Sexual Satisfaction After Gender Affirmation Surgery in Transgender Individuals.

Gender affirmation surgery (GAS) is a collection of surgical procedures that involve the reconstruction of patients' genitalia with the aim of achieving the physical appearance and functional abilities of the gender they desire. They are classified into male-to-female (MtF) and female-to-male (FtM). This study is aimed at assessing sexual satisfaction after MtF GAS. A total of 150 patients who underwent MtF GAS at the Urology Group of Southern California and Sinclair Plastic Surgery in Los Angeles, California, were retrospectively surveyed. In total, we received 29 responses, with an average of five years after their surgery. There was a significant correlation between the sensitivity of the neoclitoris and sexual satisfaction but not with vaginal sensitivity or depth. Furthermore, this study revealed an important correlation between gender dysphoria relief after GAS.

Correction: Sexual Satisfaction After Gender Affirmation Surgery in Transgender Individuals.

[This corrects the article DOI: 10.7759/cureus.27365.].

[Primary carcinoma of the head of the epididymis]. / Tumeur épithéliale primitive de la tête de l'épididyme.

The authors report the case of a 44-year-old man in whom a poorly differentiated primary carcinoma of the head of the epididymis was discovered incidentally. Due to the rarity of this diagnosis, a comprehensive assessment was performed looking for a primary tumour, but without success. Despite early surgical resection, the patient developed lymph-node metastases. This exceptional tumour showed low sensitivity to chemotherapy. Malignant tumours of the epididymis are exceptional and require investigations to detect a primary tumour. Treatment is based on surgical resection, ideally via an inguinal incision, combined with chemotherapy adapted to the histological type.

[MRI and prostate cancer: a paradigm shift]. / L'IRM du cancer de la prostate: un changement de paradigme.

A shift in the use of prostate MR for diagnosis, staging, and pre-treatment planning over the last several years has modified the MR protocols. Classically used to detect extra-prostatic tumor, MR now plays a role for diagnosis (pre-biopsy evaluation in a patient with elevated PSA and suspected cancer in an unusual site), treatment planning (prostate mapping), and follow-up after treatment (evaluation for local recurrence or follow-up after HIFU, radiation therapy, or focal treatment...). Imaging protocols at 1.5T and 3.0T combine morphological T2W imaging with functional sequences (perfusion imaging, diffusion imaging, spectroscopy) using high-resolution phased array pelvic coils or "combined" coils (added endorectal coil). To promote acceptance by clinicians and increased access to patients, the indications for prostate MR must be better defined (and provide useful data to urologists), the cost must be reduced, and results must be more reproducible and standardized.

Delta-like ligand 4 (Dll4) is induced by VEGF as a negative regulator of angiogenic sprouting.

Genetic deletion studies have shown that haploinsufficiency of Delta-like ligand (Dll) 4, a transmembrane ligand for the Notch family of receptors, results in major vascular defects and embryonic lethality. To better define the role of Dll4 during vascular growth and differentiation, we selected the postnatal retina as a model because its vasculature develops shortly after birth in a highly stereotypic manner, during which time it is accessible to experimental manipulation. We report that Dll4 expression is dynamically regulated by VEGF in the retinal vasculature, where it is most prominently expressed at the leading front of actively growing vessels. Deletion of a single Dll4 allele or pharmacologic inhibition of Dll4/Notch signaling by intraocular administration of either soluble Dll4-Fc or a blocking antibody against Dll4 all produced the same set of characteristic abnormalities in the developing retinal vasculature, most notably enhanced angiogenic sprouting and increased endothelial cell proliferation, resulting in the formation of a denser and more highly interconnected superficial capillary plexus. In a model of ischemic retinopathy, Dll4 blockade also enhanced angiogenic sprouting and regrowth of lost retinal vessels while suppressing ectopic pathological neovascularization. Our data demonstrate that Dll4 is induced by VEGF as a negative feedback regulator and acts to prevent overexuberant angiogenic sprouting, promoting the timely formation of a well differentiated vascular network.

Evaluation of the enzyme-linked immunosorbent assay for the detection of antibodies against infectious bursal disease virus (IBDV) and the estimation of the optimal age for IBDV vaccination in broilers.

