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Background Open surgical treatment of short bulbar urethral strictures (urethroplasty) is commonly performed as transecting excision and primary anastomosis (tEPA) or buccal mucosa grafting (BMG). Erectile dysfunction and penile complications have been reported, but there is an absence of randomised trials. Objective To evaluate sexual dysfunction and penile complications after urethroplasty with tEPA versus BMG. Design, setting, and participants Centres in Finland, Sweden and Norway participated. Patients with a bulbar urethral stricture of ≤2 cm without previous urethroplasty were randomised. The primary endpoints were the degree of erectile dysfunction and penile complications. Follow-up was 12 mo. Intervention Patients were randomised to either tEPA or BMG urethroplasty. Outcome measurements and statistical analysis Sexual dysfunction was measured using the International Index of Erectile Function, 5-item version (IIEF-5) and a penile complications questionnaire (PCQ) designed for this study. Continuous data were analysed using analysis of covariance and categorical data were compared using a χ2 test. Results and limitations A total of 151 patients were randomised to either tEPA (n = 75) or BMG (n = 76). The tEPA group reported more penile complications (p = 0.02), especially reduced glans filling (p = 0.03) and a shortened penis (p = 0.001). There were no differences in postoperative IIEF-5 total scores. Recurrence rates were similar in both groups (12.9%) but the study was not designed to detect differences in recurrence rates. The PCQ is not validated, which is a limitation. Conclusions More patients reported penile complications after urethroplasty with tEPA than with BMG. This should be considered when choosing the operative method, and patients should be informed accordingly. Patient summary This study compared two common operations for repair of narrowing of the male urethra. Neither of the two methods seems to cause worsened erections. However, penile problems are more common after the transection technique than after the grafting technique.

INTRODUCTION AND OBJECTIVE:The most common methods of bulbar urethral stricture surgery are resection and primary anastomosis or augmentation with onlay buccal mucosal graft. The effects on sexual ...

The aim of this study was to assess whether sclerosis in histology following bulbar urethroplasty is a predictive factor for failure of surgery.Resected stricture specimens from 45 patients undergoing open urethroplasty with excision and anastomosis were collected prospectively during 2011-2014. Histopathological characteristics, including fibrosis (grade I-III), inflammation and sclerosis, were evaluated using different routine staining. These specimens were compared to normal urethral resection specimens from patients undergoing sex-correction surgery. The uropathologist who conducted the analyses was blinded to the study design.The outcomes of the histological classifications were as follows: 19 patients had grade I fibrosis, of whom three had failures; 13 patients had grade II fibrosis, without any failures; and the most severe fibrosis, grade III, including sclerosis, was found in 13 patients (11 with sclerosis), with failure in eight. Sclerosis was a significant risk factor for restricture when comparing patients with sclerosis and those without sclerosis, and likewise when adjusting for age, inflammation and stricture length.Histological findings of sclerosis in the resected urethral stricture specimen indicate a significantly higher risk for restricture after urethroplasty surgery.

Even though more than 30 years have passed since the eradication of smallpox, high titers of smallpox-specific antibodies are still detected in the blood of subjects vaccinated in childhood. In fact, smallpox-specific antibody levels are maintained in serum for more than 70 years. The generation of life-long immunity against infectious diseases such as smallpox and measles has been thoroughly documented. Although the mechanisms behind high persisting antibody titers in the absence of the causative agent are still unclear, long lived plasma cells (LLPCs) play an important role. Most of the current knowledge on LLPCs is based on experiments performed in mouse models, although the amount of data derived from human studies is increasing. As the results from mouse models are often directly extrapolated to humans, it is important to keep in mind that there are differences. These are not only the obvious such as the life span but there are also anatomical differences, for instance the adiposity of the bone marrow (BM) where LLPCs reside. Whether these differences have an effect on the function of the immune system, and in particular on LLPCs, are still unknown. In this review, we will briefly discuss current knowledge of LLPCs, comparing mice and humans.

