Predictive accuracy of post-fire conifer death declines over time in models based on crown and bole injury.

A key uncertainty of empirical models of post-fire tree mortality is understanding the drivers of elevated post-fire mortality several years following fire, known as delayed mortality. Delayed mortality can represent a substantial fraction of mortality, particularly for large trees that are a conservation focus in western US coniferous forests. Current post-fire tree mortality models have undergone limited evaluation of how injury level and time since fire interact to influence model accuracy and predictor variable importance. Less severe injuries potentially serve as an indicator for vulnerability to additional stressors such as bark beetle attack or moisture stress. We used a collection of 164,293 individual tree records to examine post-fire tree mortality in eight western USA conifers: Abies concolor, Abies grandis, Calocedrus decurrens, Larix occidentalis, Pinus contorta, Pinus lambertiana, Pinus ponderosa, and Pseudotsuga menziesii. We evaluated the importance of fire injury predictors on discriminating between surviving trees versus immediate and delayed post-fire mortality. We fit balanced random forest models for each species using cumulative tree mortality from 1 to 5-years post-fire. We compared these results to multi-class random forest models using first-year mortality, 2-5-year mortality, and survival 5-years post-fire as a response variable. Crown volume scorched, diameter at breast height, and relative bark char height, were used as predictor variables. The cumulative mortality models all predicted trees that died within 1-year of fire with high accuracy but failed to predict 2-5-year mortality. The multi-class models were an improvement but had lower accuracy for predicting 2-5-year mortality. Multi-class model accuracies ranged from 85% to 95% across all species for predicting 1-year post-fire mortality, 42%-71% for predicting 2-5-year mortality, and 64%-85% for predicting trees that lived past 5-years. Our study highlights the differences in tree species tolerance to fire injury and suggests that including second-order predictors such as beetle attack or climatic water stress before and after fire will be critical to improve accuracy and better understand the mechanisms and patterns of fire-caused tree death. Random forest models have potential for management applications such as post-fire harvesting and simulating future stand dynamics.

Androgenetic alopecia incidence in transgender and gender diverse populations: A retrospective comparative cohort study.

BACKGROUND: Androgenetic alopecia (AGA) is a significant challenge for many transgender and gender diverse (TGD) patients, but the rate of AGA among TGD patients receiving gender-affirming hormone therapy (GAHT) compared to cisgender patients has not yet been studied on a large scale. OBJECTIVE: We examined the incidence of AGA among TGD patients receiving GAHT compared to cisgender patients. METHODS: Retrospective cohort study using electronic health records from 37,826 patients seen at Fenway Health between August 1, 2014, and August 1, 2020. Crude and adjusted incidence rate ratios (aIRR) for AGA were calculated using Poisson regression. RESULTS: TGD patients receiving masculinizing GAHT had aIRR 2.50, 95% CI 1.71-3.65 and 1.30, 95% CI 0.91-1.86 compared to cisgender women and cisgender men, respectively. The rate of AGA for TGD patients receiving feminizing GAHT was not significantly different compared to cisgender men but was significantly increased compared to cisgender women (aIRR 1.91, 95% CI 1.25-2.92). LIMITATIONS: Inability to determine causation and limited generalizability. CONCLUSION: TGD patients receiving masculinizing GAHT have 2.5 times the rate of AGA compared to cisgender women, whereas TGD patients on feminizing GAHT did not have a significantly increased rate of AGA compared to cisgender men.

Androgenetic alopecia in transgender and gender diverse populations: A review of therapeutics.

