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Background

Overall prosthesis survival is important in penile implant, which remains the final viable solution to many patients with refractory erectile dysfunction (ED). This paper is to retrospectively study the role of the anatomy of tunica albuginea (TA).

Methods

From March 1987 to March 1991 while the TA was regarded as a circumferential single layer, 21 organically ED men, aged from 27 to 77, received penile prosthesis implantation and were allocated to conventional group. From August 1992 to March 2013 while the tip of Hegar’s dilator was categorically directed medial-dorsally during corporal dilatation derived from newfound TA as a bi-layered structure with a 360° complete inner circular layer and a 300° incomplete outer longitudinal coat, 196 ED males, aged from 35 to 83, underwent penile implant and were categorized to advanced group. The model of prosthesis was recorded. Prosthesis loss rate and survival time were analyzed and the follow up period ranged from 22.4-26.4 (average 24.3) years and 0.4-20.6 (average 15.8) years to the conventional and advanced group respectively.

Results

To the conventional and advanced group, the number of inflatable and rigid type prosthesis used were 2, 19 and 15, 181 respectively, whereas the prosthesis loss was encountered in 50.0% (1/2), 15.8% (3/19) and 0.0% (0/15), 0.6% (1/181) respectively. And the prosthesis survival time were 5.1-6.3 (5.7) years, 1.3-26.4 (15.2) years and 6.1-16.2 (11.2) years, 0.4-20.6 (15.3) years to the conventional and advanced group respectively. Statistical significance was noted on prosthesis loss in groups (P=0.01) while the Mentor Acuform stood out in prosthesis survival.

