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Cureus Mar 2023Intracavernosal injection of Trimix (a combination of phentolamine, papaverine, and alprostadil) is used for the treatment of erectile dysfunction. A rare but serious...
Intracavernosal injection of Trimix (a combination of phentolamine, papaverine, and alprostadil) is used for the treatment of erectile dysfunction. A rare but serious side effect of Trimix is priapism, a persistent erection lasting for more than four hours. Penoscrotal decompression is a newer technique being used to treat refractory and persistent ischemic priapism. Here, we report a unique case of priapism treated with penoscrotal decompression in a patient following an unmeasured injection of Trimix. A 36-year-old male presented to the emergency room complaining of a persistent painful erection over the previous five days following a Trimix injection and illicit methamphetamine use. At bedside, aspiration and irrigation were attempted without any improvement. Phenylephrine injection was contraindicated due to sinus tachycardia. The patient then underwent bilateral penoscrotal decompression on day six post-Trimix injection. The procedure was successful with a resolution of the erection, though some moderate corporal fibrosis was noted. At a 10-day follow-up, the patient reported moderate pain in his penis but had regained complete potency. Misuse of Trimix can cause persistent ischemic priapism. Penoscrotal decompression is a novel technique used to treat persistent ischemic priapism and has been shown to have positive efficacy in the resolution of priapism as well as in salvaging erectile function. To our knowledge, treatment of persistent priapism with penoscrotal decompression after using Trimix has not yet been reported in the literature. Given the rarity of this, our report highlights a unique case that has potential benefit for future practitioners who are faced with this clinical scenario.
PubMed: 37123749
DOI: 10.7759/cureus.36757 -
La Radiologia Medica Jun 2023To compare the image quality of high-resolution diffusion-weighted imaging (DWI) using multiplexed sensitivity encoding (MUSE) versus reduced field-of-view (rFOV)...
OBJECTIVES
To compare the image quality of high-resolution diffusion-weighted imaging (DWI) using multiplexed sensitivity encoding (MUSE) versus reduced field-of-view (rFOV) techniques in endometrial cancer (EC) and to compare the diagnostic performance of these techniques with that of dynamic contrast-enhanced (DCE) MRI for assessing myometrial invasion of EC.
METHODS
MUSE-DWI and rFOV-DWI were obtained preoperatively in 58 women with EC. Three radiologists assessed the image quality of MUSE-DWI and rFOV-DWI. For 55 women who underwent DCE-MRI, the same radiologists assessed the superficial and deep myometrial invasion using MUSE-DWI, rFOV-DWI, and DCE-MRI. Qualitative scores were compared using the Wilcoxon signed-rank test. Receiver operating characteristic analysis was performed to compare the diagnostic performance.
RESULTS
Artifacts, sharpness, lesion conspicuity, and overall quality were significantly better with MUSE-DWI than with rFOV-DWI (p < 0.05). The area under the curve (AUC) of MUSE-DWI, rFOV-DWI, and DCE-MRI for the assessment of myometrial invasion were not significantly different except for significantly higher AUC of MUSE-DWI than that of DCE-MRI for superficial myometrial invasion (0.76 for MUSE-DWI and 0.64 for DCE-MRI, p = 0.049) and for deep myometrial invasion (0.92 for MUSE-DWI and 0.80 for DCE-MRI, p = 0.022) in one observer, and that of rFOV-DWI for deep myometrial invasion in another observer (0.96 for MUSE-DWI and 0.89 for rFOV-MRI, p = 0.048).
CONCLUSION
MUSE-DWI exhibits better image quality than rFOV-DWI. MUSE-DWI and rFOV-DWI shows almost equivalent diagnostic performance compared to DCE-MRI for assessing superficial and deep myometrial invasion in EC although MUSE-DWI may be helpful for some radiologists.
Topics: Female; Humans; Alprostadil; Sensitivity and Specificity; Magnetic Resonance Imaging; Diffusion Magnetic Resonance Imaging; Endometrial Neoplasms
PubMed: 37120661
DOI: 10.1007/s11547-023-01635-4 -
Bioorganic Chemistry Jul 2023The emergence of multidrug-resistant fungal pathogens such as Candida auris is one of the major reasons WHO has declared fungal infections as a public health threat....
