Introduction Erectile dysfunction and ischemic heart disease are common health problems that affect elderly individuals. Despite advances in treatment strategies, cardiopulmonary bypass (CPB) has been used for coronary artery bypass grafting (CABG) for over three decades for surgical myocardial revascularization. Aim To discuss the difference between the on pump and the newer alternative—the off-pump CABG (OPCABG) surgery—on the sexual function. Methods This prospective study included 100 patients who underwent CABG. Main Outcome Measures The patients were evaluated by an abridged form of International Index of Erectile Function questionnaire (IIEF-5), Pharmaco-Penile Duplex Ultrasound and finally by the European System for Cardiac Operative Risk Evaluation. The patients were underwent either on-pump CABG or OPCABG. Six months after surgery, the erectile function was revaluated according to the same preoperative measures. Results Patients included in the study were classified into two matched groups: group I—patients who underwent on-pump CABG (N = 50); and group II—patients who underwent OPCABG (N = 50). The frequency of intercourse was significantly higher in OPCABG (P < 0.05) after surgery. The mean ± standard deviation of the IIEF-5 scores of the on-pump group postoperatively became 12.48 ± 7.19 whereas it became 15.88 ± 6.67 in the off-pump group (P < 0.05). Moreover, the number of patients who reported postoperative improvement of their IIEF-5 score was significantly higher in OPCABG group (N = 23) compared with the conventional on-pump CABG group (N = 13) (P < 0.05). There was no significant change in the duplex ultrasound after surgery between both groups. Conclusions The OPCABG has a diminished impact on the sexual function of patients compared with the conventional on-pump CABG. Therefore, the type of operation can be considered a predictive factor of sexual function following CAB surgery.

Introduction A strong association between cardiovascular risk factors and erectile dysfunction (ED) was suggested. Coronary artery bypass grafting (CABG) is the gold standard for surgical myocardial revascularization. Aim We herein evaluate the impact of vascular risk factors on postoperative sexual functions in patients undergo CABG. Main Outcome Measures ED severity by the International Index of Erectile Function (IIEF-5) and penile duplex study. Methods The present study included 100 patients who underwent CABG. The patients were evaluated by an abridged form of the IIEF-5 questionnaire, followed by CABG. Six months after surgery the erectile function of all patients was revaluated utilizing the IIEF-5. Results Number of risk factors was significantly associated with postoperative change in IIEF-5 score (P = 0.02). A post hoc analysis of the association revealed that patients with one risk factor were significantly more likely to have increased IIEF-5 scores (N = 18), whereas those with two or more risk factors were significantly more likely to have decreased IIEF-5 scores (N = 21, P < 0.05). Furthermore, those with no risk factors were significantly more likely to be stable (N = 8) compared with those with more than two risk factors, who were more likely to have decreased scores (P < 0.05). The hierarchical logistic regression results showed that when examining all risk factors simultaneously, because of multicollinearity, only hyperlipidemia was significantly associated with postoperative ED (odds ratio [OR] = 11.33, confirdence interval [CI] = 1.25, 102.82). Frequency of intercourse was also significantly associated with postoperative ED after controlling for risk factors (OR = 0.71, CI = 0.52, 0.97). Conclusions This data clearly shows that the number of cardiovascular risk factors is an essential predictive factor for sexual function following surgery. Only hyperlipidemia may play a predictive role for the future sexual function of patients undergo CABG.

