Administration of daily 5 mg tadalafil improves endothelial function in patients with benign prostatic hyperplasia

Introduction: Tadalafil is a promising phosphodiesterase (PDE) 5 inhibitor prescribed for erectile dysfunction (ED). Daily low dose (5?mg) of tadalafil has also been used for the treatment of male lower urinary tract symptoms (LUTS) associated with benign prostate hyperplasia (BPH). PDE5 inhibitors induce relaxation of smooth muscle cells in the urethra, prostate, bladder neck, and blood vessels. The aim of this study was to investigate the efficacy of tadalafil on vessels endothelial function, in patients with male LUTS symptoms associated with BPH.

Methods: The Institutional Review Board (IRB) approved this clinical study and informed consents had been obtained from 81 BPH patients.

The following male LUTS parameters: international prostate symptom score (IPSS), overactive bladder symptom score (OABSS), voiding volume, max and mean voiding flow on voiding flowmetry examination and post-voiding residual urine (RU) were compared at 0, 1, 3, 6, and 12 months after a daily dose of 5?mg tadalafil.

In addition, erectile function was evaluated by the sexual health inventory for men (SHIM) score and vessels endothelial function and peripheral neuropathy were assessed by the brachial-ankle pulse wave velocity (baPWV), ankle brachial index (ABI), and vibration perception threshold (VPT) at 0, 3, 6, and 12 months after treatment.

Results: The mean age of 81 patients was 66.4?±?11.4 years old. Their prostate size was 30.2?±?22.1?ml.

Male LUTS parameters including IPSS, OABSS, and RU showed significant improvement from 1 to 12 months after tadalafil administration. Max and mean voiding flow was significantly increased at 6 months after tadalafil treatment.

The SHIM score showed significant improvement after 3 months. Whilst, the results of baPWV also showed significant improvement from 3 to 12 months. ABI was also significantly improved at 6 months. However, there was no change in the VPT at any time point.

Conclusions: Tadalafil is effective for both male LUTS and ED. It is also shown that tadalafil improves baPWV, which we can conclude that higher vessels elasticity has been obtained. This major finding of this study shows that tadalafil has the potency to improve vessels endothelial dysfunction in patients with BPH.     

Are urge incontinence and aging risk factors of erectile dysfunction in patients with male lower urinary tract symptoms?

Introduction: Several studies have indicated that erectile dysfunction (ED) patients also suffer from lower urinary tract symptoms (LUTS). We investigated a group of men with LUTS and assessed their sexual function with the aim of being able to predict ED risk factors and introduce ED treatments earlier for this patient group.

Methods: International Prostate Symptom Score (IPSS), Overactive Bladder Symptoms Score (OABSS) and Sexual Health Inventory for Men (SHIM) score were obtained from 236 men with LUTS at their first out-patients visit. Clinical parameters such as body mass index, prostate volume, residual urine volume and prostate specific antigen were also evaluated. The relationship between the SHIM score and other clinical data was analyzed.

Results: According to the SHIM score, ED in men with LUTS was severe 15%, moderate 19%, moderate to mild 28%, mild 17%, normal 7% and data was incomplete in 14%. Based on the results of a multivariate analysis, aging (p?p?=?0.024) were significantly correlated to severe and moderate ED. Furthermore, among OAB symptoms score items, urge urinary incontinence was a risk factor for severe and moderate ED (p?=?0.005).

Conclusion: Aging and OAB (notably urinary urge incontinence) are risk factors for severe and moderate ED in men with LUTS.     

The efficacy and safety of short-acting testosterone ointment (Glowmin) for late-onset hypogonadism in accordance with testosterone circadian rhythm

Introduction: It is well known that there is a reduction of circadian rhythm in blood testosterone levels with aging. Our previous report revealed that 3?mg of short-acting testosterone ointment (Glowmin: GL) elevated serum testosterone levels to within the physiological range for 4–6?h. The aim of this study was to clarify the clinical efficacy and safety of GL used topically once every morning, to enhance the circadian rhythm of testosterone, for late-onset hypogonadism (LOH).

Methods: A total of 61 LOH patients received 3?mg of GL topically once a day in the morning on scrotal skin for 24 weeks. The clinical efficacy of GL was evaluated by the aging males symptoms (AMS) scale, and blood sampling tests were measured before and after GL treatment.

Results: Mean patients age was 55.3?±?9.2 years old. Total AMS scores at 4, 12, and 24 weeks after GL treatments significantly decreased. The results of sub-analysis of AMS, including psychological, physical, and sexual factors also significantly improved after GL treatments. No severe adverse reactions or abnormal laboratory data were reported.

