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The aim of this research was to analyze and model the aptitude of temperate areas to support permanent populations of the cattle tick Rhipicephalus microplus, which is principally distributed in tropical and subtropical areas. This work integrated field-derived data of tick development with temperature and land-based models of tick spread in Argentina. The integrated analysis of the results suggest that approximately 31°S is the southern limit where R. microplus finds appropriate climatic conditions to be established permanently. The establishment of permanent populations of R. microplus south of this latitudinal threshold is currently restricted because the low temperatures in autumn and winter inhibit the development of its eggs, but the introduction of cattle infested with R. microplus from early spring to late summer in temperate areas could produce engorged females laying eggs that would originate viable larvae from late spring to winter. The comparison of the temperature-based maps of habitat suitability with those obtained considering the lands suitable for livestock grazing, clearly shows that the models based only on climatic variables overestimate the potential dispersal of the cattle tick. The outcomes of this study suggest that an increase of temperature in the months of autumn and winter around 2°-2.75 °C should be necessary for the establishment of permanent populations of R. micoplus in the region belonging to temperate areas. This would allow that a tick generation emerged in early spring due to the overwintering of eggs and larvae originated from females detached from cattle during autumn or early winter.

To evaluate the surgical and functional outcomes of urethral reconstruction associated with phalloplasty, depending on the surgical techniques and patient history.We conducted a single-centre retrospective study including 89 patients who underwent phalloplasty with urethral reconstruction between 2007 and 2018. Patients included were trans-male patients undergoing gender-affirming surgery and cis-male patients undergoing penile reconstruction after trauma, congenital malformation, or cancer. Urethral reconstructions were performed by free flap or skin graft (total or thin). Secondary urethroplasty may include direct vision urethrotomy, excision-anastomosis, or augmentation urethroplasty (skin graft, buccal mucosa graft). Patient demographics, medical history, peri- and postoperative data were collected from patient files. Functional results were evaluated using individual questionnaires.The mean (±sd) follow-up duration was 5.5 (±3.7) years. No significant difference was found for total urethral complication rate (fistula and/or stricture) according to type of urethral construction (70.9% for free flap urethra vs 73.5% for skin graft urethra; P = 0.911), nor according to the patient's grounds for surgery (72.7% for cis-male vs 71.8% for trans-male patients; P = 1). A total of 36 patients (40.5%) answered the functional questionnaire, of whom 80.5% reported usually voiding while standing and 47.5% were comfortable with urinating in public.Urethral construction in phalloplasty is associated with a high complication and revision rate regardless of the type of urethral reconstruction. Voiding in a standing position is generally possible but should not conceal feeble functional results.

The inferior epigastric artery (IEA) is commonly used as a recipient vessel in microsurgical phalloplasty but its use can be associated with abdominal parietal complications (hernia, bulging). To preclude such complications and avoid involvement of the femoral artery, we assessed an external pudendal artery (EPA) as a recipient vessel. We studied the disposition of the external pudendal system and its general anatomy. Then we compared the external diameter of the EPA to that of the first branches of the femoral artery. The most important point was to determine the location of the EPA through a reference line to facilitate a surgical approach. We then illustrated this preliminary study with a clinical case to check the reliability of the identified landmarks. Ten adult cadavers were dissected. The arteries of interest were part of a system consisting of either a common trunk or a duplicated system. The branches of the pudendal system arose from either the femoral artery or the deep femoral artery. On a horizontal reference line passing through the two pubic tubercles, we observed that 83% of EPAs arose between the reference line and 3 cm below it, at the level of a vertical axis centered on the femoral artery. The EPA could be suitable as recipient vessel in phalloplasty owing to its location, size, and ease of dissection. Using it instead of the IEA precludes abdominal parietal complications and reduces scarring in the recipient area.