The emergence of multidrug-resistant fungal pathogens such as Candida auris is one of the major reasons WHO has declared fungal infections as a public health threat. Multidrug resistance, high mortality rates, frequent misidentification, and involvement in hospital outbreaks of this fungus demand the development of novel therapeutic drugs. In this direction, we report the synthesis of novel pyrrolidine-based 1,2,3-triazole derivatives using Click Chemistry (CC) and evaluation of their antifungal susceptibility against C. auris following Clinical and Laboratory Standards Institute (CLSI) guidelines. The fungicidal activity of the most potent derivative (P6) was further quantitatively confirmed by the MUSE cell viability assay. For insight mechanisms, the effect of the most active derivative on cell cycle arrest was studied using Muse Cell Analyzer and apoptotic mode of cell death was determined by studying phosphatidylserine externalization and mitochondrial depolarization. In vitro susceptibility testing and viability assays showed that all the newly synthesized compounds have antifungal activity with P6 being the most potent derivative. Cell cycle analysis revealed that P6 arrested the cells in S-phase in a concentration dependent manner and the apoptotic mode of cell death was confirmed by the movement of cytochrome c from mitochondria to cytosol with membrane depolarization. The hemolytic assay confirmed the safe use of P6 for further in vivo studies.
Topics: Antifungal Agents; Candida auris; Candida; Alprostadil; Microbial Sensitivity Tests; Triazoles; Apoptosis; Cell Cycle Checkpoints
PubMed: 37119782
DOI: 10.1016/j.bioorg.2023.106562 -
Frontiers in Medicine 2023To systematically evaluate the clinical efficacy and safety of Shenkang injection (SKI) combined with alprostadil in the treatment of chronic renal failure (CRF).
OBJECTIVE
To systematically evaluate the clinical efficacy and safety of Shenkang injection (SKI) combined with alprostadil in the treatment of chronic renal failure (CRF).
METHOD
Randomized controlled trials (RCTs) of Shenkang injection combined with alprostadil in CRF treatment were investigated by retrieving a total of 7 databases including CNKI, Wanfang database, VIP, CBM, PubMed, Embase and Cochrane Library, with the search time ranging from 2012 to now. Revman 5.2 software was used for data analysis, and Cochrane bias risk tool was used to evaluate the quality of the included literature. The final results were represented by relative risk (RR), mean difference (MD) and 95% confidence interval (95% CI).
RESULTS
A total of 20 RCTs and 1,573 patients were included in this study. Meta-analysis showed that the overall response rate (ORR) of the treatment group was superior to the control group [RR = 0.20, 95% CI (0.16, 0.25), < 0.00001]. Compared with the control group, the treatment group achieved favorable improvement in terms of the creatinine clearance rate (Ccr) [MD = 9.48, 95% CI (8.73, 10.24), < 0.00001], serum creatinine (Scr) [MD = -55.12, 95% CI (-63.42, -46.82), < 0.00001], quantitative urine protein (Upro) [MD = -0.48, 95% CI (-0.53, -0.43), < 0.00001], and blood urea nitrogen (BUN) [MD=-3.73, 95% CI (-4.08, -3.3) 7, < 0.00001]. There was no statistical difference in the incidence of adverse reactions in each group.
CONCLUSION
Currently, Shenkang injection combined with alprostadil has been widely used in clinical treatment of CRF due to the certain effect superior to other methods. However, its specific efficacy and safety need to be further verified through numerous large-scale clinical trials.
PubMed: 37089596
DOI: 10.3389/fmed.2023.982016 -
Expert Opinion on Pharmacotherapy Jun 2023Erectile dysfunction (ED) is defined as the inability to attain and/or maintain a penile erection. The first introduction of intracavernosal injection (ICI) for the... (Review)
Review
INTRODUCTION
Erectile dysfunction (ED) is defined as the inability to attain and/or maintain a penile erection. The first introduction of intracavernosal injection (ICI) for the treatment of erectile failure was in 1982 by Virag who reported the positive effects of papaverine on erectile tissue, followed by Brindley concurrently conducting research on ICI therapy with alpha-blockade. ICI remains a viable option for the treatment of ED, even after FDA approval of phosphodiesterase type 5 inhibitors in 1998. The American Urological Association (AUA) and the European Association of Urology (EAU) both recommend ICI as a second-line therapy for the treatment of ED. We herein provide an overview of the current state of ICI therapy for the treatment of ED.
AREAS COVERED
We performed a literature review from 1977-2022, using PubMed and the current AUA and EAU guidelines to discuss the current state of ICI for the treatment of ED.
EXPERT OPINION
Although other oral agents are considered first line for the treatment of ED, the current guidelines and literature demonstrate that ICI is a safe and effective option for patients; however, careful patient selection and counseling should be performed to maximize the effectiveness and safety of this ED treatment.
