***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND  Erectile dysfunction ( ED ) is a frequent comorbidity in patients with type 2 diabetes mellitus ( T2DM ) , and is now increasingly considered a surrogate marker of endothelial dysfunction as well as a sentinel predictor of new-onset macroangiopathic events . Less attention , however , has been directed at the potential association of ED and microangiopathy in hyperglycaemic states . METHODS We analyzed 221 consecutive male T2DM out patients in whom ED was assessed by the International Index of Erectile Function ( IIEF-5 ) question naire . ED(+ ) patients ( IIEF-5 1 - 20 ; n=83 ) were compared with an age-matched ED(- ) cohort ( IIEF-5 21 - 25 ; n=51 ) , with similar diabetes duration , in terms of cardiovascular ( CV ) risk factors , micro-/macroangiopathy and the United Kingdom Prospect i ve Diabetes Study ( UKPDS ) risk score . RESULTS Mean age and diabetes duration were 58 and 10 years , respectively . IIEF-5 score ( 1 S.D ) was 23 ( 1 ) in ED(- ) vs 11 ( 6 ) in ED(+ ) . Anamnestic impotence and erectogenic drug use were reported by 52 % and 36 % , respectively , of ED(+ ) vs 12 % and 8 % , respectively , of ED(- ) ( P<0.0002 and P<0.0001 , respectively ) . The metabolic syndrome prevalence ( 88 % vs 64 % ; P=0.002 ) and central adiposity markers ( waist , waist/height and visceral fat ) were all significantly higher in ED(+ ) . HbA(1c ) was similar in both groups : 7.5 % ( 1.3 % ) , and there were also no significant differences in smoking , blood pressure , HOMA insulin sensitivity , cholesterol and glomerular filtration rate . However , prevalences of retinopathy , polyneuropathy and elevated albuminuria , and the composite endpoint of peripheral artery disease , transient ischaemic attacks and /or stroke , were markedly increased in ED(+ ) ( all P<0.05 ) . No differences were observed in coronary artery disease prevalence or in the UKPDS 10-year CV risk between the two ED groups . CONCLUSION IIEF-5-defined ED in men with T2DM is associated with a marked increase in the metabolic syndrome , central adiposity and microangiopathy . These data suggest that diagnosing ED in T2DM warrants detailed screening and monitoring for microangiopathy in target organs Background The relationship between reproductive health disorders and lifestyle factors in middle-aged and older men is not clear . The aim of this study is to describe lifestyle and biomedical associations as possible causes of erectile dysfunction ( ED ) , prostate disease ( PD ) , lower urinary tract symptoms ( LUTS ) and perceived symptoms of and rogen deficiency ( pAD ) in a representative population of middle-aged and older men , using the Men in Australia Telephone Survey ( MATeS ) . Methods A representative sample ( n = 5990 ) of men aged 40 + years , stratified by age and State , was contacted  by r and om selection of households , with an individual response rate of 78 % . All men participated in a 20-minute computer-assisted telephone interview exploring general and reproductive health . Associations between male reproductive health disorders and lifestyle and biomedical factors were analysed using multivariate logistic regression ( odds ratio [ 95 % confidence interval ] ) . Variables studied included age , body mass index , waist circumference , smoking , alcohol consumption , physical activity , co-morbid disease and medication use for hypertension , high cholesterol and symptoms of depression . Results Controlling for age and a range of lifestyle and co-morbid exposures , sedentary lifestyle and being underweight was associated with an increased likelihood of ED ( 1.4 [ 1.1 - 1.8 ] ; 2.9 [ 1.5 - 5.8 ] , respectively ) and pAD ( 1.3 [ 1.1 - 1.7 ] ; 2.7 [ 1.4 - 5.0 ] , respectively . Diabetes and cardiovascular disease were both associated with ED , with hypertension strongly associated with LUTS and pAD . Current smoking ( inverse association ) and depressive symptomatology were the only variables independently associated with PD . All reproductive disorders showed consistent associations with depression ( measured either by depressive symptomatology or medication use ) in both