Background: Cryopreservation of ovarian tissue is one of the strategies offered to girls and women needing gonadotoxic treatment, as a means of preserving their fertility. There are two methods of ovarian tissue cryopreservation: slow freezing, the reference method, and vitrification, an alternative method. The aim of the present study was to evaluate which of the two is the best method for human ovarian tissue cryopreservation. Each ovary was divided into 3 groups: Fresh, Slow freezing and Vitrification. In each group a histological study to evaluate follicular density and quality; and an evaluation of 6 gene expression (CYP11A, STAR, GDF9, ZP3, CDK2, CDKN1A) were performed. Results: We observed no significant difference in follicular density within these 3 groups. Slow freezing altered the pool of primordial follicles compared to the Fresh tissue (31.8% vs 55.9%, p = 0.046, respectively). The expression of genes involved in steroidogenesis varied after cryopreservation compared to the fresh group; CYP11A was under-expressed in both freezing groups compared to the fresh group and significantly under-expressed in the slow freezing group (p = 0.01), STAR was over-expressed in the slow freezing group and significantly under-expressed in the vitrification group (p = 0.01). Regarding the expression of genes involved in cell cycle regulation, CDKN1A was significantly under-expressed in both freezing groups (slow freezing: p = 0.0008; vitrification: p = 0.03) compared to the fresh group. Conclusion: Vitrification had no effect on the histological quality of the follicles at any stage of development compared to Fresh tissue. There was no significant difference in gene expression between the two techniques.

Background Simple cystectomy with urinary diversion is the favored option for treating conditions responsible of neurogenic bladder dysfunction after failure of conservative treatments. Despite the existence of validated assessment tools, the impact of cystectomy on female sexual function remains scarcely investigated. Aim The aim was to assess the sexual function and body image of female patients who underwent urinary diversion for a nonmalignant condition and to investigate the factors that may influence sexual life quality. Methods 36 female patients who underwent urinary diversion ± cystectomy for a benign condition between January 1, 2007 and December 15, 2019 were included. Standardized questionnaires were sent by mail between February and April 2021. Additional data were collected from patient computerized medical records. Outcomes The Female Sexual Function Index (FSFI), Body Image Scale (BIS), and Stoma Quality Of life (StomaQOL) questionnaires were used to assess sexual activity, body image, and quality of life related to a noncontinent stoma, respectively. The quality of pre- and postoperative information was also assessed. Results The most frequent etiology of bladder dysfunction was multiple sclerosis (14, 38.9%). After surgery, 29 (80.6%) patients were sexually active and the mean (range) overall FSFI score was 15.2 (2–33.3). The mean (range) overall FSFI score and FSFI Arousal sub-score were lower for the 14 patients with an ileal conduit [11.1(2–33.3] and 1 (0–4.5)) compared to the 14 patients with a continent stoma or a native urethra [19.2 (2–29.3]; P = .04 and 3.15(0-5.4); P = .014). Regarding sexual counseling, 27 (79.4%) patients did not receive any information before surgery about possible consequences on their sexual activity, 31 (91.2%) were not asked about their sexual activity during follow-up. The mean BIS score was higher for patients with an ileal conduit (14.8) compared to patients with a continent stoma (9.7) or a native urethra (5.1; P = .002). Patients with an ileal conduit had a mean StomaQOL score of 52.56. Clinical implications Optimal management should include, at least, routine assessment of sexual function prior to simple cystectomy and screening for sexual dysfunction during follow-up. Strengths and limitations The main strength of this study lies in the use of validated standardized questionnaires, including the FSFI that is considered as the most relevant tool for assessing female sexual function. Limitations include the small number of patients and the potential memory bias. Conclusion The present study suggests the urinary diversion mode has an impact on sexual function and body image after cystectomy for benign condition.

Objectives: The aim of the study was to assess the efficacy and safety of an enhanced recovery program (ERP) after robot-assisted partial nephrectomy (RAPN) for cancer. Methods: It was a monocentric, retrospective, comparative study. An ERP after RAPN was introduced at our institution in 2015 and proposed to all consecutive patients admitted for RAPN. The control group for this study was composed of patients managed immediately before the introduction of the ERP. We collected information on patient characteristics, tumor sizes, ischemia times, biology, hospital length of stays, postoperative (≤30 days) complications, and readmission rates. Group comparisons were made using the Pearson χ2 test for qualitative data and the Student t test for quantitative data. Results: Between 2015 and 2017, 112 patients were included in the ERP group. Fifty patients were included in the control group. Ninety patients in the ERP group (80.4%) were discharged at or before postoperative day (POD) 2 versus 10 patients (20%) in the control group (p < 0.001). There was no significant difference between the ERP and control groups for the urinary retention rate (respectively 3.6 vs. 2%; p = 0.593). Resumption of normal bowel function was significantly shorter in the ERP group (94.6% at POD1 vs. 69.6% in the control group, p < 0.001). There were no significant differences for postoperative complications (15.2% in the ERP group vs. 20% in the control group, p = 0.447) or readmissions within 30 days (8.04 vs. 0.2%, p = 0.140). Conclusions: ERP after RAPN seems to reduce postoperative length of stay without increasing postoperative complications or readmissions.