In order to evaluate the usefulness of the enzyme-linked immunosorbent assay (ELISA) in determining the optimal age for infectious bursal disease virus (IBDV) vaccination in broilers under field circumstances, the percentage of birds susceptible to vaccine at vaccination age was estimated in 12 flocks on the basis of ELISA titres in newborn chicks. The effective percentage of susceptible birds at the day of vaccination was checked by comparing virus neutralization (VN) titres measured in sera taken immediately before vaccine administration with the breakthrough titre of the vaccine used. In nine of the 12 flocks, the ELISA had largely overestimated the percentage of susceptible birds. Subsequently, to examine the performance of the ELISA kit, 815 chicken sera were comparatively examined in ELISA and VN tests. Results demonstrated a linear relationship between mean ELISA titres and VN titres. It was concluded that the ELISA could be a useful tool in IBDV vaccination timing, but that interpretation criteria should be adjusted to avoid vaccination at too early an age.

Effect of displacement of fractures of the greater tuberosity on the mechanics of the shoulder.

Using a dynamic biomechanical model of malunion of the shoulder, we have determined the change in deltoid force required for abduction with various combinations of superior and posterior displacement of fractures of the greater tuberosity of the humerus. We tested eight fresh human cadaver shoulders in a dynamic shoulder-testing apparatus during cycles of glenohumeral abduction from 0 degrees to 90 degrees. The greater tuberosities were osteotomised and stabilised to represent malunion with combinations of superior and posterior displacements of 1 cm and less. The peak force was measured for each displacement in each specimen and statistically compared with values of no displacement using a repeated-measures analysis of variance. The abduction force was significantly increased by 16% (p = 0.006) and 27% (p = 0.0001) by superior displacements of 0.5 cm and 1 cm, respectively, while combined superior and posterior displacement of 1 cm gave an increase in force of 29% (p = 0.001). While treatment criteria for acceptable residual displacement of the greater tuberosity are widely used, there is little information on the direct biomechanical effects of displacement on shoulder mechanics. Although the results of conservative treatment are influenced by a number of factors, including associated injuries, rehabilitation and the pre-existing function of the shoulder, our data suggest that small amounts of residual displacement may alter the balance of forces required to elevate the arm at the glenohumeral joint.

Interpretation of Emergency Department radiographs: a comparison of emergency medicine physicians with radiologists, residents with faculty, and film with digital display.

OBJECTIVE: We determined the relative value of teleradiology and radiology resident coverage of the emergency department by measuring and comparing the effects of physician specialty, training level, and image display method on accuracy of radiograph interpretation. MATERIALS AND METHODS: A sample of four faculty emergency medicine physicians, four emergency medicine residents, four faculty radiologists, and four radiology residents participated in our study. Each physician interpreted 120 radiographs, approximately half containing a clinically important index finding. Radiographs were interpreted using the original films and high-resolution digital monitors. Accuracy of radiograph interpretation was measured as the area under the physicians' receiver operating characteristic (ROC) curves. RESULTS: The area under the ROC curve was 0.15 (95% confidence interval [CI], 0.10-0.20) greater for radiologists than for emergency medicine physicians, 0.07 (95% CI, 0.02-0.12) greater for faculty than for residents, and 0.07 (95% CI, 0.02-0.12) greater for films than for video monitors. Using these results, we estimated that teleradiology coverage by faculty radiologists would add 0.09 (95% CI, 0.03-0.15) to the area under the ROC curve for radiograph interpretation by emergency medicine faculty alone, and radiology resident coverage would add 0.08 (95% CI, 0.02-0.14) to this area. CONCLUSION: We observed significant differences between the interpretation of radiographs on film and on digital monitors. However, we observed differences of equal or greater magnitude associated with the training level and physician specialty of each observer. In evaluating teleradiology services, observer characteristics must be considered in addition to the quality of image display.

A scale of methodological quality for clinical studies of radiologic examinations.

PURPOSE: To develop and evaluate a scale for assessment of the methodological quality for clinical investigations of radiologic studies. MATERIALS AND METHODS: A scale was developed that included methodological standards compiled from established sources for assessing the methodological quality of study designs in clinical research and characteristics related to biases commonly observed in clinical radiologic research. The scale was composed of 15 standards and was tested with the results of 96 studies on imaging of liver hemangioma. Interrater reliability was measured between two observers by using percentage agreement and kappa statistics. Interrater reliability between two observers for a composite quality index that encompassed the 15 standards was measured with the intraclass correlation coefficient. RESULTS: Agreement between the two observers was almost perfect (kappa value, 0.8-1.0) for 11 standards and substantial (kappa value, 0.74-0.78) for four standards. Agreement between the observers with regard to the composite quality index also was high (intraclass correlation coefficient r, 0.91 [95% CI: 0.87, 0.94]). CONCLUSION: The scale appears to be reliable for the assessment of methodological quality of clinical investigations of radiologic studies.

