Amorphizing MnIn2S4 Atomic Layers Create an Asymmetrical InO1S5 Polarization Plane for Photocatalytic Ammonia Synthesis and CO2 Reduction.

Building a polarization center is an effective avenue to boost charge separation and molecular activation in photocatalysis. However, a limited number of polarization centers are usually created. Here, a polarization plane based on two-dimensional (2D) atomic layers is designed to maximize the surface polarization centers. The Mn in a 2D crystal lattice is etched from the MnIn2S4 atomic layers to build a consecutive symmetry-breaking structure of isolated InO1S5 sites. More charges aggregate around O, making the isolated InO1S5 sites highly polarized. Due to the formation of the InO1S5 polarization plane, an enormous polarized electric field is formed perpendicular to the 2D atomic layers and the carrier lifetime can be prolonged from 93.2 ps in MnIn2S4 to 1130 ps in amorphous MnxIn2Sy. Meantime, the formed large charge density gradient favors coupling and activation of small molecules. Benefiting from these features, a good NH3 photosynthesis performance (515.8 µmol g-1 h-1) can be realized over amorphous MnxIn2Sy, roughly 2.5 and 48.9 times higher than those of MnIn2S4 atomic layers and bulk MnIn2S4, respectively. The apparent quantum yields reach 5.4 and 3.3% at 380 and 400 nm, respectively. Meanwhile, a greatly improved CO2 reduction activity is also achieved over MnxIn2Sy. This strategy provides an accessible pathway for designing an asymmetrical polarization plane to motivate photocatalysis optimization.

Nitrogen-Doped 3D-Graphene Advances Near-Infrared Photodetector for Logic Circuits and Image Sensors Overcoming 2D Limitations.

The limitations of two-dimensional (2D) graphene in broadband photodetector are overcome by integrating nitrogen (N) doping into three-dimensional (3D) structures within silicon (Si) via plasma-assisted chemical vapor deposition (PACVD) technology. This contributes to the construction of vertical Schottky heterojunction broad-spectrum photodetectors and applications in logic devices and image sensors. The natural nanoscale resonant cavity structure of 3D-graphene enhances photon capture efficiency, thereby increasing photocarrier generation. N-doping can fine-tune the electronic structure, advancing the Schottky barrier height and reducing dark current. The as-fabricated photodetector exhibits exceptional self-driven photoresponse, especially at 1550 nm, with an excellent photoresponsivity (79.6 A/W), specific detectivity (1013 Jones), and rapid response of 130 µs. Moreover, it enables logic circuits, high-resolution pattern image recognition, and broadband spectra recording across the visible to near-infrared range (400-1550 nm). This research will provide new views and technical support for the development and widespread application of high-performance semiconductor-based graphene broadband detectors.

Accelerated deprotonation with a hydroxy-silicon alkali solid for rechargeable zinc-air batteries.

Transition metal oxides are promising electrocatalysts for zinc-air batteries, yet surface reconstruction caused by the adsorbate evolution mechanism, which induces zinc-ion battery behavior in the oxygen evolution reaction, leads to poor cycling performance. In this study, we propose a lattice oxygen mechanism involving proton acceptors to overcome the poor performance of the battery in the OER process. We introduce a stable solid base, hydroxy BaCaSiO4, onto the surfaces of PrBa0.5Ca0.5Co2O5+δ perovskite nanofibers with a one-step exsolution strategy. The HO-Si sites on the hydroxy BaCaSiO4 significantly accelerate proton transfer from the OH* adsorbed on PrBa0.5Ca0.5Co2O5+δ during the OER process. As a proof of concept, a rechargeable zinc-air battery assembled with this composite electrocatalyst is stable in an alkaline environment for over 150 hours at 5 mA cm-2 during galvanostatic charge/discharge tests. Our findings open new avenues for designing efficient OER electrocatalysts for rechargeable zinc-air batteries.

Rational design of a ratiometric fluorescent probe for imaging lysosomal nitroreductase activity.