Summary Introduction. - The objective of this publication is to recall the initial oncological management of adrenal incidentalomas. Material & Methods. - The multidisciplinary working group updated french urological guidelines established by the CCAFU in 2018, based on an exhaustive literature review carried out on PubMed. Results. - Although the majority of the adrenal masses are benign and non-functional, it is important to investigate them, as a percentage of these can cause serious endocrine diseases or be cancers. Malignant adrenal tumors are mainly represented by Adrenocortical Carcinomas (ACC), malignant pheochromocytomas (MPC) and adrenal metastases (AM). The malignancy assessment of an adrenal incident includes a complete history, a physical examination, a biochemical / hormonal assessment to look for subclinical hormonal secretion. Diagnostic hypotheses are sometimes available at this stage, but it is the morphological and functional imaging and the histological analysis which will make it possible to close the malignancy assessment and make the oncological diagnosis. Conclusions. - AC and MPC are mainly sporadic but a hereditary origin is always possible. ACC is suspected preoperatively but the diagnosis of certainty is histological. The diagnosis of MPC is more delicate and is based on clinic, biology and imagery. The diagnosis of certainty of AM requires a percutaneous biopsy. At the end, the files must be discussed within the COMETE – adrenal cancer network (Appendix 1).

Summary Objective. – To update French guidelines concerning testicular germ cell cancer. Materials and methods. – Comprehensive Medline search between 2018 and 2020 upon diagnosis, treatment and follow-up of testicular germ cell cancer and treatments toxicities. Level of evidence was evaluated. Results. – Testicular Germ cell tumor diagnosis is based on physical examination, biology tests (serum tumor markers AFP, hCGt, LDH) and radiological assessment (scrotal ultrasound and chest, abdomen and pelvis computerized tomography). Total inguinal orchiectomy is the first-line treatment allowing characterization of the histological type, local staging and identification of risk factors for micrometastases. In case of several therapeutic options, one must inform his patient balancing risks and benefits. Surveillance is usually chosen in stage I seminoma compliant patients as the evolution rate is low between 15 to 20%. Carboplatin AUC7 is an alternative option. Radiotherapy indication should be avoided. In stage I non seminomatous patients, either surveillance or risk-adapted strategy can be applied. Staging retroperitoneal lymphadenectomy has restricted indications. Metastatic germ cell tumors are usually treated by PEB chemotherapy according to IGCCCG prognostic classification. Lombo-aortic radiotherapy is still a standard treatment for stage IIA. Residual masses should be evaluated by biological and radiological assessment 3 to 4 weeks after the end of chemotherapy. Retroperitoneal lymphadenectomy is advocated for every non seminomatous residual mass more than one cm. 18FDG uptake should be evaluated for each seminoma residual mass more than 3 cm. Conclusions. – A rigorous use of classifications is mandatory to define staging since initial diagnosis. Applying treatments based on these classifications leads to excellent survival rates (99% in CSI, 85% in CSII+).

