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SUMMARY The creation of a sensate, aesthetic, and functional phallus for transmasculine individuals has high reported complication rates. Neourethra reconstruction is the most challenging aspect of this surgery, with widely varying techniques and staging between providers. In an operation of this complexity, surgeons should not be expected to offer all the options, but rather the specific variation that works in their given setting. For some, it is single-stage phalloplasty with full-length urethroplasty. For others, staged phalloplasty with separation of perineal masculinization from phallus reconstruction works better. In this expert opinion article, the authors strive to give an overview of the principles behind, and a detailed explanation of, the technical details of creating the penile and bulbar urethra during phalloplasty. The authors focus on the three most common strategies: single-stage phalloplasty; two-stage phalloplasty with a metoidioplasty-first approach; and two-stage phalloplasty with a phalloplasty-first (Big Ben method) approach. It is not the authors' intent to establish the "best" or "only" way, but rather to compile different options with their respective pros and cons.

Very high resolution satellite images can be used to generate stereoscopic digital elevation models (DEMs), efficiently and at scale, as exemplified by the upcoming CO3D mission, which aims to produce worldwide DEMs by the end of 2025. In this paper we present a deep learning stereo-vision algorithm, integrated in the Stereo Pipeline for Pushbroom Images (S2P) framework. The proposed stereo matching method applies a Siamese convolutional neural network (CNN) to construct a cost volume. A median filter is applied to every slice in the cost volume to enforce spatial smoothness, and another CNN estimates a confidence map which is used to derive the final disparity map. Simulation results on the IARPA dataset show that the proposed method improves completeness by 4.5%, compared to the state of the art. A qualitative assessment also shows that the proposed method generates DEMs with less noise.

INTRODUCTION AND OBJECTIVE:Ring flap urethroplasty is a useful technique for creation of the pars fixa urethra during single stage gender affirming phalloplasty, particularly when significant ureth...

INTRODUCTION AND OBJECTIVE:Urethral strictures and fistulas are common after gender affirming phalloplasty with urethral lengthening. We report our experience in urethroplasty and fistula repairs a...

To investigate the related factors of aseptic necrosis of femoral head after closed reduction and internal fixation of femoral neck fracture.From January 2009 to January 2016, 236 patients with femoral neck fracture were treated with closed reduction and internal fixation with 3 hollow lag screws, including 111 males and 125 females, aged from 19 to 89 (50.17±12.88) years. According to the follow-up results, the correlation of aseptic necrosis of femoral head was analyzed. Univariate analysis of age, gender, injured side, body weight, injury mechanism, preoperative waiting time, Garden classification and whether there was comminution of femoral neck cortex was conducted to obtain the independent variables with significant difference. Then binary logistic regression analysis was conducted to explore the independent risk factors of avascular necrosis of femoral head.The average follow-up period of 236 cases was 4.58 years. There were significant differences in the range of injury (24.69% vs. 5.16%,High energy injury, preoperative waiting time (48 h) and comminution of femoral neck cortex were independent risk factors for aseptic necrosis of femoral head. In addition, cortical comminution on the pressure side and tension side of the femoral neck is a strong prognostic risk factor for aseptic necrosis of the femoral head, because it indicates a more serious and complex injury mechanism.

Using molecular dynamics simulations, we have studied the effects of salt on the association behavior of solute molecules in nanoconfined aqueous solutions. Three types of solute association states – dispersion, reversible and aggregation states – are still observed in nanoconfined aqueous solutions in the presence of salt. With the increase of ion concentration, the tendency toward the formation of larger clusters is enhanced and the solute critical aggregation number decreases. We even found the transformation of solute association state from the dispersion to the reversible state or from the reversible to the aggregation state within an intermediate range of solute number. This phenomenon is similar to the salting out process and is attributed to the decrease of free water molecules induced by the ion polarization.

Aiming at the difficulty of mechanical fault diagnosis with small samples, an intelligent fault diagnosis method for rotating machinery is proposed based on semi-supervised graph convolutional network (SSGCN). SSGCN has a good application in analyzing the naturally formed graph data, but it has not been researched for the complex mechanical vibration data. Besides, SSGCN is only applicable to graph data, but the collected vibration signals are one-dimensional time series. To well reflect the local geometry property between all vibration samples, we construct all vibration samples into an undirected and weighted k-nearest neighbor graph. The detailed parameter analysis is also carried out for SSGCN. Experimental results indicate that our proposed method can adaptively extract the available fault features from the raw vibration signals. Even if the label ratio is only 0.05 for each gear or bearing condition, our proposed method can still obtain an average accuracy of more than 98%.

