Orthogonality of non-coaxial Laguerre-Gaussian beams.

The conventional orthogonality of Laguerre-Gaussian (LG) beams is widely recognized and serves as the fundamental basis for mode division multiplexing utilizing LG beams as channels. However, this conventional orthogonality holds true only when two LG beams share the same axis. Whether non-coaxial LG beams, with parallel axes separated by a distance, are orthogonal to each other remains an open question. To address this issue and reveal the orthogonality of non-coaxial LG beams, we analytically derive the projection of one LG beam onto another. This projection exhibits a helical phase and a rotationally symmetric amplitude with dark rings present. These dark rings indicate that two non-coaxial LG beams are indeed orthogonal to each other when their axes are appropriately separated. Furthermore, any pair of non-coaxial LG beams within a set also exhibit orthogonality when their axes are fixed at a certain separation distance. This novel form of orthogonality predicts an innovative compound multiplexing technique that simultaneously combines mode and space, enabling more efficient packing of multiple LG beams within a single transmission aperture while maintaining parallel and closely spaced beam axes.

Effect of low-intensity extracorporeal shockwave therapy on nocturnal penile tumescence and rigidity and penile haemodynamics.

The study aims to evaluate the effect of low-intensity extracorporeal shockwave therapy (Li-ESWT) on nocturnal erection and penile haemodynamics. Patients with erectile dysfunction (ED) were enrolled from January 2018 to March 2019. Self-reported erectile symptoms, the International Index of Erectile Function-5 (IIEF-5) and Erection Hardness Scores (EHS), nocturnal penile tumescence and rigidity (NPTR) and cavernous duplex Doppler ultrasound (CDDU) were evaluated. NPTR and CDDU were evaluated by Rigiscan and vascular ultrasound system respectively. Comparisons of NPTR and CDDU parameters were performed before and after Li-ESWT (Renova, once a week, 4 weeks in total). A total of 35 cases (mean age 36.51 ± 11.47 years) were enrolled for analysis. The IIEF-5 (10.60 ± 5.99 vs. 15.13 ± 6.22, p = .003), EHS (p = .016) and self-reported erectile hardness (p = .014) were significantly improved after 1-month treatment. Nocturnal erection frequency (p = .010), duration of total erection (p = .017), duration of erectile rigidity ≥60% at penile tip and base (p = .014 and p = .002) and the best erectile rigidity at penile tip and base (p = .012 and p = .005) improved significantly after treatment. However, no CDDU parameters improved after Li-ESWT (all p > .05). Li-ESWT can effectively improve subjective erectile function and nocturnal erection in ED patients. Large sample and well-designed studies need to be developed for supporting the current findings.

Restriction on orbital angular momentum distribution: a role of media in vortex beams propagation.

The vortex beam carrying single orbital angular momentum (OAM) propagating through a medium with a certain transmission function is investigated. We show that the OAM mode weights in the output OAM spectrum involve two factors: the radial distribution of output beam power and the proposed restriction-characterized function. Based on the restriction-characterized function, we show that the OAM mode weights can only vary in a limited range. We analyze the relationship between the radial distribution of the output beam power and the OAM mode weights in the output OAM spectrum. Finally, our theoretical analysis is illustrated numerically with the cases of eccentric circular aperture and atmospheric turbulence in a weak fluctuation regime. These results provide new insights into the characterization of the OAM spectrum and may find applications for fields involving OAM, such as an OAM-based optical communication link and object detection.

[Risk factors for the complications of primary hypospadias urethroplasty with the urethral plate reserved].

