Exploring gender dysphoria and related outcomes in a prospective cohort study: protocol for the Swedish Gender Dysphoria Study (SKDS).

INTRODUCTION: There has been a drastic increase in the reported number of people seeking help for gender dysphoria in many countries over the last two decades. Yet, our knowledge of gender dysphoria and related outcomes is restricted due to the lack of high-quality studies employing comprehensive approaches. This longitudinal study aims to enhance our knowledge of gender dysphoria; different aspects will be scrutinised, focusing primarily on the psychosocial and mental health outcomes, prognostic markers and, secondarily, on the underlying mechanisms for its origin. METHODS AND ANALYSIS: The Swedish Gender Dysphoria Study is an ongoing multicentre longitudinal cohort study with 501 registered participants with gender dysphoria who are 15 years old or older. Participants at different phases of their clinical evaluation process can enter the study, and the expected follow-up duration is three years. The study also includes a comparison group of 458 age- and county-matched individuals without gender dysphoria. Data on the core outcomes of the study, which are gender incongruence and experienced gender dysphoria, body satisfaction and satisfaction with gender-affirming treatments, as well as other relevant outcomes, including mental health, social functioning and life satisfaction, are collected via web surveys. Two different research visits, before and after starting on gender-affirming hormonal treatment (if applicable), are planned to collect respective biological and cognitive measures. Data analysis will be performed using appropriate biostatistical methods. A power analysis showed that the current sample size is big enough to analyse continuous and categorical outcomes, and participant recruitment will continue until December 2022. ETHICS AND DISSEMINATION: The ethical permission for this study was obtained from the Local Ethical Review Board in Uppsala, Sweden. Results of the study will be presented at national and international conferences and published in peer-reviewed journals. Dissemination will also be implemented through the Swedish Gender Dysphoria Study network in Sweden.

A Comparative Study of the Use of Stratified Cross-Validation and Distribution-Balanced Stratified Cross-Validation in Imbalanced Learning.

Nowadays, the solution to many practical problems relies on machine learning tools. However, compiling the appropriate training data set for real-world classification problems is challenging because collecting the right amount of data for each class is often difficult or even impossible. In such cases, we can easily face the problem of imbalanced learning. There are many methods in the literature for solving the imbalanced learning problem, so it has become a serious question how to compare the performance of the imbalanced learning methods. Inadequate validation techniques can provide misleading results (e.g., due to data shift), which leads to the development of methods designed for imbalanced data sets, such as stratified cross-validation (SCV) and distribution optimally balanced SCV (DOB-SCV). Previous studies have shown that higher classification performance scores (AUC) can be achieved on imbalanced data sets using DOB-SCV instead of SCV. We investigated the effect of the oversamplers on this difference. The study was conducted on 420 data sets, involving several sampling methods and the DTree, kNN, SVM, and MLP classifiers. We point out that DOB-SCV often provides a little higher F1 and AUC values for classification combined with sampling. However, the results also prove that the selection of the sampler-classifier pair is more important for the classification performance than the choice between the DOB-SCV and the SCV techniques.

A new baseline for retinal vessel segmentation: Numerical identification and correction of methodological inconsistencies affecting 100+ papers.

In the last 15 years, the segmentation of vessels in retinal images has become an intensively researched problem in medical imaging, with hundreds of algorithms published. One of the de facto benchmarking data sets of vessel segmentation techniques is the DRIVE data set. Since DRIVE contains a predefined split of training and test images, the published performance results of the various segmentation techniques should provide a reliable ranking of the algorithms. Including more than 100 papers in the study, we performed a detailed numerical analysis of the coherence of the published performance scores. We found inconsistencies in the reported scores related to the use of the field of view (FoV), which has a significant impact on the performance scores. We attempted to eliminate the biases using numerical techniques to provide a more realistic picture of the state of the art. Based on the results, we have formulated several findings, most notably: despite the well-defined test set of DRIVE, most rankings in published papers are based on non-comparable figures; in contrast to the near-perfect accuracy scores reported in the literature, the highest accuracy score achieved to date is 0.9582 in the FoV region, which is 1% higher than that of human annotators. The methods we have developed for identifying and eliminating the evaluation biases can be easily applied to other domains where similar problems may arise.