A novel dual-polarized magneto-electric dipole antenna with wideband performance is presented in this communication. The folded jagged edges of the radiating patch contribute to a better impedance matching, as well as a compact size. The antenna is fed by a crossed coupling structure, thus dual-polarizations and a high port isolation are obtained. A parametric study is performed for providing practical design guidelines. Simulation results show that an impedance bandwidth of 100% for VSWR ≤ 2.0 from 1GHz to 3GHz is achieved. Stable radiation patterns with low crosspolarization levels are also obtained across the operation band.

A numerical technique employing the method of moments (MOM) and physical optics (PO) is presented for studying the scattering from a planar slotted waveguide array antennas. The slot scattering is calculated by MOM. Special attention is paid to the evaluation of the admittance matrix elements, which involve the internal and external mutual coupling. The structural scattering is solved using PO. Numerical results are given to demonstrate the effects of several factors including the number of basis functions , the thickness of waveguide on the radar cross section (RCS) of a slot array. As a check of the method, numerical results are compared with earlier calculations. Agreement has been found to be quite satisfactory.

Autosomal dominant polycystic kidney disease (ADPKD) is a heterogeneous disease caused by mutations in PKD1 and PKD2. The genotype–phenotype correlations are not completely understood. We performed direct PCR-sequencing plus multiplex ligation-dependent probe amplification for PKD1 and PKD2 in 46 unrelated patients. Disease-causing mutations were identified in 30 (65%) patients: 23 (77%) patients have mutations in PKD1 and 7 (23%) have mutations in PKD2. Nonsense, splicing or frame-shifting mutations were found in 18 patients, exon duplication in 1 and missense mutations in 11 patients. Two likely PKD1 hypomorphic alleles (p.Arg2477His and p.Arg3439Trp) segregated with mild disease in a family. A total of 34 mutations were identified and 17 (50%) of which are novel. The median age at onset of dialysis was significantly earlier in patients with PKD1 mutations (52 years) than in patients with PKD2 mutations (65.5 years) and those with an undetermined genotype (67 years) by survival analysis (log-rank test, P=0.014). Patients carrying PKD1-truncating mutations have a trend toward earlier initiation of dialysis compared with carriers of non-truncating mutations (52 years vs 57 years, P=0.061). A family history of dialysis before 55 years was more common in PKD1 patients than in others (P

Female urethral stricture disease is very rare, but can cause bothersome urinary tract symptoms. Because of rarity, knowledge of how to treat true female urethral strictures can be lacking. Strictures can be caused by infection, trauma, instrumentation, or prior urethral surgery. Treatment options vary depending on patient goals and overall health, as well as the location, length, and severity of the stricture. These include serial dilation, internal urethrotomy, or urethroplasty. Local vaginal flaps and buccal free grafts can be used for onlay urethroplasty with good success rates, although many other techniques are described. Pelvic fracture urethral distraction defects (PFUDs) in women are especially rare. Acutely, they may require urgent repair with primary anastomosis (in contradistinction to male PFUDs which are not reanastomosed acutely), and chronic cases may require urethroplasty.

Objective To evaluate the safety and feasibility of same-day anterior urethroplasty at our institution and define predictors of postoperative admission and surgical failure. Methods We retrospectively reviewed the charts of 118 consecutive anterior urethroplasties performed at a tertiary care center. Data were analyzed to detect predictors of postoperative admission and urethroplasty failure. The 30-day complications and long-term outcomes were compared between same-day and admitted patients. Results Ninety-two patients (78%) were discharged on the day of surgery. A penile stricture location compared with a bulbar stricture location (odds ratio: 13.4, P = .009) and having undergone more than 3 prior endoscopic stricture interventions (odds ratio: 10.2, P = .001) were significantly associated with postoperative admission. Patients with a ventral onlay approach were more likely to be discharged home ( P = .03), whereas patients with combined repairs were more likely to be admitted ( P = .04). Same-day urethroplasty did not increase 30-day postoperative complications, patient emergency room visits, unplanned clinic visits, or phone calls. Success rates did not differ between same-day (89%) and admitted (79%) cohorts, and no individual stricture characteristic was predictive of urethroplasty failure. Conclusion Same-day anterior urethroplasty is safe and feasible and could help increase utilization of urethroplasty for urethral stricture disease.

Big data has become a new perspective in education ecosystem research. And the education ecosystem has been changed under the influence of big data. This paper discusses the position of education ecosystem under big data, from education resource, user location, education cooperation, service model, value mining and education environment, and so on. According to educational ecosystem's position, this paper presents strategies and measures of how to construct education ecosystem. Such as: establish the core cultural values, integration of educational resources, legal and regulatory system specification, and innovative talent team structure, and the use of big data IT, and so on.

