Objective To illustrate the details and effects of a new technique of penile augmentation-a dual plane approach to enhance the penile girth with human acellular dermal matrix (ADM)through the incision on the dorsal penile root.Methods Firstly,a reversed V incision was made at the dorsal root of the penis and the superficial suspensory ligament of the penis was released.A Dartos fascia incision was then made and the plan between Dartos fascia and Buck's fascia was dorsally dissected toward the coronary sulcus.A Buck's fascia incision was made 1.5-2 cm from the coronary sulcus and the fascia was undermined distally.One or two sheets of ADM was dorsally placed by a dual plane method which combined partial sub-Buck's fascia plane and partial sub-Dartos fascia plane to enhance the penile circumference.Finally,the Dartos fascia incision was closed and followed by the closure of the wound with V-Y advancement.Results A total of 35 patients underwent dual plane penile augmentation No dorsal penile skin necrosis and exposure of ADM sheet happened in our group postoperatively.25 patients were followed from 6 to 24 months after operation.All patients were satisfied with their penile appearance and 21 married patients reported satisfied sexual activity.The increase of penile circumference was (2.65±0.41) cm at flaccid state and (1.85±0.35) cm at erectile state 6 months postoperatively.No pleat or absorb of the ADM sheet,losses of sensitivity of the penis occurred during the follow-up period.Conclusions By adjusting the plane of ADM placement,the dual plane penile augmentation ensures adequate soft-tissue coverage and sufficient blood supply of penile skin and offers increased benefits and fewer tradeoffs compared with a single plane.This technique could be an effective way to lengthen and enlarge the penis in one stage without major complication.

To investigate whether chemotherapy could prolong the postoperative survival time in patients with early stages pancreatic ductal adenocarcinoma (PDAC). A total of 5280 stage ⅠA -ⅡB PDAC patients diagnosed from 2010 to 2015 were selected from surveillance，epidemiology，and end results (SEER) database. Propensity score matching (PSM) analysis was adopted to reduce the baseline differences between the groups. Univariate survival analysis was conducted with the Kaplan-Meier method. Multivariate survival analysis was performed with the Cox proportional hazards model. Univariate and multivariate survival analyses showed that age, differentiation, stage, chemotherapy were independent risk factors for the survival of PDAC patients. After PSM, it is found that adjuvant chemotherapy could prolong the median overall survival time (mOS) for stage ⅠB, ⅡA and ⅡB patients. However, for stage ⅠA patients, there were no significant differences in 3-year survival rate and mOS between patients with chemotherapy (=283) and without chemotherapy (=229) (57.4% vs 55.6%, vs all >0.05). Further analyses show that among 101 patients with well differentiated PDAC and 294 patients with moderately differentiated PDAC, there were no significant differences in survival rate and mOS between patients with and without chemotherapy (all >0.05). Among 117 patients with low-differentiated + undifferentiated PDAC, 3-year survival rate and mOS in patients with chemotherapy were significantly better than those without chemotherapy (48.5% vs 34.1%, vs all <0.05). Chemotherapy regimen used currently is not beneficial for patients with moderately and well differentiated stage ⅠA PDAC, but it is an independent prognostic factor for low-differentiated + undifferentiated PDAC patients.
Adenocarcinoma/pathology* ; Carcinoma, Pancreatic Ductal/surgery* ; Chemotherapy, Adjuvant ; Humans ; Neoplasm Staging ; Pancreatic Neoplasms/drug therapy* ; Prognosis ; Propensity Score