Summary Objective. – To update French oncology guidelines concerning penile cancer. Methods. – Comprehensive Medline search between 2018 and 2020 upon diagnosis, treatment and follow-up of testicular germ cell cancer to update previous guidelines. Level of evidence was evaluated according to AGREE-II. Results. – Epidermoid carcinoma is the most common penile cancer histology. Physical examination is mandatory to define local and inguinal nodal cancer stage. MRI with artificial erection can help to assess deep infiltration in cases of organ-sparing intention. Node negative patients (defined by palpation and imaging) will present micro nodal metastases in up to 25% of cases. Invasive lymph node assessment is thus advocated except for low risk patients. Sentinel node dynamic biopsy is the first line technique. Modified bilateral inguinal lymphadenectomy is an option with higher morbidity. 18-FDG-PET is recommended in patients with palpable nodes. Chest, abdominal and pelvis computerized tomography is an option. Fine needle aspiration (when positive) is an easy way to assess inguinal palpable node pathological involvement. Its results determine the type of lymphadenectomy to be performed (for diagnostic or curative purposes). Treatment is mostly surgical. Free margins status is essential, but it also has to be organ-sparing when possible. Brachytherapy and topic agents can cure in selected cases. Lymph node assessment should be synchronous to the removal of the tumour when possible. Limited inguinal lymph node involvement (pN1 stage) can be cured with the only lymphadenectomy. In case of larger lymph node stage, one should consider multidisciplinary treatment including chemotherapy and inclusion in a trial. Conclusions. – Penile cancer needs demanding surgery to be cured, surrounded by chemotherapy in node positive patients. Lymph nodes involvement is a major prognostic factor. Thus, inguinal node assessment cannot be neglected.

Summary Objective. - To update French urological guidelines on retroperitoneal sarcoma. Materials and methods. - Comprehensive Medline search between 2018 and 2020 upon diagnosis, treatment and follow-up of retroperitoneal sarcoma. Level of evidence was evaluated. Results. - Chest, abdomen and pelvis CT is mandatory to evaluate any suspected retroperitoneal sarcoma. MRI sometimes helps surgical planning. Before histological confirmation through biopsy, the patient must be registered in the French sarcoma pathology reference network. The biopsy standard should be an extraperitoneal coaxial percutaneous sampling before any retroperitoneal mass therapeutic decision. Surgery is retroperitoneal sarcoma cornerstone. The main objective is grossly negative margins and can be technically challenging. Multimodal treatment risks and benefits must be discussed in multidisciplinary teams. The relapse rate is related to tumor grade and surgical margins. Reported Negative margins rate thus encourage surgery in high-volume centers. Conclusion. - Retroperitoneal sarcoma prognosis is poor and closely related to the quality of initial management. Centralization through dedicated sarcoma pathology network in a high-volume center is mandatory.

The aim of this work is to report the presence of resistance to fluazuron in a population of Rhipicephalus microplus in Argentina. The evidence was obtained from field and in vitro trials. In the field trial, cattle infested with ticks was treated with two commercial formulations of fluazuron. The in vitro trial (adult immersion test, AIT) was performed by using technical grade fluazuron. In the field trial, there were no significant differences between the treated and control groups between days 2 and 34 post-treatment. The only exceptions (treated group I in day 14 post-treatment, treated group II in days 23 and 29 post-treatment) had a significantly lower tick load than the untreated group, but the efficacy was not higher than 70%. Viable engorged females were collected on both groups of treated bovines in all counts, and the production of viable larvae was not precluded with the application of the two commercial formulations of fluazuron evaluated in this study. The results obtained with the in vitro assay (AIT) also indicate that the R. microplus population tested in this work has a higher level of resistance to fluazuron than another susceptible field strain. The integrated analysis of the field and in vitro trials clearly reveals the emergence of resistance to fluazuron in a R. microplus population from Argentina. This diagnosis of resistance does not imply that the fluazuron has lost its functionality at a regional scale, but it highlights the need to establish control strategies that minimize the use of this drug in order to preserve its functionality as an acaricide.