OBJECTIVE: To investigate the risk factors for the complications of urethroplasty in patients with primary hypospadias by postoperative follow-up observation. METHODS: We retrospectively analyzed 110 cases of primary hypospadias repair performed from November 2010 to October 2015, including 70 cases of tubularized incised plate (TIP) urethroplasty and 40 cases of inlay internal preputial graft (IIPG) urethroplasty, all with the urethral plate reserved. We followed up the patients for 15.6－36 months, (27.3 ± 0.52) mo for those with and (26.9 ± 0.22) mo for those without complications. The mean age of the two groups of patients was (7.5 ± 0.2) and (7.0 ± 0.5) yr, respectively. RESULTS: The follow-up data were collected from all the patients, 17 (15.5%) with and 93 (84.5%) without complications. The success rate of surgery was 84.5%. There were no statistically significant differences in the follow-up time and age between the two groups of patients (P >0.05). Single-factor analysis of variance showed significant differences between the complication and non-complication groups in the preoperative urethral opening (P <0.01), ventral penile curvature (P <0.01), and length of urethral defect (P = 0.04), while multiple linear regression analysis exhibited that only ventral curvature was associated with the postoperative complications of the patients (OR = 1.12, 95% CI: 1.06－1.19, P<0.01). CONCLUSIONS: We chose single-stage urethroplasty with the urethral plate reserved for the treatment of primary hypospadias and achieved satisfactory outcomes. Ventral penile curvature is an independent risk factor for the complications of primary hypospadias, and a higher degree of curvature is associated with a higher incidnece of complications.

Decreased expression of hepatocyte nuclear factor 4α (Hnf4α)/microRNA-122 (miR-122) axis in hepatitis B virus-associated hepatocellular carcinoma enhances potential oncogenic GALNT10 protein activity.

MicroRNA-122 (miR-122), a mammalian liver-specific miRNA, has been reported to play crucial roles in the control of diverse aspects of hepatic function and dysfunction, including viral infection and hepatocarcinogenesis. In this study, we explored the clinical significance, transcriptional regulation, and direct target of miR-122 in hepatitis B virus (HBV)-associated hepatocellular carcinoma. Reduced expression of miR-122 in patients with HBV-associated hepatocellular carcinoma was correlated with venous invasion and poor prognosis. Furthermore, UDP-N-acetyl-α-D-galactosamine:polypeptide N-acetylgalactosaminyltransferase-10 (GALNT10) was identified as a bona fide target of miR-122 in hepatoma cells. Ectopic expression and knockdown studies showed that GALNT10 indeed promotes proliferation and apoptosis resistance of hepatoma cells in a glycosyltransferase-dependent manner. Critically, adverse correlation between miR-122 and GALNT10, a poor prognosticator of clinical outcome, was demonstrated in hepatoma patients. Hepatocyte nuclear factor 4α (Hnf4α), a liver-enriched transcription factor that activates miR-122 gene transcription, was suppressed in HBV-infected hepatoma cells. Chromatin immunoprecipitation assay showed significantly reduced association of Hnf4α with the miR-122 promoter in HBV-infected hepatoma cells. Moreover, GALNT10 was found to intensify O-glycosylation following signal activation of the epidermal growth factor receptor. In addition, in a therapeutic perspective, we proved that GALNT10 silencing increases sensitivity to sorafenib and doxorubicin challenge. In summary, our results reveal a novel Hnf4α/miR-122/GALNT10 regulatory pathway that facilitates EGF miR-122 activation and hepatoma growth in HBV-associated hepatocarcinogenesis.

Self-recovery effect of orbital angular momentum mode of circular beam in weak non-Kolmogorov turbulence.

It is generally true that the orbital angular momentum (OAM) mode persistently degenerate when a vortex beam propagates in the atmospheric turbulence. Here, however, we unveil an interesting self-recovery effect of OAM mode of the circular beam (CiB) in weak non-Kolmogorov turbulence. We show that the CiB displays the self-focusing effect and has clear focus in the weak non-Kolmogorov turbulence if we choose proper complex parameters, and the detection probability of the original OAM mode reaches the maximum at the focus. Our study proposes a method to alleviate the turbulent effects on OAM-based communication.

Autocorrelation properties of fully coherent beam with and without orbital angular momentum.

The spatial correlation singularity of a partially coherent vortex beam was demonstrated recently [Phys. Rev. Lett. 92, 143905 (2004)], and it was shown that the cross-correlation singularity disappears when the spatial coherence is high. In this paper, we demonstrate that the spatial autocorrelation function of a fully coherent beam in the far-field is equivalent to the Fourier transform of its intensity in the source plane. Our theoretical and experimental results show that, depending on both the radial and azimuthal mode indices (p, λ) of the incident light beam, the distribution of the far-field autocorrelation function displays a series of concentric, alternate bright and dark rings. This phenomenon may be used to determine the topological charge (the azimuthal index) of light beam with a nonzero radial index.

[Single nucleotide polymorphisms of the DGKK gene and hypospadias in Chinese children].