Overexpressed nitroreductase (NTR) is often utilized to evaluate the hypoxic degree in tumor tissues, thus it is of great importance to develop high selective and efficient optical method to detect NTR. The dynamic fusion and function of lysosome promoted us to explore the possible appearance of NTR inside this organelle and to probe its behavior in a cellular context. In this work, a ratiometric fluorescent probe based on an extended π-π conjugation of a triphenylamine unit was designed for NTR detection and lysosomes imaging. The dual-emission mechanism of the probe in the presence of catalytic NTR was confirmed by theoretical study. The structure-function relationship between probe and NTR was revealed by docking calculations, suggesting a suitable structural and spatial match of them. The photophysical studies showed the probe had high selectivity, rapid response and a wide pH range towards NTR. MTT assay indicated the probe had low cytotoxicity in both normal (HUVEC) and tumor (MCF-7) cells. Furthermore, the inverse fluorescent imaging results confirmed the probe was NTR-active and exhibited time- and concentration-dependent fluorescence signals. In addition, the relatively high Pearson's correlation coefficient (0.99 in HepG2 and 0.97 in MCF-7 cells, compared to Lyso-Tracker Red) demonstrated the probe had excellent lysosomes colocalization. This study illustrates a ratiometric detection of NTR agent for lysosomes fluorescent imaging, which may provide a novel insight in molecular design.

Learning task-agnostic and interpretable subsequence-based representation of time series and its applications in fMRI analysis.

The recent success of sequential learning models, such as deep recurrent neural networks, is largely due to their superior representation-learning capability for learning the informative representation of a targeted time series. The learning of these representations is generally goal-directed, resulting in their task-specific nature, giving rise to excellent performance in completing a single downstream task but hindering between-task generalisation. Meanwhile, with increasingly intricate sequential learning models, learned representation becomes abstract to human knowledge and comprehension. Hence, we propose a unified local predictive model based on the multi-task learning paradigm to learn the task-agnostic and interpretable subsequence-based time series representation, allowing versatile use of learned representations in temporal prediction, smoothing, and classification tasks. The targeted interpretable representation could convey the spectral information of the modelled time series to the level of human comprehension. Through a proof-of-concept evaluation study, we demonstrate the empirical superiority of learned task-agnostic and interpretable representation over task-specific and conventional subsequence-based representation, such as symbolic and recurrent learning-based representation, in solving temporal prediction, smoothing, and classification tasks. These learned task-agnostic representations can also reveal the ground-truth periodicity of the modelled time series. We further propose two applications of our unified local predictive model in functional magnetic resonance imaging (fMRI) analysis to reveal the spectral characterisation of cortical areas at rest and reconstruct more smoothed temporal dynamics of cortical activations in both resting-state and task-evoked fMRI data, giving rise to robust decoding.

Polymer-Unit Fingerprint (PUFp): An Accessible Expression of Polymer Organic Semiconductors for Machine Learning.

High-performance organic semiconductors (OSCs) can be designed based on the identification of functional units and their role in the material properties. Herein, we present a polymer-unit fingerprint (PUFp) generation framework, "Python-based polymer-unit-recognition script" (PURS), to identify the subunits "polymer unit" in the polymer and generate polymer-unit fingerprint (PUFp). Using 678 collected OSC data, machine learning (ML) models can be used to determine structure-mobility relationships by using PUFp as a structural input, and the classification accuracy reaches 85.2%. A polymer-unit library consisting of 445 units is constructed, and the key polymer units affecting the mobility of OSCs are identified. By investigating the combinations of polymer units with mobility performance, a scheme for designing OSCs by combining ML approaches and PUFp information is proposed. This scheme not only passively predicts OSC mobility but also actively provides structural guidance for high-mobility OSC material design. The proposed scheme demonstrates the ability to screen materials through pre-evaluation and classification ML steps and is an alternative methodology for applying ML in high-mobility OSC discovery.

Atractylodes macrocephala-Paeonia lactiflora Class Formula for the Treatment of Irritable Bowel Syndrome: A Systematic Review With Meta-Analysis and Trial Sequential Analysis.

