necrotic index was significantly lower for all three treatment groups (Groups A, B, C) and was the lowest for the combined treatment group. On histologic evaluations, combined treatment was associated with decreased inflammation and increased capillary vessel formation, when compared with control group.

Conclusion

Both sildenafil-only and alprostadil treatments were independently associated with increased flap survival rate. Sildenafil citrate and alprostadil had a synergistic effect in increasing flap survival rate.

Alprostadil combined with peritoneal lavage therapy for treatment of hyperlipidemic severe acute pancreatitis

AIM: To evaluate the clinical effects of alprostadil combined with peritoneal lavage therapy in the treatment of hyperlipidemic severe acute pancreatitis (HSAP).

METHODS: Twenty-seven patients with HSAP were randomly divided into two groups: a control group (13 patients) and a treatment group (14 patients). Both groups received the same conventional medical therapy, and the treatment group additionally received alprostadil and peritoneal lavage therapy (14 d as a cycle). Curative effects were compared between the two groups.

RESULTS: Compared with the control group, the time to patient's condition improvement (5.55 d ± 3.12 d vs 8.18 d ± 4.09 d, 4.14 d ± 2.94 d vs 6.75 d ± 3.58 d), the time to improvement of triacylglycerol (5.42 d ± 2.06 d vs 8.28 d ± 3.55 d), total response rate (85.71% vs 61.54%), rates of complications (21.6% vs 38.5%) and mortality (7.14% vs 15.38%), average hospital stay (23.84 d ± 7.54 d vs 31.98 d ± 12.18 d), and total expenses of the medical treatment (34.56 ± 13.44 vs 41.29 ± 18.81) were significantly better in the treatment group (P < 0.05 or P < 0.01).

CONCLUSION: Alprostadil combined with peritoneal lavage therapy is a safe and effective therapy for HSAP. It may become a basic choice for treating HSAP.

Is it worth continuing sexual rehabilitation after radical prostatectomy with intracavernous injection of alprostadil for more than 1 year?

Introduction

Intracavernous alprostadil injection (IAI) is a widely used treatment for sexual rehabilitation (SR) after radical prostatectomy (RP). It is unknown whether the continuation of IAI beyond 1 year continues to improve erectile function.

Aims

To assess evolution of sexual function in patients using IAI who are nonresponsive to phosphodiesterase type 5 inhibitors (PDE5i) between 12 (M12) and 24 (M24) months after RP.

Methods

We retrospectively studied 75 men with a nerve-sparing laparoscopic RP, who had normal preoperative erectile function, and who regularly used IAI for SR for at least 24 months. At M12, no patients had responded to PDE5i.

Main Outcome Measures

At 12 and 24 months, sexual function was assessed with the UCLA Prostate Cancer Index (UCLA-PCI), International Index of Erectile Function (IIEF)-15, and erection hardness score (EHS) with and without IAI. We also assessed the satisfaction rate with IAI, injection-related penile pain, and satisfaction of treatment. Statistical analysis was performed by using t-tests for paired data and Spearman's rho correlation coefficients to assess the relationships between scores at M12 and M24.

Results

Improvement of nocturnal erection was noted (UCLA-PCI, question 25); however, no significant difference was found for IIEF-erectile function with (19.60 ± 9.80 vs. 18.07 ± 10.44) and without IAI (4.63 ± 2.93 vs. 4.92 ± 4.15), UCLA-PCI-sexual bother (37.14 ± 21.45 vs. 37.54 ± 19.67), nor the EHS score with (2.97 ± 1.30 vs. 2.57 ± 1.30) and without IAI (0.67 ± 1.11 vs. 0.76 ± 0.10). The rate of satisfaction with treatment decreased over time (66.6% vs. 46.7%, P = 0.013). Improved response to IAI at M12 was not correlated to improvement in spontaneous erections at M24.