Androgenetic alopecia (AGA) management is a significant clinical and therapeutic challenge for transgender and gender-diverse (TGD) patients. Although gender-affirming hormone therapies affect hair growth, there is little research about AGA in TGD populations. After reviewing the literature on approved treatments, off-label medication usages, and procedures for treating AGA, we present treatment options for AGA in TGD patients. The first-line treatments for any TGD patient include topical minoxidil 5% applied to the scalp once or twice daily, finasteride 1 mg oral daily, and/or low-level laser light therapy. Spironolactone 200 mg daily is also first-line for transfeminine patients. Second-line options include daily oral minoxidil dosed at 1.25 or 2.5 mg for transfeminine and transmasculine patients, respectively. Topical finasteride 0.25% monotherapy or in combination with minoxidil 2% solution are second-line options for transmasculine and transfeminine patients, respectively. Other second-line treatments for any TGD patient include oral dutasteride 0.5 mg daily, platelet-rich plasma, or hair restoration procedures. After 6-12 months of treatment, AGA severity and treatment progress should be assessed via scales not based on sex; eg, the Basic and Specific Classification or the Bouhanna scales. Dermatologists should coordinate care with the patient's primary gender-affirming clinician(s) so that shared knowledge of all medications exists across the care team.

Testing and Evaluation of Wi-Fi RTT Ranging Technology for Personal Mobility Applications.

The rapid growth in the technological advancements of the smartphone industry has classified contemporary smartphones as a low-cost and high quality indoor positioning tools requiring no additional infrastructure or equipment. In recent years, the fine time measurement (FTM) protocol, achieved through the Wi-Fi round trip time (RTT) observable, available in the most recent models, has gained the interest of many research teams worldwide, especially those concerned with indoor localization problems. However, as the Wi-Fi RTT technology is still new, there is a limited number of studies addressing its potential and limitations relative to the positioning problem. This paper presents an investigation and performance evaluation of Wi-Fi RTT capability with a focus on range quality assessment. A set of experimental tests was carried out, considering 1D and 2D space, operating different smartphone devices at various operational settings and observation conditions. Furthermore, in order to address device-dependent and other type of biases in the raw ranges, alternative correction models were developed and tested. The obtained results indicate that Wi-Fi RTT is a promising technology capable of achieving a meter-level accuracy for ranges both in line-of-sight (LOS) and non-line-of-sight (NLOS) conditions, subject to suitable corrections identification and adaptation. From 1D ranging tests, an average mean absolute error (MAE) of 0.85 m and 1.24 m is achieved, for LOS and NLOS conditions, respectively, for 80% of the validation sample data. In 2D-space ranging tests, an average root mean square error (RMSE) of 1.1m is accomplished across the different devices. Furthermore, the analysis has shown that the selection of the bandwidth and the initiator-responder pair are crucial for the correction model selection, whilst knowledge of the type of operating environment (LOS and/or NLOS) can further contribute to Wi-Fi RTT range performance enhancement.

[The tube in tube thoracodorsal perforator flap phalloplasty]. / Phalloplastie par Lambeau perforant thoracodorsal « tube in tube ¼.

This article deals with a clinical case of a tube in a tube TDAP phalloplasty in a 38 years old trans-man. While penis reconstruction surgery aroused an efflorescence of different operative techniques, the resulting female to male surgery sees these procedures boil down to two or three flaps. If we usually discuss before surgery about the way to lengthen the urinary tract, as the way to implant later for intercourse; the choice of the donor site remains too systematized. Surgeons commonly focus on the reconstructed site prior to the donor site. In this case, laxity in the back and reliability of direct closure make us harvest the thoracodorsal perforator flap. Dissection of perforators saves muscular function and direct closure afford an aesthetic result less visible than a graft on the forearm. The thin flap we harvest allows tube in tube phalloplasty so that phallus and urethra are being built in the same time. One case has been reported in the literature of thoracodorsal perforator flap phalloplasty with grafted urethra, but no case of tube within a tube TDAP phalloplasty.

Victim Detection and Localization in Emergencies.