Previous meta-analyses suggested that Chinese herbal medicine (CHM) is effective for irritable bowel syndrome (IBS). Formulas with Atractylodes macrocephala and Paeonia lactiflora as the core pairs have been widely used by traditional Chinese medicine (TCM) practitioners for the treatment of IBS. We aimed to examine the efficacy and safety of the Atractylodes macrocephala-Paeonia lactiflora class formula (A-P CHM) for IBS through a meta-analysis and trial-sequential analysis (TSA). The protocol is registered in the International Prospective Register of Systematic Reviews (PROSPERO) under registration number CRD42023439087. We searched seven databases for data up to May 23, 2023. The primary outcome was global IBS symptom relief. The secondary outcomes included the IBS severity scoring system (IBS-SSS) score and treatment-related adverse events. The relative ratio (RR) (dichotomous variables), the standardized mean difference (SMD) (continuous variables), the number needed to treat (NNT), the number needed to harm (NNH), and the required information size (RIS) were calculated. Twenty-four eligible articles with 3,768 participants were included. Thirteen trials were at low risk of bias (RoB). Compared with placebo or Western medication, A-P CHM was associated with a significantly higher proportion of relief of global IBS symptoms. The TSA analysis verified the primary outcome. For the secondary outcome, the A-P CHM IBS-SSS score was lower than Western medication or placebo at the end of the treatment, which was further confirmed by the TSA analysis. We asserted that A-P CHM might be a potential candidate for patients with IBS, especially for IBS-D. It may provide a theoretical basis for future optimization of irritable bowel syndrome with diarrhea (IBS-D) herbal formulas. The overall certainty of the evidence was not high; more tightly designed randomized controlled trials (RCTs) are required in the future.

[Clinical effects of acupoint catgut embedding with quadruple therapy on Hp (+) chronic atro-phic gastritis of spleen and stomach deficiency syndrome].

OBJECTIVE: To evaluate the clinical effects of acupoint catgut embedding combined with quadruple therapy on Helicobacter pylori (Hp)-positive (+) chronic atrophic gastritis (CAG) of spleen and stomach deficiency syndrome and explore the underlying mechanism. METHODS: Hp (+) CAG patients with spleen and stomach deficiency syndrome were randomly divi-ded into a control group (n=68) and a treatment group (n=71). In addition to the routine quadruple therapy for two weeks, the patients in the control group received oral Weifuchun Tablets (4 tablets once, tid.), and those in the treatment group underwent acupoint catgut embedding at Pishu (BL20), Weishu (BL21), Zhongwan (CV12), and Zusanli (ST36), once a week. The two groups were treated for three months in total. The scores of traditional Chinese medicine (TCM) symptoms and signs, clinical efficacies, quality of life scale scores (PRO scores and HAMA scores), endoscopic and histopathologic scores, Hp eradication rates detected by 13C breath test, and the recurrence rates after six months of the two group were compared. The changes in serum gastrin 17 (G-17), pepsinogen Ⅰ (PGⅠ) and pepsinogen Ⅱ (PGⅡ) were detected by ELISA, and PGⅠ/PGⅡ was calculated. RESULTS: There was no significant difference in the eradication rate of Hp between the two groups after treatment (P>0.05), but the recurrence rate after six months in the treatment group was lower than that of the control group (P<0.05). After treatment, the scores of TCM symptoms and signs, endoscopic and histopathologic scores, PRO scores, and HAMA scores were decreased in both groups (P<0.01), while serum levels of G-17, PG Ⅰ, PG Ⅱ, and PG Ⅰ/PG Ⅱ were increased (P<0.05, P<0.01). The treatment group was superior to the control group in alleviating stomach discomfort by pressing or warmth, decreasing the total score of TCM symptoms and signs, relieving anorexia, mottled gastric mucosa, mucosal ulcer, chronic inflammation, and activity, improving anxiety, and regulating G-17 (P<0.05, P<0.01). The effective rates of the treatment group and the control group were 40.85% (29/71) and 23.53% (16/68)，the treatment group was higher than the control group (P<0.05). CONCLUSION: Acupoint catgut embedding combined with quadruple therapy in the treatment of Hp (+) CAG of spleen and stomach deficiency syndrome is significant in clinical efficacy and low in recurrence rate, which is presumedly achieved by repairing gastric mucosa and sensitizing the secretion of G-17 and pepsinogen.

Efficacy and safety assessment of glandular augmentation with hyaluronic acid for premature ejaculation.

Glandular augmentation (GA) with hyaluronic acid (HA) is a newly developed, minimally invasive therapy for patients with premature ejaculation (PE); however, evidence supporting its efficacy is scarce. To provide a comprehensive profile of GA with HA gel in managing PE, 184 patients with PE who received GA with HA gel therapy from October 2017 to November 2019 were included and followed up for 1 year. The Fan technique was applied. Intravaginal Ejaculation Latency Time (IELT), Chinese Index of Premature Ejaculation-5(CIPE-5) and Visualised Satisfaction Index (VSI) of sexual experience were assessed at initial and 1-, 3-, 6- and 12-month post injection. A total of 71 patients with primary PE (pPE, 38.6%) and 113 patients with acquired PE (aPE, 61.4%) were enrolled. The mean IELT increased to 100.7 ± 43.2 s(p < .05) for pPE patients and 359.2 ± 87.1 s (p < .05) for aPE patients 1-month post injection and remained significantly higher at the end point with acceptable attenuation. The mean CIPE-5 score increased to 17.6 ± 6.4 (p < .05) in the 1st month and remained steady. The VSI scores increased to 6.6 ± 1.0 (p < .05) for patients with pPE and 7.7 ± 1.2 (p < .01) for patients with aPE. Increments in VSI in patients with aPE were significantly higher than those in patients with pPE (p < .01). No severe complications were noted. GA with HA may be an effective and safe method to treat PE. Patients with acquired PE were also more satisfied post treatment.

