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GÜNEŞ G, CAN Z, ARDA A, APAK MR. Determination of ketamine using melamine-modified gold nanoparticles. Turk J Chem 2023; 47:1053-1063. [PMID: 38173732 PMCID: PMC10760846 DOI: 10.55730/1300-0527.3593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 10/31/2023] [Accepted: 06/07/2023] [Indexed: 01/05/2024] Open
Abstract
Ketamine is used in medicine because of its anaesthetic and antidepressant effects at low doses. Unfortunately, due to its narcotic effect when used at high doses, its abuse among young people is increasing. It is also one of the most common drugs used in rape. Therefore, there is a need for fast and inexpensive tests that can be performed on-site. With the advancement of nanotechnology, nanoparticle-based approaches have found their place in selective analyses as in many fields. In the developed method, firstly gold nanoparticles were modified with melamine (AuNPs@Mel). Under optimized conditions, hydrogen bonds formed between ketamine and AuNPs@Mel cause the red colour of AuNPs@Mel to shift to blue-purple (i.e. aggregation-induced surface plasmon absorption shift). The association between absorbance and concentration produced a calibration line (curve) having a linearity correlation coefficient of 0.9981 for ketamine concentrations ranging from 4.76 to 47.6 mg L-1. The detection limit of the proposed method was 1.5 mg L-1 and the RSD (relative standard deviation) values of concentrations were changed ranging from 5.2% to 8.2%. The intra-assay and inter-assay measurements using the suggested method resulted in coefficients of variation (CVs) of 5.7% and 8.5%, respectively. Scan transmission electron microscopy (STEM), UV-vis spectrophotometry and FTIR spectroscopy were used to characterize the synthesized and modified AuNPs. Additionally, the procedure was successfully carried out with some interference materials and a real sample of fetal bovine serum. Lastly, using the Student t-test and F tests, the suggested technique was compared to and confirmed against an LC-MS/MS procedure previously published.
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Affiliation(s)
- Güler GÜNEŞ
- TEBIP High Performers Program, Board of Higher Education of Turkiye, Istanbul University-Cerrapaşa, İstanbul,
Turkiye
| | - Ziya CAN
- Department of Chemistry, Faculty of Engineering, İstanbul University, İstanbul,
Turkiye
| | - Ayşem ARDA
- Department of Chemistry, Faculty of Engineering, İstanbul University, İstanbul,
Turkiye
| | - Mustafa Reşat APAK
- Department of Chemistry, Faculty of Engineering, İstanbul University, İstanbul,
Turkiye
- Turkish Academy of Sciences (TUBA), Ankara,
Turkiye
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Li MW, Chao TC, Lim LY, Chang HH, Yang SSD. The Acute Effects and Mechanism of Ketamine on Nicotine-Induced Neurogenic Relaxation of the Corpus Cavernosum in Mice. Int J Mol Sci 2023; 24:ijms24086976. [PMID: 37108139 PMCID: PMC10138932 DOI: 10.3390/ijms24086976] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 03/30/2023] [Accepted: 04/04/2023] [Indexed: 04/29/2023] Open
Abstract
The present study aimed to investigate the acute effects and the mechanism of ketamine on nicotine-induced relaxation of the corpus cavernosum (CC) in mice. This study measured the intra-cavernosal pressure (ICP) of male C57BL/6 mice and the CC muscle activities using an organ bath wire myograph. Various drugs were used to investigate the mechanism of ketamine on nicotine-induced relaxation. Direct ketamine injection into the major pelvic ganglion (MPG) inhibited MPG-induced increases in ICP. D-serine/L-glutamate-induced relaxation of the CC was inhibited by MK-801 (N-methyl-D-aspartate (NMDA) receptor inhibitor), and nicotine-induced relaxation was enhanced by D-serine/L-glutamate. NMDA had no effect on CC relaxation. Nicotine-induced relaxation of the CC was suppressed by mecamylamine (a non-selective nicotinic acetylcholine receptor antagonist), lidocaine, guanethidine (an adrenergic neuronal blocker), Nw-nitro-L-arginine (a non-selective nitric oxide synthase inhibitor), MK-801, and ketamine. This relaxation was almost completely inhibited in CC strips pretreated with 6-hydroxydopamine (a neurotoxic synthetic organic compound). Ketamine inhibited cavernosal nerve neurotransmission via direct action on the ganglion and impaired nicotine-induced CC relaxation. The relaxation of the CC was dependent on the interaction of the sympathetic and parasympathetic nerves, which may be mediated by the NMDA receptor.
