[Description of a vaginoplasty technique using a peritoneal flap harvested by coelioscopic approach for male-to-female gender affirmations (MtF)]. / Description d'une technique de vaginoplastie utilisant un lambeau péritonéal prélevé par voie cœlioscopie pour les affirmations de genre homme-à-femme (HtF).

AIM: The aim of this article is to provide a comprehensive description of the peritoneal flap technique in male-to-female (MtF) gender affirmation surgery, particularly in cases of insufficient depth after penile inversion vaginoplasty. RESULTS: Our short-term results reveal that the peritoneal flap vaginoplasty, adapted from the Davydov procedure, has shown significant potential for improving functional and aesthetic outcomes, including the creation of a self-lubricating neovagina. However, the complexity of the procedure requires advanced surgical expertise and appropriate postoperative care. Patient selection also plays an essential role as not all patients are ideal candidates for this procedure. CONCLUSION: Despite its promises, the widespread adoption of the peritoneal flap technique in male-to-female (MtF) gender affirmation surgery is hindered by several challenges, including the need for specialized training and potential postoperative complications. Thus, this technique should be considered as an alternative or complement to traditional methods, depending on individual patient factors. Further research and extensive clinical trials are needed to better understand its potential and limitations in order to enhance the arsenal of effective surgical options for MtF gender affirmation surgery.

[Phalloplasty by radial forearm free flap in the context of female-to-male gender reassignment surgery]. / Phallopoièse par lambeau antébrachial radial libre dans la chirurgie de réassignation sexuelle femme à homme.

AIMS: The aims of this article are to provide an overview of the technique of phalloplasty by radial forearm free flap in the context of female-to-male gender reassignment surgery, with a specific focus on surgical technical details and the prevention of postoperative complications. METHODS: In the light of our 30 years of experience in caring for female-to-male transgender individuals and conducting a critical review of the literature, we exhaustively present our technique of radial forearm free flap phalloplasty in female-to-male gender reassignment surgery. RESULTS: The technique of radial forearm free flap phalloplasty, utilizing a one-stage approach for neourethral and neophallus construction based on the "tube within a tube" principle, not only achieves an aesthetically pleasing appearance of the neophallus resembling a normal penis with tactile and erogenous sensitivities but also yields a functional neourethra and satisfactory penile rigidity using implants for standing voiding and sexual intercourse. This intricate surgical procedure demands not only meticulous execution of all surgical maneuvers but also high-level postoperative care. Despite refinements in technique over recent decades, aesthetic sequelae at the donor site of the flap remain subject to criticism, and postoperative complications, particularly of vascular and urological nature, remain significant. CONCLUSION: Future optimization of the surgical technique for this procedure will be imperative to minimize postoperative complications and establish a true technical "gold standard" for phalloplasty in female-to-male transgender individuals.

CHALLENGES OF AN OVARIAN NEUROENDOCRINE METASTASIS OF ADVANCED SMALL-CELL LUNG CARCINOMA - LITERATURE REVIEW AND CASE REPORT.

Metastatic tumors account for 5-10% of all ovarian malignancies. They are usually bilateral tumors with a multinodular surface and extensive extra ovarian spread. Lung cancer is a rare source (0.3% of metastatic ovarian tumors). Among synchronous primary cancers, ovarian cancer is most frequently associated with endometrial cancer. The differential diagnosis between a primary ovarian carcinoma, synchronous primary cancers, and metastatic ovarian carcinoma is very important, as the treatment and prognosis are markedly different. We report the case of a 25-year-old woman who had been diagnosed and treated for stage IIIB small cell lung carcinoma (SCLC). Imaging undertaken for abdominal pain revealed a unilateral 8.5 cm ovarian tumor for which adnexectomy was performed. Histology and immunohistochemistry led to the diagnosis of ovarian metastasis from SCLC, a high-grade neuroendocrine lung tumor. This patient's particular features, all infrequent in a metastatic tumor, are the lesion's unilaterality (atypical for ovarian metastases in other cancers, but often observed in SCLC), the smooth ovarian surface with intact capsule, and the absence of intra-abdominal dissemination. The patient developed liver and vertebral metastases. This report focuses on the differential diagnosis between primary and metastatic ovarian neoplasms. We performed an extensive search of the literature on SCLC and ovarian metastases. Immunohistochemistry is essential for diagnosis when imaging and the pathological evaluation of the ovarian tumor cannot make the differential diagnosis.

Arbuscular mycorrhizas are present on Spitsbergen.