OBJECTIVE: To investigate the role of single nucleotide polymorphisms of the gene of diacylglycerol kinase κ (DGKK) in hypospadias in Chinese children. METHODS: We performed direct sequencing on 2 hypospadias-related candidate single nucleotide polymorphisms of the DGKK gene (rs1934179 and rs7063116, never previously reported in the Chinese population) from 300 children with sporadic hypospadias and 200 healthy controls, and compared the results between the two groups. RESULTS: The mutation frequencies of rs1934179 and rs7063116 were 5.0% (15/300) and 5.67% (17/300) respectively in the hypospadias patients, significantly higher than 1.5% (3/200) and 2.0% (4/200) in the normal controls (P <0.05). The mutation frequencies of rs1934179 and rs7063116 in the cases of distal and middle hypospadias were also remarkably higher (6.5%, [13/200] and 7.5% [15/200], P <0.05), but those in the proximal cases (both 2.0% [2/100]) showed no statistically significant difference from the control (P >0.05). CONCLUSION: The polymorphisms of the DGKK gene may be associated with hypospadias, particularly distal and middle hypospadias, in Chinese children.

[Microsurgical management of male infertility in china: 15-year development and prospects].

Male infertility is a common and complex disease in urology and andrology, and for many years there has been no effective surgical treatment. With the emergence of microsurgery and assisted reproductive medicine (IVF/ICSI), rapid development has been achieved in the treatment of male infertility. The Center for Male Reproductive Medicine and Microsurgery at Weill Cornell Medical College of Cornell University has been playing an important leading role in developing microsurgical techniques for the management of male infertility. The development of microsurgical treatment of male infertility in China has experienced the 3 periods of emerging, making, and boosting ever since its systematic introduction from Weill Cornell Medical College 15 years ago. At present, many Chinese hospitals have adopted microsurgery in the management of male infertility, which has contributed to the initial establishment of a microsurgical treatment system for male infertility in China. However, some deficiencies do exist concerning microsurgical treatment of male infertility, as in normalized technical training programs for competent surgeons, unified criteria for evaluation of surgical outcomes, and detailed postoperative follow-up data. This article presents an overview on the 15-year development of microsurgical management of male infertility in China, points out the existing deficiencies, and offers some propositions for the promotion of its development.

The value of audiovisual sexual stimulation with virtual reality in diagnosing erectile dysfunction.

Background: The traditional audiovisual sexual stimulation (AVSS) test may experience limitations including low erectile response rate and lack of unified diagnostic criteria. Aim: We aimed to explore the clinical value of AVSS with virtual reality (VR-AVSS) test in assessing erectile function and diagnosing erectile dysfunction (ED). Methods: Participants 18 to 60 years of age were screened for analysis in 3 clinical centers from June 2020 to March 2022. Demographic data, 5-item International Index of Erectile Function (IIEF-5), erectile hardness score (EHS), and self-reported symptom questions were collected. The ED patients and control patients were confirmed according to the IIEF-5 and EHS. All subjects watched a 60-minute erotic video by VR device during RigiScan recording. The parameters including tip average rigidity, tip effective erectile duration (duration of rigidity ≥60%, tip effective erectile duration), base average rigidity, and base effective erectile duration were evaluated. Outcomes: The main outcome of interest was the application of VR immersion technology to improve the traditional AVSS test. Results: A total of 301 ED cases and 100 eligible control patients were included for final analysis. Compared with control patients, ED cases had significantly lower IIEF-5 scores, EHS, positive response rate, and erectile rigidity and duration. The positive response rate of ED and control patients were 75.5% and 90.9%, respectively. The cutoff points of tip average rigidity, tip effective erectile duration, base average rigidity, and base effective erectile duration were 40.5% (sensitivity: 77.6%, specificity: 70.2%; P < .001), 4.75 minutes (sensitivity: 75.9%, specificity: 75.4%; P < .001), 48.5% (sensitivity: 77.6%, specificity: 75.1%; P < .001), and 7.75 minutes (sensitivity: 79.3%, specificity: 75.7%; P < .001). Clinical Implications: The technological superiority of VR will enable the VR-AVSS immersion test to be a more accurate detection than traditional AVSS modes. Strengths and Limitations: Our study applied VR immersion technology to establish the standard operation procedure for the AVSS test, which could effectively reduce the interference of adverse factors and minimize the detecting errors. However, the test data only included positive response subjects, so the true erectile status of men with a negative response to the AVSS test cannot be obtained. Conclusions: The VR-AVSS test can effectively improve the diagnostic accuracy of ED. The average rigidity and effective erectile duration were the optimal diagnostic parameters for excluding ED.