Topics: Male; Humans; Erectile Dysfunction; Vasodilator Agents; Alprostadil; Papaverine; Penile Erection
PubMed: 37078428
DOI: 10.1080/14656566.2023.2204189 -
Sexual Medicine Reviews Oct 2022Erectile dysfunction (ED) is a substantial cause of dissatisfaction among many men. This discontentment has led to the emergence of various drug treatment options for... (Review)
Review
INTRODUCTION
Erectile dysfunction (ED) is a substantial cause of dissatisfaction among many men. This discontentment has led to the emergence of various drug treatment options for this problem.
OBJECTIVES
Unfortunately, due to various interactions, contraindications, and side effects, systemic therapies such as phosphodiesterase-5 inhibitors (including sildenafil, tadalafil, vardenafil, avanafil, etc.) are not welcomed in many patients. These problems have led researchers to look for other ways to reduce these complications.
METHODS
This article holistically reviews the efficacy of topical prostaglandins and their role in treating ED. We sought to provide a comprehensive overview of recent findings on the current topic by using the extensive literature search to identify the latest scientific reports on the topic.
RESULTS
In this regard, topical and transdermal treatments can be suitable alternatives. In diverse studies, prostaglandins, remarkably PGE1 (also known as alprostadil), have been suggested to be an acceptable candidate for topical treatment.
CONCLUSION
Numerous formulations of PGE1 have been used to treat patients so far. Still, in general, with the evolution of classical formulation methods toward modern techniques (such as using nanocarriers and skin permeability enhancers), the probability of treatment success also increases.
Topics: Male; Humans; Erectile Dysfunction; Alprostadil; Prostaglandins; Sildenafil Citrate; Phosphodiesterase 5 Inhibitors
PubMed: 37051966
DOI: 10.1016/j.sxmr.2022.06.004 -
Journal of Neurotrauma Dec 2023Spinal cord injury (SCI) is a serious neurological disorder, with the consequent disabilities conferred by this disorder typically persisting for life....
Comparison of the Anti-Inflammatory Effects of Mouse Adipose- and Bone-Marrow-Derived Multilineage-Differentiating Stress-Enduring Cells in Acute-Phase Spinal Cord Injury.
Spinal cord injury (SCI) is a serious neurological disorder, with the consequent disabilities conferred by this disorder typically persisting for life. Multilineage-differentiating stress-enduring (Muse) cells are endogenous stem cells that can be collected from various tissues as well as from mesenchymal stem cells (MSCs); additionally, these Muse cells are currently being used in clinical trials. The anti-inflammatory effect of stem cell transplantation prevents secondary injuries of SCI; however, its effect on Muse cells remains unclear. In this study, we aimed to compare the anti-inflammatory effects of adipose (AD)- and bone marrow (BM)-Muse cells that were isolated from mice (6-week-old C57BL/6J) following intralesional administration during the acute phase of SCI. Flow cytometry was used to isolate Muse cells from AD and BM MSCs. The percentage of Muse cells was 3.9 and 2.7% for AD and BM MSCs, respectively. To examine cell viability, Muse cells were incubated under HO-induced oxidative stress conditions. Overall, AD-Muse cells exhibited higher viability than BM-Muse cells ( = 0.032). In enzyme-linked immunosorbent assay analysis, AD-Muse cells displayed greater secretion of brain-derived neurotrophic factor (BDNF; = 0.008), vascular endothelial growth factor ( = 0.032), and hepatocyte growth factor ( = 0.016). DNA microarray analysis revealed higher expression of neurotrophin-3 nerve growth factor ), pleiotrophin and midkine in AD-Muse cells than in BM-Muse cells. To assess their anti-inflammatory effects , Muse cells and macrophages were co-cultured, and the levels of cytokines (tumor necrosis factor [TNF] α and interleukin [IL] 10) were measured in the medium. Consequently, we found that TNFα levels were lower in AD-Muse cells than in BM-Muse cells ( = 0.009), and IL10 levels were higher in AD-Muse cells than in BM-Muse cells ( = 0.008). Further, we induced moderate injuries via contusion of the spinal cord at the T10 level; Muse cells were transplanted intralesionally 7 days post-SCI. The number of surviving cells, alongside the number of CD86+ (M1 inflammatory effect), and CD206+ (M2 anti-inflammatory effect) macrophages in the spinal cord were measured 7 days post-transplantation. The number of surviving AD-Muse cells was higher than the number of surviving BM-Muse cells (ratio of AD-Muse/BM-Muse = 2.5, > 0.05). The M1/M2 ratio in the AD-Muse cell-group (0.37) was lower than that in the control (phosphate-buffered saline) group (3.60, = 0.008). The lesion area in the AD-Muse cell group was smaller than that in the BM-non-Muse ( = 0.049) and control groups ( = 0.012). As AD-Muse cells conferred a higher cell survival and neurotrophic factor secretion ability AD-Muse cells demonstrated reduced inflammation after SCI. Overall, intralesional AD-Muse cell therapy is a potential therapeutic candidate that is expected to exhibit anti-inflammatory effects following acute SCI.