Objectives To present the surgical results and the functional outcomes after surgical correction of congenital penile curvature (CPC) by different plication techniques. Methods All consecutive patients operated for CPC from 2010 to 2019 in a university hospital of Lyon, France, were retrospectively identified and included for analyzing surgical results. They were proposed to answer a questionnaire (between January 2020 and May 2020) that included questions of the Peyronie's Disease Questionnaire (PDQ), the Erection Hardness Score (EHS), and the Internal Index of Erectile Function (IIEF5), along with non-validated specific questionnaires. Results A total of 31 patients were included, their mean (SD) age was 21.2 (4.9) years, their mean (SD) follow-up of 55.5 (33.7) months. The principal curvature was ventral for 25 (80.6%) patients. After the surgery, 28 (90.3%) patients had straight penis or a residual curvature less than 15°, and 2 (6.5%) required a second surgery. A total of 23 (74.2%) patients answered the post-operative questionnaire. The mean (SD) scores were 1.2/16 (1.8) for PDQ-Bothered Score, 1.5/24 (2.1) for PDQ Psychological and Physical, and 1.7/30 (2.7) for PDQ pain. The mean (SD) IIEF5 was 22.7/25 (4.6). All patients had an EHS of 4/4. There were 10 patients who never had sexual intercourse before the surgery and 4 who still had not when answering the questionnaire. All patients (23/23) were either “satisfied” or “very satisfied” with the outcomes of the operation, and 13 (56.5%) reported improvement of their sexual life after surgery. Conclusion This study confirmed the favorable outcomes of surgical plication for CPC with low morbidity. A concomitant sexological care may be useful for some patients.

Background: The aim of the present study was to evaluate the effect of Activin A on the activation of in vitro folliculogenesis of human ovarian tissues with or without our new three-dimensional structure (3D-structure). Methods: Five fresh ovarian human tissues were cultured in vitro in 4 groups with 100ng/mL Activin A or without Activine A and within or without a 3D-structure for 20 or 22 days of in vitro culture. Follicular density and quality were evaluated, and follicular diameters were measured. Estradiol secretion was quantified. Proliferation and apoptosis through immunostaining were performed.Results: The proportion of primordial follicles was significantly reduced, and the proportion of primary and secondary follicles was significantly increased in all four groups (p0.05). The 3D-structure increased the density of primary follicles and decreased the estradiol secretion (pConclusion: The presence of Activin A did not seem to play a key role in in vitro folliculogenesis activation. However, the results may indicate that the 3D-structure could be more physiological and could prevent a pejorative in vitro folliculogenesis flare-up.

Introduction The ZSI 475FtM is a new prosthesis that has recently been specifically designed for phalloplasty. It has several functions that have been conceived to answer the challenges of implantation after phalloplasty: a large base for pubic bone fixation, realistically shaped hard glans, and a pump shaped like a testicle. Aim To assess the safety, feasibility, and patient satisfaction of the ZSI 475 FtM. Methods Surgical outcomes were analyzed after implantation of the prosthesis between June 2016 and September 2017 (single institution, single surgeon). Patients were then asked to answer a satisfaction questionnaire that included the International Index of Erectile Function–5, Erectile Dysfunction Inventory of Treatment Satisfaction, and Self-Esteem and Relationship, as well as other non-validated questions. Main Outcome Measure Complication rates and the scores of the different questionnaires were reviewed. Results 20 patients who had gender dysphoria and underwent operation for a female-to-male procedure were included. The mean age was 37.9 years. Complications after 21 implantations included 2 (9.5%) infections that were medically treated (Clavien II), 1 (4.7%) infection treated by explantation (Clavien IIIb), 2 (9.5%) mechanical failures (Clavien IIIb), and 1 (4.7%) malpositioning (Clavien IIIb). The mean follow-up was 8.9 months (SD 4.0), with 50% of the implanted patients having >12 months of follow-up. 14 patients (70%) answered the satisfaction questionnaire. 12 patients (85.7%) had regular penetrative sexual intercourse. The mean International Index of Erectile Function–5 score was 20.2 of 25 (standard deviation [SD] 7.9), the mean Self-Esteem and Relationship score was 84.5 of 100 (SD 9.9), and the mean Erectile Dysfunction Inventory of Treatment Satisfaction score was 82 of 100 (SD 17.5). 13 patients (92.8%) were satisfied or very satisfied with the prosthesis. Clinical Implications This new innovative prosthesis could better answer the challenges faced by the implantation of an erectile device by phalloplasty. Strength & Limitations Our study is the first to report data on this new prosthesis. The main limitation is the small number of patients and the short follow-up. Conclusion Preliminary results for the ZSI 475 FtM are encouraging. Safety seems to be satisfactory, and patient satisfaction is high. Long-term studies are needed for further analysis.

