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Background Past studies have shown that elevated estradiol levels could inhibit penile erection, but the relationship between estradiol and erection of the penile tip or base has not been extensively researched. Methods We therefore investigated estradiol's effects on the erection of the penile tip and base, with a cross-sectional study of 135 patients with erectile dysfunction (ED), based on scores of ≤21 according to the International Index of Erectile Function-5. All patients were tested for nocturnal penile tumescence, blood pressure (BP), serum glucose, total cholesterol (TC), triglyceride (TG), high-density lipoprotein (HDL), low-density lipoprotein (LDL), luteinizing hormone (LH), follicle-stimulating hormone (FSH), prolactin (PRL), progesterone (P), estradiol (E), and testosterone (T). Univariate and multivariate analyses were used to assess associations between estradiol levels and erection at the penile tip and base. Results We found no obvious relationship between erection time at penile tip and estradiol levels but did observe a negative correlation between base erection time and estradiol level [hazard ratio (HR) ‒0.11; 95% CI ‒0.80-1.72]. With increasing estradiol concentration, multivariate analysis showed an obvious reduction in base erection time among patients with normal Rigiscan results (HR ‒0.31; 95% CI ‒1.63-1.29) (P less then 0.05) as estradiol concentration increased. Conclusions Our data indicate that estradiol inhibits penile erection, particularly at the penile base. Also, when the effective erection time of the penile base lasts longer than 10 min, estradiol has a more obvious inhibitory effect on penile base erection. 2019 Translational Andrology and Urology. All rights reserved.Out of hospital cardiac arrest (OHCA) is a leading cause of death worldwide. Early cardiopulmonary resuscitation (CPR) and early defibrillation are key to improving outcomes of patients with OHCA including return of spontaneous circulation (ROSC) and survival to hospital discharge with good neurologic outcomes. Lebanon like other developing countries, suffers from absence of organized prehospital cardiac arrest care bundle and from absence of a legal framework for community involvement in cardiac arrest care. Scientific societies, involved non-governmental organizations (NGOs) and local governmental stakeholders organized a national meeting to launch a strategy aiming at improving OHCA outcomes in Lebanon. This article represents a position statement of the Lebanese Society of Cardiology and the Lebanese Society of Emergency Medicine summarizing the strategy to improve out-of-hospital CPR. Participating stakeholders developed and submitted a law proposal of a "Good Samaritan Law" to the Lebanese parliament. Several of activities were also launched aiming at establishing public access defibrillation programs and at training bystanders in different areas in Lebanon to perform bystander CPR and use automated external defibrillators (AEDs). Additional recommendations were proposed to local emergency medical system (EMS) agencies to improve prehospital care and introduce medical direction to prehospital activities. 2019 Cardiovascular Diagnosis and Therapy. All rights reserved.A patient presented with an intraluminal fibrous cord in the distal segment of ascending aorta. On axial images, the fibrous cord had the appearance of an aortic dissection flap. Observation of continuous images and multiplanar reconstruction were critical for differential diagnosis. Volume render images showed both ends of the fibrous cord had tentiform attachments to the aorta inner wall, which indicating a congenital aorta anomaly. One possible hypothesis for the congenital variation might be the fifth primitive aortic arches remnant. 2019 Cardiovascular Diagnosis and Therapy. All rights reserved.Background Little is known about the long-term outcomes of medical therapy (MT) versus successful percutaneous coronary intervention (PCI) in elderly patients with coronary chronic total occlusions (CTOs). Methods There were 1,294 consecutive patients with 1,520 CTOs included (2007 to 2016) and were divided into the younger group (age less then 65 years; n=664, 51.3%) and the older group (age ≥65 years; n=630, 48.7%). In the older group, 630 patients were divided into MT group (n=421) and successful CTO-PCI group (n=209) according to the initial treatment strategy. In the younger group, they were divided into two groups 379 patients in the MT group and 285 patients in the successful CTO-PCI group. We performed propensity score matching to minimize any selection bias. The primary end point was cardiac mortality. The secondary end point was major adverse cardiac event (MACE). Results After 3.6 (IQR, 2.1-5.0) years follow-up, no significant difference was observed between the MT and successful CTO-PCI groups inardiovascular Diagnosis and Therapy. All rights reserved.Background Left ventricular (LV) extracellular volume fraction (ECV) provides prognostic information in patients with variety of cardiomyopathies. However, data on the clinical significance of LV ECV in patients with atrial fibrillation (AF), especially in patients without replacement fibrosis are sparse. This study sought to investigate whether the presence of LV fibrosis identified by cardiac magnetic resonance (CMR) ECV quantification would independently predict the recurrence of AF after first catheter ablation (CA) in patients with AF. Methods A total of 130 consecutive patients who were referred for CA of AF underwent CMR examination prior to ablation. LV function, T1 mapping derived LV ECV, LV late gadolinium enhancement (LGE) were assessed. Patients were followed for arrhythmia recurrence after the CA procedure. Results Of 130 AF patients, 65 patients had paroxysmal AF, and 65 patients had persistent AF. There were 50 AF recurrences over a median follow-up period of 13 months. LV ECV were significantly higher in patients with recurrent AF compared to those with no recurrence (30.4%±3.3% vs. 27.4%±2.9%, P less then 0.001). In multivariable model, gender (HR 0.348, 95% CI 0.174-0.697, P=0.003), body mass index (BMI) (HR 1.159, 95% CI 1.050-1.279, P=0.003), AF duration (HR 1.006, 95% CI 1.001-1.011, P=0.017), and LV ECV (HR 1.158, 95% CI 1.071-1.251, P=0.000) were significantly associated with AF recurrence. In subgroup of patients without LGE, gender, BMI, AF duration and LV ECV were still the independent predictors of AF recurrence. Conclusions LV ECV expansion is associated with AF recurrence after CA and is a strong independent predictor of AF recurrence. [https://www.selleckchem.com/products/fg-4592.html Selleckchem Roxadustat] 2019 Cardiovascular Diagnosis and Therapy. All rights reserved.