對於男性來說，男科問題是一個難以啟齒的問題，尤其是勃起功能障礙，不僅給患者造成了難以承受的心理負擔，也同時影響了家庭的和諧。據了解，功能勃起障礙的發病率占成年男性的50%左右，其發病原因可分為心理性勃起功能障礙和器質性勃起功能障礙，器質性勃起功能障礙占50%，主要包括血管性、神經性、內分泌性、糖尿病性、陰莖海綿體纖維化性等。於是犀利士哪裡買也得到了很多的關注，也想加入到這個行列當中。https://www.cialis-hk.cn

　　教授在演講中也提到，慢性疾病是勃起功能障礙的主要危險因子，如糖尿病、攝護腺疾病、周邊血管疾病、心臟問題高血脂癥、高血壓等。同時勃起功能障礙和良性攝護腺肥大癥所伴隨的下泌尿道癥狀也有密切的關系。有數據指出，72%的勃起功能障礙男性同時患有下泌尿道癥狀，而62%有下泌尿道癥狀的病患被診斷出有勃起功能障礙問題。

　　治療勃起功能障礙，犀利士長期服藥仍然有效

　　那麼有沒有一種藥物能有有效的治療勃起功能障礙，同時也能夠緩解與良性攝護腺肥大相關的下泌尿道癥狀？

　　犀利士5mg能做到！教授在演講中介紹，犀利士5mg能夠緩解良性攝護腺肥大癥所伴隨的下泌尿道癥狀，同時對於勃起功能障礙也很有效。根據IPSS國際攝護腺(前列腺)癥狀評分問卷顯示，犀利士5mg最快第二周便能顯著改善下泌尿道癥狀，例如：頻尿、尿急憋不住、小便斷斷續續、小便解不幹凈、需要用力才能解出小便等癥狀。而對於治療勃起功能障礙的臨床實驗追蹤結果也顯示，連續服用犀利士5mg一年後，停藥一個月，有 46.3% 的患者表示仍具有療效。同時患有糖尿病或高血壓的勃起功能障礙患者，停藥一個月後表示仍然具有療效的比例較高(分別為 56.8% 和 69.6% )；而心因性的患者其比例則反之較低(32%)。此外，即使在服藥後的4-36小時，患者性交成功率亦高達約80%，並且還可增加晨間勃起的機會。

　　需要註意的是犀利士也是有其適應癥和禁忌癥的，患者在服用前應該了解清楚。

　　許多民眾對於犀利士每日錠躍躍卻試，但往往不知道使用原則及注意事項，現在與大家分享tadalafil的使用事項及併用原則。另外也特別提醒民眾，使用該類藥物必須諮詢專科醫師建議，切勿胡亂服藥。如此，我相信犀利士5mg在未來必定大有可為，創造屬於行業的奇跡。https://www.cialis-hk.cn

　　一、犀利士5mg與10mg、20mg的差別？

　　大家一定想說，就劑量不同啊，的確如此，但是每天服用5毫克的tadalafil與單次服用5毫克是不一樣的唷。當健康受試者服用之劑量範圍為 2.5 至 20 毫克時，tadalafil 之暴露量(AUC)和劑量呈線性(如下圖)，但是tadalafil的代謝慢、半衰期長(17.5小時)，所以每日服用具有加成性。研究顯示每天服用犀利士每日錠5毫克tadalafil，在 5 天內血漿濃度可達穩定狀態，此時之暴露量約為單一劑量給與藥物後的 1.6 倍，簡單來說相對於單次服用8毫克的劑量。

　　從下圖可見，單次口服給藥後，最大血漿濃度(Cmax)之時間在給藥後 30 分鐘至 6 小時間(中位數為 2 小時)，所以tadalafil建議至少在事前30分鐘至2個小時服用。倘若每日服用5毫克，血中隨時保持在8毫克相對效益，節省等後藥效發揮的時間。另一方面，從副作用來看，服用劑量愈高，副作用發生比例愈高，所以一般建議從較低劑量補充為宜。

　　二、犀利士Tadalafil 5毫克使用注意事項

　　不少民眾一定困擾過，如果每天服用犀利士每日錠，可以在需要時再併用較高單位的錠劑或併用sildenafil嗎？答案是看劑量而定。從tadalafil藥物動力學來看，每天服用5毫克持續5天，血漿濃度可達穩定狀態，此時血中濃度約為8毫克的服用劑量，所以若有需要，仍可於性行為前30分鐘補服用Tadalafil 10毫克。另外有研究顯示，每日服用tadalafil 5毫克情況下，需要時併用50毫克 的sildenafil改善勃起功能效果更佳，且副作用發生率沒有提高，顯示二者需要時併用是安全的。