Penile augmentation with injectable hyaluronic acid gel: an alternative choice for small penis syndrome.

There is no well-established procedure for the management of small penis syndrome (SPS), especially when psychological interventions fail. This study aimed at systematically evaluating the physical and psychological benefits of penile augmentation (PA) using injectable hyaluronic acid (HA) gel. Thirty-eight patients receiving PA with HA gel from January 2017 to March 2020 were included and followed up for 1 year. Penile size, erectile function, and psychological burden measured by the Index of Male Genital Image (IMGI), Index of International Erectile Function (IIEF), and Beliefs about Penis Size (BPAS), respectively, were assessed at the beginning and at 1, 3, 6, and 12 months postinjection. The volume of HA gel injected was 21.5 ± 3.7 ml. Compared to baseline data, flaccid penile girth and length significantly increased by 3.41 ± 0.95 cm (P < 0.01) and 2.55 ± 0.55 cm (P < 0.01) at the 1st month postinjection, respectively. At the endpoint, despite attenuations, statistically significant improvements in flaccid penis size were still obtained, namely 2.44 ± 1.14 cm in girth (P < 0.01) and 1.65 ± 0.59 cm in length (P < 0.01). Similarly, erectile penile girth statistically increased by 1.32 ± 1.02 cm (P < 0.01) at the 1st month but were only 0.80 ± 0.54 cm bigger than baseline (P < 0.01) at the endpoint. At the 1st month, the average score of IMGI and the mean score of IIEF statistically increased by 46.2 ± 10.5 (P < 0.01) and 7.6 ± 6.2 (P < 0.01), respectively; the score of BAPS significantly decreased by 18.3 ± 4.5 (P < 0.01). These alterations remained steady during follow-up. Considering the significant penile size improvement, lasting psychological benefit, and low complication rate, PA with HA might serve as an appropriate alternative for patients with SPS.

[Normalized diagnosis and treatment of small penis: Advances in studies].

Small penis is abnormal development of the male external genitalia with unknown etiology. It is closely related to abnormal endocrine or pubertal development, chromosomal or genetic abnormalities. Pubertal growth retardation and secondary hypogonadism are commonly complicated by small penis or small testis; primary hypogonadal lesion develops in the testis; testosterone deficiency often results in small penis and short stature; sexual dysfunction and male infertility tend to occur in adult men. Attention should be paid to the four aspects concerning the clinically standardized diagnosis and treatment of small penis, namely, accurate measurement of the stretched penile length, active screening of possible causes, diagnosis and differential diagnosis, and active and effective clinical interventions for the purpose of increasing the penile length and improving the prognosis, patient's quality of life, and natural pregnancy rate.

What Mediates Fibrosis in the Tumor Microenvironment of Clear Renal Cell Carcinoma.

Previous studies have demonstrated that direct targeting of interstitial cancer-associated fibroblasts (CAF) and tumor fibrosis alone seemed to be an unpromising treatment option for malignant tumors. Therefore, it is necessary to further explore the mechanism of the influence of collagen and tumor fibrosis on the biological behavior of malignant tumors. The current study aimed to explore the effect of intratumor fibrosis on the prognosis of renal clear cell carcinoma (ccRCC) and its mechanism. With the bioinformatic analysis of The Cancer Genome Atlas (TCGA) database (n = 537), the study showed that high Collagen type I α 1 (COL1A1) mRNA expression indicated the poor prognosis of ccRCC patients compared with low expression ones. We further used the Two-photon-excited fluorescence (TPEF)/second harmonic generation (SHG) microscopy to determine the intratumor fibrosis of 68 patients with surgical resection of ccRCC and confirmed that a high fibrosis level in the tumor was associated with a poor prognosis compared with patients with low expression (Progression-Free Survival: p = 0.030). We further measured the protein chips of 640 cytokines in ccRCC specimens and found that several cytokines, including prolactin (PRL), were associated with the degree of fibrosis in the tumor, as confirmed by the prolactin receptor (PRLR) immunohistochemical method. In addition, the study showed that PRLR expression decreased significantly in the ccRCC compared with adjacent normal tissue (p < 0.05). Our research shows that low expression of PRLR predicted the poor survival of the patient. We used the Cell Counting Kit-8 experiment, the transwell and the plate clone formation assay to evaluate the role of PRL in the 7860 and the ACHN cell lines. We found that PRL promoted ccRCC cell proliferation and migration. JAK-STAT3 activation was found in the high prolactin expression group by mass spectrum analysis. This study delineated the fibrosis-based tumor microenvironment characteristics of ccRCC. PRL/PRLR may be involved in the fibrosis process and are essential prognostic risk factors for ccRCC.