Bladder reflexes evoked by stimulation of pudendal afferent nerves (PudA-to-Bladder reflex) were studied in normal and chronic spinal cord injured (SCI) adult cats to examine the reflex plasticity. Physiological activation of pudendal afferent nerves by tactile stimulation of the perigenital skin elicits an inhibitory PudA-to-Bladder reflex in normal cats, but activates an excitatory reflex in chronic SCI cats. However, in both normal and chronic SCI cats electrical stimulation applied to the perigenital skin or directly to the pudendal nerve induces either inhibitory or excitatory PudA-to-Bladder reflexes depending on stimulation frequency. An inhibitory response occurs at 3–10 Hz stimulation, but becomes excitatory at 20–30 Hz. The inhibitory reflex activated by electrical stimulation significantly (P

Inhibition of bladder activity by tibial nerve stimulation was investigated in α-chloralose-anesthetized cats with an intact spinal cord. Short-duration (3–5 min) tibial nerve stimulation at both low (5 Hz) and high (30 Hz) frequencies applied repeatedly during rhythmic isovolumetric bladder contractions was effective in inhibiting reflex bladder activity. Both frequencies of stimulation were also effective in inducing inhibition that persisted after the termination of the stimulation. The poststimulation inhibitory effect induced by the short-duration stimulation significantly increased bladder capacity to 181.6 ± 24.36% of the control capacity measured before applying the stimulation. Thirty-minute continuous stimulation induced prolonged poststimulation inhibition of bladder activity, which lasted for more than 2 h and significantly increased bladder capacity to 161.1 ± 2.9% of the control capacity. During the poststimulation periods, 5-Hz stimulation applied during the cystometrogram elicited a further increase (∼30% on average) in bladder capacity, but 30-Hz stimulation was ineffective. These results in cats support the clinical observation that tibial nerve neuromodulation induces a long-lasting poststimulation inhibitory effect that is useful in treating overactive bladder symptoms.

Objective Surgical resection is the standard of care for stage I non–small cell lung cancer. The objective of this study was to evaluate computed tomography–guided radiofrequency ablation as an alternative treatment option for high-risk patients with stage I non–small lung cancer. Methods Patients with medically inoperable stage I non–small lung cancer were offered radiofrequency ablation. Thoracic surgeons evaluated and performed radiofrequency ablation under computed tomographic scanning guidance. Response was assessed by means of computed tomographic and positron emission tomographic scanning. Time to progression and survival were monitored every 3 months. Results Nineteen patients underwent radiofrequency ablation over a 3-year period. There were 8 men and 11 women with a median age of 78 years (range, 68-88 years). Radiofrequency ablation resulted in pneumothorax requiring a pigtail catheter in 12 (63%) patients. An initial complete response was observed in 2 (10.5%) patients, a partial response in 10 (53%) patients, and stable disease in 5 (26%) patients. Early progression occurred in 2 (10.5%) patients. During follow-up, local progression occurred in 8 (42%) nodules, and the median time to progression was 27 months. There were no procedure-related mortalities, and 6 deaths occurred during follow-up. The mean follow-up in the remaining patients was 29 months (range, 9-52 months). The probability of survival at 1 year was estimated to be 95% (95% confidence interval, 0.85-1.0). The median survival was not reached. Conclusion Our experience indicates that radiofrequency ablation is safe in high-risk patients with stage I non–small lung cancer, with reasonable results in patients who are not fit for surgical intervention.

INTRODUCTION AND OBJECTIVES: Transurethral incision of bladder neck contracture (TUIBNC) has high failure rates, prompting concomitant injection of a scar modulator. We present our single institution series of bipolar TUIBNC with immediate mitomycin C (MMC) injection to determine if the combination therapy could improve patency rates. METHODS: Records for all patients who underwent TUIBNC with intralesional MMC at a single institution from 2013e2014 were retrospectively reviewed. Instruments used were the biopolar Gyrus ACMI PK button electrode or PK Plasma-CISE . A total of 2mg of 40% mitomycin C solution was injected in four quadrants of the treated BNC. Postoperatively, patients were monitored for stricture recurrence using a combination of serial postvoid residuals, uroflowometry and flexible cystoscopy. Failure was defined as the need for subsequent intervention. RESULTS: Fifteen patients underwent bipolar TUIBNC with MMC. All were Caucasian males with a median age of 66 years (IQR 6). Etiologies included radical prostatectomy (8), transurethral prostate resection (3), radical cystoprostatectomy (2), and prostate brachytherapy (2). Fourteen (93%) patients had failed at least one prior intervention. Overall, 7 (47%) patients recurred following an initial TUIBNC with MMC at a median follow up of 9.9 months (IQR 9.2). Six of the 7 chose to undergo repeat TUIBNC with MMC, 2 (33%) of whom recurred during median follow up of 7 months (IQR 11). Likelihood of BNC recurrence was not significantly associated with history of prior pelvic radiation (33% vs 56%, p 1⁄4 0.4). Two patients experienced a postoperative complication but no serious adverse events occurred. CONCLUSIONS: Bipolar TUIBNC with MMC injection had lower than expected efficacy with a 10-month failure rate near 50%.