A nested polymerase chain reaction-restriction fragment length polymorphism (nPCR-RFLP) assay based on the amplification of the Anaplasma spp. highly conserved msp5 gene and posterior digestion with HindIII endonuclease was developed and evaluated in field samples. Results were compared using an nPCR specific for Anaplasma marginale (nPCR-Am) based on the msp1β gene and an nPCR specific for A. centrale (nPCR-Ac) based on the msp2 operon (msp2-o) gene. Amplicons dilutions of msp1β and msp5 of A. marginale and msp2-o and msp5 of A. centrale and dilutions of parasited erythrocytes (PE) with A. marginale and A. centrale were used to determine the detection limits. The results were 20 DNA copies/reaction and 30 PE for A. marginale and A. centrale by nPCR-RLFP and nPCR-Am/Ac. A mix of msp5-Am and msp5-Ac was used to evaluate the interference of msp5 from one species for the detection of the other. Co-amplification of the DNA from both species was observed up to a 1:7 ratio of one species to the other. Field samples positive for Anaplasma spp. antibodies (n = 260) from 32 herds were evaluated. Strength of agreement between results by nPCR-RFLP and nPCR-Am or nPCR-Ac was 78% (κ = 0.44) and 94% (κ = 0.85), respectively. Thirty-four samples were positive for A. marginale by nPCR-RFLP but negative by nPCR-Am. msp1β amplicons of 10 samples from 5 herds with discrepancies between nPCR-Am and nPCR-RFLP results were cloned and sequenced. The analysis of the msp1β sequence showed several mutations in the target region of the internal forward primer that would explain the failure in the amplification. Only 10 of the 20 coinfections identified by nPCR-Ac/nPCR-Am were detected by nPCR-RFLP. nPCR-RFLP is a sensitive, low-cost and accessible molecular method for low-complexity laboratories. More studies are needed to establish in which circumstances coinfections can be underestimated.

This article presents the surgical outcomes of a consecutive series of 71 transmen undergoing pre-expanded suprapubic phalloplasty (SPP) in a specialized center. The median [IQR] duration to finalize this three-stage phalloplasty procedure was 7 months [6–7]. Median [IQR] follow-up was 39.4 months [19.7–81.2]. Among those included, 25 (35.2%) had a urethroplasty, and 40 (56.3%) a penile prosthesis as additional procedures. Complications were the result of disorders of wound healing (dehiscence, infection, partial necrosis) or tissue expander (migration, infection). Sixty patients (84.5%) experienced at least one complication during the phalloplasty procedure, mostly minor complications Clavien < IIIa (81.8%). Among these, 16 (22.5%) underwent at least one reintervention, 2 of whom underwent two reinterventions (18 reinterventions in total for Clavien ≥ IIIa complication). There was no loss of phalloplasty. Among the wide variety of techniques developed for phalloplasty, the suprapubic technique seems to be a valuable option for transmen on the path to genital gender affirming surgery.

International audience; The definition of the Cenomanian stage was based on the description of several type 34 sections scattered in the vicinity of Le Mans (Sarthe, France). Despite limited exposures 35 nowadays, the area remains a reference for the palaeontology of the Cenomanian due to its 36 outstanding richness in marine macrofossils, especially molluscs, bryozoans, brachiopods and 37 echinoderms. The publication in 2015 of the volume dedicated to the Cenomanian stratotype 38 yielded the opportunity to restudy the last accessible outcrops. This paper provides a high39 resolution stratigraphic scheme and palaeoenvironmental reconstruction for the middle and 40 late Cenomanian interval in its type area. La Garenne Quarry is a window on the middle Cenomanian, where Praeglobotruncana rillella nov. sp. has been identified. The δ 13 41 Ccarb and δ 18 42 Ocarb record of a Cenomanian–Turonian succession close to Le Mans is correlated with the 43 type section of Pueblo (Colorado). Isotopic and biotic events highlight the presence of several 44 hiatuses in the sedimentary record of Le Mans especially around the Cenomanian–Turonian boundary with a dramatic truncation of the plateau of high δ 13 45 Ccarb values. Coiling reversal 46 events among the surface dwellers Muricohedbergella delrioensis, indicate sea surface 47 temperature changes with transient coolings, including the Plenus cold event, and warm 48 conditions at the Cenomanian–Turonian boundary. Sandy to chalky facies have yielded 49 empty, well-preserved shells of foraminifera allowing the description of Dicarinella 50 falsohelvetica nov. sp. Oxygen isotopic analyses performed on right- and left-coiled M. 51 delrioensis reveal a systematic offset during cold events which lead to discuss about the 52 potential occurrence of cryptic species in the Mesozoic.