Efficacy and Safety of Ningmitai Capsule in Patients With Chronic Prostatitis/Chronic Pelvic Pain Syndrome: A Multicenter, Randomized, Double-blind, Placebo-controlled Trial.

OBJECTIVE: To validate the efficacy and safety of Ningmitai capsule (NMT) in the patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). METHODS: We conducted a multicenter, randomized, double-blind, placebo-controlled trial in 120 men with CP/CPPS to evaluate the efficacy and safety of NMT. Participants were randomly assigned (1:1) to NMT or placebo treatment for 4 weeks at 3 centres. The patients were evaluated by the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) at baseline, the end of 2 and 4 weeks of treatment. The primary endpoints were the changes of the NIH-CPSI pain scores from baseline to the end of 2 and 4 weeks of the treatment. The secondary endpoints include the changes of the NIH-CPSI total scores, urinary symptoms scores and the quality of life (QoL) as well as the responder rate. RESULTS: After 2 and 4 weeks of treatment, the mean decreases of the NIH-CPSI pain scores, total scores and QoL in the NMT group were all significantly superior to those in the placebo group. The responder rate was significantly higher in the NMT group than that in the placebo group at both 2 and 4 weeks. No adverse events were reported during the treatment. CONCLUSION: NMT could significantly improve the pain symptoms and QoL in the patients with CP/CPPS as early as in 2 weeks, and the efficacy enhanced at the end of the 4-week treatment. The safety of NMT was confirmed in this trial.

Multivariate analysis of factors for failed continuous bladder irrigation in hemorrhagic cystitis patients after hematopoietic stem cell transplantation.

BACKGROUND: Continuous bladder irrigation (CBI) and proper adjustment of saline irrigation speed are important to avoid CBI failure in hemorrhagic cystitis (HC) patients after allogeneic hematopoietic stem cell transplantation (HSCT). Nevertheless, too fast irrigation speed could take away the patient's much heat, contribute to blood coagulopathy, and increase the nursing workload. Evaluation of risk for CBI failure remains an unmet clinical need. METHODS: The general information, clinical characteristics, and consultation records of HC patients in 1380 patients with hematopoietic stem cell transplantation in our center from 2017 to 2019 were analyzed retrospectively. The receiver operating characteristic (ROC) curve was used to calculate the cutoff point of the continuous variable, and multivariate logistic regression was used to analyze the risk factors affecting CBI failure in HC patients. RESULTS: The incidence of HC after HSCT was 23%. A total of 227 patients with HC above grade 2 were included. Univariate analysis showed that CRP, age, platelet counts, onset time after transplantation, albumin, and hemoglobin were associated with CBI failure in the short-term (P < 0.05). ROC curve and multivariate logistic regression analysis showed that CRP > 8.89 ng/ml (RR = 7.828, 95% CI 2.885-21.244), age < 14.5 years (RR = 9.940, 95% CI 3.219-30.697), and onset time of HC > 37d after transplantation (RR = 7.021, 95% CI 2.204-22.364), were independent risk factors for failure of CBI (P < 0.05). CONCLUSIONS: The study identified CRP > 8.89 ng/ml, age < 14.5 years, and onset time of HC after HSCT > 37d are independent factors for failure of CBI, which could be combined to allow stratification of HC after HSCT patients into low-, intermediate- and high-risk subgroups of CBI failure.

Human Acellular Dermal Matrix Augmentation Phalloplasty Surgery.