Detecting and locating victims in emergency scenarios comprise one of the most powerful tools to save lives. Fast actions are crucial for victims because time is running against them. Radio devices are currently omnipresent within the physical proximity of most people and allow locating buried victims in catastrophic scenarios. In this work, we present the benefits of using WiFi Fine Time Measurement (FTM), Ultra-Wide Band (UWB), and fusion technologies to locate victims under rubble. Integrating WiFi FTM and UWB in a drone may cover vast areas in a short time. Moreover, the detection capacity of WiFi and UWB for finding individuals is also compared. These findings are then used to propose a method for detecting and locating victims in disaster scenarios.

Affordable Open-Source Quartz Microbalance Platform for Measuring the Layer Thickness.

The layer thickness measurement process is an indispensable companion of vacuum sputtering and evaporation. Thus, quartz crystal microbalance is a well-known and reliable method for monitoring film thickness. However, most commercial devices use very simple signal processing methods, offering only a readout of the frequency change value and an approximate sputtering rate. Here, we show our concept of instrument, to better control the process parameters and for easy replication. The project uses open-source data and its own ideas, fulfilling all the requirements of a measuring system and contributing to the open-source movement due to the added value and the replacement of obsolete technologies with contemporary ones. The device provides an easy way to expand existing sputtering machines with a proper controller based on our work. The device described in the paper can be easily used in need, being a proven project of a fast, inexpensive, and reliable thin-film thickness monitor.

A Two-Step Fusion Method of Wi-Fi FTM for Indoor Positioning.

The Wi-Fi fine time measurement (FTM) protocol specified in the IEEE 802.11-2016 standard provides a new two-way ranging approach to enhance positioning capability. Similar to other wireless signals, the accuracy of the real-time range measurement of FTM is influenced by various errors. In this work, the characteristics of the ranging errors is analyzed and an abstract ranging model is introduced. From the perspective of making full use of the range measurements from FTM, this paper designs two positioning steps and proposes a fusion method to refine the performance of indoor positioning. The first step is named single-point positioning, locating the position with the real-time range measurements based on the geometric principle. The second step is named the improved matching positioning, which constructs a distance database by utilizing the existing scene information and uses the modified matching algorithm to obtain the position. In view of the different positioning accuracies and error distributions from the results of the aforementioned two steps, a fusion method using the indirect adjustment principle is proposed to adjust the positioning results, and the advantages of the matching scene information and the range measurements are served simultaneously. Finally, a number of tests are conducted to assess the performance of the proposed method. The experimental results demonstrate that the precision and stability of indoor positioning are improved by the proposed fusion method.

WiFi FTM and UWB Characterization for Localization in Construction Sites.

A high-precision location is becoming a necessity in the future Industry 4.0 applications that will come up in the near future. However, the construction sector remains particularly obsolete in the adoption of Industry 4.0 applications. In this work, we study the accuracy and penetration capacity of two technologies that are expected to deal with future high-precision location services, such as ultra-wide band (UWB) and WiFi fine time measurement (FTM). For this, a measurement campaign has been performed in a construction environment, where UWB and WiFi-FTM setups have been deployed. The performance of UWB and WiFi-FTM have been compared with a prior set of indoors measurements. UWB seems to provide better ranging estimation in LOS conditions but it seems cancelled by reinforcement concrete for propagation and WiFi is able to take advantage of holes in the structure to provide location services. Moreover, the impact of fusion of location technologies has been assessed to measure the potential improvements in the construction scenario.

Indoor Localization Using Uncooperative Wi-Fi Access Points.