A previous study of 76 plant species on Spitsbergen in the High Arctic concluded that structures resembling arbuscular mycorrhizas were absent from roots. Here, we report a survey examining the roots of 13 grass and forb species collected from 12 sites on the island for arbuscular mycorrhizal (AM) colonisation. Of the 102 individuals collected, we recorded AM endophytes in the roots of 41 plants of 11 species (Alopecurus ovatus, Deschampsia alpina, Festuca rubra ssp. richardsonii, putative viviparous hybrids of Poa arctica and Poa pratensis, Poa arctica ssp. arctica, Trisetum spicatum, Coptidium spitsbergense, Ranunculus nivalis, Ranunculus pygmaeus, Ranunculus sulphureus and Taraxacum arcticum) sampled from 10 sites. Both coarse AM endophyte, with hyphae of 5-10 µm width, vesicles and occasional arbuscules, and fine endophyte, consisting of hyphae of 1-3 µm width and sparse arbuscules, were recorded in roots. Coarse AM hyphae, vesicles, arbuscules and fine endophyte hyphae occupied 1.0-30.7, 0.8-18.3, 0.7-11.9 and 0.7-12.8% of the root lengths of colonised plants, respectively. Principal component analysis indicated no associations between the abundances of AM structures in roots and edaphic factors. We conclude that the AM symbiosis is present in grass and forb roots on Spitsbergen.

A randomized, double-blind, crossover, placebo-controlled trial of 6 weeks benfotiamine treatment on postprandial vascular function and variables of autonomic nerve function in Type 2 diabetes.

AIMS: In a pilot study we suggested that benfotiamine, a thiamine prodrug, prevents postprandial endothelial dysfunction in people with Type 2 diabetes mellitus. The aim of this study was to test these effects in a larger population. METHODS: In a double-blind, placebo-controlled, randomized, crossover study, 31 people with Type 2 diabetes received 900 mg/day benfotiamine or a placebo for 6 weeks (with a washout period of 6 weeks between). At the end of each treatment period, macrovascular and microvascular function were assessed, together with variables of autonomic nervous function in a fasting state, as well as 2, 4 and 6 h following a heated, mixed test meal. RESULTS: Participants had an impaired baseline flow-mediated dilatation (2.63 ± 2.49%). Compared with the fasting state, neither variable changed postprandially following the placebo treatment. The 6 weeks' treatment with high doses of benfotiamine did not alter this pattern, either in the fasting state or postprandially. Among a subgroup of patients with the highest flow-mediated dilatation, following placebo treatment there was a significant postprandial flow-mediated dilatation decrease, while this effect was attenuated by benfotiamine pretreatment. CONCLUSIONS: In people with Type 2 diabetes and markedly impaired fasting flow-mediated dilatation, a mixed test meal does not further deteriorate flow-mediated dilatation or variables of microvascular or autonomic nervous function. Because no significant deterioration of postprandial flow-mediated dilatation, microvascular or autonomic nervous function tests occurred after placebo treatment, a prevention of the postprandial deterioration of these variables with benfotiamine was not feasible.

[Post traumatic entero-mesenteric venous infarct]. / Infarct entero-mezenteric venos cvasitotal acut posttraumatic.

The paper presents a case of entero-mesenteric venous infarct, occurred in a man of 34 years, discovered intraoperator, when to intervene surgically in emergency surgery for acute abdomen of peritonitic type. The etiology of this venous infarct was posttraumatic, the patient underwent an abdominal aggression with seven days prior to onset of symptoms. In literature, the posttraumatic etiology is found in a small number compared to the large number of abdominal contusion, intimal lesional factor beeing associated with blood thickness. Paraclinical investigations were not significant in terms of preoperator diagnosis, surgical intervention (backward and forward thrombectomy of superior mesenteric vein with Fogarty probe and venosuture) having a favorable evolution. This intervention is practiced as an exception on the basis of the idea that venous thrombosis spreads to mezenteric vein and its collaterals followed by extensive arterial thrombosis and total compromise of intestinal viability.

Improved anti-obesity effect of herbal active and endogenous lipids co-loaded lipid nanocarriers: Preparation, in vitro and in vivo evaluation.