INTRODUCTION AND OBJECTIVE: Many men often have the need to enlarge their penises for psychological gain and to satisfy or to impress their partners. Many surgical techniques have been reported. However, none is the gold standard. AIM: To evaluate the efficacy and safety of human acellular dermal matrix allograft in augmentation phalloplasty technique. METHODS: From March 2015 to September 2017, a total of 182 patients were prospectively recruited into our cohort after complete physical and psychological evaluation that deemed suitable for penile enhancement. Penis circumference was measured at the mid-length of the penis. Mean was 7.03 cm (6.93 ± 1.00 cm) and 12.1 cm (10.59 ± 1.15 cm) during flaccid and erection, respectively. All patients received human acellular dermal matrix graft under spinal or local anesthesia. The allograft was preconditioned in normal saline for 20 minutes, and mesh incisions were made to optimize blood flow. The width was equal to the circumference of both corpus cavernosa but without corpus spongiosum. The length of the graft was determined by measuring the length between the tip of the coronary sulcus and the root of penis. A complete incision below the coronary sulcus to the depth of the Buck's fascia was made. Then separate the dartos fascia from the Buck's fascia. The prepared graft was then placed on top of the Buck's fascia, with the blood-remained side facing the Buck's fascia. The graft was sutured using 4-0 absorbable polyglycolic acid suture to the Buck's fascia. Extra caution needed to be taken when fixing ventrally to avoid injuring the urethra. Once completed, the dartos fascia was restored, the dartos fascia and subcutaneous tissue were sutured with 4-0 absorbable suture, and skin closure is achieved subsequently. RESULTS: The post-operative course was without complications. At the follow-up after 1 year, the mean flaccid girth increased to 8.07 ± 1.06 cm (P < .05), while the mean erect girth increased to 12.79 ± 1.23 cm (P < .05). Sexual activity was allowed after 8 weeks of surgery. The majority reported that sexual self-esteem and functioning significantly improved. In addition, 59 patients reported alleviation of premature ejaculation. CONCLUSIONS: Compared to autologous dermis-fat graft and xenograft, augmentation phalloplasty using human acellular dermal matrix has several advantages: (1) it avoids harm harvesting site of the autograft; (2) the effects of dermis allograft can last at least 1 year; and (3) acellular dermal matrix is more likely to be accepted by people.

INTRODUCTION ET OBJECTIF: De nombreux hommes ressentent le besoin de subir une augmentation du pénis pour des raisons psychologiques et pour impressionner leur conjointe. Il existe de nombreuses techniques chirurgicales, mais aucune n'est la norme de référence. BUT: Évaluer l'efficacité et l'innocuité de l'allogreffe par matrice dermique acellulaire dans la technique de phalloplastie. MÉTHODOLOGIE: De mars 2015 à septembre 2017, 182 patients ont fait l'objet d'un recrutement prospectif après une évaluation physique et psychologique complète jugée convenable pour l'augmentation pénienne. La circonférence du pénis était mesurée à mi-longueur. La moyenne était de 7,03 cm (6,93±1,00 cm) flasque et de 12,1 cm (10,59±1,15 cm) en érection. Tous les patients ont reçu une greffe de matrice dermique acellulaire humaine sous anesthésie spinale ou locale. L'allogreffe était préconditionnée 20 minutes dans une solution physiologique, et des incisions en treillis étaient pratiquées pour optimiser la circulation sanguine. La largeur était égale à la circonférence des deux corps caverneux, mais sans le corps spongieux. La longueur de la greffe était déterminée par la mesure de la longueur entre le bout du sillon coronaire et la racine du pénis. Une incision complète était pratiquée sous le sillon coronaire jusque dans la profondeur du fascia de Buck, puis le fascia du dartos était séparé du fascia de Buck. La face sur laquelle se trouve le sang de la greffe préparée était ensuite placée sur le fascia de Buck. La greffe était cousue au fascia de Buck à l'aide d'une suture d'acide polyglycolique absorbable 4-0. Il fallait faire preuve d'une extrême prudence pour la fixer sur la face ventrale afin d'éviter d'endommager l'urètre. Une fois l'intervention terminée, le fascia du dartos était restauré, le fascia du dartos et les tissus sous-cutanés étaient cousus à l'aide d'une suture absorbable 4-0, puis la peau était refermée. RÉSULTATS: L'évolution postopératoire s'est déroulée sans complications. Au suivi au bout d'un an, la circonférence flasque moyenne était passée à 8,07±1,06 centimètres (P < 0,05), et la circonférence en érection, à 12,79±1,23 centimètres (P < 0,05). L'activité sexuelle était autorisée huit semaines après l'opération. La majorité des patients ont constaté une amélioration importante de l'estime de soi sexuelle et du fonctionnement sexuel. De plus, 59 patients ont déclaré une atténuation de l'éjaculation précoce. CONCLUSIONS: Par rapport à la greffe autologue de derme et de graisse et à la xénogreffe, la phalloplastie d'augmentation par matrice dermique acellulaire humaine comportait plusieurs avantages : 1) elle évite les dommages au foyer de prélèvement de l'autogreffe; 2) les effets de l'allogreffe du derme peuvent durer au moins un an; 3) la matrice dermique acellulaire est plus susceptible d'être acceptée.