Urethral stricture is a common disease that is characterised by fibrotic tissue arising from inflammation after urethral injury. Urination is inhibited when there is total obstruction, and the suffering is immense. Following the paradigm shift in treatments, from internal urethrotomy to open urethroplasty surgery, different surgical techniques have emerged. The aims of this thesis were to assess the outcomes of different reconstructive surgical techniques, including redo surgery, and to analyse the histopathology of urethral stricture disease. All consecutive patients subjected to urethroplasty at Sahlgrenska University Hospital during the period 1999–2014 were identified and data were retrieved from their medical charts. Papers I-III were retrospective studies and Paper IV was prospective. All the patients were subjected to a follow-up regimen of 3, 12, and 24 months, and more if deemed necessary. If the patient was satisfied with his micturition after 2 years of follow-up, he was discharged from follow-up and instructed to come back if micturition problems should re-appear. Failure or restricture were in all the studies defined as the need for a new surgical intervention, such as dilatation, internal urethrotomy, or a redo urethroplasty. For bulbar strictures, treated with either transection with excision followed by anastomosis (EA) or using a graft as an onlay, Paper I reported success rates of 91% and 71%, respectively, with a low risk of sexual dysfunction. This indicates that EA is a feasible method for treating bulbar strictures. In Paper II, penile strictures were studied; they were treated with one- and two-stage substitution urethroplasty, (SU) with success rates of 65% and 72%, respectively. Limited clinical experience, obesity and previous urethral surgery emerged as predictors for less favourable outcome. In Paper III, 195 re-interventions performed for 82 failures out of 407 consecutive primary urethroplasties, were analysed. EA and SU were equally successful interventions for bulbar restrictures. Twenty percent of the patients were cured with one single direct vision internal urethrotomy. After one or up to seven re-interventions in each patient, 18 patients remained as failures at the study end-point date, yielding an overall success rate of 78%. The most complex cases involved redo surgery for penile restrictures, these complicated strictures probably need to be centralised at a specialised clinic, to ensure an optimal outcome. Paper IV the histological findings of the resected part of the urethral stricture were analysed. The fibrosis was classified into Grades I–III, where III involved sclerosis. The occurrence of severe fibrosis with sclerosis was a strong predictor of failure after EA surgery for bulbar strictures. In summary, transection and non-transection surgical procedures entail low rates of sexual dysfunction. Overall, bulbar strictures have a higher success rate than penile strictures, the latter being the most complex ones. Two-stage procedures, involving grafting of buccal mucosa, appear to be the most successful treatment for penile strictures. There are several risk factors associated with urethroplasty surgery. Redo surgery was a relatively rewarding treatment in this cohort, even though several re-interventions were needed to achieve a satisfactory outcome. Sclerosis is a risk factor for failure of urethroplasty in bulbar strictures. The establishment of a classification system for fibrosis pave the way for extended investigations into the origin how strictures develop on the cellular level, as well as novel therapeutic regimens.

Multi-Processor Systems on Chip (MPSoC) run multiple independent applications, often developed by different parties. The applications share the hardware resources, e.g. processors, memories and interconnect. The sharing typically causes interference between the applications, which severely complicates system integration and verification. Even if the applications are verified in isolation, the system designer must verify the combined behaviour, leading to an explosion in design complexity. Composable MPSoCs have no interference between applications, thus allowing independent design and verification. For an MPSoC to be composable, all the hardware resources must offer composability. A particularly challenging resource is the processors, often purchased as off-the-shelf intellectual property. In this work we present the design and implementation of CompOSe, a light-weight (only 1500 lines of code) composable operating system for MPSoCs. CompOSe uses fixed-size time slices, coupled with a composable scheduler, to enable composable processor sharing. Using instances of ARM7, ARM11 and the Xilinx MicroBlaze we experimentally demonstrate the ability to provide temporal composability, even in the presence of dynamic application behaviour and multiple use cases. We do so using a diverse set of processor architectures, without requiring any hardware modifications. We also show how CompOSe allows slack to be distributed within and between applications through a novel two-level scheduler and slack-distribution system.