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. Disclosure Work supported by industry: no.

Objectives 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. Methods 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 analyses was performed to examine the association between erectile hardness and age, current medical history, metabolic risk factors, and lifestyle factors. Results 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. Conclusion 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. Disclosure Work supported by industry: no.

Objective: Demand for erectile dysfunction treatments has increased not only in elderly patients but also in young patients. Reports indicate that frequent causes of erectile dysfunction in Japan are organic disorders in elderly patients and psychogenetic disorders in young patients. Methods: We defined patients under the age of 40 as young erectile dysfunction patients, and those over 65 as elderly erectile dysfunction patients. We divided these two groups and conducted a retrospective comparative study based on medical questionnaires. We selected 215 cases of patients under the age of 40, and 176 cases of patients over the age of 65, and created a group of young patients and a group of elderly patients. We implemented the erectile hardness score, Sexual Health Inventory for Men, and sexual encounter profile questions 2 and 3 as the patient's daily clinical journal. Results: The median age of young patients was 36 years, and that of elderly patients was 70 years. With respect to Sexual Health Inventory for Men, the average score was a significantly higher score in the young patients (9.26 vs 7.10, P < 0.001). Concerning erectile hardness score, young patients showed significantly higher scores in erectile hardness score (3.15 vs 2.06, P < 0.001). In terms of sexual encounter profile question 2, 50.9% of young patients responded "yes," but 24.3% of elderly patients responded, thus indicating a significantly higher score in young patients. In terms of sexual encounter profile question 3, 6.1% of young patients responded "yes," and 0.7% of elderly patients responded "yes," indicating a significantly higher in young patients. Conclusions: The results showed that many young patients with erectile dysfunction were able to perform insertion, but were unable to maintain erection.

We have found a radio-wave-reflection effect in rock salt that could be used for the detection of ultra-high energy neutrinos (UHEν's). They were predicted by Berezinsky and Zatsepin to be generated in Greisen, Zatsepin, and Kuzmin (GZK) processes in the universe. When an UHEν interacts with rock salt or ice as a detection medium, a shower is generated. The shower is composed by hadronic and electromagnetic avalanche processes. The energy of the UHEν shower converts to thermal energy through ionization processes. Consequently, the temperature rises along the shower. The refractive index of the medium rises with temperature. The irregularity of the refractive index in the medium leads to a reflection of radio waves. This reflection effect combined with the long attenuation length of radio waves in rock salt and ice would give rise to a new method to detect UHEν's. We measured the power reflection fraction and the phase of the reflected radio wave under irradiation with an electron beam on ice and rock salt powder. A series of simulations of Geant4 (CERN) and Multiphysics (COMSOL AB Co. Ltd. ,Sweden) had been done to know how they could reproduce the experimental results. They did not coincided in absolute values but their curves of the reflection fraction and phase shift of the reflected radio wave with irradiation time were similar in shapes. Due to the similar shapes, we regard that the reflection mechanism was verified by the simulations.

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. Disclosure Work supported by industry: no.