Conclusions

Anatomy-based managing maneuver appears to deliver better surgery success in penile implant. Tunica anatomy is significant in performing implant surgery.  相似文献   
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OBJECTIVE: This study tested the hypothesis that triangulation of two anterior vertebral screws without penetration of the cortex offers more resistance to pullout than two screws placed in parallel and penetrated. DESIGN: The pullout strength for two parallel or two triangulated anterior vertebral screws fixation, with a uni-cortical or bi-cortical purchase, were tested and compared to the strength of a single-screw fixation with a bi-cortical purchase. Four porcine spines (six months old) were used for biomechanical test and bone mineral density was measured for each specimen before testing. BACKGROUND: The potential hazards from penetration by anterior vertebral cortex screws including neurovascular and organs injuries are well documented. However, bi-cortical screw penetration is widely recognized as necessary for good anterior spinal stabilization. The authors are not aware of any biomechanical study on the anterior placement of triangulated vertebral screws without penetration and its effect on the fixation strength of anterior vertebral device remains unclear. METHODS: In this study five modes of screw fixations in lateral vertebral bodies were performed: Group A, triangulated screws with one screw penetration; Group B, triangulated screws without penetration; Group C, parallel penetrating screws; Group D, parallel nonpenetrating screws; and Group E, a single-screw with bi-cortical purchase. Biomechanical analysis with a material testing system machine was performed to determine the pull out strength of each configuration. RESULTS: The results showed that the pullout strength in the various double-screw fixation modes were statistically increased as compared to that of the single-screw with bi-cortical purchase mode. There existed statistical differences (P<0.05) between Groups A and B, Groups C and D and Groups D and E, respectively. However, no significant difference was found between Groups B and C (P=0.144). CONCLUSIONS: Based on the current data, triangulation of two anterior vertebral screws without penetration of the cortex (Group B) achieved pullout strengths similar to that of two-parallel double-cortical screws (Group C). The authors believe that this is an attractive alternative in anterior spinal instrumentation avoiding the potential risks of cortical penetration. However, in the event of pullout failure, the triangulation configuration will produce a more disastrous consequence. RELEVANCE: Triangulation of two anterior vertebral screws without penetration of the cortex achieve pullout strengths similar to that of two-parallel double-cortical screws. This is an attractive alternative in anterior spinal instrumentation that avoids the potential risks of cortical penetration.  相似文献   
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Limited studies have reported on outcomes for lymphoid malignancy patients receiving alternative donor allogeneic stem cell transplants. We have previously described combining CD34-selected haploidentical grafts with umbilical cord blood (haplo-cord) to accelerate neutrophil and platelet engraftment. Here, we examine the outcome of patients with lymphoid malignancies undergoing haplo-cord transplantation at the University of Chicago and Weill Cornell Medical College. We analyzed 42 lymphoma and chronic lymphoblastic leukemia (CLL) patients who underwent haplo-cord allogeneic stem cell transplantation. Patients underwent transplant for Hodgkin lymphoma (n?=?9, 21%), CLL (n?=?5, 12%) and non-Hodgkin lymphomas (n?=?28, 67%), including 13 T cell lymphomas. Twenty-four patients (52%) had 3 or more lines of therapies. Six (14%) and 1 (2%) patients had prior autologous and allogeneic stem cell transplant, respectively. At the time of transplant 12 patients (29%) were in complete remission, 18 had chemotherapy-sensitive disease, and 12 patients had chemotherapy-resistant disease. Seven (17%), 11 (26%), and 24 (57%) patients had low, intermediate, and high disease risk index before transplant. Comorbidity index was evenly distributed among 3 groups, with 13 (31%), 14 (33%), and 15 (36%) patients scoring 0, 1 to 2, and ≥3. Median age for the cohort was 49 years (range, 23 to 71). All patients received fludarabine/melphalan/antithymocyte globulin conditioning regimen and post-transplant graft-versus-host disease (GVHD) prophylaxis with tacrolimus and mycophenolate mofetil. The median time to neutrophil engraftment was 11 days (range, 9 to 60) and to platelet engraftment 19.5 days (range, 11 to 88). Cumulative incidence of nonrelapse mortality was 11.6% at 100 days and 19 % at one year. Cumulative incidence of relapse was 9.3% at 100 days and 19% at one year. With a median follow-up of survivors of 42 months, the 3-year rates of GVHD relapse free survival, progression-free survival, and overall survival were 53%, 62%, and 65%, respectively, for these patients. Only 8% of the survivors had chronic GVHD. In conclusion, haplo-cord transplantation offers a transplant alternative for patients with recurrent or refractory lymphoid malignancies who lack matching donors. Both neutrophil and platelet count recovery is rapid, nonrelapse mortality is limited, excellent disease control can be achieved, and the incidence of chronic GVHD is limited. Thus, haplo-cord achieves high rates of engraftment and encouraging results.  相似文献   
45.
Even in the modern era of targeted therapies, allogeneic hematopoietic stem cell transplantation (allo-HCT) can offer a chance of extended survival in B cell non-Hodgkin lymphoma (B-NHL) patients who relapse after or are deemed ineligible for autologous transplantation. A better understanding of the factors influencing the graft-versus-lymphoma (GVL) response would be useful in identifying B-NHL patients who may benefit from allo-HCT. Based on prior single-center reports, we hypothesized that certain HLA alleles, or haplotypes, may be associated with superior GVL compared with others after allo-HCT. To test this possibility we retrospectively evaluated whether the presence of HLA-A2, HLA-C1C1, HLA-DRB1*01:01, or HLA-DRB1*13 alleles or the presence of HLA-A1+, HLA-A2-, and HLA-B44- haplotypes is associated with outcomes in a cohort of 1314 HLA-8/8 matched sibling or unrelated donor HCT for relapsed/refractory B-NHL. We observed no significant association between any HLA allele or haplotype and overall survival or any of the secondary endpoints. In conclusion, this study represents the largest reported series of allo-HCT outcomes of B-NHL patients based on HLA type. Identification of other variables will be required to delineate the immunologic impact of donor–host interactions on outcomes of allo-HCT for B-NHL.  相似文献   
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Lai  Chih-Yang  Lai  Po-Ju  Tseng  I-Chuan  Su  Chun-Yi  Hsu  Yung-Heng  Chou  Ying-Chao  Yu  Yi-Hsun 《World journal of surgery》2022,46(3):568-576
World Journal of Surgery - Data on the functional outcomes of patients with open pelvic fractures after osteosynthesis are limited, and whether open fracture is a risk factor for worse outcomes, as...  相似文献   
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