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Trafford’s team used sheep to study the effects of PDE5 inhibition because their hearts are similar to human hearts. After inducing heart failure in the animals, the team administered Cialis at a dose similar to what’s used to treat ED in people. They observed that Cialis restored the heart’s ability to respond to adrenaline—and that improved its ability to pump blood. Most heart failure cheap generic sildenafil medications can slow the progression of the disease and teva pharmaceuticals generic viagra lower the probability of deadly cardiac events. But actually reversing heart failure is difficult, especially without surgery or the assistance of medical devices. Various groups of scientists are exploring methods for reversing heart failure with drugs. A team at Imperial College London recently found that blocking the MAP4K4 protein could reduce heart damage. In a 2017 Nature study, Baylor College of Medicine researchers discovered that the Hippo signaling pathway can prevent damaged heart muscle from repairing itself, and by blocking it, they restored pumping ability in mouse hearts. But the University of Manchester researchers believe the best strategy may be to return to the original goal in PDE5 inhibition. “We seem to have gone full-circle, with findings from recent studies suggesting that [ED drugs] may be effective in the treatment of some forms of heart disease—in this case, heart failure,” said Metin Avkiran, associate medical director of the British Heart Foundation, which funded the study. "The evidence from this study, that a Viagra-like drug could reverse heart failure, should encourage further research in humans to determine if such drugs may help to save and improve lives.” Erections after prostatectomy surgery: does Viagra still work? In this blog for a non-medical audience, Alastair Lamb, Senior Fellow in Robotic surgery and Consultant Urologist at Oxford University Hospitals, and Altan Omer, Pelvic GU-Oncology fellow, look at the evidence for use of PDE5 inhibitors (Viagra, Cialis & Levitra) for penile rehabilitation after prostate cancer surgery. Some 6,500 radical prostatectomies are performed every year in the UK (British Association A relationship between two characteristics, such that as one changes, the other changes in a predictable way. For example, statistics demonstrate that there is an association between smoking and lung cancer. In a positive association, one quantity increases as the other one increases (as with smoking and lung cancer). In a negative association, an increase in one quantity corresponds to a decrease in the other. Association does not necessarily mean that one thing causes the other. While approximately half of these men have pre-existing erectile dysfunction, over 50% of the other half can expect to lose natural erections after prostatectomy surgery, especially if their cancers are locally advanced and require wide clearance to ensure removal of the whole tumour. There’s pretty good evidence to show that men can continue to recover erectile function up to two years after prostatectomy surgery (Montorsi et al., 2014), which we believe is partly because it takes time for the bruising and scar tissue after surgery to settle down. But if spontaneous erections do not recover by this point then it is unlikely that they will do so thereafter. Conversely, there is good evidence that drugs such as Viagra can be used to enhance erections after surgery and that, even if such drugs do not work – for example if the nerves have been removed to maximise cancer clearance – mechanical devices such as vacuum pumps, cavaject injections into the side of the penis or MUSE therapy (small tablets inserted into the end of the urethra) are effective. The question therefore remains as to whether brand viagra without prescription longer term recovery of spontaneous erections can be assisted by such devices and particularly by the use of PDE5 inhibitors. This is a process generally known as “penile rehabilitation”. The concept is that men need to ‘use’ their penises in order to speed up recovery of the blood vessels and nerves that are essential for erections, indeed that lack of use may inhibit recovery. This Cochrane review pulled together randomised trials testing the effect of PDE5i on erectile function after radical prostatectomy (Philippou et al., 2018). There were eight randomised Randomization is the process of randomly dividing into groups the people taking part in a trial. One group (the intervention group) will be given the intervention being tested (for example a drug, surgery, or exercise) and compared with a group which does not receive the intervention (the control group). trials Clinical trials are research studies involving people who use healthcare services. They often compare a new or different treatment with the best treatment currently available. This is to test whether the new or different treatment is safe, effective and any better than what is currently used. No matter how promising a new treatment may appear during tests in a laboratory, it must go through clinical trials before its benefits and risks can really be known. including 1699 men and the drugs used were either Viagra (sildenafil), Cialis (tadalafil) or Levitra (vardenafil). The review found no evidence to support penile rehabilitation, defined as an improvement in erectile function, off drug, at the end of the period of follow up (one to two years) compared to a control group who had not received any drug. The authors did note however that the quality of evidence The certainty (or quality) of evidence is the extent to which we can be confident that what the research tells us about a particular treatment effect is likely to be accurate. Concerns about factors such as bias can reduce the certainty of the evidence. Evidence may be of high certainty; moderate certainty; low certainty or very-low certainty.
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