Generation of a human haploid neural stem cell line for genome-wide genetic screening.

BACKGROUND: Haploid embryonic stem cells (haESCs) have been established in many species. Differentiated haploid cell line types in mammals are lacking due to spontaneous diploidization during differentiation that compromises lineage-specific screens. AIM: To derive human haploid neural stem cells (haNSCs) to carry out lineage-specific screens. METHODS: Human haNSCs were differentiated from human extended haESCs with the help of Y27632 (ROCK signaling pathway inhibitor) and a series of cytokines to reduce diploidization. Neuronal differentiation of haNSCs was performed to examine their neural differentiation potency. Global gene expression analysis was con-ducted to compare haNSCs with diploid NSCs and haESCs. Fluorescence activated cell sorting was performed to assess the diploidization rate of extended haESCs and haNSCs. Genetic manipulation and screening were utilized to evaluate the significance of human haNSCs as genetic screening tools. RESULTS: Human haESCs in extended pluripotent culture medium showed more compact and smaller colonies, a higher efficiency in neural differentiation, a higher cell survival ratio and higher stability in haploidy maintenance. These characteristics effectively facilitated the derivation of human haNSCs. These human haNSCs can be generated by differentiation and maintain haploidy and multipotency to neurons and glia in the long term in vitro. After PiggyBac transfection, there were multiple insertion sites in the human haNSCs' genome, and the insertion sites were evenly spread across all chromosomes. In addition, after the cells were treated with manganese, we were able to generate a list of manganese-induced toxicity genes, demonstrating their utility as genetic screening tools. CONCLUSION: This is the first report of a generated human haploid somatic cell line with a complete genome, proliferative ability and neural differentiation potential that provides cell resources for recessive inheritance and drug targeted screening.

A prospective randomized controlled study on scheduled PDE5i and vacuum erectile devices in the treatment of erectile dysfunction after nerve sparing prostatectomy.

Cavernous nerve injury is an important cause of erectile dysfunction (ED). Although protective nerve technology has been widely used in nerve-sparing radical prostatectomy (nsRP), the incidence of ED is still very high after surgery. The purpose of our study was to evaluate erectile function (EF) and penile length in the non-erectile state (PLNES) following scheduled phosphodiesterase 5 inhibitor (PDE5i), vacuum erectile device (VED) treatment, and combination therapy after nsRP. One hundred patients with localized prostate cancer and normal EF were randomized to scheduled PDE5i group, VED treatment group, a combined treatment group, and the control group without any intervention. The International Index of Erectile Function-5 (IIEF-5) scores and PLNES were evaluated after 6 months and 12 months of treatment. Sexual Encounter Profile (SEP-Question 2 and SEP-Question 3) were evaluated after 12 months of treatment. Ninety-one of the 100 randomized patients completed the study. We found that the 5 mg tadalafil once a day (OaD) combined with VED can help improve IIEF-5 scores in nsRP patients after both 6 months and 12 months. VED alone or combined with tadalafil OaD can help patients maintain PLNES. VED combined with tadalafil OaD can improve the rate of successful penetration (SEP-Question 2) after 12 months. There were no significant differences in the return to target EF after 12 months among the groups. No significant correlation was noted between the variables and return to target EF (IIEF ≥ 17), and between the variables and effective shortening of the patient's penis (shortening ≥ 1 cm) after 12 months of intervention.

Synthesis and Characterization of Polyimides with Naphthalene Ring Structure Introduced in the Main Chain.