age-adjusted and multivariate analyses . Conclusion A range of lifestyle factors , more often associated with chronic disease , were significantly associated with male reproductive health disorders . Education strategies directed to improving general health may also confer benefits to male reproductive health Purpose : Aging changes the balance of sex hormones and causes endothelial dysfunction in the penis , both of which are important determinants of erectile dysfunction ( ED ) . The purpose of this study was to evaluate whether exercise training could protect against erectile dysfunction by increasing serum testosterone and penile eNOS levels in aging rats . Methods : A total of 14 young ( 2‐month‐old ) and 14 middle‐aged ( 18‐month‐old ) Sprague Dawley rats were r and omly assigned to either untrained control ( young control , [ YC ] , middle‐aged control , [ MC ] ) or endurance exercise‐trained ( young exercise , [ YE ] , middle‐aged exercise , [ ME ] ) groups with seven rats per group . The exercise groups trained with treadmill running for 6weeks . Body composition parameters ( body weight , heart mass , liver mass , and testicular mass ) , serum sex hormone levels ( testosterone , luteinizing hormone , follicle‐stimulating hormone , and prolactin ) , endothelial function‐related parameters in the penis ( endothelial nitric oxide synthase [ eNOS ] , CD31 , alpha smooth muscle actin [ & agr;‐SMA ] ) , and maximal intracavernous pressure measure ( ICP ) and total ICP were analyzed in middle‐aged rats . Results : The middle‐aged groups showed increased body weight , as compared with the young groups , but exercise training attenuated the aging‐induced increase in body weight . The middle‐aged groups had lower testicular mass compared with the young groups , but exercise training attenuated aging‐induced decreases in testicular mass  . Exercise training  increased serum testosterone levels in both the young and middle‐aged groups . However , there were no changes in the levels of luteinizing hormone , follicle‐stimulating hormone , and prolactin among the groups . MC group showed decreased protein levels of p‐eNOS , as compared with the YC group . However , exercise training protected against aging‐induced decrease in eNOS and p‐eNOS protein levels in the penis . Interestingly , exercise training also increased protein levels of & agr;‐SMA and maximal ICP in the middle‐aged group . Conclusions : Exercise training has beneficial effects on erectile function in aged rats through increased testosterone production from the testis and strengthening of the cavernous endothelium with activation of eNOS . Therefore , exercise training may be a therapeutic modality for improving erectile dysfunction associated with aging Background The prevalence of erectile dysfunction  among diabetic men varies between 35–90 % . Although erectile dysfunction is widespread among men with diabetes , the condition often remains undiagnosed and dem and s appropriate assessment and prompt treatment . Erectile dysfunction can affect all aspects of a patient ’s life including physical , emotional , social , sexual , and relationships . The main aim of this study is to determine the prevalence and determinants of erectile dysfunction among diabetic patients attending hospitals in the Central and Northwest zone of Tigray , Ethiopia . Methods A hospital based cross-sectional study was conducted on 249 male diabetic patients attending five hospitals in the Central and Northwestern Zone of Tigray , Ethiopia using systematic r and om sampling . The data was collected from January 1 – February 30 , 2016 and was entered and analyzed using SPSS version 20 . Correlation and multivariate logistic regression was employed to test associations between independent and outcome variables . Results The mean age of study participants was 43.39 years and the mean duration of diabetes diagnosis was 6.22 years . The overall prevalence of erectile dysfunction was 69.9 % , with 32.9 % suffering from mild , 31.7 % moderate , and 5.2 % severe erectile dysfunction . Multivariate logistic regression revealed that erective dysfunction was significantly