The treatment modalities of erectile dysfunction range from oral pharmacotherapy to intracavernosal injections, intraurethral pellets, vacuum erectile devices, and the surgical option of penile prosthesis insertion. Oral phosphodiesterase 5 inhibitors still remain the preferred treatment for patients since they are the least invasive, not to mention that they can be prescribed by non-urologists. Due to these factors, there has been development of newer drugs with fewer side effects. This is a review of the second generation phosphodiesterase 5 inhibitor, avanafil, looking into its pharmacology as well as its clinical utility. Avanafil’s faster onset and shorter duration of action has made it preferred as compared to other PDE5 inhibitors for patients with multiple comorbidities.
We established double-haploidentical (DH) hematopoietic stem cell transplantation (HSCT) murine models to explore competitive engraftment, graft-versus-graft effect and graft-versus-host disease (GVHD). T cell-depleted (TCD) bone marrow (BM) cells from B6SJF1 (donor 1 [D1]) and B6D2F1 (donor 2 [D2]) mice achieved >90% donor engraftment when transplanted into B6CBAF1 mice. B6CBAF1 recipients survived without evidence of GVHD when undergoing HSCT with TCD-BM from 2 haploidentical donors, D1 and D2. DH-HSCT recipients had significantly higher leukocyte and neutrophil counts than single-haploidentical HSCT recipients from either D1 or D2. DH recipients consistently showed successful mixed chimerism in both BM and spleen. Two other DH-HSCT models, B6D2F1 + C3D2F1→B6C3F1 and B6CBAF1 + B6SJLF1→B6D2F1, showed similar engraftment patterns. Low-dose T cell infusion from both D1 and D2 increased the degree of early engraftment of the respective donors in BM and spleen; however, this early engraftment pattern did not determine long-term engraftment dominance. In the long term, minimally engrafted D1 BM recovered and comprised >50% of all donor- derived B, T, and natural killer cells. We conclude that early BM engraftment is determined by donor T cell immunodominance, but long-term engraftment is related to the engraftment potential of stem cells after DH-HSCT.
INTRODUCTION AND OBJECTIVES: Stent Early Encrustation (SEE) presents a complicated technical challenge. We sought to examine and characterize differences in twenty-four hour urine (TFHU) studies between encrusters and non-encrusters. METHODS: An IRB approved prospective study identified patients with SEE, defined as a calcified stent identified within 3 months of stent placement. From June 2016 to November 2017, patients with indwelling ureteral stents were evaluated for SEE upon exchange or removal and compared to patients without SEE. Demographic data and culture data were evaluated. TFHU studies were examined and compared between these two groups. RESULTS: There were fifteen cases of SEE identified. The average age was 48 years old, with 53% being female. Thirteen patients screened were identified as non-encrusters, 42% of which were female, with an average age of 54 years. Non SEE patients were found to have statistically significant higher urinary concentrations of uric acid (0.729 vs 0.460 g/day, p ¼ 0.05), sulfate (43.2 vs 20.0 mEq/day, p ¼ 0.02), magnesium (115.1 vs 57.2 mg/day, p ¼ 0.01), ammonium (44.6 vs 22.0 mmol/day, p ¼ 0.02), and total creatinine (1954.9 vs 1157.2 mg/ day, p ¼ 0.03). Additionally, when compared to SEE, non SEE patients had a trend towards significance in total urine volume (2.253 vs 1.344 liters, p ¼ 0.06) and urinary citrate (654.2 vs 374.8, p ¼ 0.08. CONCLUSIONS: Non SEE patients were found to have a significantly higher concentration of stone inhibitors. Additionally, urine volume and urinary citrate, were higher in the non SEE patients, although not statistically significant. Further investigation into concentrations of these stone inhibitors may lead to future development of ureteral stent composition to prevent SEE.
on masturbation as a taboo. From 1950th, it became the most common method of semen collection CONCLUSIONS: Once a great diagnostic hope, SA remains a grand illusion in the game of cutoff points. Despite significant technological and methodological advances, constant attempts to make SA a reliable diagnostic test remain unsuccessful. Complete makeover of SA will be necessary to reach this historic goal
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