Clinical relevance of the substitution of different brands of sustained-release theophylline.

In order to assess whether clinically important changes in serum theophylline concentrations occur when patients switch their brand of slow-release (SR) theophylline, 10 subjects with asthma were administered the same dose of four different SR theophylline formulations for 2-week periods in a random, double-blinded, crossover manner. Analysis of the data revealed significant differences in mean peak-to-trough fluctuations of serum theophylline concentrations between the formulations of SR theophylline, which varied from 60% to 106% of trough concentration (p less than 0.0001, analysis of variance). On at least one occasion in every subject, switching between brands of SR theophylline was responsible for raising the serum theophylline concentrations outside the accepted therapeutic range, and this was associated with symptoms of toxicity in five of the subjects. Worsening pulmonary functions were observed in two of the subjects whose switching resulted in lowered theophylline concentrations. Many of the formulation-related changes in theophylline concentrations appeared to be idiosyncratic and could not be predicted by the overall bioavailability differences between the drugs. These results argue against the open substitution of these formulations and suggest that if patients are switched between different brands of SR theophylline, their serum theophylline concentrations need to be closely monitored.

Duration of action of oral albuterol in an asthmatic population.

In a randomized, double-blind, two-way crossover study in four centers, 124 patients received single doses of 4 or 6 mg of albuterol and placebo on two separate visits. Pulmonary function tests were performed at intervals up to ten hours. Both dosages produced peak bronchodilation responses which occurred at two hours and significant activity was maintained for at least eight hours. Adverse experiences were typical of adrenergic agents.

Cross allergenicity among grasses determined by tissue threshold changes.

Twenty-seven volunteers with grass-pollen allergy who had not received prior immunotherapy had titrated prick tests with fivefold dilutions of 10 grasses (timothy, Bermuda, smooth brome, grama, salt, quack, western wheat, Johnson, June, and Bahia) to a final dilution of 1:3,906,250 w/v. Ten subjects served as untreated control subjects. Seventeen subjects received immunotherapy with an extract containing equal parts of timothy and Bermuda. Twelve months later subjects had repeat titrated skin testing with reconstituted aliquots of the same lyophilized extract, at the same time of day, and at the same location on the back as in the initial testing period. Nine treated subjects and eight control subjects completed the study protocol. The skin test areas with all 10 grass extracts were significantly decreased in the treated group compared to the control group (p less than 0.01), and there was no difference in the extent of the reduction among the 10 grasses by analysis of variance. We conclude that immunotherapy to timothy and Bermuda alone is capable of reducing to a similar degree the clinical sensitivity to all 10 grasses studied. The results of this study suggest that treatment with timothy and Bermuda alone may be sufficient in most grass-sensitive individuals.

A comprehensive allergen extract monograph with advice for the patient.

Interest in increased patient education regarding medications they receive is gathering momentum. An historical overview is provided as well as summaries of available patient information resources. To date little such information has been available for patients receiving immunotherapy with allergen extracts. A comprehensive draft monograph driven from multiple sources for the various products available is proposed, as well as suggested advice for patients. Comments and suggestions for revision are solicited, prior to proposed inclusion in a national patient information publication.

Rural-to-urban migration and the shadow wage in LDCs.

"This paper discusses the amount of rural-to-urban migration which will be forthcoming when a new urban job is created for which an institutionally fixed wage above the market-clearing level is offered. A simple formula is proposed to estimate migration response. It can be used to calculate the shadow wage in cost-benefit analysis (CBA) in less developed countries (LDCs)."

The effect of troleandomycin and methylprednisolone alone and in combination on bronchial sensitivity to methacholine.

The effect singly and in combination of methylprednisolone and troleandomycin (TAO) on methacholine sensitivity was studied in eight mildly asthmatic patients who did not require regular bronchodilator therapy. Neither drug alone nor in combination significantly altered the bronchial reactivity to methacholine.

[The methodology of a survey on differential morbidity among young children in Wallonia]. / Methodologie d'une enquete de morbidite differentielle de la petite enfance en Wallonie

PIP: The methodology of a 1981 survey on perinatal morbidity in Wallonia, Belgium, is described. The emphasis is on examining differences in infant morbidity among the three Walloon regions in order to throw more light on differentials in infant mortality. The differences with regard to environmental, social, economic, and cultural factors are considered. (summary in ENG)^ieng