In this paper, a new aromatic diamine monomer 4,4'-(2,6-naphthalenediyl)bis[benzenamine]) (NADA) was synthesized and a series of modified PI films containing naphthalene ring structure obtained by controlling the molar ratio of NADA monomer, ternary polymerization with 4,4'-oxydianiline (ODA), and pyromellitic dianhydride (PMDA). The effects of the introduction of the naphthalene ring on the free volume and various properties of PI were investigated by molecular dynamic simulations. The results show that the comprehensive properties of the modified films are all improved to some extent, with 5% thermal weight loss temperature (Td5%) of 569 °C, glass transition temperature (Tg) of 381 °C, tensile strength of 96.41 MPa, and modulus of elasticity of 2.45 GPa. Dielectric property test results show that the dielectric constant (Dk) of the film at 1 MHz is reduced from 3.21 to 2.82 and dielectric loss (Df) reduced from 0.0091 to 0.0065. It is noteworthy that the PI-1 dielectric constant is reduced from 3.26 to 3.01 at 10 GHz with only 5% NADA doping, which is expected to yield the best ratio and provide the possibility of industrial production.

[Correction of penile curvature by various tunica albuginea plasty].

OBJECTIVE: To explore various tunica albuginea plasty for penile curvature and their efficacies. METHODS: From July 2005 to July 2008, there were a total of 8 patients with a mean age of 34 ± 9 years old (range: 23 - 47) undergoing corrective surgery for various types of penile curvature. Among them, 4 patients (3 with ventral curvature, 1 with lateral curvature) were treated by 16-dot plication technique, 2 patients of lateral curvature with tightening ring in tunica albuginea corrected by V-Y plasty and 2 patients (one caused by Peyronie's disease while the other by tunica scar contracture) repaired by venous graft patch. The pre-and post-operative levels of sexual satisfaction were evaluated by the International Index of Erectile Function (IIEF-5) scoring system. RESULTS: All cases were followed up at 3, 6 & 9 months postoperatively. Their mean curvature at maximal erection was (58.2 ± 9.7)°. And a postoperative office assessment revealed a functional straight in all patients [mean degree (11 ± 4)°]. One patient (12.5%) reported penile shortening without dissatisfaction about it. No patients complained of anesthesia or other sensory abnormality on their penile skin. An improvement of IIEF-5 scores was noted (21 ± 3 vs 15 ± 5, P < 0.05) and all patients were satisfied with their outcomes. No complications, such as hematoma, infection or erectile dysfunction, occurred. CONCLUSION: To achieve a better penile morphology and functional outcomes with fewer complications, various arthroplasty should be adopted according to the cause, degree and direction of penile curvature.

Study on the time-varying and propagating characteristics of ultrashort pulse Laguerre-Gaussian beams.

This work proposes a simple model of pulse Laguerre-Gaussian Beams (LGBs) by chopping the incident continuous wave LGB into ultrashort pulse. The pulse LGBs are expanded into a series of LGBs with the same angular quantum number (AQN), whose expansion coefficients show the time-varying and propagating characteristics. Bigger radial quantum number (RQN) of incident LGB will cause more serious mode dispersion. This work discusses the case of zero RQN incident LGB intensively, in which the original modes, i.e. the same eigen-modes as the incident beams, can be used to approximate the pulse LGBs in short propagating range, e.g. 2zR. The original modes decrease, expand and delay when propagating, and it's more evident for incident LGBs with larger AQN . These conclusions are important for the optical communication by using the OAM division multiplexing (OAM-DM) technology.

Three new lignans from the seeds of Saussurea involucrata.

Three new lignans, arctigenin-4-O-(6''-O-acetyl-ß-d-glucoside) (1), arctigenin-4-O-(2''-O-acetyl-ß-d-glucoside) (2), and arctigenin-4-O-(3''-O-acetyl-ß-d-glucoside) (3), together with two known lignans, were isolated from the seeds of Saussurea involucrata. Their structures were established by spectroscopic methods, mainly 1D and 2D NMR, and mass spectral analysis.

Assembly of MXene/PP Separator and Its Enhancement for Ni-Rich LiNi0.8Co0.1Mn0.1O2 Electrochemical Performance.

In this work, a few-layer MXene is prepared and sprinkled on a commercial polypropylene (PP) separator by a facile spraying method to enhance the electrochemistry of the Ni-rich LiNi0.8Co0.1Mn0.1O2 (NCM811) cathode. Scanning electron microscope (SEM) and X-ray diffraction (XRD) are used to characterize the morphology and structure of MXene. Fourier transform infrared spectroscopy (FT-IR) and a contact angle tester are used to measure the bond structure and surface wettability PP and MXene/PP separator. The effect of the MXene/PP separator on the electrochemical performance of ternary NCM811 material is tested by an electrochemical workstation. The results show that the two-dimensional MXene material could improve the wettability of the separator to the electrolyte and greatly enhance the electrochemical properties of the NCM811 cathode. During 0.5 C current density cycling, the Li/NCM811 cell with MXene/PP separator remains at 166.2 mAh/g after the 100 cycles with ~90.7% retention. The Rct of MXene/PP cell is measured to be ~28.0 Ω. Combining all analyses results related to MXene/PP separator, the strategy by spraying the MXene on commercial PP is considered as a simple, convenient, and effective way to improve the electrochemical performance of the Ni-rich NCM811 cathode and it is expected to achieve large-scale in high-performance lithium-ion batteries in the near future.