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Affiliation(s)
- Ming-Wei Li
- Division of Urology, Department of Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei 23142, Taiwan
| | - Tze-Chen Chao
- Division of Urology, Department of Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei 23142, Taiwan
| | - Li-Yi Lim
- Division of Urology, Department of Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei 23142, Taiwan
| | - Hsi-Hsien Chang
- Division of Urology, Department of Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei 23142, Taiwan
| | - Stephen Shei-Dei Yang
- Division of Urology, Department of Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei 23142, Taiwan
- School of Medicine, Tzu Chi University, Hualien 97004, Taiwan
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Chung SD, Praveen Rajneesh C, Chen KC, Tai HC, Chang ML, Tseng XW, Cheng JH, Tsai WK, Chiang HS, Wu YN. Specific Impacts of Ketamine on Bladder Dysfunction and Associated Histological Alterations in Rats-A Time Course Validation through Transmission Electron Microscopy. Int J Mol Sci 2022; 23:ijms23042194. [PMID: 35216309 PMCID: PMC8878520 DOI: 10.3390/ijms23042194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 02/12/2022] [Accepted: 02/14/2022] [Indexed: 02/01/2023] Open
Abstract
This study explored the specific effects of ketamine on bladder function followed by a sequence of histological changes in a rat bladder at fixed time course intervals. The rats were grouped into normal control and experimental animals, and ketamine (100 mg/kg/day) was administrated to the experimental animals for 2, 4, and 8 weeks, respectively; similarly, the control animals received saline. All animals were evaluated for bladder function and histological responses to the treatment. Ultrastructural changes were observed by transmission electron microscopy (TEM). The results showed progressive bladder dysfunctions with hyperactive bladder conditions according to the time course and frequency of exposure to ketamine. Significantly, decreased inter contraction intervals, residual urine volume, peak micturition pressure, and increased micturition frequency were observed. Bladder histology results revealed substantial inflammation and comprehensive submucosa edema in week 2 and 4 rats along with fibrosis and significant bladder detrusor hypertrophy in week 8 rats. TEM analysis revealed bladder wall thickening, deformed blood vessels, detrusor hypertrophy, wobbled gap junction, and barrier dysfunction at different time course levels in experimental animals. These results provided a profound knowledge about the prognosis and step-by-step pathophysiology of the disease, which might help in developing new therapeutic interventions.
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Affiliation(s)
- Shiu-Dong Chung
- Division of Urology, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City 220, Taiwan;
- Department of Nursing, College of Healthcare & Management, Asia Eastern University of Science and Technology, New Taipei City 220, Taiwan
- Graduate Insitute of Medicine, Yuan Ze University, Taoyuan City 320, Taiwan
| | - Chellappan Praveen Rajneesh
- School of Medicine, Fu Jen Catholic University, New Taipei City 242, Taiwan; (C.P.R.); (K.-C.C.); (H.-C.T.); (M.-L.C.)
| | - Kuo-Chiang Chen
- School of Medicine, Fu Jen Catholic University, New Taipei City 242, Taiwan; (C.P.R.); (K.-C.C.); (H.-C.T.); (M.-L.C.)
- Department of Urology, Cathay General Hospital, Taipei City 106, Taiwan
| | - Huai-Ching Tai
- School of Medicine, Fu Jen Catholic University, New Taipei City 242, Taiwan; (C.P.R.); (K.-C.C.); (H.-C.T.); (M.-L.C.)
- Department of Urology, Fu Jen Catholic University Hospital, New Taipei City 242, Taiwan;
| | - Meng-Lin Chang
- School of Medicine, Fu Jen Catholic University, New Taipei City 242, Taiwan; (C.P.R.); (K.-C.C.); (H.-C.T.); (M.-L.C.)
- Department of Urology, Fu Jen Catholic University Hospital, New Taipei City 242, Taiwan;
| | - Xiao-Wen Tseng
- Program in Pharmaceutical Biotechnology, College of Medicine, Fu Jen Catholic University, New Taipei City 242, Taiwan;
| | - Jai-Hong Cheng
- Center for Shockwave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung 833, Taiwan;
- Department of Medical Research, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung 833, Taiwan
- Department of Leisure and Sports Management, Cheng Shiu University, Kaohsiung 833, Taiwan
| | - Wei-Kung Tsai
- Department of Urology, Mackay Memorial Hospital, Taipei City 104, Taiwan;
- Ph.D. Program in Nutrition and Food Science, Fu Jen Catholic University, New Taipei City 242, Taiwan
- Department of Medicine, Mackay Medical College, New Taipei City 252, Taiwan
- Mackay Junior College of Medicine, Nursing, and Management, Taipei City 11260, Taiwan
- Graduate Institute of Biomedical and Pharmaceutical Science, Fu Jen Catholic University, New Taipei City 242, Taiwan
| | - Han-Sun Chiang
- Department of Urology, Fu Jen Catholic University Hospital, New Taipei City 242, Taiwan;
- Graduate Institute of Biomedical and Pharmaceutical Science, Fu Jen Catholic University, New Taipei City 242, Taiwan
| | - Yi-No Wu
- School of Medicine, Fu Jen Catholic University, New Taipei City 242, Taiwan; (C.P.R.); (K.-C.C.); (H.-C.T.); (M.-L.C.)