Conclusion

The response to IAI remained stable after 2 years of treatment, and no significant improvement of spontaneous erections during intercourse attempts was found between M12 and M24. Patients should be informed of the limited effect of IAI on natural erections after 1 year. Yiou R, Bütow Z, Parisot J, Binhas M, Lingombet O, Augustin D, de la Taille A, and Audureau E. Is it worth continuing sexual rehabilitation after radical prostatectomy with intracavernous injection of alprostadil for more than 1 year? Sex Med 2015;3:42–48.

Changes in plasma ET-1 and NO in patients with severe acute pancreatitis and effect of alprostadil on ET-1 and NO

AIM: To detect the changes in plasma endothelin-1 (ET-1) and nitric oxide (NO) in patients with severe acute pancreatitis and to observe the effect of alprostadil on ET-1 and NO levels.

METHODS: Sixty patients with SAP were randomly divided into two groups: a control group (n = 30) or a combination group (n = 30). The control group received intravenous infusion of somatostatin on the basis of conventional therapy, and the combination group received intravenous infusion of alprostadil and somatostatin on the basis of conventional therapy. Plasma levels of ET-1 and NO were measured at admission, 12 h, 48 h, 72 h, and 1 week after onset, and ET-1/NO ratio was calculated.

RESULTS: Plasma levels of ET-1 and NO initially increased, peaked at 12 h, were still maintained at high levels at 72 h, and then declined at 1 week below the levels at admission. The trend of changes of ET-1 and NO were similar between the two groups from admission to 24 h (ET-1 at admission: 97.7 ng/L ± 14.9 ng/L vs 98.8 ng/L ± 15.6 ng/L; 12 h: 157.4 ng/L ± 14.4 ng/L vs 160.3 ng/L ± 15.8 ng/L; 24 h: 146.0 ng/L ± 18.8 ng/L vs 146.4 ng/L ± 19.2 ng/L; NO at admission: 29.0 µmol/L ± 4.4 µmol/L vs 29.7 µmol/L ± 6.0 µmol/L; 12 h: 40.2 µmol/L ± 3.9 µmol/L vs 41.2 µmol/L ± 5.5 µmol/L; 24 h: 39.7 µmol/L ± 4.7 µmol/L vs 39.7 µmol/L ± 4.6 µmol/L; P > 0.05 for all). The levels of ET-1 decreased more significantly from 48 h to 1 week in the combination group (48 h: 134.1 ng/L ± 18.5 ng/L vs 128.3 ng/L ± 17.8 ng/L; 72 h: 99.5 ng/L ± 16.6 ng/L vs 109.8 ng/L ± 17.3 ng/L; 1 wk: 71.4 ng/L ± 12.1 ng/L vs 78.8 ng/L ± 13.3 ng/L; P < 0.05 for all), while the levels of NO decreased more significantly in the control group (48 h: 30.1 µmol/L ± 4.9 µmol/L vs 33.8 µmol/L ± 4.1 µmol/L; 72 h: 22.2 µmol/L ± 4.8 µmol/L vs 28.0 µmol/L ± 4.2 µmol/L; 1 wk: 17.0 µmol/L ± 3.7 µmol/L vs 20.2 µmol/L ± 3.4 µmol/L; P < 0.05 for all).

CONCLUSION: ET-1 and NO are important factors mediating microcirculation disturbance in SAP. Alprostadil can ameliorate pancreatic microcirculation possibly by altering ET-1 and NO expression.

Prophylactic phenylephrine for iatrogenic priapism: a pilot study with Peyronie's patients

Purpose

Although penile duplex Doppler ultrasonography (PDDU) is a common and integral procedure in a Peyronie's disease workup, the intracavernosal injection of vasoactive agents can carry a serious risk of priapism. Risk factors include young age, good baseline erectile function, and no coronary artery disease. In addition, patients with Peyronie's disease undergoing PDDU in an outpatient setting are at increased risk given the inability to predict optimal dosing. The present study was conducted to provide support for a standard protocol of early administration of phenylephrine in patients with a sustained erection after diagnostic intracavernosal injection of vasoactive agents to prevent the deleterious effects of iatrogenic priapism.

