A 35-Year-Old Man Presenting Sleep-Related Painful Erections (Erpes): A Case Report and Review of Literature

Introduction: Erectile episodes occurring in the night time are considered normal and are usually related to the REM sleep. Spontaneous painful erections are unusual but they can have a great impact in the patient’s quality of sleep and, for consequence, quality of life. Report: We present a patient who has been presenting painful erections which wake him up almost every night. We discuss the workup and treatment offered to the patient, as well as the short-time response and two months follow-up. Discussion: Although studies still do not explain this relationship, nocturnal erections occur only during rapid eye movement (REM) sleep, which can be confirmed by polysomnography accompanied by Nocturnal Penile Tumescence testing or RigiScan test. However, diagnosis can be established based exclusively on clinical aspects. Based on all literature reviewed, the initial treatment should safely consist in improvement in sleep architecture and pelvis muscles relaxation. Conclusion: After the first suspicion, polysomnography with rigidity measurements of nocturnal erections should be considered although clinical diagnosis and therapeutic test may be acceptable. The management we suggest is usually effective, well tolerated and sustained.

Regaining of morning erection and sexual confidence in patients with erectile dysfunction

Aim： To investigate how erectile dysfunction （ED） medications affect morning erection in patients with ED and how they respond to the return of morning erection. Methods： This study was conducted in 120 patients who experienced successful intercourse with either tadalafil or sildenafil. Using a random face-to-face interview and a questionnaire （about the quality and number of days getting morning erection after using the two medications）, the impact of the medications on the morning erections was investigated, and the participants were asked about their feelings on regaining morning erection. Results： Of the respondents, 81% （68% of those with sildenafil and 99% of those with tadalafil） experienced morning erections after taking an oral ED medication. The men who took tadalafil mainly for 2 days with one dose, while those who took sildenafil experienced morning erections mainly for 1 day. The major sentiment upon regaining a morning erection was, ＂having more confidence as a man＂ （74%）. Among the 96 respondents who experienced morning erections with tadalafil, 52% preferred tadalafil over sildenafil, not only because of freedom from concerns about a specific time to have relations, but also regaining morning erection. Conclusion： Regaining a morning erection affects the recovery of confidence as a man and influences the preference for tadalafil over sildenafil.

Recent insights into androgen action on the anatomical and physiological substrate of penile erection

Erectile response is centrally and peripherally regulated by androgens. The original insights into the mechanisms of action of androgens were that androgens particularly exert effects on libido and that erections in response to erotic stimuli were relatively androgen-independent. It was shown that sexual functions in men required androgen levels at the low end of reference values of testosterone. So it seemed that testosterone was not useful treatment for men with erectile difficulties, particularly following the advent of the phosphodiesterase type 5 （PDE5） inhibitors. However, approximately 50% of those treated with PDE5 inhibitors discontinue their treatment. A number of recent developments shed new light on testosterone treatment of erectile dysfunction （ED） in aging men. （1） A recent insight is that, in contrast to younger men, elderly men might require higher levels of testosterone for normal sexual functioning. （2） Several studies have indicated that PDE5 inhibitors are not always sufficient to restore erectile potency in men, and that testosterone improves the therapeutical response to PDE5 inhibitors considerably. （3） There is growing insight that testosterone has profound effects on tissues of the penis involved in the mechanism of erection and that testosterone deficiency impairs the anatomical and physiological substrate of erectile capacity, reversible upon androgen replacement. The synthesis of PDE5 is upregulated by androgens, and the arterial inflow into the penis is improved by giving androgen. The above invites a re-examination of the merits of giving testosterone to aging men with ED. The beneficial effects of PDE5 inhibitors may only be optimally expressed in a eugonadal environment. （Asian J Androl 2006 Jan; 8： 3-9）

Study on effect of segments erection tolerance and wedge-shaped segment on segment ring in shield tunnel

Deformation and dislocations of segments of shield tunnel in construction stage have apparent effect on tunnel structure stress and even cause local cracks and breakage in tunnel. 3D finite element method was used to analyze two segment ring models under uniform injected pressure: (1) segment ring without wedge-shaped segment, which has 16 types of preinstall erection tolerance; (2) segment ring with wedge-shaped segment, which has no preinstall erection tolerance. The analysis results indicate that different erection tolerances can cause irregular deformation in segment ring under uniform injected pressure, and that the tolerance values are enlarged further. Wedge-shaped segment apparently affects the overall deformation of segment ring without erection tolerances. The uniform injected pressure can cause deformation of ring with wedge-shaped segment irregular, and dislocations also appear in this situation. The stress of segment with erection tolerances is much larger than that of segment without erection tolerances. Enlarging the central angle of wedge-shaped segment can make the irregular deformation and dis- locations of segments smaller. The analysis results also provide basis for erection tolerance control and improvement of segment constitution.