Suprapubic Liposuction With a Modified Devine's Technique for Buried Penis Release in Adults.

BACKGROUND: With the increasing prevalence of overweight and obesity, adult-acquired buried penis is more common in recent years. Many surgical techniques have been reported. However, none is the gold standard. OBJECTIVE: To evaluate the safety and efficacy of combining suprapubic liposuction and modified Devine's technique for penile lengthening in adult patients with buried penis due to obesity. METHODS: From September 2015 to June 2018, 26 consecutive suitable patients (mean age: 33 ± 5.7 years, mean body mass index: 29 ± 5.4 kg/m2) with a buried penis received suprapubic liposuction and modified Devine's technique for penis release in our medical centre. A retrospective study was conducted. Their penile length from tip to the skin (flaccid) was measured pre- and post-operatively. The amount of liposuction was also recorded accordingly. RESULTS: The mean length of the follow-up on the 26 patients is 18 ± 7.1 months (range 3-33 months). The average amount of liposuction is 450 ± 90.2 mL. The average penile length measured preoperatively, post-operatively (on table), and 3 months after the operation is 2.9 ± 1.3, 7.4 ± 2.1, and 5.3 ± 1.8 cm, respectively. The post-operative penile length had significantly increased by 4.5 ± 1.6 cm (on table) and 2.4 ± 0.7 cm (3 months post-operation) with a P value <.05. No patient had difficulties in sexual intercourse or urination post-operatively. None of the patients were dissatisfied with their surgical outcomes. CONCLUSIONS: The combination of suprapubic liposuction and modified Devine's technique is a safe and effective method for releasing the buried penis of adults with satisfying outcomes.

CONTEXTE: Avec la prédominance croissante du surpoids et de l'obésité, le pénis enterré adulte-acquis est plus commun ces dernières années. Beaucoup de techniques chirurgicales ont été rapportées. Cependant, aucun n'est l'étalon-or. OBJECTIF: Évaluer l'innocuité et l'efficacité de la combinaison de la liposuccion suprapubique et de la technique modifiée de Devine pour l'allongement du pénis chez les patients adultes avec un pénis enterré en raison de l'obésité. MÉTHODES: De septembre 2015 à juin 2018, 26 patients appropriés consécutifs (âge moyen : 33 ± 5.7 ans, indice de masse corporelle moyen : 29 ± 5.4 kg/m2) avec un pénis enterré ont reçu une liposuccion suprapubique et modifié la technique de Devine pour la libération du pénis dans notre centre médical. Une étude rétrospective a été menée. Leur longueur pénienne de la pointe à la peau (flasque) a été mesurée avant et postopératoirement. La quantité de liposuccion a également été enregistrée en conséquence. RÉSULTATS: La durée moyenne du suivi sur les 26 patients est de 18 ± 7.1 mois (gamme 3-33 mois). La quantité moyenne de liposuccion est de 450 ± 90.2 ml. La longueur pénitenelle moyenne mesurée de façon préopératoire, postopératoire (sur la table) et de 3 mois après l'opération est de 2.9 ± 1.3, 7.4 ± 2.1 et 5.3 ± 1.8 cm, respectivement. La longueur du pénis postopératoire avait considérablement augmenté de 4.5 ± 1.6 cm (sur la table) et de 2.4 ± 0.7 cm (3 mois après l'opération) avec une valeur P < 0.05. Aucun patient n'a eu des difficultés dans les rapports sexuels ou la miction postopératoire. Aucun des patients n'était insatisfait de leurs résultats chirurgicaux. CONCLUSIONS: La combinaison de la liposuccion suprapubienne et de la technique modifiée de Devine est une méthode sûre et efficace pour libérer le pénis enterré des adultes avec des résultats satisfaisants.