Conclusions: This study shows that TRT for LOH with once daily GL treatment supports testosterone circadian rhythm and should be considered to be an effective and safe therapy for LOH.     

Social inequality and art institutions

Our objective is to examine how several aspects of the class structure influence the prevalence of artistic institutions. The analysis is based on quantitative comparisons of the 125 largest metropolitan areas in the United States. Most of the literature on the history of art concludes that artistic developments depend on the patronage of an elite—as noble patrons, as rich donors, or even as affluent bourgeois donors and audiences. Whereas these conclusions imply that class inequalities further the growth of the arts, our empirical findings indicate the opposite. Both lesser inequality and reductions of inequality in a metropolis increase a variety of artistic institutions, and these influences persist when other influences on these institutions are controlled.     

Constitutions and Public Support for Welfare Policies*

Objectives. This research explores how constitutional designs affect a cross‐national gap in public support for welfare policies. We contend that the constitution's statements regarding the citizens' right to receive welfare services constrain elite discourse on social welfare, which in turn exerts a strong influence on the level of mass support for and ambivalence over welfare policies. Methods. Survey data from 15 consolidated democracies merged with country‐level data are analyzed using a hierarchical linear model. Results. Empirical analysis shows that citizens residing in countries with a more liberal constitution show more supportive and less ambivalent attitudes toward welfare policies. Conclusions. Our findings suggest that the political principles reflected in national constitutions explain the cross‐national gap in mass support for welfare policies.     

Selecting the regularization parameters in high-dimensional panel data models: Consistency and efficiency

This article considers panel data models in the presence of a large number of potential predictors and unobservable common factors. The model is estimated by the regularization method together with the principal components procedure. We propose a panel information criterion for selecting the regularization parameter and the number of common factors under a diverging number of predictors. Under the correct model specification, we show that the proposed criterion consistently identifies the true model. If the model is instead misspecified, the proposed criterion achieves asymptotically efficient model selection. Simulation results confirm these theoretical arguments.     

Computing the conditional stationary distribution in Markov chains of level-dependent M/G/1-type

This paper considers the computation of the conditional stationary distribution in Markov chains of level-dependent M/G/1-type, given that the level is not greater than a predefined threshold. This problem has been studied recently and a computational algorithm is proposed under the assumption that matrices representing downward jumps are nonsingular. We first show that this assumption can be eliminated in a general setting of Markov chains of level-dependent G/G/1-type. Next we develop a computational algorithm for the conditional stationary distribution in Markov chains of level-dependent M/G/1-type, by modifying the above-mentioned algorithm slightly. In principle, our algorithm is applicable to any Markov chain of level-dependent M/G/1-type, if the Markov chain is irreducible and positive-recurrent. Furthermore, as an input to the algorithm, we can set an error bound for the computed conditional distribution, which is a notable feature of our algorithm. Some numerical examples are also provided.     

Age related variation of salivary testosterone values in healthy Japanese males

Objective. We examined age associated variation in salivary testosterone values among Japanese males as well as anthropometric measurements.

Methods. Salivary samples were collected in pretreated sodium azide treated tubes. The first series: 15–79-year-old males (n = 99); two morning and two evening samples were collected at home for two days. The second series: 90-year-old males (n = 29); one morning sample was collected. Testosterone values were determined using an iodine125-based radioimmunoassay kit modified for saliva.

Results. Results show 1) a significant decrease in salivary testosterone values from 20s to 40s and older, 2) no significant decline after 40 through 90 years old, 3) no significant age-related differences in the degree of intraindividual diurnal fluctuation across age groups of 40–70s, and 4) higher BMI is associated with the lower salivary testosterone among 40–70s.

Conclusions. These results suggest that neither a constant decrease of salivary testosterone values or markedly reduced intraindividual fluctations are universal aspects of aging. Older males may maintain relatively high testosterone levels compared to younger men and a relatively ‘robust’ neuroendocrinological system.     

Mathematical model allowing the coexistence of closely related competitors at the initial stage of evolution

The mathematical model presented here aims to elucidate the essential mechanisms of coexistence of species, especially those of closely related forms, as a result of competition in the same environment. It describes a system where the fate of the competitors or mutants is observed at the initial stage of evolution. The model encompasses both the external variables and the internal state of the competitors, which differ only in one of the metabolic rate constants. Results of simulations, even with the simplified form of the model, show that stable coexistence of closely related forms in a uniform environment is possible. In addition, the model allows the analysis of the limitations on the level of differences and similarities among the competitors for achieving a state of coexistence. The essential mechanisms for the coexistence of closely related competitors are proposed to be the involvement of the metabolic network in allowing the same growth rate of competitors which have different internal states, and the interplay between the internal states of the competitors and the external variables of their environment.