To retrospectively analysis the curative effect of wrist scaphoid bone fracture,and explore the causes and preventive methods of misdiagnosis.From September 2007 to September 2010,16 patients with wrist scaphoid bone fractures were treated with plaster cast and cannulated screws fixation. There were 10 males and 6 females,ranging in age from 26 to 44 years with an average of 35 years. Among them, 12 cases manifested swelling pain of radial lateral wrist, tenderness at snuffbox area, wrist pain aggravated when stretching wrist joint, thumb or forefinger; 4 cases manifested no obviously symptoms and limited movement; 9 cases were early diagnosed; 5 cases were treated by plaster cast; 4 cases were treated with cannulated screws fixation; Among 7 cases with misdiagnosis, there were 4 cases without obvious symptoms and they were dealt with activating blood to dissipate swelling and pain process in preliminary stage. Four cases were treated with plaster cast and 3 cases with cannulated screws fixation.All the patients were followed up from 3 months to 39 months (averaged 21 months). Among 16 patients, 9 cases were early diagnosis, 7 cases were misdiagnosis and the rate of misdiagnosis was 43.8%. Seven cases with screws fixation were no wound infection. There was 1 case with occurred chronic pain and declining wrist mobility in both plaster cast and screw group, and both of them were misdiagnosed. According to curative effect rating criteria,these 2 cases were classified into moderate, other 14 cases were excellent.Wrist scaphoid bone fracture are easy to misdiagnose, so early diagnosis and treatment is particularly important. The main causes of misdiagnosis are nonspecific symptoms at early stage, combination with other injuries, lack of knowledge and ignorance of the further examination. Therefore, detailed inquiries and particular examination, multi-dimensional radiography and CT scan or MRI scan are the main measures for prevention.

To study the clinical efficacy of the endobutton in the treatment of acute acromioclavicular joint dislocation by reconstructing coracoclavicular ligaments.From October 2008 to January 2010,12 patients with acute acromioclavicular joint dislocation were immobilized with the endobutton. All the patients had the dislocations of or above type III according to Rockwood classification. Among the patients, 9 patients were male and 3 patients were female, with an average age of 55 years (ranged from 31 to 83 years). Eight patients had injuries in the left, and 4 patients in the right. Four patients had accompanied injuries of rib fractures, 2 patients had brain injuries,and 1 patient had femoral fracture. Seven patients were injured by traffic accident, 4 patients were injured by falling down,and 1 patient was sports injuries. All the patients had pain and tenderness at the shoulder, positive piano sign, and shoulder confined activity. The duration from injury to operation ranged from 2 days to 10 days (averaged 6 days). The therapeutic effects were evaluated by Karlsson criteria based on range of motion of acromioclavicular joint, subjective feeling,and postoperative X-ray.All the patients were followed up, and the duration ranged from 4 months to 19 months (averaged 11 months). The motion of the shoulder joint recovered to normal about 15 to 35 days after operation. There were no displacement, dislocation and redislocation occurred. All the patients got A degree results according to Karlsson criteria.Reconstruction of coracoclavicular ligament by using the endobutton to treat acute acromioclavicular dislocation of or above type III is a perfect method with advantage of rigid fixation, micro-injury, and early functional exercise.

Epithelioid hemangioendothelioma (EHE) is a rare vascular tumor of low malignant potential most commonly found in the lung, liver, and soft tissues. Here we describe the very rare presentations of primary EHE in the kidney and on the penis. One patient is a 59-year-old man with a renal lesion found incidentally on surveillance radiography, and the other is a 26-year-old man with an asymptomatic subdermal glanular lesion. Both were treated surgically via open partial nephrectomy and partial penectomy, respectively. Surgery is standard treatment, and close clinical follow up is necessary due to the unpredictable nature of EHE.