Effects of castration and testosterone replacement on veno-occlusion during penile erection in the rat

Aim: To determine if androgens directly regulate veno-occlusion or if androgens act indirectly to maintain the penilestructures which control outflow. Methods: Using CASTRATE and TESTO rats, measurement was made of meanarterial pressure (MAP), intracavernosal pressure (CCP), and intracavernosal flow (CCF) during erection resultingfrom stimulation of the autonomic innervation of the penis. CCP and CCF were also measured during saline infusioninto the cavernosal sinuses before and after treatment with sodium nitroprusside (SNP, a nitric oxide donor drag) tofully relax cavernosal smooth muscle. Penile tissue was also collected to measure the content of α actin and proline andhydroxyproline to determine if brief withdrawal of androgenic support led to changes in the number of smooth musclecells or the collagen content of the tissue. Results: Infusion of saline into the cavernosal sinuses demonstrated thatveno-occlusion was defective in CASTRATE rats while reno-occlusion was fully functional in TESTO animals.Furthermore, veno-occlusion could be induced in CASTRATE rats if they were first treated with SNP. Thisobservation suggests that failure of veno-occlusion in the CASTRATE rats is due to a deficiency in the production of NOresulting in a reduction in the degree of relaxation of the penile smooth muscle. The measurements of smooth muscleα actin and proline and hydroxyproline content of collagen showed that both were unaffected by castration and that thebasic structure of the penis did not degenerate after one week without androgenic support. Conclusion: Theseresults can be interpreted to mean that androgens control the veno-occlusive mechanism indirectly via a NO dependentmechanism and not by maintaining the structures of the penis which are essential to reno-occlusion.

Characteristics of sildenafil erections in healthy young men

Aim： To determine the effect of sildenafil citrate on the nocturnal penile erections （i.e. time to onset, the duration of erection, and the interval between first and second erections） of healthy young men. Methods： Twenty-two potent men, 23-29 years old, were recruited for the study. All subjects completed three sessions over consecutive nights using the RigiScan monitoring device （Dacomed, Minneapolis, USA）. After a first night of adaptation, night 2 records were their baseline values, and on night 3 they received 100 mg of sildenafil citrate. Statistical comparisons were done between the second and third night data. Results： The mean time to onset of the first erection with sildenafil citrate was （34 ± 18） min, whereas it was （74 ± 24） min （P 〈 0.001） without sildenafil citrate. The number of erections observed during the first 5 h after sildenafil citrate medication was 3.6 ± 0.5 in contrast to 2.4 ± 0.5 with no medica- tion （P = 0.001）. The interval between first and second erections was shorter with sildenafil citrate： （52 ± 26） min vs. （85 ± 34） min （P = 0.01）. The duration of the last erection was statistically significantly longer with the sildenafil citrate： （64 ± 33） min vs. （42 ± 28） min （P 〈 0.01）. Conclusion： Healthy young men achieved erection within 34 min after sildenafil citrate administration, which is shorter than the 1 h interval proposed by the manufacturer. The interval between the first and second erections was shorter and the duration of the last nocturnal erection was longer.

Three-dimensional nonlinear flutter analysis of long-span suspension bridges during erection

In this work, the aerodynamic stability of the Yichang Suspension Bridge over Yangtze River during erection was determined by three dimensional nonlinear flutter analysis, in which the nonlinearities of structural dynamic characteristics and aeroelastic forces caused by large deformation are fully considered. An interesting result obtained was that the bridge was more stable when the stiffening girders were erected in a non symmetrical manner as opposed to the traditional symmetrical erection schedule. It was also found that the severe decrease in the aerodynamic stability was due to the nonlinear effects. Therefore, the nonlinear factors should be considered accurately in aerodynamic stability analysis of long span suspension bridges during erection.