predicted by old age ( Adjusted Odds Ratio [ AOR ] = 15.013 , CI:3.212–70.166 ) , longer duration of diabetes ( AOR = 3.77 , CI:1.291–11.051 ) , and lower monthly income ( AOR = 0.285 , CI:0.132–0.615 ) . No association was found with body mass index , co-morbidity , glycemic control , and alcohol consumption . Conclusion The prevalence of erective dysfunction in this study population was very high . Age , income , and duration of diabetes were the independent predictors of erectile dysfunction . Nearly all of the patients in the sample ( 97 % ) had not been screened or treated for erectile dysfunction . Assessment and management of erectile dysfunction in the diabetic clinic should be part of routine medical care during follow-up visits with diabetic patients . Healthcare providers should put an emphasis on screening and treating older patients and those who had a diabetes diagnosis for a longer duration We prospect ively examined common coronary artery disease ( CAD ) risk factors ( age , smoking , hypertension , diabetes mellitus , hypercholesterolemia , hypertriglyceridemia , and obesity ) in 570 community-dwelling men , aged 30 to 69 years ( mean age , 46 years ) at baseline . After an average follow-up period of 25 years , incident erectile dysfunction ( ED ) was evaluated by the 5-item International Index of Erectile Function . Age , body mass index , and hypercholesterolemia were each significantly associated with an increased risk of ED . In all , 1 in 5 men had > or =3 risk factors and were at a 2.2-fold increased risk of ED . Improving CAD risk factors in midlife may decrease ED risk as well as CAD risk Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Aim The aim of this study is to investigate the prevalence of  erectile dysfunction ( ED ) in Qatar and to determine the risk factors associated with it . Material s and Methods This is a cross-sectional survey study of men attending the outpatient department at Hamad Medical Corporation in Qatar between February 2012 and February 2013 . The International Index of Erectile Function (IIEF)-5 question naire was used for data collection . In addition to the IIEF-5 score , each participant 's medical history was taken , with special emphasis on risk factors for ED , including diabetes mellitus ( DM ) , hypertension ( HTN ) , dyslipidemia , coronary artery disease ( CAD ) , and smoking habits , and on their body mass index . Results One thous and fifty-two participants were r and omly selected to fill out the IIEF-5 question naire . The participants ' mean age ( ±SD ) was 41.87 ± 13.24 years . Analysis of replies to the IIEF-5 showed that ED was present in 573 out of 1,052 participants ( 54.5 % ) . Fifty-six ( 5 % ) participants had severe ED , 61 ( 6 % ) had moderate ED , 173 ( 16 % ) had mild to moderate ED , and 283 ( 27 % ) had mild ED . Risk factors for ED that held statistical significance were age ( odds ratio [ OR ] = 2.9 , 95 % confidence interval [ CI ] 2.1–4.1 , P < 0.001 ) , DM ( OR = 2.6 , 95 % CI 1.7–3.9 , P < 0.001 ) , HTN ( OR = 1.6 , 95 % CI 1.1–2.5 , P = 0.012 ) , dyslipidemia ( OR = 1.5 , 95 % CI 1.1–2.4 , P = 0.024 ) , and CAD ( OR = 3.2 , 95 % CI 1.3–7.5 , P = 0.009 ) . Conclusion We found that the prevalence rate of ED in Qatar is quite similar to the regional reported rates . Overall , we demonstrated that nearly more than half of our participants suffered from ED . Besides age , DM , HTN , CAD , and dyslipidemia were found to be the most important risk factors for ED . Al N aim i A , Majzoub AA , Talib RA , Canguven O , and Al Ansari A.  Erectile dysfunction in Qatar : Prevalence and risk factors in 1,052 participants —A pilot study . Sex Med 2014;2:91–95 Objective This study investigated sexual functioning in persons with obesity and seeking weight loss , and the associations of sexual functioning with relevant demographic and clinical variables as well as quality of life . Design and Methods Participants were enrolled in a two-year r and omized clinical trial . Participants were 
    Output:
    
Findings from the present study suggest that reducing adiposity is a crucial approach in patients with ED who are affected by obesity