- Correspondence: ; Tel.: +886-2-2905-6442
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Tinco-Jayo JA, Aguilar-Felices EJ, Enciso-Roca EC, Arroyo-Acevedo JL, Herrera-Calderon O. Phytochemical Screening by LC-ESI-MS/MS and Effect of the Ethyl Acetate Fraction from Leaves and Stems of Jatropha macrantha Müll Arg. on Ketamine-Induced Erectile Dysfunction in Rats. Molecules 2021; 27:molecules27010115. [PMID: 35011347 PMCID: PMC8746923 DOI: 10.3390/molecules27010115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 12/21/2021] [Accepted: 12/21/2021] [Indexed: 11/16/2022] Open
Abstract
Jatropha macrantha Müll Arg. L is also known as “huanarpo macho” and used in the Peruvian traditional medicine as an aphrodisiac and erectile dysfunction (ED). The aim of this study was to determine the phytochemical constituents in leaves and stems ethyl acetate fraction (LEAF and SEAF) of J. macrantha and to compare the antioxidant activity and the ameliorative effect on ketamine-induced erectile dysfunction in rats. The phytochemical constituents were determined by LC-ESI-MS/MS, the total phenolic compounds and total flavonoids (TPC and TF) by Folin-Ciocalteu and aluminum chloride, respectively. The antioxidant activity was determined by DPPH, ABTS, and FRAP assays. Experimental groups were divided as follows: I: negative control; II: positive control (ketamine at 50 mg/ kg/d); III: sildenafil 5 mg/kg; IV, V, VI: LEAF at 25, 50 and 100 mg/kg, respectively, and VII, VIII, IX: SEAF at 25, 50, and 100 mg/kg, respectively. The phytochemical analysis revealed the presence mainly of coumarins, flavonoids, phenolic acids, and terpenes. TPC of LEAF and SEAF were 359 ± 5.21 mg GAE/g and 306 ± 1.93 mg GAE/g, respectively; TF in LEAF and SEAF were 23.7 ± 0.80 mg EQ/g, and 101 ± 1.42 mg EQ/g, respectively. The DPPH, ABTS, FRAP in SEAF were 647 ± 3.27; 668 ± 2.30; and 575 ± 2.86 μmol TE/g, respectively, whilst LEAF showed 796 ± 3.15; 679 ± 0.85; and 806 ± 3.42 μmol TE/g, respectively. Regarding sexual behavior, LEAF showed a better effect in mount frequency, intromission frequency, ejaculation frequency, mount latency, intromission latency, ejaculatory latency, and post ejaculatory latency than SEAF. As conclusion, LEAF of J. macrantha at 50 mg/kg showed a better effect on sexual behavior in male rats with erectile dysfunction than SEAF but not higher than sildenafil.
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Affiliation(s)
- Johnny Aldo Tinco-Jayo
- Department of Human Medicine, Faculty of Health Sciences, Universidad Nacional de San Cristobal de Huamanga, Portal Independencia 57, Ayacucho 05003, Peru; (J.A.T.-J.); (E.J.A.-F.); (E.C.E.-R.)
| | - Enrique Javier Aguilar-Felices
- Department of Human Medicine, Faculty of Health Sciences, Universidad Nacional de San Cristobal de Huamanga, Portal Independencia 57, Ayacucho 05003, Peru; (J.A.T.-J.); (E.J.A.-F.); (E.C.E.-R.)
| | - Edwin Carlos Enciso-Roca
- Department of Human Medicine, Faculty of Health Sciences, Universidad Nacional de San Cristobal de Huamanga, Portal Independencia 57, Ayacucho 05003, Peru; (J.A.T.-J.); (E.J.A.-F.); (E.C.E.-R.)