Materials and Methods

This was a retrospective review of Peyronie's disease patients who received phenylephrine reversal after intracavernosal alprostadil (prostaglandin E1) administration to look at the priapism rate. Safety was determined on the basis of adverse events reported by subjects and efficacy was determined on the basis of the rate of priapism following intervention.

Results

Patients with Peyronie's disease only had better hemodynamic values on PDDU than did patients with Peyronie's disease and erectile dysfunction. All of the patients receiving prophylactic phenylephrine had complete detumescence of erections without adverse events, including no priapism cases.

Conclusions

The reversal of erections with phenylephrine after intracavernosal injections of alprostadil to prevent iatrogenic priapism can be effective without increased adverse effects.

Octreotide combined with alprostadil for treatment of cirrhosis with hepatorenal syndrome

AIM: To evaluate the efficacy of octreotide combined with alprostadil in the treatment of cirrhosis with hepatorenal syndrome (HRS).

METHODS: Seventy-eight cirrhotic patients with HRS were randomly divided into two groups: a control group (n = 38) and an observation group (n = 40). On the basis of albumin infusion, nutrition support and other conventional therapies, the observation group was given octreotide and alprostadil, and the control group was given alprostadil only. After treatment, liver and kidney function indicators and clinical symptoms were observed and compared between the two groups.

RESULTS: In the observation group, 14 (35.0%) cases showed significant improvement, 19 (47.5%) cases showed moderate improvement, and 7 (17.5%) cases showed no improvement; the corresponding figures in the control group were 10 (26.3%), 12 (31.6%) and 16 (42.1%), respectively. The total response rate in the observation group was significantly higher than that in the control group (82.5% vs 57.9%, P < 0.05). In addition, liver and kidney function indicators in the observation group showed significant improvement compared with the control group (P < 0.05).

CONCLUSION: Octreotide combined with alprostadil is effective in the treatment of cirrhosis with HRS.

Protective Effects of N-acetylcysteine and a Prostaglandin E1 Analog, Alprostadil, Against Hepatic Ischemia: Reperfusion Injury in Rats

Ischemia–reperfusion (I/R) injury has a complex pathophysiology resulting from a number of contributing factors. Therefore, it is difficult to achieve effective treatment or protection by individually targeting the mediators or mechanisms. Our aim was to analyze the individual and combined effects of N-acetylcysteine (NAC) and the prostaglandin E1 (PGE1) analog alprostadil on hepatic I/R injury in rats. Thirty male Sprague-Dawley rats were randomly divided into five groups (six rats per group) as follows: Control group, I/R group, I/R + NAC group, I/R + alprostadil group, and I/R + NAC + alprostadil group. The rats received injections of NAC (150 mg/kg) and/or alprostadil (0.05 μg/kg) over a period of 30 min prior to ischemia. These rats were then subjected to 60 min of hepatic ischemia followed by a 60-min reperfusion period. Hepatic superoxide dismutase (SOD), catalase, and glutathione levels were significantly decreased as a result of I/R injury, but they were increased in groups treated with NAC. Hepatic malondialdehyde (MDA), myeloperoxidase (MPO), and nitric oxide (NO) activities were significantly increased after I/R injury, but they were decreased in the groups with NAC treatment. Alprostadil decreased NO production, but had no effect on MDA and MPO. Histological results showed that both NAC and alprostadil were effective in improving liver tissue morphology during I/R injury. Although NAC and alprostadil did not have a synergistic effect, our findings suggest that treatment with either NAC or alprostadil has benefits for ameliorating hepatic I/R injury.

Erection hardness score for the evaluation of erectile dysfunction: further psychometric assessment in patients treated by intracavernous prostaglandins injections after radical prostatectomy

INTRODUCTION

Erectile dysfunction (ED) affects quality of life in patients treated by radical prostatectomy (RP). The Erection Hardness Score (EHS) is a single-item scale that has demonstrated good psychometric properties for assessing erectile function (EF) in patients treated by sildenafil, but its applicability to other treatment contexts has not yet been tested.