Topics: Mice; Animals; Brain-Derived Neurotrophic Factor; Bone Marrow; Vascular Endothelial Growth Factor A; Alprostadil; Hydrogen Peroxide; Mice, Inbred C57BL; Spinal Cord Injuries; Spinal Cord; Anti-Inflammatory Agents; Mesenchymal Stem Cell Transplantation
PubMed: 37051701
DOI: 10.1089/neu.2022.0470 -
Journal of Neural Engineering Apr 2023In recent years, imagined speech brain-computer (machine) interface applications have been an important field of study that can improve the lives of patients with speech...
In recent years, imagined speech brain-computer (machine) interface applications have been an important field of study that can improve the lives of patients with speech problems through alternative verbal communication. This study aims to classify the imagined speech of numerical digits from electroencephalography (EEG) signals by exploiting the past and future temporal characteristics of the signal using several deep learning models.This study proposes a methodological combination of EEG signal processing techniques and deep learning models for the recognition of imagined speech signals. EEG signals were filtered and preprocessed using the discrete wavelet transform to remove artifacts and retrieve feature information. To classify the preprocessed imagined speech neural signals, multiple versions of multilayer bidirectional recurrent neural networks were used.The method is examined by leveraging MUSE and EPOC signals from MNIST imagined digits in the MindBigData open-access database. The presented methodology's classification performance accuracy was noteworthy, with the model's multiclass overall classification accuracy reaching a maximum of 96.18% on MUSE signals and 71.60% on EPOC signals.This study shows that the proposed signal preprocessing approach and the stacked bidirectional recurrent network model are suitable for extracting the high temporal resolution of EEG signals in order to classify imagined digits, indicating the unique neural identity of each imagined digit class that distinguishes it from the others.
Topics: Humans; Algorithms; Alprostadil; Brain-Computer Interfaces; Neural Networks, Computer; Electroencephalography
PubMed: 37001511
DOI: 10.1088/1741-2552/acc976 -
Journal of Primary Care & Community... 2023The purpose of this feasibility pilot study was to evaluate safety and adherence of a wearable brain sensing wellness device designed to reduce stress among healthcare...
OBJECTIVE
The purpose of this feasibility pilot study was to evaluate safety and adherence of a wearable brain sensing wellness device designed to reduce stress among healthcare professionals (HCP).
METHODS
A total of 40 HCP were invited to participate in an open-label pilot study. Participants were asked to use a brain sensing wearable device (MUSE-S™) on a daily basis to reduce their stress, for a total of 90 days. Total study participation duration was 180 days. Study enrollment began in August 2021 and ended December 2021. The exploratory outcomes included stress, depression, sleep, burn-out, resilience, quality of life, and cognition.
RESULTS
Among the 40 HCP in study, the majority were female (85%), white (87.5%) and with an average age of 41.3 ± 11.0 years (SD). Participants used the wearable device an average of 23.8 times over a 30-day period with a mean duration of 5.8 min with each use. Study results demonstrate the positive impact of guided mindfulness using the wearable device MUSE-S™ and its accompanying application (APP). A statistically significant improvement was found for a reduction in stress ( < .001) and improvement in resilience ( = .02), quality of life ( = .003), and cognition ( < .001). The majority (91.9%) of the participants indicated they felt more relaxed after using the device, and 73% indicated they would continue to use this device at end-of-study. No adverse effects were reported.
CONCLUSION
Study results show that 3 to 10 min of guided meditation during work hours through the use of a brain sensing wearable device is safe and acceptable, with associated health benefits for HCP.
Topics: Humans; Male; Female; Adult; Middle Aged; Pilot Projects; Mindfulness; Quality of Life; Pandemics; Alprostadil; Health Personnel; Brain
PubMed: 36960553
DOI: 10.1177/21501319231162308