| | - Jorge Luis Arroyo-Acevedo
- Department of Dynamic Sciences, Faculty of Medicine, Universidad Nacional Mayor de San Marcos, Av. Miguel Grau 755, Lima 15001, Peru;
| | - Oscar Herrera-Calderon
- Department of Pharmacology, Bromatology and Toxicology, Faculty of Pharmacy and Biochemistry, Universidad Nacional Mayor de San Marcos, Jr. Puno 1002, Lima 15001, Peru
- Correspondence: ; Tel.: +51-956-550-510
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Xie X, Liang J, Huang R, Luo C, Yang J, Xing H, Zhou L, Qiao H, Ergu E, Chen H. Molecular pathways underlying tissue injuries in the bladder with ketamine cystitis. FASEB J 2021; 35:e21703. [PMID: 34105799 DOI: 10.1096/fj.202100437] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 05/14/2021] [Indexed: 12/11/2022]
Abstract
Ketamine cystitis (KC) is a chronic bladder inflammation leading to urinary urgency, frequency, and pain. The pathogenesis of KC is complicated and involves multiple tissue injuries in the bladder. Recent studies indicated that urothelium disruption, lamina propria fibrosis and inflammation, microvascular injury, neuropathological alterations, and bladder smooth muscle (BSM) abnormalities all contribute to the pathogenesis of KC. Ketamine has been shown to induce these tissue injuries by regulating different signaling pathways. Ketamine can stimulate antiproliferative factor, adenosine triphosphate, and oxidative stress to disrupt urothelium. Lamina propria fibrosis and inflammation are associated with the activation of cyclooxygenase-2, nitric oxide synthase, immunoglobulin E, and transforming growth factor β1. Ketamine contributes to microvascular injury via the N-methyl-D aspartic receptor (NMDAR), and multiple inflammatory and angiogenic factors such as tumor necrosis factor α and vascular endothelial growth factor. For BSM abnormalities, ketamine can depress the protein kinase B, extracellular signal-regulated kinase, Cav1.2, and muscarinic receptor signaling. Elevated purinergic signaling also plays a role in BSM abnormalities. In addition, ketamine affects neuropathological alterations in the bladder by regulating NMDAR- and brain-derived neurotrophic factor-dependent signaling. Inflammatory cells also contribute to neuropathological changes via the secretion of chemical mediators. Clarifying the role and function of these signaling underlying tissue injuries in the bladder with KC can contribute to a better understanding of the pathophysiology of this disease and to the design of effective treatments for KC.
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Affiliation(s)
- Xiang Xie
- Public Center of Experimental Technology and The School of Basic Medical Sciences, Southwest Medical University, Luzhou, China
| | - Jiayu Liang
- Public Center of Experimental Technology and The School of Basic Medical Sciences, Southwest Medical University, Luzhou, China
| | - Run Huang
- Public Center of Experimental Technology and The School of Basic Medical Sciences, Southwest Medical University, Luzhou, China
| | - Chuang Luo
- Public Center of Experimental Technology and The School of Basic Medical Sciences, Southwest Medical University, Luzhou, China
| | - Jiali Yang
- Public Center of Experimental Technology and The School of Basic Medical Sciences, Southwest Medical University, Luzhou, China
| | - Hongming Xing
- Public Center of Experimental Technology and The School of Basic Medical Sciences, Southwest Medical University, Luzhou, China
| | - Le Zhou
- Public Center of Experimental Technology and The School of Basic Medical Sciences, Southwest Medical University, Luzhou, China
| | - Han Qiao
- Public Center of Experimental Technology and The School of Basic Medical Sciences, Southwest Medical University, Luzhou, China
| | - Erti Ergu
- Public Center of Experimental Technology and The School of Basic Medical Sciences, Southwest Medical University, Luzhou, China
| | - Huan Chen
- Public Center of Experimental Technology and The School of Basic Medical Sciences, Southwest Medical University, Luzhou, China
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Zhang KQ, Tian T, Hu LL, Wang HR, Fu Q. Effect of probucol on autophagy and apoptosis in the penile tissue of streptozotocin-induced diabetic rats. Asian J Androl 2021; 22:409-413. [PMID: 31464204 PMCID: PMC7406090 DOI: 10.4103/aja.aja_89_19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Autophagy and apoptosis have been regarded as important processes in the development of diabetic erectile dysfunction (DMED). Probucol is considered to have anti-apoptotic effects, but its relationship with autophagy has not been reported. The aim of this study was to investigate the effects and mechanisms of probucol on erectile function. Thirty Sprague–Dawley (SD) male rats (12 weeks old) were fasted for 12 h. Twenty SD rats were injected with a single intraperitoneal injection of 60 mg kg−1 streptozotocin (STZ). Ten rats were given vehicle only and used as a sham group. After 72 h, 20 STZ-treated rats with random blood glucose concentrations consistently greater than 16.7 mmol l−1 were used as successfully established diabetic rats. The diabetic rats were divided randomly into two groups and treated with a daily gavage of probucol at a dose of 0 or 500 mg kg−1 for 12 weeks. After treatment, the intracavernous pressure (ICP) was used to measure erectile function upon electrical stimulation of the cavernous nerve. After euthanasia, penile tissue was examined using immunohistochemistry and Western blot to assess the protein levels of B-cell lymphoma-2 (Bcl-2), BCL2-associated X (Bax), microtubule-associated protein light chain 3-II (LC3-II), mammalian target of rapamycin (mTOR), and sequestosome 1 (P62). Caspase-3 activity was measured to determine apoptosis using a caspase-3 assay kit. After 12 weeks of treatment, the erectile function of the probucol group was significantly better than that of the DM group (P < 0.05). Bax and LC3-II protein expression and caspase-3 activity were significantly lower in the probucol group than those in the DM group (all P < 0.05), while Bcl-2, mTOR, and P62 protein expression levels were significantly higher than those in the DM group (all P < 0.05). We demonstrated that probucol inhibited apoptosis and autophagy in STZ-induced diabetic rats.