Complications and Management of Penile Girth Enhancement with Acellular Dermal Matrix.

INTRODUCTION: Acellular dermal matrix (ADM) is a common filler used widely in clinical practice to increase penile girth for cosmetic reasons, but there are few studies on its complications. AIM: The aim of this study was to investigate and analyze the complications of penile girth enhancement (PGE) with ADM. METHODS: The medical records of 78 patients who underwent PGE with ADM between June 2016 and January 2019 were retrospectively reviewed. MAIN OUTCOME MEASURE: Related complications and their subsequent management were summarized and analyzed. RESULTS: 78 patients (mean age 31.14 years [21-66 years]) received PGE with ADM. At the 3-month follow-up, the penile circumference was increased by 1.1 (0.5-2.1) cm on average. There were 47 patients with erectile discomfort, 12 with delayed healing, 10 with unobvious augmentation effect, 8 with wound hematoma, 7 with prepuce edema, 4 with wound infection, and 3 patients with skin necrosis of the dorsal side. 7 patients eventually underwent ADM removal. CLINICAL IMPLICATIONS: These adverse complications indicate that ADM should be used with caution for PGE. STRENGTH & LIMITATIONS: This study adds important data, as there are few published reports on the complications of PGE with ADM. However, this study did not compare postoperative complications with ADM to those seen with other filler material. CONCLUSION: Even with standardized surgical methods and rigorous postoperative care, complications of PGE using ADM are severe, which indicates that it is not an ideal or safe method for PGE. Xu T, Zhang G, Bai W, et al. Complications and Management of Penile Girth Enhancement with Acellular Dermal Matrix. J Sex Med 2019;16:2011-2017.

Suspensory ligament release combined with acellular dermal matrix filler in infrapubic space: A new method for penile length augmentation.

Until now, no reliable method is recognised in treating buried penis. This study explored a new method of penile length augmentation using acellular dermal matrix filler in infrapubic space combined with liposuction and penile suspensory release. Patients with "small-sized penis" received penile length augmentation procedure including suprapubic liposuction, penile suspensory ligament release and insertion of folded acellular dermal matrix between corpora cavernosa and pubis symphysis. Their penile length from tip to skin was measured pre-operatively and post-operatively. The post-operative complications and patients' satisfaction were also recorded. Fifteen adult male patients were included with the mean age of 33.2 ± 4.6 years old and BMI of 28.9 ± 5.3 kg/m2 . The average amount of liposuction was 430 ± 90.0 ml. The average penile length measured pre-operatively and post-operatively (on table and 3 months afterwards) was 3.0 ± 1.3 cm, 7.3 ± 2.1 cm and 5.4 ± 1.8 cm. The penile length has significantly increased by 4.3 ± 1.6 cm (on table) and 2.4 ± 0.8 cm (3 months post-operatively; p < 0.05). The post-operative complications included oedema of penis, ecchymosis of lower abdomen and poor wound healing. No patient was dissatisfied with the appearance and function. The new method using acellular dermal matrix combined with liposuction and penile suspensory ligament release is safe and effective. The method could be applied to selected patients with buried penis.

A Clinical Study on Microsurgical Denervation of Spermatic Cord for Refractory Chronic Orchialgia.

OBJECTIVES: Microsurgical denervation of the spermatic cord (MDSC) is a treatment option for chronic orchialgia (CO) refractory to conservative treatment. Studies showed specific nerve fibers as the possible cause of CO. We aimed to present the outcomes of ligation of these nerves using targeted MDSC. METHODS: We retrospectively reviewed 30 cases who underwent targeted MDSC from August 2014 to February 2018. Patients included were under strict criteria. Pain was assessed preoperatively and postoperatively using a subjective visual analog scale (VAS) and objectively with the standardized and validated Pain Impact Questionnaire-6 (PIQ-6) score. RESULTS: Data were available on 28 cases at repercussion. During a median follow-up of 12 months (range 10-29), 25 cases (89.2%) showed a significant reduction in pain and 3 (9.8%) had no change in pain by subjective VAS scoring. Of cases with a significant reduction in pain, 15 (53.5%) had complete resolution and 19 (67.9%) had a 50% or greater reduction. Objective PIQ-6 analysis showed a significant reduction in pain in 78.6% of patients at 6 months postoperatively, in 82.1% at 1 year, in 82.1% at 2 years. CONCLUSIONS: Targeted MDSC is an effective, minimally invasive approach with potential long-term durability in patients with refractory CO.