The corporo-glans ligament: description and functional significance of a ligament connecting the corpora cavernosa to the glans penis

The two corpora cavernosa (CC) end blindly under cover of the glans penis (GP). The method of attachment of the CC to the GP could not be traced in the literature. The current communication investigated the hypothesis of a ligamentous attachment existing between the two corporal ends and the GP. In all, 18 male cadaveric specimens were studied by direct dissection and histologically. Six were neonates and 12 adults (mean age 32.3+/-10.6 s.d. y). After examining and photographing the connection between the CC and GP, sagittal, parasagittal, and coronal sections of the connection were stained and studied microscopically. A triangular fibrous tissue band connected the distal blind ends of the two CC with the GP. The base of this band was attached to the tunica albuginea of the two CC, while the apex was continuous with the fibrous septa between the sinusoids of the cavernous tissue of the GP. Microscopically, the ligament consisted of collagen and elastic fibers; in some sections, the collagen fibers of the tunica albuginea were continuous with those of the band. A band of collagen and elastic fibers could be identified connecting the two CC to the GP; we term it the 'corporo-glans ligament'. This ligament presumably affords the connection with rigidity, flexibility, and tissue strength. We suggest that it firmly connects the GP to the CC during penile thrusting. Further studies are required to assess the possible role of this ligament in erectile dysfunction.     

Extracardiac reconstruction of anomalous superior systemic venous return

A heretofore undescribed surgical approach for correcting a rare congenital cardiac malformation consisting of an absent right superior vena cava with persistent left superior vena cava associated with situs solitus draining into the left atrium is presented. The intra-atrial septum was intact. Normal anatomy was achieved and recovery was uneventful.     

Indirect fabrication of multiple post-and-core patterns with a vinyl polysiloxane matrix

In the described technique, a vinyl polysiloxane material is used as a matrix for the indirect fabrication of multiple custom-cast posts and cores. The matrix technique enables the clinician to fabricate multiple posts and cores in a short period of time. The form, harmony, and common axis of preparation for all cores are well controlled before the definitive crown/fixed partial denture restorations are fabricated. Oral tissues are not exposed to the heat of polymerization or the excess monomer of the resin material when this technique is used.     

British women's choice between sentinel node biopsy and axillary node clearance for breast cancer

BACKGROUND: Recent studies have demonstrated that the sentinel node biopsy (SNB), which utilises a simple principle, is a reliable and minimally invasive method for determining the status of the regional lymph nodes in patients with clinically node-negative breast cancer. The technique is increasingly being used in the management of patients with early breast cancer despite the lack of long-term data from randomised controlled trials which are currently in progress. However, increasing numbers of breast cancer patients are specifically requesting SNB in order to avoid axillary nodal clearance (ANC) if the sentinel node is negative for malignancy. The aim of this study is to determine the proportion of female patients attending a breast unit who would choose the SNB in preference to ANC. METHODS: A detailed questionnaire, based on a utility analysis and containing clear and precise information on arm morbidity associated with ANC (1 in 10) versus a potential reduction in the 5-year-survival rate with SNB (1 in 1000) was distributed to 200 female patients attending the Princess Grace Hospital Breast Unit (London, UK) during January 2003. The questionnaire consisted of two possible treatment scenarios (ANC or SNB) for early-stage breast cancer with their associated risks and benefits, and participants were asked to choose one of the two options. RESULTS: A total of 200 completed questionnaires were received. Out of the 200 women, 99 (49.5%) chose the SNB option and 101 (50.5%) chose the ANC option. There is no significant relationship between the option made with a woman's age (mean age: 53.4 vs 54), family history of breast cancer (p = 0.118), personal history of breast cancer (p = 0.85), or employment status (p = 0.96). CONCLUSION: This study demonstrates that a high level of acceptance exists among women for SNB as an alternative to ANC as the preferred treatment of early breast cancer, despite the risk involved. As this exciting technique continues to evolve and improve, it is hoped that more women will be given the choice to opt for this treatment and that eventually SNB may completely replace ANC as the standard treatment for early breast cancer.     

Chemoprophylaxis during transrectal prostate needle biopsy: critical analysis through randomized clinical trial

Purpose

To compare the efficacy of three chemoprophylaxis approaches in prevention of post-transrectal biopsy infectious complications (TBICs).