Comparative analysis of sports consumption habits in Hungary, Poland and Germany.

BACKGROUND: The so-called sports consumption models are looking for the factors that influence the sports spending of households. This paper aims to examine the Hungarian, Polish and German households' sports expenditures which can be an important indicator of physical activity and sporty lifestyle. METHODS: Surveying of households in three countries (Hungary, Poland and Germany) has been conducted with a self-designed questionnaire. We have used descriptive and bivariate non-parametric and parametric statistical methods: (1) χ2 test, Mann-Whitney test and Kruskal-Wallis test for checking the relationship between sociodemographic and physical activity variables and (2) independent sample t-test and ANOVA for checking the differences in sports expenditures. RESULTS: Our research concluded that men, especially previous athletes, exercise more than women and those who have no history as registered athletes. The choice of sports venues is obviously different between the countries in the sample. Members of the study population spend the most on sports services while they spend the least on sports equipment. German households have the highest spending rates compared to the other two countries. CONCLUSIONS: Results are in line with our previous research findings and with other literatures. The difference in preferences of sports venues could have the reason of different supply of sports clubs or the different living standards too. It needs further researches to clear it. Material wealth, income level and sport socialisation can be a determining factor regarding the level of sports spending.

Psychometric properties and concurrent validity of the Transgender Congruence Scale (TCS) in the Swedish setting.

The Transgender Congruence Scale (TCS) is a non-binary tool used in Sweden for gender dysphoria (GD) assessment; however, its Swedish version has not been validated. To investigate the psychometric properties of the TCS, its capacity to distinguish individuals with GD and its concurrent validity compared to other scales. Patients with GD (n = 135) and controls (n = 443) filled in a questionnaire containing sociodemographic questions, the TCS, the Utrecht Gender Dysphoria Scale (UGDS), and the Gender Identity/Gender Dysphoria Questionnaire for Adolescents and Adults (GIDYQ-AA). TCS had good discriminatory validity and internal consistency. Patients with GD, stratified by birth-assigned sex, had lower TCS scores compared to controls. Confirmatory factor analysis (CFA) supported the two-factor model of the TCS. Multiple-group CFA suggested measurement invariance between birth-assigned sexes and configural invariance between patients with GD and controls. Area under the ROC curve for birth-assigned males was 0.991 and for females 0.994. A TCS mean value of three provided sensitivity 94.3% and 95.1% as well as specificity 98.6% and 98% for aM and aF, respectively. The TCS was significantly correlated to UGDS and GIDYQ-AA. The TCS may be a valuable tool in the clinical assessment of individuals with GD.

Image analysis of platelet derived growth factor receptor-beta (PDGFRß) expression to determine the grade and dynamics of myelofibrosis in bone marrow biopsy samples.

BACKGROUND: Myelofibrosis (MF) is characterized by accumulation of stromal cells and extracellular matrix. Progression of fibrosis is an important clinical issue and monitoring is required for new therapeutic approaches. Currently, the quantification is based on semiquantitative evaluation of reticulin silver stained slides. We recently reported that platelet derived growth factor receptor beta (PDGFRß) expression in fibroblasts is a useful marker of stromal activation. PDGFRß expression based scores represent significant differences in different MF grade which provides optimal source of quantification. In this study, slide-based measurements were performed to support correlations of PDGFRß expression with MF grade. METHODS: Scanned image tiles from 79 bone marrow samples (BM) with different MF grades were evaluated for PDGFRß-related IHC parameters. Following the determination of immunopositive (brown component) and total area (region of interest) of the BM, PDGFRß related image parameters were defined and evaluated in comparison with the classical reticulin based grading. RESULTS: Eight PDGFRß expression related image parameters showed excellent correlation with the MF grade (correlation coefficient ranging between 0.79 and 0.83) and with PDGFRß score (0.76-0.87). Despite the significant sample heterogeneity, the parameters showed significant differences between fibrotic and nonfibrotic cases and between mild and advanced fibrosis. Distribution of values within a particular specimen emphasizes the heterogeneity of bone marrow involvement which may cause difficulties in semiquantitative methods. CONCLUSIONS: Our results clearly demonstrated the correlation between MF and PDGFRß expression considering all relevant areas in BM samples. This method provides good basis for follow-up comparison of the fibrotic samples.