Serpulid polychaetes are described as common encrusting organisms inhabiting various substrates, but very few studies deal with tube-dwelling polychaetes as substrates for encrusters and borers. Here we focus on Pyrgopolon (Pyrgopolon) deforme, a serpulid species common in the Cenomanian of Le Mans region which acted as small solid benthic islands for colonization by invertebrates on a soft sandy/marly bottom. A relatively rich assemblage of 88 individuals was studied surficially, 15 specimens were imaged with CT, and five specimens were prepared as vacuum epoxy casts. Borings found in the tubes show relatively low diversity; nevertheless, several different, recurring shapes were recognized. Borings of the ichnogenus Rogerella are among the best preserved. The examined tubes represent the second known case of interaction between boring barnacles (Rogerella tracemakers) and serpulid worms. Short shafts perpendicular to tube surfaces are attributable to Trypanites isp. Longer, irregularly meandering tunnels resemble another form of Trypanites isp., but usually display more than one opening, suggesting Maeandropolydora. Another boring is a drop-shaped chamber with a relatively large aperture and several narrower side openings. They can be preliminarily assigned to unicamerate entobians. Among sclerozoans, encrusting oysters and cheilostome and cyclostome bryozoan colonies are the most abundant groups. Other encrusters such as serpulid and sabellid worms and foraminifers are less common, infesting fewer than 10% of tubes. Due to the high density of infestation, random distribution of boreholes and lack of signs of repair of the penetrated tube walls by the host organism, post-mortem infestation of Pyrgopolon (P.) deforme is suggested.

Introduction Gender-affirming surgery is common for the treatment of gender dysphoria, but its effect on genital sensitivity is not well known. Aims To investigate genital sensory detection thresholds in male-to-female transgender women postoperatively and their relation to psychological well-being and variables of satisfaction. Methods Prospective study on 28 transgender women at least 18 years old operated on at least 3 months before the study by a single surgeon (N.M.J.). Main Outcome Measures Medical complications; sensory detection thresholds for light touch, pressure, and vibration; and questionnaires on general and sexual satisfaction, sexual function, depression, and psychological well-being. Results Sensory detection thresholds ranged from 0.07 to 2.82 g for light touch, with the neck being most sensitive; from 20.23 to 34.64 g for pressure, with similar results for the neck and clitoris; and from 0.0052 to 0.0111 V for vibration, with similar findings for all stimulation points. Satisfaction with the appearance of the labia, vulva, clitoris, and sexual function was good to very good. Frequency of sexual activities increased significantly postoperatively for orogenital stimulation and decreased significantly for frequency of fantasies (t = −4.81; P < .0001). Orgasmic function was reported by 80% of participants. Psychological adjustment was good to very good, with low depression scores. Sexual satisfaction was statistically and positively correlated with vaginal function and depth, clitoral sensation, appearance of the vulva and labia minora, and natural lubrication and negatively correlated with depression scores. Conclusion Gender-affirming surgery yields good results for satisfaction with appearance and function. Genital sensitivity showed the best results with pressure and vibration.

The rich Cenomanian assemblage of tube-dwelling polychaete worms of the families Sabellidae and Serpulidae from Le Mans region (Sarthe) is described in detail for the first time in one place; the systematics and the palaeoecology of the species are discussed. The 19 species described belong to 12 genera: Glomerula Brunnich Nielsen, 1931; Filograna Berkeley, 1835; Protula Risso, 1826; Filogranula Langerhans, 1884; Serpula Linnaeus, 1758; Cementula Brunnich Nielsen, 1931; Neovermilia Day, 1961; Dorsoserpula Parsch, 1956; Mucroserpula Regenhardt, 1961; Placostegus Philippi, 1844; Cycloplacostegus Jager, 2005; Pyrgopolon de Montfort, 1808. Two new species are described: Serpula? pseudoserpentina sp. nov. and Pyrgopolon (Septenaria) cenomanensis sp. nov.