　　大家都知道, tadalafil與硝化甘油併用，可能導致血壓明的下降，甚至產生危險，所以禁止併用。但倘若有併用的可能，到底要間隔多久才不會影響血壓呢？藥品仿單明確指出，二者間隔48小時以上，就不太會造成血壓改變。除此之外，另一個常見併用引起血壓降低的是「酒精」，事實上酒精本身就是種輕度的血管擴張劑，如果飲用超過5 單位或更多酒精【註】且併服tadalafil，會增加直立性低血壓病徵與癥狀的發生率，包括心跳加速、站立時血壓降低、頭暈與頭痛等。

　　一般來說，腎功能嚴重至肌酸酐清除率< 30 mL/min，或有以下心血管疾病的民眾，不建議服用犀利士每日錠。

　　(1)有最近90天內有心肌梗的病人

　　(2)有不穩定型心絞痛或曾在性交時發生心絞痛的病人

　　(3)在最近6個月患有依紐約心臟協會分級為第二級或以上心臟衰竭的病人

　　(4)病人有未控制的心律不整、低血管(<90/50毫米汞柱)，或未受控制的高血壓

　　(5)最近6個月有中風的病人。

　　【註】一單位的酒精=四分三罐（約250毫升）酒精含量為5%的啤酒

　　從藍色小藥丸（威而剛）問世以來，老男人似乎活得愈來愈有自信，六十歲以後還是一尾活龍似乎已不是神話。其實威而鋼（Viagra）屬於所謂第5型磷酸二脂酶抑制劑（PDE5-I），是目前治療男性性功能障礙的口服選擇藥物。隨著其他藥廠開發新藥加入競爭，目前市面上流通的PDE5-I除威而剛（Viagra）外，還有樂威壯（Levitra）和犀利士（Cialis）兩種，三者劑量和藥物活性有些差異，但是都可以治療性功能障礙，但是患者必須依需求在性行為前服用藥物，效果可以達六至七成。我認為犀利士邊度買一定可以成為行業的領導者，翹首高端產品之列。https://www.cialis-hk.cn

　　但是漸漸地有文獻指出: 某些陽痿病人，如攝護腺手術後性神經受損，糖尿病患，或嚴重血管活性不佳的病人等，使用PDE5-I治療陽痿則效果偏低。另一方面，根據統計35-47%的病人單次使用PDE5-I覺得有效就會停藥，而需要時才使用（on demand）藥物，其實還是無法完全使病人（40-50%）恢復”正常”的性生活，因為有計畫的性行為可能導致病患焦慮而影響表現。

　　研究人員發現：在經歷攝護腺根除手術後，兩側性神經受損而陽痿的病人中，長期服用PDE5 Inhibitor可以減低海綿體組織中平滑肌的細胞衰亡，也可減低血管內皮細胞的失能。在老鼠動物實驗模式中也發現，長期持續以威而剛20mg/kg餵食老鼠45天後發現，實驗組老鼠可以減緩海綿體組織的纖維化，避免海綿體平滑肌的損失，更可刺激NO的產生。就這樣，愈來愈多的文獻證實了比較持續每天使用PDE5-I和依需求使用PDE5-I，對性功能障礙治療至少一樣好或更好，且對於整體人體血管的健康也有益處。而上述三者已經上市的藥物中，犀利士半衰期長達17.5 小時，反應時間達36小時，使得每日使用較低劑量就可以使人體內維持一定的藥物作用濃度。每日口服犀利士5mg使用五天後，體內濃度可以達單次使用的1.6倍，因此可以有效治療器質性的性功能障礙。在McMahon的研究中，比較單次使用on demand的20mg犀利士和持續每天使用10mg犀利士26周後發現: 後者比前者在經IIEF EF領域（性功能慣用評估指標）評估證實，能有效維持已提昇的勃起功能。進一步臨床試驗中，每日給予一次犀利士5 mg的療效，和依需求使用犀利士10 mg或20 mg之臨床試驗的整合結果相同。而病人服用犀利士每日錠5 mg的耐受性，也和依需求使用犀利士10 mg或20 mg之臨床試驗的整合結果相同。

　　因此，犀利士每日錠成為目前唯一通過衛生署核準可持續天天服用的PDE5-I藥物。優點是長期使用可以改善內皮細胞的功能，副作用發生率可能較低，對於已經診斷必須使用PDE5-I來治療性功能障礙的病人，如果病人要求的是恢復更”自然”的性行為，而每日錠使用可打破原本吃藥才能性行為的預期焦慮。臨床上的資料也證實：每日使用一次犀利士通常具有良好的耐受性。目前並沒有證據顯示對治療產生耐藥性或抗藥性。