[Comparative analysis of three different surgical approaches to varicocelectomy].

OBJECTIVE: To compare three different surgical approaches to varicocelectomy. METHODS: Eighty-eight cases of varicocelectomy performed in our hospital between January 2006 and January 2008 were divided into an retroperitoneal high ligation group (n = 44), a laparoscopy group (n = 12) and a microsurgery group (n = 32), and retrospectively analyzed for postoperative semen quality, recurrence, early complications, hospital stay, and medical cost. RESULTS: The rates of semen quality improvement were 56.52% (13/23), 66.67% (4/6) and 78.26% (18/23) , the rates of recurrence were 25% (8/32), 22.22% (2/9) and 7.41% (2/27), and the medical costs were RMB yen (1984 +/- 126), (8576 +/- 547) and (2159 +/- 298), respectively, in the retroperitoneal high ligation, laparoscopy and microsurgery groups (P < 0.05). None experienced serious early complications. CONCLUSION: Microsurgery is obviously superior to retroperitoneal high ligation and laparoscopic approaches in improving semen quality and preventing postoperative recurrence, and, with its advantages of minor invasiveness and quick recovery, is preferred by most patients. Laparoscopy, however, ranks highest in medical cost.

[The need for high-quality training and surgical standards for adult male circumcision in China].

Although HIV is a significant problem in Africa, HIV infection rates are rising rapidly in other regions such as Asia and South America. International health organizations have recognized the need to develop effective strategies to check the worldwide transmission of HIV. Studies have demonstrated the significant reduction of HIV, HPV, HSV-2 and other STD infection rates with male circumcision (MC). Although numerous MC techniques are available, there are no standardized protocols and surgical training programs. Studies have shown that the standardization of MC techniques coupled with training programs can significantly reduce complication rates. High complication rates have been a primary obstacle to the implementation of MC services. We recommend the establishment of surgical standards and training protocols prior to the promotion of MC services in China.

[A recommendable standard protocol of adult male circumcision with the Chinese Shang Ring: outcomes of 328 cases in China].

OBJECTIVE: Standardization of and training in adult male circumcision can significantly reduce its complication rate. Currently no such program exists for its standardization and training, making it difficult to guarantee the quality of male circumcision services. We therefore established a standardized surgical protocol for adult male circumcision in China using the Shang Ring, and applied it to a clinical study examining the performance of the Shang Ring in adult male circumcision. METHODS: A total of 328 adult men aged 18-58 (mean 27.8) years, 25 with phimosis and 303 with redundant prepuce, underwent circumcision with the Shang Ring, and evaluation of the operation time, pain scores (using the visual analog scale), postoperative complications, time for wound healing, and their satisfaction with the postoperative appearance. RESULTS: The operation time was 4.7 +/- 1.3 minutes. The pain scores were 0. 2 +/- 0.6 during the surgery, 1.6 +/- 1.0 twenty hours postoperatively, 1.7 +/- 1.1 twenty hours prior to the ring removal, and 2.7 +/- 1.4 during the ring removal. Complications included infection in 2 (0.6%), bleeding in 2 (0.6%), and wound dehiscence in 2 (0.6%) of the patients. None of the patients with wound dehiscence required postoperative suturing and all were managed conservatively instead. Sixteen of the patients (4.9%) experienced penile edema. The time for complete wound healing after circumcision was 20.3 +/- 6.7 days. The rate of the patients'satisfaction was 99.7% (327/328). CONCLUSION: The standard protocol of adult male circumcision with the Shang Ring has the advantages of short operation time, slight pain, low rate of complications, and high satisfaction and acceptance of the patients. Strict standardization of the surgical protocol can maximize its clinical advantages for adult male circumcision.