Effect of sildenafil citrate on penile erection of rhesus macaques

Aim: To examine the effect of sildenafil citrate on penile erection of male rhesus macaque. Methods: Twenty Macaca mulatta were divided into the sildenafil treated and the control groups of 10 animals each. The penile size, the corpus cavernosal electromyogram (EMG) and the intra-corpus cavernosal pressure (ICP) were determined. Results: The diameter of penis and the ICP were significantly increased and the corpus cavernosal EMG significantly reduced in the sildenafil group. Conclusion: Sildenafil citrate increases the penile size and ICP and reduces the corpus cavernosal EMG in male rhesus macaque.

Production Balance of Ship Erection

A network plan model of ship erection was established based on the network planning technology and the work-package breakdown system. The load-oriented production control method was introduced to build up a throughput diagram model thus it is possible to describe the ship erection process numerically. Based on the digitalized models some cases of production balance of ship erection were studied and three balance indexes were put forward, they are the load balance rate, the input manpower balance rate and the maximum gantry crane operating times. Such an analytic method based on the balance evaluation is the important foundation for digitization and intelligentization of shipyard production management.

On Erection of Shiplock Miter Gate

The extreme large miter gates of TGP permanent shiplock are of great difficulty in erection,in view of the stringent requirement of precision control and the complicated components.The major erection problems,such as the erection measurement control, the selection of erection position of gate leaf,welding and deformation manipulation,the erection of back tie rods,the installation of apex pintle and prestressing anchorages,etc., had been carefully deliberated, and the optimized approaches were adopted.The erection practice of the miter gate at No.1 lock head shows that the adopted erection technology is safe,reliable and effective, and it may be used for reference for similar miter gates.

Selective control by posterior spinal nerve roots of micturition and erection in rats

The posterior rootlets in L6 and S1 spinal cord of adult male Sprague-Dawley rats underwent electrostimulation. The bladder pressure, urethral perfusion pressure and intracavernous pressure were recorded. When some posterior rootlets of L6 and Sl were electrostimulated, the intracavernous pressure peaked rapidly, but the bladder pressure and the urethral perfusion pressure curve did not show great change. When other rootlets were stimulated, the bladder pressure changed greatly, but the urethral perfusion pressure and the intracavernous pressure did not show great change. When different rootlets were stimulated, the urethral perfusion pressure changed maximally, but there were no great changes in bladder pressure or intracavernous pressure. Furthermore, stimulation of some rootlets produced simultaneous changes in two or three different pressure measures mentioned above. The results demonstrate that regulation by L6 and S1 posterior rootlets of the rat bladder detrusor, external urethral sphincter and penis cavernous body are significantly distinct. Different rootlets can be distinguished by electrostimulation.

Physiological significance of nitrergic transmission in human penile erection

Aim: Epididymal proteins are known to play an important role in the maturation of spermatozoa, we ought to deter-mine if there are regional differences in androgen-dependent epididymal proteins. Methods: A group of adult rats wascastrated and epididymides were removed three days following castration. The epididymides were dissected into caput,corpus and cauda segments, homogenized, and proteins were fractionated by anion exchange HPLC. Proteins in select-ed fractions were resolved by SDS-PAGE and visualized by silver staining. Results: It was observed that the levels ofmultiple proteins drastically reduced in the various regions of epididymis of the orchiectomized rats. Conclusion: Theepididymal proteins appear to be useful markers to study androgenic action in the epididymis.

Potentiation of apomorphine effect on sildenafil-induced penile erection in conscious rabbits

Aim: To investigate a possible potentiation effect of apomorphine (APO) on sildenafil-induced penile erection in the conscious rabbit. Methods: Erection of male New Zealand White rabbits (3.5-4.0 kg, n=12) was assessed by measuring the length of the uncovered penile mucosa and the duration of erection before and after intravenous administration of agents. After injection of APO (0, 0.05, 0.1 and 0.4 mg/kg), sildenafil was administered intravenously in a dose-response manner (0.5, 1 and 5 mg/kg). In additional experiments, the effect of increasing doses of sildenafil in combination with APO on systemic blood pressure was evaluated. Results: Systemic administration of sildenafil induced a dose-dependent increase in the penile length. Intravenous injection of APO alone did not produce any change in the penile length, while significantly enhanced the penile erection induced by sildenafil. The co-administration of 0.1 mg/kg of APO and 1 mg/kg of sildenafil was found to be the most effective combination in producing penile erection. Intravenous administration of sildenafil caused a concentration-dependent decrease in systemic blood pressure, but no additional decrease was observed with co-administration of APO. Conclusion: APO enhances the penile erection induced by sildenafil in the conscious rabbit without causing an additional decrease in blood pressure.