　　安全性評估

　　目前相關的研究結果並不多。已知的結果指出，使用低劑量犀利士每日錠和依需求使用（on demand）來比較，副作用的種類和發生比率並沒有多大差異。其中最常被報告出來的副作用是消化不良，頭痛，背痛和疑似感冒的癥狀。

　　絕對禁忌

　　和所有PDE5-I一樣，犀利士禁用於使用任何形式有機硝酸鹽的患者。若需給予硝酸鹽藥物，必須間隔至少48小時，並由醫護人員藉由適當的血液動力學監測，進行嚴密監控。另外，犀利士也禁用於因非動脈性前部缺血性視神經病變（NAION）而失去單眼視力的患者。

　　結論

　　人類使用PDE5-I治療性功能障礙歷史已經要邁入第二個十年，愈來愈多臨床醫師發現單次使用PDE5-I藥物達到勃起目的，事實上並不是治療性功能障礙完全成功，因為病患希望的要求是恢復往日雄風，想做就做，而不是吃藥才能完成有計畫的性行為。事實上，治療陽痿常常必須考量到個體不同的需求和想法，但現在的研究結果往往無法回答這些複雜的問題。如果病人要求的是恢復更”自然”的性行為，在醫師專業的評估之後，犀利士每日錠持續使用，可能是治療陽痿的一個新的契機。

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[Houthi militants release attack video” target=_blank>

On July 16, local time, the Houthi armed forces in Yemen released a video of the organization attacking the Red Sea sailing ship Chios Lion (CL).

The Houthi armed forces issued a statement saying that the ship violated the Houthi ban and headed for an Israeli port, so it was attacked by the Houthi armed forces on the 15th.

After the attack, the U.S. Central Command said no casualties were caused.

The Houthi armed forces said they would continue to attack ships related to or bound for Israel until Israel stops attacks on the Gaza Strip and lifts the blockade.

On July 15, local time, Yahya Sareya, military spokesman for the Houthi armed forces in Yemen, issued a statement saying that the armed forces attacked three ships that day, the ships BI and CL on the Red Sea, and the ship O sailing on the Mediterranean Sea.

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Jerusalem, May 15 (Reporters Lu Yingxu and Wang Zhuolun) Israeli Prime Minister Benjamin Netanyahu said on the 15th that Israel refused to accept the resolution recently adopted by the United Nations General Assembly on the issue of Palestinian membership, saying that the resolution does not constitute future Israeli-Palestinian negotiations. basis.

According to a press release issued by the Israeli Government Information Office, the Israeli government unanimously decided that day to refuse to accept the UN General Assembly resolution. Netanyahu said in the communiqué that the UN General Assembly resolution will not change the status of the disputed territory or the rights of Israel and the Jewish people on Israeli land. This resolution does not form the basis for future negotiations between the two sides, nor will it accelerate the peaceful settlement of the Palestinian-Israeli issue.

On the 10th of this month, the 10th emergency special session of the United Nations General Assembly adopted a resolution with a vote of 143 in favor, 9 against, and 25 abstentions, concluding that the State of Palestine meets the membership of the United Nations as stipulated in the United Nations Charter and should be accepted as a member of the United Nations. The resolution recommended that the Security Council reconsider Palestine’s application to join the United Nations as a member state from a favorable perspective.

Palestine is currently an observer state at the United Nations. In September 2011, Palestine submitted a formal application to the United Nations to become a member of the United Nations, but it was not approved by the Security Council. In early April this year, at Palestine’s request, the 15 members of the Security Council reviewed Palestine’s application for membership in the United Nations again and voted on relevant draft resolutions on April 18. The draft was not adopted because the United States used its veto power to cast a negative vote.

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According to a report by Russian Satellite News Agency on March 17, government officials in the Russian-controlled Zaporozhye region told reporters on the 17th that an assassination attempt against a close friend of Russian President Vladimir Putin was foiled in the city of Berdyansk in the region.

According to reports, Vladimir Rogov, a senior official of the local administration in Zaporozhye, revealed that the authorities had stopped an assassination plot involving a confidant of Russian President Vladimir Putin.

He said: Ukraine terrorists planned the attack but did not succeed. Their criminal plans were thwarted by professional actions by the Russian secret service.

Rogoff added that all those involved in the planning of the terrorist attack will be hunted down.

The 17th is the last day of voting in the Russian presidential election. (Compiled by Wei Yudong)

Related news reports:

Russia announces: repelled all cross-border attacks, killing 550 people in Uzbekistan

Reference News Report on March 17 According to a report by Russian Satellite News Agency on March 17, Russian Presidential Press Secretary Dmitry Peskov told reporters that the military would routinely report Uzbekistan’s attacks on Russian territory to President Putin.

He pointed out: Putin received reports from the military that Ukrainian troops recently attempted to attack Russian territory in Belgorod and Kursk regions.

