| Objective: To investigate the protective effect of postconditioning treatment of acute unilateral testicular complete torsion-detorsion Injury and its relevant mechanisms.and to access the value of ultrasound technology on completely testicular torsion.Methods: 78 white male rabbits were randomly divided into groups: sham operation group (group S), group A(A0,A1,A2,A3),group B(B0,B1,B2,B3),group C(C0,C1,C2,C3), ,with 6 in each. The acute testicular hemodynamic disorder models were established in A,B and C groups by completely blocking the left testicular blood flow for 2hours,4hours,6hours respectively and were dynamic observed by Color Dppler Ultrasound(CDU).The ischemic testes in group A0,B0,C0 were reperfusion immediately, the testes in group A1,B1,C1were subjected to 3 cycles of 15 sec release and 15 sec occlusion (15s/15s) ,the testes in group A2,B2,C2 were subjected to 3 cycles of 30s/30s,the testes in group A3,B3,C3 were subjected to 3 cycles of 45s/45s.The contrast-enhanced ultrasonographic (CEUS) was performed before operation and reperfusion in each group. The time intensity curves were evaluated by using Syngo US Workplace and the parameters includeβ,time-to- peak(TTP),peak-base indensity(PBD),half of declining time(DT/2) were analyzed. After 3 days of breeding, the CEUS was performed again, the histology structure, tissue sample of malonaldehyde (MDA),superoxide dismutase (SOD) were determined.Western blot was used to detect the caspace-3,Bcl-2 expression in the spematogenic epitllelial cells. The Johnsen's score,apoptosis index(AI) by Tunel was analyzed. Analysis the correlation between histological,biochemics changes and the CDU and CEUS appearances of each group.Results: The CEUS parameters of bilateral testes showed no significantly difference in all group before operation(P>0.05). 3 days after reperfusion , the parameters showed no significant difference in group S and A;The parameters of DT/2 was extended significantly in group B comparing with group S(P<0.05) ,but parameters of PBD were increased in group B1 and B2,comparing with group S, they have significant differernce(P<0.05).The parameters is 0 in group C. The content of the MDA was increased significantly in group A3 comparing with other groups of A(P<0.05), group B1,B2 were lower than group B0,B3 (P<0.05), and there was no significant difference in each subgroup of C (P>0.05). The content of the SOD was decreased significantly in group A3 comparing with other group of A(P<0.05), group B1,B2 was higher than group B0,B3 (P<0.05), and there was no significant difference in each subgroup of C (P>0.05).The Johnsen's score was decreased with the time of ischemia, the Johnsen's score of A3 was decreased significantly comparing with other groups of A, group B1,B2 were higher than group B0,B3(P<0.05),and group B0 was higher than group B3(P<0.05),and there was no significant difference in each subgroup of C(P>0.05). The ultrastructure showed significant difference in group A,B,C.The apoptosis index(AI)was increased with the time of ischemia, the AI of groups A3 was highest(p<0.05), A2 secondly(P<0.05) ,A0,A1 have no significant difference (P>0.05);The AI of group B0,B3 were higher than group B1,B2(P<0.05),and group B2 was higher than group B1(P<0.05);The AI of group C0,C3 were higher than group C1,C2(P<0.05),and C2 was higher than C1(P<0.05). The western blot analysis showed that the expression of caspase-3 was increased with the time of ischemia ,group A3 was lightly increased comparing with other subgroups of A(P<0.05), groupB1,B2 were remarkably decreased comparing with B0,B3(P<0.05),and there were no significant difference in each subgroup of C (P>0.05). The expression of Bcl-2 was only observed in group S and A,and the amount was little and have no difference between group S and A (P>0.05).Conclusions: 1 Ultrasonography combined with CDU could make an accurate diagnosis of acute testicular complete torsion ,and the time-intensity curves of CEUS could indirectly response to the microcirculation of internal testicular,and evaluate the effect of detorsion then guide the next step of treatment. 2 IP can significantly reduce the IR injury after detorsion by reducing the AI et al if the time of ischemia is not too long or too short. 3 The protective effect of IR is determined by the ischemic time and the implementation of the specific ways.4 The molecular mechanism of anti-apoptotic by postconditioning due to reducing ROS generation ,decreased caspase-3 expression, thereby reducing apoptosis.5 ischemia reperfusion injury become more prominent with the time of ischemia,and no-reflow phenomenon increased also.
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