Image analysis of platelet derived growth factor receptor-beta (PDGFRß) expression to determine the grade and dynamics of myelofibrosis in bone marrow biopsy samples.

Background: Myelofibrosis (MF) is characterized by accumulation of stromal cells and extracellular matrix. Progression of fibrosis is an important clinical issue and monitoring is required for new therapeutic approaches. Currently the quantification is based on semi-quantitative evaluation of reticulin silver stained slides. We recently reported that platelet derived growth factor receptor beta (PDGFRß) expression in fibroblasts is a useful marker of stromal activation. PDGFRß expression based scores represent significant differences in different myelofibrosis grade which provides optimal source of quantification. In this study slide based measurements were performed in order to support correlations of PDGFRß expression with MF grade. Methods: Scanned image tiles from 79 bone marrow samples (BM) with different myelofibrosis grades were evaluated for PDGFRß-related IHC parameters. Following the determination of immunopositive (brown component) and total area (region of interest) of the BM, PDGFRß related image parameters were defined and evaluated in comparison to the classical reticulin based grading. Results: Eight PDGFRß expression related image parameters showed excellent correlation with the MF grade (correlation coefficient ranging between 0.79 and 0.83) and with PDGFRß score (0.76-0.87). Despite the significant sample heterogeneity the parameters showed significant differences between fibrotic and non-fibrotic cases and between mild and advanced fibrosis. Distribution of values within a particular specimen emphasizes the heterogeneity of bone marrow involvement which may cause difficulties in semi-quantitative methods. Conclusions: Our results clearly demonstrated the correlation between myelofibrosis and PDGFRß expression considering all relevant areas in BM samples. This method provides good basis for follow-up comparison of the fibrotic samples. © 2014 Clinical Cytometry Society.

Different effect of IgA nephropathy and polycystic kidney disease on arterial stiffness.

BACKGROUND: Renal function is a major predictor of vascular function and cardiovascular diseases. Little information exists about the effect of specific renal diseases on vascular function in chronic kidney diseases (CKD). METHODS: One hundred and twenty patients (60 with IgA nephropathy, IgAN, and 60 with polycystic kidney disease, PKD) with CKD stages 1-4 were studied and compared. Pulse-wave velocity was measured by the digital volume pulse (DVP) method and stiffness index (SI(DVP)) was derived. RESULTS: All CKD (IgAN and PKD) patients had increased SI(DVP) compared to controls (10.39 vs. 8.87 ± 1.79 m/s, p = 0.008). PKD patients had increased SI(DVP) compared to IgAN and controls (11.14 ± 2.19, 9.66 ± 2.02 and 8.87 ± 1.79 m/s, respectively, p < 0.001). An inverse correlation was found between SI(DVP) and glomerular filtration rate in all CKD (IgAN and PKD) patients (p = 0.001) and in IgAN alone (p < 0.01), but not in PKD. With multivariate regression analysis, only age and 24-hour systolic blood pressure exerted independent effects on SI(DVP). CONCLUSIONS: Compared to controls, arterial stiffness was increased in CKD patients. However, arterial stiffening was more pronounced in PKD than in IgAN, suggesting that vascular function is not similarly altered in etiologically different CKD groups. The fact that blood pressure was an independent risk factor underscores a therapeutic opportunity.

[Vena cava superior syndrome: surgical treatment of the thrombosis of the superior vena cava after implantation of a hemodialysis catheter--a case report and review of the literature]. / Vena cava superior szindróma: dializáló katéter okozta vena cava superior trombózis sebészi kezelése--irodalmi összefoglaló egy esetünk kapcsán.

One of the rare reasons of the non malignant superior vena cava syndrome is the thrombosis of superior vena cava. Obstruction or occlusion of central veins is one of the many complications of the more and more frequently used central venous catheters and pacemaker electrodes. The authors report a case of superior vena cava thrombosis resulting in dialysis catheter insufficiency in case of a young, uraemic, female patient wit Tesio catheter and the surgical treatment of it with the use of cardiopulmonary bypass during the operation. Apropos of this case, the authors outline the causes of malignant, non-malignant and iatrogenic superior vena cava syndrome, furthermore the conservative, surgical and catheter therapy of the syndrome.