AIM

This study aims to test the validity and time and treatment responsiveness of the EHS to assess ED in men with post-RP ED treated with alprostadil injections.

METHODS

This is a 1-year follow-up cohort study of 75 patients treated by RP for localized prostate cancer in a urology department setting between January 2007 and December 2008. Data were prospectively collected at 6 and 12 months post-RP.

MAIN OUTCOME MEASURES

The EHS, the International Index of Erectile Function (IIEF) reference questionnaire, the Global Assessment Questionnaire (GAQ), and Numeric Pain Scale (NPS) were collected. Convergent validity (Spearman correlation coefficients with IIEF domains), known-groups validity (comparing EHS scores across ED severity groups), time and treatment responsiveness (effect size with/without treatment and over the follow-up period), and predictive ability (area under the receiver operating characteristics curve [AUC-ROC]) were analyzed for this study.

RESULTS

The EHS showed good convergent validity (all Spearman coefficients significant at the P<0.05 level), adequate known-groups validity (global differentiation between IIEF-EF severity groups; P<0.001), and treatment responsiveness (effect size: +1.8 [6 months], +2.1 [12 months]), but limited time responsiveness and predictive ability of the EHS for a normal EF at 12 months follow-up when compared with the IIEF-EF domain (AUC-ROC: 0.72 vs. 0.85; P<0.01).

CONCLUSION

Our findings support the overall good psychometric properties of the EHS in patients with post-RP ED treated with alprostadil injections. However, evidence for limited predictive validity and responsiveness to change over time should be considered for its use in clinical follow-up in this population.

Therapeutic effects of octreotide combined with alprostadil on cirrhosis with hepatorenal syndrome

AIM: To explore the therapeutic effects of octreotide combined with alprostadil on cirrhosis with hepatorenal syndrome.

METHODS: Sixty patients with cirrhosis and hepatorenal syndrome were randomly divided into two groups: a control group and an experimental group. The control group was treated by conventional treatment, while the experimental group was additionally given octreotide combined with alprostadil on the basis of conventional treatment. The indexes of renal function, hemodynamic parameters, diameters of the portal vein and splenic vein, and clinical effects were compared.

RESULTS: In the experiment group, the levels of BUN and SCr were significantly lower (10.15 mmol/L ± 5.02 mmol/L vs 19.02 mmol/L ± 7.45 mmol/L, 136.13 μmol/L ± 18.62 μmol/L vs 211.42 μmol/L ± 17.66 μmol/L, P < 0.05) and the level of 24 h urine volume was significantly higher (1644.36 mL/d ± 178.30 mL/d vs 443.41 mL/d ± 77.88mL/d, P < 0.05) after treatment than before treatment. In the control group, the level of SCr was significantly lower (152.60 μmol/L ± 16.89 μmol/L vs 207.12 μmol/L ± 16.27 μmol/L, P < 0.05) and the level of 24 h urine volume was significantly higher (1207.26 mL/d ± 177.05 mL/d vs 459.51 mL/d ± 90.37mL/d, P < 0.05) after treatment than before treatment. The levels of BUN and SCr were significantly lower (10.15 mmol/L ± 5.02 mmol/L vs 15.72 mmol/L ± 7.71 mmol/L, 136.13 μmol/L ± 18.62 μmol/L vs 152.60 μmol/L ± 16.89 μmol/L, P < 0.05) and the level of 24 h urine volume was significantly higher (1644.36 mL/d ± 178.30 mL/d vs 1207.26 mL/d ± 177.05 mL/d, P < 0.05) in the experimental group than in the control group. There were no significant differences in the levels of MAP and HR between before and after treatment in both groups (78.45 mmHg ± 4.01 mmHg vs 76.44 mmHg ± 4.06 mmHg, 84.08/min ± 4.70/min vs 86.22/min ± 4.67/min, 78.53 mmHg ± 4.17 mmHg vs 78.22 mmHg ± 4.08 mmHg, 84.77/min ± 4.34/min vs 85.55/min ± 4.58/min, P > 0.05). The diameters of the portal vein and splenic vein were significantly lower (11.99 mm ± 1.33 mm vs 14.02 mm ± 1.37 mm, 8.16 mm ± 1.20 mm vs 10.65 mm ± 1.57 mm, 13.05 mm ± 1.16 mm vs 13.94 mm ± 1.27 mm, 9.36 mm ± 1.61 mm vs 10.50 mm ± 1.61 mm, P < 0.05) after treatment than before treatment in both groups. The diameters of the portal vein and splenic vein in the experiment group were significantly lower than those in the control group (11.99 mm ± 1.33 mm vs 13.05 mm ± 1.16 mm, 8.16 mm ± 1.20 mm vs 9.36 mm ± 1.61 mm, P < 0.05). The improvement rate and the total response rate in the experimental group were significantly higher than those in the control group (20.00% vs 6.67%, 83.33% vs 46.67%, P < 0.05), although there was no significant difference in mortality (6.67% vs 6.67%, P > 0.05).

