| Part 1 Preliminary clinical observation on the treatment of erectile dysfunction with low intensity extracorporeal shock waveObjective : In order to observe the effect and the security of low intensity extracorporeal shock wave therapy on erectile dysfunction.Methods: History >3 months and IIEF-5 score <22 of ED patients 104 cases. The average age of the patients was 38.5 years.The experimental group was treated with CS-2012A-9 type extracorporeal shock wave therapy machine and the control group was treated with sham treatment that the energy of the shock wave intensity is not generated.Results: After LI-ESWT treatment,Psychological ED SEP3 increased from 46.05% to 84.29%,IIEF-ED score increased from 14.14 to 20.90,Organic ED SEP3 increased from 19.41% to 53.45%,IIEF-ED score increased from 8.18 to 14.86,Mixed ED SEP3 increased from 12.29% to 51.33%, IIEF-ED score increased from 6.67 points to 14.67 points, and the differences were statistically significant(P <0.05). While there was no significant difference in the control group(P >0.05). After receiving the treatment of LI-ESWT, test group psychological ed, organic ed, mixed sex ED penile erection hardness score was significantly higher than before treatment is significantly improved, and the difference has statistical significance(P < 0.05); the control group psychological ed, organic ed, mixed sex ed EHS differences had no statistical significance.After receiving the treatment of LI-ESWT and test group mild ed sep3 from 45.76% increased to 82.33%, the score IIEF-ED 14.14 points from the increased to 20.62; moderate ed sep3 from 34.25% increased to 62.83%, scoring IIEF-ED 10.08 points from the increased to 16.83; severe ed sep3 from 6.63% increased to 48.68%, IIEF-ED rating points from 6.26 to 13.84, and the difference had statistical significance(P < 0.05); the control group mild ed, moderate ed, severe ed sep3, IIEF-ED score differences were no statistical significance. The test group received the treatment of LI-ESWT mild ed, moderate ed, severe ed the penis erects hardness score were compared with those before treatment improved, and the difference has statistical significance(P < 0.05); the control group mild ed, moderate ed and severe ed the penis erects hardness score differences had no statistical significance.After receiving the treatment of LI-ESWT test ed group history < 1 year sep3 from 45.43% increased to 82.57%, the score IIEF-ED 13.95 points from the increased to 20.67%; increase the ED history > 1 year sep3 from 17.55% to 54%, scoring IIEF-ED 7.87 points from the raised to 14.97 points; and the difference is statistically significant(P < 0.05); control group ed history < 1 year, ed history > 1 year difference were not statistically significant. After receiving the treatment of LI-ESWT test ed group history < 1 year; ed history > penile erection hardness score was significantly higher than before treatment improved; and the difference is statistically significant(P < 0.05); control group ed history < 1 year, ED history > 1 year difference were not statistically significant.After receiving the treatment of LI-ESWT, smoking history of test group patients with ED sep3 from 25.27% increased to 30.24%, IIEF-ED score from 960 to improve to 15.87 points; no smoking history of test group patients with ED sep3 increased from 59.60% to 67.95%, IIEF-ED score from 10.62 points improved to 17.84 points; and the difference is statistically significant(P < 0.05); history of smoking control group ED patients, no history of smoking control difference before and after treatment in patients with ED group were not statistically significant. After receiving the treatment of LI-ESWT, ed in test group patients with a history of smoking and no smoking history of ED in test group patients with penile erection hardness score were compared with those before treatment improved; and the difference has statistical significance(P < 0.05); history of smoking control group ED patients, no history of smoking control difference before and after treatment in patients with ED group were not statistically significant.After receiving the treatment of LI-ESWT, history of hypertension of test group patients with ED sep3 from 18.35% increased to 53.17%, IIEF-ED score from 7.83 points increased to 14.74%, compared with before treatment, the penis erects hardness score increased, and the difference has statistical significance(P < 0.05); and no history of hypertension of test group patients with ED sep3 from 37.10% increased to 75.34%, IIEF-ED score from 12.31 points increased to 19.28%, compared with before treatment, the penis erects hardness score improve, and the difference has statistical significance(P < 0.05); history of hypertension control group ED patients, and no history of hypertension control difference before and after treatment in patients with ED group were not statistically significant.After receiving the treatment of LI-ESWT, history of diabetes test group patients with ED sep3 from 9.69% to 49%, IIEF-ED score from 6.69 points increased to 14 points, compared with before treatment, the penis erects hardness score increased, and the difference has statistical significance(P < 0.05); no history of diabetes