Methods

Patients were randomly assigned to receive ciprofloxacin 3 days 500 mg B.I.D 3 days starting the night prior to biopsy (standard prophylaxis), augmented prophylaxis using ciprofloxacin and single preprocedure shot of 160 mg gentamicin IM (augmented prophylaxis) and rectal swab culture-based prophylaxis (targeted prophylaxis). Patients were assessed 2 weeks prior to biopsy, at biopsy and 2 weeks after. Primary end point was occurrence of post-TBICs that included simple UTI, febrile UTI or sepsis. Secondary end points were post-biopsy change in the inflammatory markers (TLC, ESR and CRP), unplanned visits, hospitalization and occurrence of fluoroquinolones resistance (FQ-R; bacterial growth on MacConkey agar plate with 10 μg/ml ciprofloxacin) in the fecal carriage of screened men.

Results

Between April/2015 and January/2017, standard, augmented and targeted prophylaxes were given to 163, 166 and 167 patients, respectively. Post-TBICs were reported in 43 (26%), 13 (7.8%) and 34 (20.3%) patients following standard, augmented and targeted prophylaxes protocols, respectively (P?=?0.000). Post-TBICs included UTI in 23 (4.6%), febrile UTI in 41 (8.2%) and sepsis in 26 (5.2%) patients. Significantly lower number of post-biopsy positive urine culture was depicted in the augmented group (P?=?0.000). The number of biopsy cores was statistically different in the three groups (P?=?0.004). On multivariate analysis, augmented prophylaxis had independently lower post-TBICs (OR 0.2, 95% CI 0.1–0.4, P?=?0.000) when compared with the other two groups regardless of the number of biopsy cores taken (OR 1.07, 95% CI 0.95–1.17, P?=?0.229). Post-biopsy hospitalization was needed in four (2%), one (0.6%) and ten (6%) patients following standard, augmented and targeted prophylaxes, respectively (P?=?0.014). However, sepsis-related hospitalization was not statistically different. Post-biopsy changes in the inflammatory markers were significantly less in augmented prophylaxis (P?<?0.05). FQ-R was depicted in 139 (83.2%) of the screened men.

Conclusion

Augmented prophylaxis with single-dose gentamicin is an effective and practical approach. Targeted prophylaxis might be reserved for cases with contraindication to gentamicin.

     

Frequencies of FoxP3+ naive T cells are related to both viral load and naive T cell proliferation responses in HIV disease

HIV infection results in depletion and dysfunction of na?ve CD4(+) T cells. The mechanisms underlying these deficiencies are not understood. We investigated the frequencies of CD4(+) na?ve subsets in HIV disease as defined by expression of CD25 and/or FoxP3 and the relationship of these frequencies to na?ve T cell proliferation function. We observed increased proportions of CD25(+)FoxP3(+) and CD25(+)FoxP3(-) cells and decreased proportions of CD25(-)FoxP3(-) cells within the na?ve CD4(+) cell compartment from HIV-infected persons compared with findings in healthy donors. These perturbations were related to higher plasma HIV RNA levels but not with higher immune activation, as measured by the proportions of CD38(+) memory CD4(+) T cells. Na?ve T cell proliferation responses to mitogen stimulation were inversely related to the frequencies and absolute numbers of FoxP3(+) na?ve T cells. MDA, a marker of oxidative stress, and sCD14, a marker of monocyte activation and a surrogate for microbial translocation, were increased in serum samples from HIV(+) donors; however, neither marker was related to na?ve T cell function in HIV(+) donors. These observations suggest that alterations in na?ve T cell subset frequencies could contribute to na?ve T cell dysfunction in HIV disease, but these alterations are not necessarily the result of chronic immune activation.     

Achieving behavioral control with millisecond resolution in a high-level programming environment

The creation of psychophysical tasks for the behavioral neurosciences has generally relied upon low-level software running on a limited range of hardware. Despite the availability of software that allows the coding of behavioral tasks in high-level programming environments, many researchers are still reluctant to trust the temporal accuracy and resolution of programs running in such environments, especially when they run atop non-real-time operating systems. Thus, the creation of behavioral paradigms has been slowed by the intricacy of the coding required and their dissemination across labs has been hampered by the various types of hardware needed. However, we demonstrate here that, when proper measures are taken to handle the various sources of temporal error, accuracy can be achieved at the 1ms time-scale that is relevant for the alignment of behavioral and neural events.