The association of numerous advantages of natural active compounds (from vegetal and herbs) and endogenous lipid in the same delivery system is a straightforward approach for the development of safe and better tolerated anti-obesity therapy. In the present study we envisage a novel concept for obesity therapy, devoted to the development of innovative lipid nanostructured formulas with improved gastric tolerability and enhanced specificity in adipose cells targeting. For this purpose, an anti-obesity herbal active from red pepper extract - Capsaicin (Cap) and an endogenous lipid regulator of appetite - oleoylethanolamide (OEA) or a structural analogue of OEA - Phenylalaninol oleamide (PAO), are simultaneously integrated within the same delivery system - nanostructured lipid carriers (NLC) prepared with linseed oil that has anti-inflammatory and hypotriglyceridemic properties. The NLC-OEA/PAO-Cap presented mean diameters under 200 nm, size that allow an efficient uptake of actives by enterocytes and lead to an extended biological action of all actives - Cap, OEA/PAO and linolenic acid. NLC revealed a polidispersity index ranging from 0.16 to 0.22, which represents a narrow dispersion around mean size and suggests an adequate unimodal behavior. The two types of NLC co-loaded with Cap and OEA/PAO were both negatively charged, with zeta potentials of -42.8 mV and -58.5 mV that offered a guarantee for an excellent stability of NLC in time. Despite to the competition between the accommodations of both actives into the lipid core of nanocarriers, the entrapment efficiency exceeds 92% for OEA/PAO and is ranged between 71 and 82% for Cap. In the presence of NLC-OEA/PAO-Cap, ABTS+⁎ inhibition proceeded in a Capsaicin concentration dependent manner and was dependent on the type of NLC formulation. A remarkable radical-scavenging activity against ABTS+⁎ was determined for Cap and OEA based-NLC. The in vitro release demonstrated that NLC played an important role on the delay of Cap dissolution; the NLC have ensured a slow release of Cap, eg only 21% Cap was released after 24 h of in vitro experiments. The in vivo pharmacological evaluation has revealed that the NLC-OEA/PAO-Cap treatment resulted in a body weight decrease and improves the lipid and glucose profile, as compared to the obese mice batch. Obesity mice treated with NLC-OEA exhibited a weight loss of ~15% and ~10% weight loss for NLC-POA, after 10-days treatment. Administration of NLC-OEA/PAO-Cap to the Albino Swiss mice led to significant decrease of glucose level (e.g. 117.4 mg/dL for NLC-OEA-Cap treated mice versus 213.9 mg/dL for obese mice batch) and exhibited a desired decrease effect of triglyceride (e.g. 71.1 mg/dL for NLC-OEA-Cap versus 129.5, for obese batch). Moreover, the cholesterol values have been lowered to almost half from the value determined for the control batches. Overall, study highlights that using appropriate lipid mediators in association with an herbal anti-obesity active, both formulated into lipid nanocarriers, could enhance the therapeutic response in the obesity treatment.

Cis-regulatory evolution of chalcone-synthase expression in the genus Arabidopsis.

The contribution of cis-regulation to adaptive evolutionary change is believed to be essential, yet little is known about the evolutionary rules that govern regulatory sequences. Here, we characterize the short-term evolutionary dynamics of a cis-regulatory region within and among two closely related species, A. lyrata and A. halleri, and compare our findings to A. thaliana. We focused on the cis-regulatory region of chalcone synthase (CHS), a key enzyme involved in the synthesis of plant secondary metabolites. We observed patterns of nucleotide diversity that differ among species but do not depart from neutral expectations. Using intra- and interspecific F1 progeny, we have evaluated functional cis-regulatory variation in response to light and herbivory, environmental cues, which are known to induce CHS expression. We find that substantial cis-regulatory variation segregates within and among populations as well as between species, some of which results from interspecific genetic introgression. We further demonstrate that, in A. thaliana, CHS cis-regulation in response to herbivory is greater than in A. lyrata or A. halleri. Our work indicates that the evolutionary dynamics of a cis-regulatory region is characterized by pervasive functional variation, achieved mostly by modification of response modules to one but not all environmental cues. Our study did not detect the footprint of selection on this variation.

[Pancreatico-jejunal vs pancreatico-gastric anastomosis after cephalic duodenopancreatectomy]. / Anastomoza pancreatico-digestiva dupa duodenopancreatectomia cefalica.

Pancreatoduodenectomy has been for a long time a procedure with high postoperative morbidity and mortality. Several complications after pancreatic resections are known, but one of the most severe is the fistula of the pancreatic anastomosis. Avoiding the pancreatic fistula caused many surgical innovations regarding the procedure of reestablishing the continuity after pancreatoduodenectomy. The aim of this retrospective study was to compare pancreatico-jejunostomy vs pancreatico-gastrostomy with regard to safety of pancreatic anastomosis after pancreatoduodenectomy. No technique was proved to be superior so far, the benefits of these 2 types of pancreatic anastomosis being the subject for intense debates. From 2000 to 2004, 17 patients underwent pancreatoduodenectomy, for pancreas, ampulla, distal bile duct or duodenum cancers. Pancreatic anastomosis was accomplished by pancreatico-gastrostomy in 11 cases and by pancreatico-jejunostomy in 6 cases. There was no significant difference between the two groups (age, gender and primary disease). Comparison between the two groups was made mainly analysing postoperative mortality and morbidity. Postoperative morbidity was 9,1% after pancreatico-gastrostomy and 33,3% after pancreatico-jejunostomy. Postoperative mortality was none after pancreatico-gastrostomy and 16,7% after pancreatico-jejunostomy. This study seems to demonstrate the superiority of the pancreatico-gastric anastomosis, but in most cases the surgeon will choose based on his experience. These results have to be confirmed or invalidated by a prospective multicentric randomised study.