Role of the brain in the control of erection

In contrast to the spinal control of erection, relatively little is known about the brain control. In the present review, we have outlined the role of brain structures involved in penile erection and provided a synopsis on the brain circuit of erection. Findings from both animal and human studies are discussed. Evidence suggests that the most important structures are the frontal lobe, cingulate gyrus, amygdala, thalamus and hypothalamus. Within the brain circuit of erection, the thalamus serves as a gate-controller in which all relevant information is evaluated and further processed to higher and lower centres.

Aerodynamic stability of cable-stayed bridges under erection

In this work, nonlinear multimode aerodynamic analysis of the Jingsha Bridge under erection over the Yangtze River is conducted, and the evolutions of structural dynamic characteristics and the aerodynamic stability with erection are numerically generated. Instead of the simplified method, nonlinear multimode aerodynamic analysis is suggested to predict the aerodynamic stability of cable-stayed bridges under erection. The analysis showed that the aerodynamic stability maximizes at the relatively early stages, and decreases as the erection proceeds. The removal of the temporary piers in side spans and linking of the main girder to the anchor piers have important influence on the dynamic characteristics and aerodynamic stability of cable-stayed bridges under erection.

A Virtual Erection Simulation System for a Steel Structure Based on 3-D Measurement Data

he virtual erection simulation system was explained for a steel structure including ship and ocean plant blocks. The simulation system predicted the erection state to optimize any gap or overlap of blocks based on 3-D measurement data. The blocks were modified （cut） on the basis of the simulation result on the ground before erecting them by crane. The re-cutting process was not required and the blocks were erected into a mother ship speedily. Therefore, the erection time is reduced, increasing the dock turnover.

Wind Tunnel Test on the Wind-Resistant Behavior of a Long-Span Cable-Stayed Bridge during Erection

In order to investigate the aerodynamic behavior of the Sutong bridge over Yangtze River during erection, a 1：50 sectional model of the bridge deck, a 1： 100 full aeroelastic model of the free standing pylon and a 1： 125 full aeroelastic model for the maxim cantilever configuration were built. The test results show that there was no serious vortex-induced vibration at the bridge deck, and that the free standing tower, the model scale and the turbulence intensity influenced static loading. The buffeting responses during the maximum cantilever configuration did not affect the safety of the bridge under construction.

Possible Function of Frenulum of Prepuce in Penile Erection

Objective To discuss the possible function of frenulum of prepuce in penile erection. Methods Nine patients had premature ejaculation whose frenula were short. Two patients suffered unsatisfied intercourse whose frenula were injured and departed 12 and 6 months ago. Three males endured premature ejaculation whose frenula were hurt in coition 30 min ago.We prolonged short frenulum and reconstructed the ruptured frenulum. To the fresh wound,we debrided the cut,then sutured the injured frenulum vertically. Results Investigated 3 to 6 months,all patients got satisfied sexual intercourse. Conclusion Frenulum is important in erecting time.

Research on the stiffening girder erection sequence of three-tower suspension bridge

Compared to the conventional two-tower suspension bridge, the three-tower suspension bridge has obviously different characteristics in structural performance because of the extra middle tower and main span. The construction sequence for the stiffening girder is significantly different between the three-tower suspension bridge and the two-tower suspension bridge. The tangential angle of the main cable is one of the controlling factors of the stiffening girder erection stage for a suspension bridge. According to 5 feasible cases for the stiffening girder erection scheme in Taizhou Bridge, the research about the tangential angle in each case mentioned above was made, and some factors that should be taken into account for the erection scheme of stiffening girder were pointed out.

Discussion on Construction and Erection Technology of Bridge Precast Box Girder

At present,the precast construction technology has been widely used,especially in the process of bridge construction,where the precast box girder construction and erection technology has attracted more attention compared to other available methods.In order to effectively improve the application effect of this technology,and the overall quality of the bridge,this paper discusses the advantage and disadvantage of implementing the precast box girder construction and erection technology in the bridge construction.