Networks of Limited-Valency Patchy Particles.

Equilibrium gels provide physically attractive counterparts of nonequilibrium gels, allowing statistical understanding and design of the equilibrium gel structure. Here, we assemble two-dimensional equilibrium gels from limited-valency "patchy" colloidal particles and follow their evolution at the particle scale to elucidate cluster-size distributions and free energies. By finely adjusting the patch attraction with critical Casimir forces, we let a mixture of two-valent and pseudo-three-valent patchy particles approach the percolated network state through a set of equilibrium states. Comparing this equilibrium route with a deep quench, we find that both routes approach the percolated state via the same equilibrium states, revealing that the network topology is uniquely set by the particle bond angles, independent of the formation history. The limited-valency system follows percolation theory remarkably well, approaching the percolation point with the expected universal exponents.

Endocrine treatment of gender-dysphoric/gender-incongruent persons: an Endocrine Society clinical practice guideline

OBJECTIVE: To update the "Endocrine Treatment of Transsexual Persons: An Endocrine Society Clinical Practice Guideline," published by the Endocrine Society in 2009. PARTICIPANTS: The participants include an Endocrine Society-appointed task force of nine experts, a methodologist, and a medical writer. EVIDENCE: This evidence-based guideline was developed using the Grading of Recommendations, Assessment, Development, and Evaluation approach to describe the strength of recommendations and the quality of evidence. The task force commissioned two systematic reviews and used the best available evidence from other published systematic reviews and individual studies. CONSENSUS PROCESS: Group meetings, conference calls, and e-mail communications enabled consensus. Endocrine Society committees, members and cosponsoring organizations reviewed and commented on preliminary drafts of the guidelines. CONCLUSION: Gender affirmation is multidisciplinary treatment in which endocrinologists play an important role. Gender-dysphoric/gender-incongruent persons seek and/or are referred to endocrinologists to develop the physical characteristics of the affirmed gender. They require a safe and effective hormone regimen that will (1) suppress endogenous sex hormone secretion determined by the person's genetic/gonadal sex and (2) maintain sex hormone levels within the normal range for the person's affirmed gender. Hormone treatment is not recommended for prepubertal gender-dysphoric/gender-incongruent persons. Those clinicians who recommend gender-affirming endocrine treatments-appropriately trained diagnosing clinicians (required), a mental health provider for adolescents (required) and mental health professional for adults (recommended)-should be knowledgeable about the diagnostic criteria and criteria for gender-affirming treatment, have sufficient training and experience in assessing psychopathology, and be willing to participate in the ongoing care throughout the endocrine transition. We recommend treating gender-dysphoric/gender-incongruent adolescents who have entered puberty at Tanner Stage G2/B2 by suppression with gonadotropin-releasing hormone agonists. Clinicians may add gender-affirming hormones after a multidisciplinary team has confirmed the persistence of gender dysphoria/gender incongruence and sufficient mental capacity to give informed consent to this partially irreversible treatment. Most adolescents have this capacity by age 16 years old. We recognize that there may be compelling reasons to initiate sex hormone treatment prior to age 16 years, although there is minimal published experience treating prior to 13.5 to 14 years of age. For the care of peripubertal youths and older adolescents, we recommend that an expert multidisciplinary team comprised of medical professionals and mental health professionals manage this treatment. The treating physician must confirm the criteria for treatment used by the referring mental health practitioner and collaborate with them in decisions about gender-affirming surgery in older adolescents. For adult gender-dysphoric/gender-incongruent persons, the treating clinicians (collectively) should have expertise in transgender-specific diagnostic criteria, mental health, primary care, hormone treatment, and surgery, as needed by the patient. We suggest maintaining physiologic levels of gender-appropriate hormones and monitoring for known risks and complications. When high doses of sex steroids are required to suppress endogenous sex steroids and/or in advanced age, clinicians may consider surgically removing natal gonads along with reducing sex steroid treatment. Clinicians should monitor both transgender males (female to male) and transgender females (male to female) for reproductive organ cancer risk when surgical removal is incomplete. Additionally, clinicians should persistently monitor adverse effects of sex steroids. For gender-affirming surgeries in adults, the treating physician must collaborate with and confirm the criteria for treatment used by the referring physician. Clinicians should avoid harming individuals (via hormone treatment) who have conditions other than gender dysphoria/gender incongruence and who may not benefit from the physical changes associated with this treatment.

Enfermedad ulcerosa péptica / Peptic ulcer disease

Han habido grandes avances en el tratamiento médico de la "Enfermedad ulcerosa Péptica". Aunque el tratamiento neutralizante con antiácidos, continúa siendo la "piedra angular" del tratamiento, los antagonistas de receptores H2, han facilitado el tratamiento de rutina de la enfermedad ulcerosa. La Cimetidina, el bloqueador H2 más ampliamente usado y mejor estudiado, ha probado su eficacia, mientras nuevos agentes (Ranitidina y Oximetidina) pueden demostrar mayor efectividad y menos efectos colaterales. Con el advenimiento del sucralfato, el clínico puede escoger ahora entre 3 esquemas de tratamiento: 1) Antiácidos altamente potentes a 7 dosis al día (con una capacidad neutralizante diaria deaproximadamente 1.000 meq). 2) Cimetidina 300 mg 3 veces al día, antes de las comidas y al acostarse. 3) Sucralfato 1 gr. 4 veces al día. El paciente debe evitar el fumar y el uso de medicamentos ulcerogénicos. No hay recomendaciones específicas respecto a dieta, pero los pacientes deben evitar los alimentos y bebidas que les causan síntomas. Si el paciente se despierta permanentemente con síntomas, sería aconsejable que ponga el despertador y se despierte antes de sus síntomas para tomar una dosis de antiácidos. El costo de 4 semans de tratamiento con Sucralfato o Cimetidina en EEUU es aproximadamente el mismo. El costo de los antiácidos varía dependiendo del preparado usado, pero un antiácido potente 7 veces al día es más caro que Sucralfato o Cimetidina. El uso inicial de tratamiento antiácido intenso combinado con Cimetidina o Sucralfato, es probablemente innecesario , inconveniente y caro. Pueden usarse antiácidos de acuerdo a los síntomas. Se han estudiado otras drogas ( antidepresivos tricíclicos, pirenzepina, bismuto, carbenoxolona y análogos a P.G.E.), pero su papel en el tratamiento habitual no se ha establecido aún. Finalmente, mientras el tratamiento médico inicial se indica, aún para el tratmiento de enfermedad ulcerosa péptica no complicada, los refinamientos de la técnica quirúrgica, principalmente la vagotomía gástrica proximal, ofrece una alternativa adicional de tratamiento segura y efectiva