A pilot study to estimate incidence of guanidinoacetate methyltransferase deficiency in newborns by direct sequencing of the GAMT gene.

BACKGROUND: GAMT deficiency is an autosomal recessive disorder of creatine biosynthesis causing developmental delays or intellectual disability in untreated patients as a result of irreversible brain damage occurring prior to diagnosis. Normal neurodevelopmental outcome has been reported in patients treated from neonatal period highlighting the importance of early treatment. METHODS: Five hundred anonymized newborns from the National Newborn Screening Program of The Netherlands were included into this pilot study. Direct sequencing of the coding region of the GAMT gene was applied following DNA extraction. The disease causing nature of novel missense variants in the GAMT gene was studied by overexpression studies. GAA and creatine was measured in blood dot spots. RESULTS: We detected two carriers, one with a known common (c.327G>A) and one with a novel mutation (c.297_309dup (p.Arg105Glyfs*) in the GAMT gene. The estimated incidence of GAMT deficiency was 1:250,000. We also detected five novel missense variants. Overexpression of these variants in GAMT deficient fibroblasts did restore GAMT activity and thus all were considered rare, but not disease causing variants including the c.131G>T (p.Arg44Leu) variant. Interestingly, this variant was predicted to be pathogenic by in silico analysis. The variants were included in the Leiden Open Variation Database (LOVD) database (www.LOVD.nl/GAMT). The average GAA level was 1.14µmol/L±0.45 standard deviations. The average creatine level was 408µmol/L±106. The average GAA/creatine ratio was 2.94±0.136. CONCLUSION: The estimated incidence of GAMT deficiency is 1:250,000 newborns based on our pilot study. The newborn screening for GAMT deficiency should be implemented to identify patients at the asymptomatic stage to achieve normal neurodevelopmental outcome for this treatable neurometabolic disease. Biochemical investigations including GAA, creatine and GAMT enzyme activity measurements are essential to confirm the diagnosis of GAMT deficiency. According to availability, all missense variants can be assessed functionally, as in silico prediction analysis of missense variants is not sufficient to confirm the pathogenicity of missense variants.

Corneal collagen cross-linking in keratoconus -- long-term prospective study.

PURPOSE: To determine the refractometric, keratometric and functional results 3 years after cross-linking therapy in patients with keratoconus. PATIENTS AND METHODS: Eighty-one patients in various stages of keratoconus were studied, all meeting eligibility criteria for the cross-linking technique. RESULTS: The results showed a decrease both in the K-values, of about 1.5 D, and in the refraction. Visual acuity improved by 1, 2 or 3 Snellen lines in 70% of the cases. CONCLUSIONS: The cross-linking technique is a modern method for stopping the progression of keratoconus.

Suppression in strabismus and the hemiretinal trigger mechanism.

A perimeter and a modified Lees screen were used to determine the area of visual field that is suppressed in strabismus. Strabismic patients without fusion suppress the whole area of the visual field of the deviating eye that could have correspondence with the dominant eye. In the monofixation syndrome, suppression only involves the fovea and the diplopic point of the deviating eye. Diplopia, if present, is appreciated throughout the visual field shared by the two eyes, except for the blind spots. No evidence of hemiretinal suppression was found in any type of horizontal strabismus, including exotropia. However, there is a hemiretinal trigger mechanism for suppression. Once suppression has been triggered by this mechanism, it involves the whole visual field of the deviating eye, except for the monocular temporal crescent.

Community periodontal index and treatment needs values (CPITN) in a factory worker group in Cluj-Napoca, Romania.

The aim of the study was to determine the prevalence of periodontal disease and the treatment needs in a population of 214 factory workers in Romania. Of those examined, 9.34 per cent were in periodontal health (code 0), 21.49 per cent had gingival bleeding (code 1), 18.69 per cent had supra- or subgingival calculus (code 2), 32.71 per cent presented with pathological pockets 4-5 mm deep (code 3) and 17.76 per cent had pathological pockets 6 mm or deeper (code 4). The distribution of these subjects among the treatment need categories revealed that 30.83 per cent would need improvement in personal oral hygiene (I), 51.40 per cent from the subjects would need treatment (I) + scaling (II) and 17.76 per cent would need treatment (I + II) + complex treatment (III).