CONCLUSION: Octreotide combined with alprostadil can improve renal function, reduce the portal pressure, has less impact on haemodynamics and high safety in patients with cirrhosis with hepatorenal syndrome.

How effective are alprostadil and hydrocortisone on reperfusion injury in kidney after distant organ ischemia?

BACKGROUND

After reestablishment of blood flow to ischemic limb recirculation of free radicals may cause ischemia-reperfusion injury in many organs. This study designed to investigate effects of hydrocortisone and alprostadil distant injury to kidneys by both measuring biochemical markers of oxidative stress and histopathologic examination in an experimental rat model of hind limb ischemia-reperfusion.

MATERIALS AND METHODS

This study conducted in Isfahan University of Medical Sciences during 2011-2012. Ischemia was established by infra renal aortic clamping for 60 min in 32 male Wistar rats. Animals were divided into those receiving alprostadil (group ischemia-reperfusion plus alprostadil (IR/A), n = 8), those receiving hydrocortisone (group ischemia-reperfusion plus hydrocortisone (IR/H), n = 8), control group (group ischemia-reperfusion (IR), n = 8), and sham group (n = 8). After 120 min of reperfusion both kidneys were removed. Levels of superoxide dismutase (SOD), malondialdehyde (MDA), and glutathione (GSH) as indirect markers of oxidative injury was measured. Finally all data in different groups were compared using the analysis of variance (ANOVA) test by Statistical Package for Social Sciences (SPSS) version 16.

RESULTS

Administration of alprostadil or hydrocortisone does not improve the biochemical parameters of oxidative injury including MDA and SOD. However, statistically significant difference was seen in GSH level among sham and IR groups. Mean (± standard deviation (SD)) concentration of GSH in IR, IR/A, IR/H, and sham groups were 1028.77 (72.65), 924.82 (70.66), 1000.28 (108.77), and 846.69 (163.52), respectively (P = 0.015). Histopathological study of specimens did not show any significant changes between groups.

CONCLUSION

Alprostadil and hydrocortisone do not improve the kidney GSH, SOD, and MDA level and kidney releases its GSH reserve during ischemia-reperfusion event, and another point is that, 3 h of ischemia-reperfusion does not develop injury in kidney.

Oral and non-oral combination therapy for erectile dysfunction

An estimated 30 million men in the United States suffer from varying degrees of erectile dysfunction. Increasing age and comorbidities are likely to increase the number of men who are initially refractory or become refractory to phosphodiesterase (PDE)-5 inhibitors, the most popular oral therapy. Combination therapy, a concept well proved in other areas of medicine, is therefore of increasing importance. Combination oral and non-oral (intracavernosal injection and intraurethral application) therapies have been shown to salvage monotherapy. The early introduction of combination therapy has been shown to expedite both the return of natural function and PDE-5 inhibitor responsiveness in post-prostatectomy patients with no reports of serious adverse events. Larger controlled studies are needed to corroborate those encouraging findings.