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VIAGRA was first placed on the Japanese market in 1999. Since then, PDE5 inhibitors, such as VIAGRA, have been widely used as the first alternative therapeutic medication to treat erectile dysfunction (ED). A new form of VIAGRA called VIAGRA OD Film was launched in the Japanese market on October 21st, 2016. OD film is taken orally without water and is fast dissolving. It is therefore expected to be easier to consume. Moreover, this medication is packaged in thin aluminum sheets to improve portability compared to the original tablets. For this study, we surveyed 25 patients to analyze the OD film formulation. These patients desired ED treatment and used the VIAGRA OD Film. All the participants answered our survey. They were aged between 21 and 79. Thirteen patients switched from the tablets to the OD film and 12 patients only used the OD film. The survey items included: 1) portability, 2) storage, 3) ease of consumption, 4) comfortableness, 5) level of self-consciousness with their partner, 6) thoughts on taking the film formulation, 7) comparison with the tablets, and 8) efficacy and adverse reaction. We observed that 61.5% of the patients who switched from tablets to film found that storage and portability were improved. Additionally, 61.5% of the patients who switched from tablets to film and 75.0% of the patients who were prescribed film only were able to comfortably swallow them. We also found that 69.2% who switched from tablets to film and 75.0% who were prescribed film only felt more at ease using it and 61.5% who switched from tablets to film and 66.7% who were prescribed film only felt more comfortable with the film. Finally, 28.0% of the individuals stated a negative opinion on the ease of consuming the OD film. The efficacy of the film was the same as the tablets. We identified two cases of adverse reactions with mild hot flashes and headache but no severe adverse reaction. This survey indicates that the ease of intake and portability was improved with OD film. Work supported by industry: no. [ABSTRACT FROM AUTHOR]

The Erection Hardness Score (EHS) can assess erectile hardness with a single question and is readily used in routine clinical practice. We investigated the correlation between EHS and both erectile function and metabolic risk, lifestyle, and other factors. This study included 548 men who underwent a complete standard medical checkup at our hospital between July 1, 2016, and August 31, 2018, and answered the question about erectile hardness. The following variables were evaluated: age, erectile hardness on the EHS, erectile function on the Sexual Health Inventory for Men (SHIM), current medical history (diabetes, hypertension, dyslipidemia, heart disease, stroke), metabolic risk factors (abdominal circumference, hyperglycemia, high blood pressure, lipid abnormality), and lifestyle factors. First, to examine the correlation between erectile hardness and erectile function, the mean SHIM score by EHS grade was determined for each age group. Then, an analyse s was performed to examine the association between erectile hardness and age, current medical history, metabolic risk factors, and lifestyle factors. In each age group, a lower EHS grade was associated with a lower mean SHIM score. Lipid abnormality, diabetes, and age were independent risk factors for decreased erectile hardness. The EHS as a measure of erectile hardness was correlated with erectile functional as assessed using the SHIM, and current diabetes and lipid abnormality were independent risk factors for decreased erectile hardness. However, neither dyslipidemia nor lipid abnormality is listed as a risk factor in the ED guidelines. Traditionally, lipid abnormality was assessed based mainly on the presence or absence of current hyper-lipidemia and serum total cholesterol level. Today, the diagnostic criteria for metabolic syndrome proposed by the World Health Organization, International Diabetes Federation, and Japanese Society of Internal Medicine also recommend the use of serum triglyceride and HDL cholesterol levels, instead of total cholesterol level, for evaluating lipid abnormality. I think the assessment of lipid abnormality should be used triglyceride and HDL cholesterol levels, instead of total cholesterol level. Work supported by industry: no. [ABSTRACT FROM AUTHOR]

In recent years, awareness of erectile dysfunction and the demand for treatment have been increasing even among young men. We investigated the status of young patients 40 years of age or younger with erectile dysfunction. The subjects were 208 patients who visited the urology departments of Showa University Fujigaoka Hospital and affiliated hospitals with a chief complaint of erectile dysfunction. The erectile function was assessed with the Sexual Health Inventory for Men (SHIM), diary questions on sexual intercourse from the Sexual Encounter Profile, and the Erection Hardness Score, which measures the hardness of erection. The treatment was monotherapy with sildenafil (25 or 50 mg), vardenafil (10 or 20 mg), or tadalafil (10 or 20 mg) or a combination of multiple phosphodiesterase 5 (PDE5) inhibitors. To investigate the cause, blood tests including free testosterone and the Self-rating Depression Scale questionnaire were conducted, and Pulse Wave Velocity (PWV) was measured. The median age of the patients was 36 years. As for the cause of erectile dysfunction, psychogenic erectile dysfunction was observed in 141 patients, accounting for 67.7% of the patients. However, 82.1% of patients who underwent PWV measurement showed measurements suggestive of organic changes. The efficacy rates of PDE5 inhibitors were 77% for sildenafil, 73% for vardenafil, and 85% for tadalafil. This study showed that psychogenic erectile dysfunction was common in young patients, and that PDE5 inhibitors were effective for them. In addition, the study suggested the presence of organic changes as a risk factor for erectile dysfunction even in young patients. Work supported by industry: no. [ABSTRACT FROM AUTHOR]

We investigated the circadian variation of myocardial ischemia in patients with unstable angina using a 24-hour 12-lead electrocardiographic monitoring system with computer analysis. The circadian variation of ischemic attacks in patients who had ST elevation showed a similarity to that of the onset of acute myocardial infarction and most of these patients had vasospasm without organic stenosis; no similarity was seen in patients with organic stenosis. [ABSTRACT FROM AUTHOR]

The article presents a study to collect evidence on monotherapy with tadalafil that was approved for the treatment of benign prostatic hyperplasia (BPH)/lower urinary tract symptoms (LUTS) in Japan. The article mentions various mechanisms of action, including smooth muscle relaxation in the lower urinary tract, improvement of blood flow, and modulation of afferent pathways from the urinary bladder to relieve LUTS. It concludes that monotherapy with tadalafil also improved sexual function.