The characteristics of reverse logistics make the inventory management issues very complex. Once shortage happens, the reverse logistics network nodes will have insufficient workload even stop work. The previous studies about shortage more established on the assumptions of complete backlogging or complete losing, but the partial backlogging problem is less discussed. So this study develops a partial backlogging reverse logistics inventory model, and proposes a new algorithm to minimize the total cost. Finally, a practical example of the numerical analysis is given.

We investigated the effects of tibial nerve stimulation on bladder overactivity induced by acetic acid irritation.Cystometry was performed in 10 α-chloralose anesthetized female cats by infusing saline or acetic acid through a urethral catheter that was secured by a ligature around the urethra. Intravesical infusion of 0.25% acetic acid was used to irritate the bladder and induce bladder overactivity. Multiple cystometrograms were done before, during and after tibial nerve stimulation to determine the inhibitory effect on the micturition reflex.Infusion of 0.25% acetic acid irritated the bladder, induced bladder overactivity and significantly decreased bladder capacity to about 20% of control capacity measured during saline infusion. Tibial nerve stimulation at low (5 Hz) or high (30 Hz) frequency significantly increased bladder capacity to about 40% of saline control capacity when it was applied during acetic acid infusion cystometrogram. Bladder contraction amplitude was smaller during acetic acid irritation than during saline distention due to significantly smaller bladder capacity. Tibial nerve stimulation at 5 Hz increased bladder capacity and bladder contraction amplitude.Activation of somatic afferents in the tibial nerve of cats can partially reverse the bladder overactivity induced by intravesical administration of a chemical irritant that activates C-fiber afferent nerves. These data are consistent with clinical studies showing that tibial nerve neuromodulation is effective treatment for overactive bladder symptoms.

Nephroureterectomy alone fails to adequately treat many patients with advanced upper tract urothelial carcinoma (UTUC). Perioperative platinum-based chemotherapy has been proposed but requires adequate renal function.Our aim was to determine whether the ability to deliver platinum-based chemotherapy following nephroureterectomy is affected by postoperative changes in renal function.We retrospectively reviewed data on 388 patients undergoing nephroureterectomy for UTUC between 1991 and 2009. Four institutions were included.All patients underwent nephroureterectomy.All patients had serum creatinine measured before and after surgery. The value closest to 3 mo after surgery was taken as the postoperative value (range: 2-52 wk). Estimated glomerular filtration rate (eGFR) was calculated using the abbreviated Modification of Diet in Renal Disease study equation. eGFR values before and after surgery were compared using the paired t test. We chose an eGFR of 45 and 60 ml/min per 1.73 m(2) as possible cut-offs for chemotherapy eligibility and compared eligibility before and after surgery using the chi-square test.Our cohort of 388 patients included 233 men (60%) with a median age of 70 yr. Mean eGFR decreased by 24% after surgery. Using a cut-off of 60 ml/min per 1.73 m(2), 49% of patients were eligible for chemotherapy before surgery, but only 19% of patients remained eligible postoperatively. Using a cut-off of 45 ml/min per 1.73 m(2), 80% of patients were eligible preoperatively, but only 55% remained eligible after surgery. This distribution persisted when we limited the analysis to patients with advanced pathologic stage (T3 or higher). Patients older than the median age of 70 yr were more likely to be ineligible for chemotherapy both pre- and postoperatively by either definition, and they were significantly more likely to have an eGFR45 ml/min per 1.73 m(2) postoperatively, regardless of their starting eGFR. This study is limited by its retrospective nature, and there was some variability in the timing of postoperative serum creatinine measurements.eGFR is significantly diminished after nephroureterectomy, particularly in elderly patients. These changes in renal function likely affect eligibility for adjuvant cisplatin-based therapy. Accordingly, we suggest strong consideration of neoadjuvant regimens.

The incidence of esophageal cancer has increased dramatically in the Western population in the last two decades. Many of these patients tend to present late in the disease course with symptoms of dysphagia and malnutrition. Thus a majority of patients at presentation may require palliation of their symptoms. Lung cancer is the most common cause of cancer related mortality in the United States. Similar to esophageal cancer, many patients present in advanced stages where surgical resection for cure may not be an option. Endobronchial obstruction from both primary and metastatic neoplasm causes significant morbidity. The modalities, which are currently available for palliation of symptoms include surgery, photodynamic therapy, dilation, external beam radiation, stents, Nd:YAG laser therapy, and brachytherapy. Each of these modalities has their specific advantages and drawbacks. In this article, we discuss the role of photodynamic therapy in the palliation of esophageal and lung cancer.