The aim of SEEP2017 is to bring together the researches within the field of sustainable energy and environmental protection from all over the world.The contributed papers are grouped in 18 sessions in order to provide access to readers out of 300 contributions prepared by authors from 52 countries.We thank the distinguished plenary and keynote speakers and chairs who have kindly consented to participate at this conference. We are also grateful to all the authors for their papers and to all committee members.We believe that scientific results and professional debates shall not only be an incentive for development, but also for making new friendships and possible future scientific development projects. Increasing efforts and resources have been devoted to research during environmental studies, including the assessment of various harmful impacts from industrial, civic, business, transportation and other economy activities. Environmental impacts are usually quantified through Life Cycle Assessment (LCA). In recent years, footprints have emerged as efficient and useful indicators to use within LCA. The footprint assessment techniques has provided a set of tools enabling the evaluation of Greenhouse Gas (GHG) -including CO2, emissions and the corresponding effective flows on the world scale. From all such indicators, the energy footprint represents the area of forest that would be required to absorb the GHG emissions resulting from the energy consumption required for a certain activity, excluding the proportion absorbed by the oceans, and the area occupied by hydroelectric dams and reservoirs for hydropower.An overview of the virtual GHG flow trends in the international trade, associating the GHG and water footprints with the consumption of goods and services is performed. Several important indications have been obtained: (a) There are significant GHG gaps between producer's and consumer's emissions -US and EU have high absolute net imports GHG budget. (b) China is an exporting country and increasingly carries a load of GHG emission and virtual water export associated with consumption in the relevant importing countries. (c) International trade can reduce global environmental pressure by redirecting import to products produced with lower intensity of GHG emissions and lower water footprints, or producing them domestically.To develop self-sufficient regions based on more efficient processes by combining neighbouring countries can be a promising development. A future direction should be focused on two main areas: (1) To provide the self-sufficient regions based on more efficient processes by combining production of surrounding countries. (2) To develop the shared mechanism and market share of virtual carbon between trading partners regionally and internationally. HAKAN SERHAD SOYHAN 4 Development in energy sector, technological advancements, production and consumption amounts in the countries and environmental awareness give shape to industry of energy. When the dependency is taken into account in terms of natural...

Background: Erectile dysfunction has multiple causes in older men. Combination therapy may therefore be an attractive option. Methods: We conducted a randomized double blind trial over 2 months. We allocated 89 men who had different causes of erectile dysfunction and low testosterone concentrations randomly to two groups. One group received topical therapy with placebo cream and the other received active cream containing testosterone 0.8%, isosorbide dinitrate 0.5% and co-dergocrine mesylate 0.06%. Serum concentrations of total testosterone were measured every 15 days. Response to each therapy was assessed by measurement of tumescence using RigiScan and a sexual questionnaire. Results: Serum concentrations of total testosterone increased significantly in all patients (p < 0.05) after 15 days of treatment with active cream (240 AE 27 ng/dl vs. 360 AE 29 ng/dl). Application of active cream to the penile shaft in the laboratory induced full tumescence in 18% of patients and partial tumescence in 53%. No patient had full tumescence after application of placebo cream. Sexual desire was improved in 70% of patients during treatment with active cream. Analysis of data from the questionnaires showed that 40% of patients reported full erections with successful intercourse, sexual enjoyment and satisfaction and 37% reported partial erections that were insufficient for successful intercourse. No patient experienced a full erection and successful intercourse after placebo cream. No major side effects were reported. Conclusion: Topical treatment with cream containing testosterone and vasoactive agents is a new effective treatment for erectile dysfunction associated with low testosterone concentrations, particularly for patients with psychogenic causes.

Introduction The published studies discussing the prognostic factors for expected sexual function after coronary artery bypass graft (CABG) are still limited. Aim Examining the correlation between the European System for Cardiac Operative Risk Evaluation (EuroSCORE) and the abridged form of International Index of Erectile Function questionnaire (IIEF-5), as a quick and inexpensive tool for the cardiologist to predict the sexual function after CABG. Main Outcome Measures Validated standardized questionnaire commonly used by cardiologists in identifying appropriate weight to various risk factors related to adult cardiac operations. Methods Preoperatively patients were evaluated as regards to the sexual function by (IIEF-5) and pharmaco-penile duplex ultrasound. Moreover all patients were evaluated bu EuroSCORE. Six months after surgery, the erectile function of all patients was revaluated according to the same preoperative procedures. The patients were categorized with EuroSCORE as follows: The low-risk group (EuroSCORE 0–2), the medium-risk group (EuroSCORE 3–5), and the high-risk group (EuroSCORE 6 plus). Results The EuroSCORE was negatively correlated with the IIEF-5 score (r = −0.224, P = 0.025 or rs=−0.259, P = 0.009). Moreover, low-risk patients had significantly higher IIEF-5 scores compared with medium-risk patients (mean ± standard deviation=15.27 ± 6.03 vs. 12.18 ± 6.07, P &lt;0.05). Conclusions There is an inverse correlation between the components of EuroSCORE and the IIEF-5 score. Patients with higher EuroSCORE had lower IIEF-5 scores and vice versa.The EuroSCORE is a useful, quick, and inexpensive tool that allows prediction of ED in those patients with coronary artery disease patients who are undergoing CABG.