test group patients with ED sep3 increased from 37.31 to 72.89%, scoring IIEF-ED 11.94 points from the increased to 18.72 points, compared with before treatment, the penis erects hardness score improve, and the difference has statistical significance(P < 0.05); diabetic control group patients with ED, without diabetes control group ED patients treated before and after the treatment, the difference had no statistical significance.No pain and other adverse reactions occurred after LI-ESWT treatment.Conclusion: The clinical research proved that LI-ESWT, in particular, has a certain therapeutic effect on ED caused by hypertension, diabetes. Low intensity extracorporeal shock wave is a safe and effective method for the treatment of erectile dysfunction.Part 2 The effect of low intensity extracorporeal shock wave on endothelial cell in cavernous tissues of diabetic rats with erectile dysfunctionObjective:In order to observe the effect of low intensity extracorporeal shock wave on endothelial cell in cavernous tissues of diabetic rats with erectile dysfunctionMethods: Total of 9 experimental rats were divided into normal control group(n=3)and the rest ones(n=6)were established type I diabetic rat models with erectile dysfunction by Streptozotocin(STZ)and Apomorphine(APO).Then the established ED model rats were randomly subdivided into diabetic ED group and low intensity extracorporeal shock wave group. After the treatment of low intensity extracorporeal shock wave, we compared the erection times of rats in each group. The penile tissues of all test rats were collected after treatment. The endothelial cell markers CD31 were detected by immunofluorescence cell cavernosal in each group. The e NOS expression of rat penile tissue was detected by immunohistochemical methods in each group.Results: The erectile frequency of DM in ED group was significantly lower than that in normal control group(P<0.01). The erectile frequency of DM+LISW group was significantly higher than that of ED group DM(P< 0.01). DM+LISW group of erectile frequency lower than normal control group(P< 0.01). The expression of CD31 was ont in normal SD rat penile tissue. The expression of ED in corpus cavernosum of diabetic rats without CD31. Diabetic ED rats after low intensity of extracorporeal shock wave treatment of endothelial cells in corpus cavernosum tissue visible green fluorescence marks CD31 positive expression. The expression of e NOS was expressed in the penile tissues of rats in each group. The expression level of e NOS protein in the DM ED group was significantly lower than that in the control group(P< 0.01). The expression level of e NOS protein in the DM+LISW group was significantly higher than that in the ED group of DM(P< 0.01). The expression level of e NOS protein in the DM+LISW group was lower than that in the control group(P< 0.01).Conclusion: Low intensity extracorporeal shock wave may improve erectile function by promoting endothelial cell regeneration. Low intensity extracorporeal shock wave may improve erectile function by increasing the expression of e NOS in the penile tissue. Part 3 Effect of low intensity extracorporeal shock wave on the proliferation of human adipose derived mesenchymal stem cells cultured in vitro and a preliminary discussion on the mechanism of ED in the treatment of the low intensity extracorporeal shock waveObjective:In order to observe the effect of low intensity extracorporeal shock wave on the proliferation activity of human adipose tissue derived mesenchymal stem cells cultured in vitro and possible mechanism of extracorporeal shock wave therapy for male erectile dysfunction.Methods: Human adipose tissue was collected, digested with 0.075% collagenase I. Adherent culture could obtain ADSCs. The morphological changes of adipose derived mesenchymal stem cells in the endothelial cells were observed. Endothelial cell differentiation markers were detected by immunocytochemistry and RT-PCR. Cell growth curve was drawn before and after LESW shock. The changes of the proliferation activity of adipose derived stem cells were observed. A series of changes in the morphology of adipose derived mesenchymal stem cells in the induction of endothelial cells had happened.Results: Human adipose derived mesenchymal stem cells were obtained. Flow cytometry has shown that cells were highly positive for CD105, CD90, and weakly positive for CD34, CD45. The endothelial cells differentiated from adipose derived mesenchymal stem cells could express endothelial markers, such as CD31,CD34,? factor,VE-cadherin and endothelial nitric oxide synthetase(eNOS). LESW can promote the proliferation of adipose derived mesenchymal stem cells.The shock wave energy of 0.09MJ/mm2 300 can significantly promote the proliferation of fat stem cells.Conclusion: Adipose derived mesenchymal stem cells were MSCs. Adipose derived mesenchymal stem cells can differentiate into endothelial cells in vitro. Low intensity extracorporeal shock waves may induce the proliferation of adipose derived mesenchymal stem cells. Adipose derived mesenchymal stem cells may differentiate into endothelial cells in the treatment of male erectile dysfunction. |
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