The influence of hexestrol diacetate on gametogene function in male rabbit.

The research was performed on 24 male sexually mature domestic rabbits, divided in two equal batches. The rabbits from the first batch were administered 0.5 mg/kg of body weight hexestrol diacetate intramuscularly twice a week for four consecutive weeks. Batch 2 was used for control. The testicular tissue samples obtained after orchidectomy were processed in order to obtain histological samples, stained using the Goldner's trichrome method. Examination of histological sections from the control batch showed that a natural aspect of seminal tubule epithelium, without reported injuries, even discrete. In the experimental batch were recorded a number of changes to all categories of the seminal cells. The severity and extent of damages varied greatly from one seminal tube to another and even from one part to another of the same seminal tube. These changes were the appearance of apoptotic cells and apoptotic bodies, vacuolar degenerescence of spermatocytes and spermatides, syncitialisation of spermatides, areas of necrosis accompanied by severe disruption of the seminiferous epithelium. In some areas, the lesions were so severe that the affected area of the cells forms "basal area". If lesions in the "adluminal area" affects only temporarily gametogenetic function the lesions in the "basal area" are irreversible as there are named "reserve cells" which is the starting point of spermatogenesis. Highlighted issue raised on the opportunity use of hexestrol diacetate in therapy or animal production stimulation as it gametogenetic function in males while their risk transfer to humans through consumption of foods of animal origin.

Isospin dependence of incomplete fusion reactions at 25 MeV/nucleon.

40Ca+;{40,48}Ca,46Ti reactions at 25 MeV/nucleon have been studied using the 4pi CHIMERA detector. An isospin effect on the competition between fusionlike and binarylike reaction mechanisms has been observed. The probability of producing a heavy residue is lower in the case of N approximately Z colliding systems as compared to the case of reactions induced on the neutron rich 48Ca target. Predictions based on constrained molecular dynamics II calculations show that the competition between fusionlike and binary reactions in the selected centrality bins can constrain the parametrization of the symmetry energy and its density dependence in the nuclear equation of state.

Advances in the early diagnosis and therapy of primary liver cancer.

The prevalence of primary liver cancer (PLC), unlike that of the other digestive carcinomas, is constantly increasing. Epidemiologic data have revealed the risk factors for PLC. New methods of detection allow to define the cases at high risk for PLC, and an active follow-up permits the early disease detection, when the tumor can still be operated on. The diagnostic value of each method is analysed.

[Diagnostic and treatment possibilities in cochleovestibular syndromes]. / Posibilitati de diagnostic si de tratament în sindroamele cohleovestibulare.

The cases of cochleovestibular syndromes admitted into the O.R.L. ward during one year are statistically processed. 81 cases of hypoacusis of perception and vertiginous syndromes were admitted between January 1 and December 31, 1987. 42 of them were males and 29 females. 31 were pure cochlear syndromes, 32 vestibular syndromes without affecting the cochlea, and 15 were cochleovestibular syndromes. The paper surveys the available ways of investigation, by which a topographic and etiologic diagnosis can be determined, within certain limits and an adequate treatment can be recommended.

The value of thyroglobulin (TGL) assay in following the post-therapeutic course of differentiated thyroid cancer.

Serum TGL was assayed in 32 patients with total thyroidectomy performed on account of differentiated thyroid cancer, and in whom postoperative serum TGL values were above 60 ng/ml. The purpose of the study was to demonstrate the specific TGL response in differentiated thyroid cancer relapse and metastases, and the value of serum TGL assay as a test for early diagnosis of relapse and metastasis in this form of cancer. The results were compared to those from the following lots: 15 euthyroid volunteers, 15 patients with differentiated thyroid cancer diagnosed postoperatively whose serum TGL values were under 60 ng/ml and, 14 patients with non-thyroid cancer metastases.

Conventional spectral Doppler and color Doppler ultrasound imaging. Principles, limitations, artifacts and clinical indications in hepatology.

The physical principles, limitations, errors and indications of conventional Doppler and color encoded Doppler sonography are reviewed and their applications in the investigation of liver, spleen, portal and suprahepatic portal venous circulation are analysed. The actual possibilities and advantages of Doppler imaging, both in normal conditions and in pathologic ones, such as portal hypertension, portal venous thrombosis or cavernous transformation, liver cirrhosis, hepatoma and liver transplantation are discussed.