Introduction The creation of a neophallus is a complex surgery that must meet functional and esthetic requirements. It is a long and demanding surgical process whose final stage consists of the implantation of a rigid or inflatable material that can be used to reproduce an erection. Data in the literature are scarce, with only the pioneering series present, which includes the use of the first devices and techniques. Aim To report the outcome of patients with phalloplasty after implantation of erectile implants using standardized surgical techniques and the use of recent prosthesis types with or without a vascular graft. Methods This is a retrospective hospital-based analysis of all patients with phalloplasty who underwent implantation of an erectile prosthesis from March 2007 to May 2015. Factors associated with complications were investigated by multivariate logistic regression analysis. Main Outcome Measures Early-onset (during the first month after surgery) and late-onset complications, including erosion, infections, malpositioning, and dysfunction. Results Sixty-nine patients were included in the study and 95 procedures were analyzed. After a median follow-up of 4 years (minimum = 169 days, maximum = 6.1 years), the original prosthesis was still in place in 43 patients (62.3%). Patients underwent phalloplasty after female-to-male transsexualism (n = 62, 89.9%), malformation (n = 4, 5.8%), or trauma (n = 3, 4.3%). The proportions for the different types of phalloplasty were 58% for forearm free flap phalloplasty (n = 40), 33.3% for suprapubic phalloplasty (n = 23), and 7% for other (n = 6). The erectile prostheses used were the two-piece AMS Ambicor (n = 71, 74.7%), the Ambicor with a vascular graft (n = 19, 20.0%), and the AMS 700CXR, AMS 700CX, or AMS600-650 (n = 5, 5.2%). There were no early-onset complications in 89 procedures (93.7%) and, when present, they were always related to infection (n = 4, 4.2%). Late-onset complications were erosion (n = 4, 4.2%), infection (n = 4, 4.2%), dysfunction (n = 10, 10.5%), and malpositioning (n = 12, 12.6%). No significant difference was observed for malpositioning (12.7% vs 10.5%, P = .87) and dysfunction (7.0% vs 10.5%, P = .78) between the AMS Ambicor prosthesis and the Ambicor prosthesis with a vascular graft. Conclusion This study provides updated data on complications after the implantation of erectile implants. Multicenter studies, including the evaluation of patient satisfaction, are needed to increase our understanding of factors associated with the outcomes.

Oxygen delivery to cells is the basic prerequisite of life. Within the human body, an ingenious oxygen delivery system, comprising steps of convection and diffusion from the upper airways via the lungs and the cardiovascular system to the microvascular area, bridges the gap between oxygen in the outside airspace and the interstitial space around the cells. However, the complexity of this evolutionary development makes us prone to pathophysiological problems. While those problems related to respiration and macrohemodynamics have already been successfully addressed by modern medicine, the pathophysiology of the microcirculation is still often a closed book in daily practice. Nevertheless, here as well, profound physiological understanding is the only key to rational therapeutic decisions. The prime guarantor of tissue oxygenation is tissue blood flow. Therefore, on the premise of intact macrohemodynamics, the microcirculation has three major responsibilities: 1) providing access for oxygenated blood to the tissues and appropriate return of volume; 2) maintaining global tissue flood flow, even in the face of changes in central blood pressure; and 3) linking local blood flow to local metabolic needs. It is an intriguing concept of nature to do this mainly by local regulatory mechanisms, impacting primarily on flow resistance, be this via endothelial or direct smooth muscle actions. The final goal of microvascular blood flow per unit of time is to ensure the needed exchange of substances between tissue and blood compartments. The two principle means of accomplishing this are diffusion and filtration. While simple diffusion is the quantitatively most important form of capillary exchange activity for the respiratory gases, water flux across the blood-brain barrier is facilitated via preformed specialized channels, the aquaporines. Beyond that, the vascular barrier is practically nowhere completely tight for water, with paracellular filtration giving rise to generally low but permanent fluid flux outwards into the interstitial space at the microvascular high pressure segment. At the more leaky venular aspect, both filtration and diffusion allow for bidirectional passage of water, nutrients, and waste products. We are just beginning to appreciate that a major factor for maintaining tissue fluid homeostasis appears to be the integrity of the endothelial glycocalyx.