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Affiliation(s)
- Ke-Qin Zhang
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, China
| | - Tao Tian
- Department of Urology, Shandong Zaozhuang Municipal Hospital, Zaozhuang 277000, China
| | - Liang-Liang Hu
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, China.,Department of Urology, Shandong Zaozhuang Municipal Hospital, Zaozhuang 277000, China
| | - Hao-Ran Wang
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, China
| | - Qiang Fu
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, China
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Wu YN, Chiang HS, Chang ML. Can cavernous nerves be spared after radical prostatectomy? Evidence from animal studies. UROLOGICAL SCIENCE 2021. [DOI: 10.4103/uros.uros_110_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Yang SSD, Jang MY, Lee KH, Hsu WT, Chen YC, Chen WS, Chang SJ. Sexual and bladder dysfunction in male ketamine abusers: A large-scale questionnaire study. PLoS One 2018; 13:e0207927. [PMID: 30485367 PMCID: PMC6261603 DOI: 10.1371/journal.pone.0207927] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 11/08/2018] [Indexed: 12/20/2022] Open
Abstract
Purpose To evaluate the prevalence of lower urinary tract symptoms (LUTS) and erectile dysfunction (ED) in the illicit male ketamine abusers (KA). Materials and methods The male street KAs caught by policemen and patients visiting urologic clinics were invited to answer a structured questionnaire including demographic data, illicit drug use related details (duration, frequency, dosage and abstinence status), international prostate symptoms score (IPSS), interstitial cystitis symptoms and problem index (ICSI and ICPI) and International index of erectile function (IIEF-5). Erectile dysfunction was defined as IIEF-5 ≦21. Results Finally, we included 1056 participants (993 street, 63 hospital KAs) with a mean age of 27.4 ±6.2 years. ED presented in 30.8% of all KAs. and Hospital KAs were more subject to having ED than street KAs (69.6% vs. 28.0%, p<0.01). Multi-variate analysis revealed that risk factor for male ED were age ≧30 years (OR = 1.765). Subgroup analysis on male street KAs disclosed that abstinence ≧3 months is a protective factor for ED. Lower urinary tract symptoms (ICSI+ICPI ≧12) was prevalent in KAs and multivariate analysis disclosed that significant risk factors for LUTS (ICSI+ICPI ≧12) were age ≧30 years, duration ≧24 months and co-use of other illicit drugs. Conclusions Male ED and LUTS were frequently observed in the ketamine abusers. We suggested that street ketamine abuse should be considered in young men presented with ED and LUTS in the clinics.
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Affiliation(s)
- Stephen She-Dei Yang
- Department of Urology, Taipei Tzu Chi Hospital, New Taipei, Taiwan
- School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan
| | - Mei-Yu Jang
- Department of Urology, Kaohsiung Municipal Hsia-Kang Hospital, Kaohsiung City, Taiwan
| | - Kau-Han Lee
- Division of Urology, Department of Surgery, Chi Mei Medical Center, Tainan City, Taiwan
| | - Wen-Tsang Hsu
- Department of Urology, Keelung Hospital, Ministry of Health and Wealthfare, Keelung City, Taiwan
| | - Yi-Chu Chen
- Department of Urology, Taipei Tzu Chi Hospital, New Taipei, Taiwan
| | - Wan-San Chen
- Department of Urology, Taipei Tzu Chi Hospital, New Taipei, Taiwan
| | - Shang-Jen Chang
- Department of Urology, Taipei Tzu Chi Hospital, New Taipei, Taiwan
- School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan
- * E-mail:
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