Reported that Peskov said that all attacks were successfully repelled, while 1700 of the 2500 saboteurs were killed and 550 people were killed.

He also said that in the early morning of the 16th, the enemy also tried several times to invade Belgorod and Kursk regions. The Ukraine saboteurs ultimately failed and failed even to get close to the Russian border. Peskov said that the enemy lost nearly 70% of its personnel.

The report also said that on the 16th, Russian troops thwarted Ukrainian saboteurs ‘attempts to cross the border from the direction of Popovka, a residential area in Sumizhou, and from Spodaliushno and Kozinka in Belgorod Oblast. The Ukrainian army lost about 30 soldiers, 3 tanks, 2 armored fighting vehicles, a Czech-made vampire multiple rocket launcher and a Hail multiple rocket launcher under bombing and shelling.

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Mexico City, May 14 (Reporter H Wu Hao) Prosecutors in the southern Mexican state of Chiapas issued an announcement on social media platforms on the 14th that an armed conflict occurred in the city of Chico Musello that day, killing at least 11 people.

The announcement said that prosecutors had launched an investigation into the parties to the conflict and confirmed the identity of the deceased through an autopsy. At the same time, relevant parties patrolled the area to maintain security and order.

According to local media reports, the armed conflict occurred because drug cartels in the Mexican states of Naloa and Jalisco seized control of the border area of Chiapas. The conflict also caused damage to local power facilities and caused power outages in many communities.

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United Nations, March 11 (Reporter Shang Xuqian) United Nations Secretary-General Guterres called on the 11th to cease hostilities in the Gaza Strip and Sudan during Ramadan.

Guterres said at a press conference held at the United Nations Headquarters in New York at the beginning of Ramadan that Ramadan is the month when Muslims around the world advocate peace, reconciliation and unity. Ramadan has arrived, but the killing, bombing and bloodshed continue in the Gaza Strip. He called for the immediate cessation of gunshots in Gaza, the removal of all obstacles to humanitarian relief, and the release of all detainees.

At the same time, Guterres once again urged the Sudanese conflict parties to stop hostilities during Ramadan. He said the Sudanese people were facing hunger, terror and unspeakable suffering, and the fighting must end.

Guterres called on political, religious and community leaders in the Gaza Strip, Sudan and other parts of the world to do everything they can to keep Ramadan peaceful and it is time to end the terrible suffering.

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Brussels, March 18 (Reporter Fu Yiming) The European Council announced on the 18th that it will allocate another 5 billion euros to provide military assistance to Ukraine.

The Council of the European Union said in a press release on the same day that it decided to set up a special Ukraine aid fund within the framework of the existing European Peace Fund and allocate 5 billion euros to provide military assistance to Ukraine.

The communiqué said that the Ukraine Aid Fund will enable the EU to further meet the changing needs of the Ukraine armed forces by providing lethal and non-lethal military equipment and training; the fund complements military assistance provided to Ukraine by EU member states.

In March 2021, the Council of the European Union approved the establishment of the European Peace Fund, which aims to enhance the EU’s capabilities in the fields of conflict prevention, peace-building and strengthening international security. The fund is not included in the EU’s fiscal budget. After multiple additions, the fund’s total budget ceiling for the period from 2021 to 2027 currently exceeds 17 billion euros.

Data released by the European Union shows that since the Russia-Ukraine conflict escalated in February 2022, the European Union and its member states have provided or promised to provide more than 138 billion euros in various assistance to Ukraine, of which 28 billion euros are military assistance.

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Tehran, March 13 (Reporter Shadati) Iranian Foreign Minister Abdullahiyan said on the 13th that Israel’s continued killing of Palestinians and its siege of the Gaza Strip are worrying. Israel’s actions have sounded the alarm for a humanitarian disaster unprecedented in this century.

The Iranian Ministry of Foreign Affairs said in a statement issued on the 13th that Abdullahiyan made the above remarks in a letter to the Secretary-General of the United Nations, the Secretary-General of the Organization of Islamic Cooperation, the President of the United Nations Security Council, and foreign ministers of Muslim and other countries.

Abdullahiyan said in the letter that Israel continues to carry out genocide in the Gaza Strip, Israel commits war crimes in the West Bank, prevents humanitarian aid and food delivery to the Gaza Strip and starve Palestinians, all of which have sounded the alarm for an unprecedented humanitarian disaster in this century. Iran strongly condemns Israel’s actions.

Abdullahiyan emphasized that the United States has used its veto power excessively in the United Nations Security Council, completely obviously and deliberately preventing the Security Council from taking any effective measures; it is necessary for the international community to find practical ways to take serious measures to support the Palestinian people and immediately stop Israel’s military strikes on the Gaza Strip and end the current terrible situation.