Indoor localization using fine time measurement (FTM) round-trip time (RTT) with respect to cooperating Wi-Fi access points (APs) has been shown to work well and provide 1-2 m accuracy in both 2D and 3D applications. This approach depends on APs implementing the IEEE 802.11-2016 (also known as IEEE 802.11mc) Wi-Fi standard ("two-sided" RTT). Unfortunately, the penetration of this Wi-Fi protocol has been slower than anticipated, perhaps because APs tend not to be upgraded as often as other kinds of electronics, in particular in large institutions-where they would be most useful. Recently, Google released Android 12, which also supports an alternative "one-sided" RTT method that will work with legacy APs as well. This method cannot subtract out the "turn-around" time of the signal, and so, produces distance estimates that have much larger offsets than those seen with two-sided RTT-and the results are somewhat less accurate. At the same time, this method makes possible distance measurements for many APs that previously could not be used. This increased accessibility can compensate for the decreased accuracy of individual measurements. We demonstrate here indoor localization using one-sided RTT with respect to legacy APs that do not support IEEE 802.11-2016. The accuracy achieved is 3-4 m in cluttered environments with few line-of-sight readings (and using only 20 MHz bandwidths). This is not as good as for two-sided RTT, where 1-2 m accuracy has been achieved (using 80 MHz bandwidths), but adequate for many applications A wider Wi-Fi channel bandwidth would increase the accuracy further. As before, Bayesian grid update is the preferred method for determining position and positional accuracy, but the observation model now is different from that for two-sided RTT. As with two-sided RTT, the probability of an RTT measurement below the true distance is very low, but, in the other direction, the range of measurements for a given distance can be much wider (up to well over twice the actual distance). We describe methods for formulating useful observation models. As with two-sided RTT, the offset or bias in distance measurements has to be subtracted from the reported measurements. One difference is that here, the offsets are large (typically in the 2400-2700 m range) because of the "turn-around time" of roughly 16 µs (i.e., about two orders of magnitude larger than the time of flight one is attempting to measure). We describe methods for estimating these offsets and for minimizing the effort required to do so when setting up an installation with many APs.

Evaluation of Life Improvement in Trans Men After Mastectomy: A Prospective Study Using the TRANS-Q.

BACKGROUND: Mastectomy is the most common and sometimes the only surgery performed in FtM transgender individuals. In this study, it was aimed to evaluate the improvement in life standards of patients who underwent double incision mastectomy with free nipple-areolar complex graft and periareolar mastectomy by using TRANS-Q in trans men. MATERIALS AND METHODS: TRANS-Q was performed in 71 trans men at the preoperative and postoperative 1st year, and the revision and complication rates in both groups were compared. RESULTS: A statistically significant difference was observed in the postoperative satisfaction rates in both groups. We observed that the patients who underwent periareolar mastectomy had significantly higher satisfaction rates than the patients who underwent double incision mastectomy with free nipple areolar complex graft. In both groups, postoperative satisfaction rates were found to be significantly higher. CONCLUSION: Improvement in life standards has been observed in trans men who underwent mastectomy, and late results should be evaluated with further prospective studies. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Effects of testosterone therapy on constructs related to aggression in transgender men: A systematic review.

BACKGROUND: Transgender men are assigned female sex at birth, but identify as men. The anabolic and androgenic sex hormone testosterone has been positively associated with aggression. Therefore, transgender men are warned of increasing aggression when initiating testosterone therapy. AIM: To explore the literature regarding the effects of testosterone therapy on aggression-related constructs in transgender men. METHODS: Following PRISMA-guidelines, PsycINFO, MEDLINE®, EMBASE, and PubMed® were searched in November 2019. Risk of bias was analyzed using the Newcastle-Ottawa-Scale, and result-synthesis was grouped by aggression-outcome. RESULTS: Seven prospective cohort studies investigating aggression-dimensions pre- and post-testosterone therapy, reporting on data from 664 transgender men, were eligible. The studies had moderate to high risk of bias due to non-randomization, lack of appropriate control groups, and reliance on self-report. The behavioral tendency to react aggressively increased in three studies out of four (at three months follow-up), whereas only one study out of five found angry emotions to increase (at seven months follow-up). In contrast, one out of three studies reported a decrease in hostility after initiation of testosterone therapy. The remaining studies found no change in aggressive behavior, anger or hostility during hormone therapy. DISCUSSION AND CONCLUSION: Four out of seven studies reported an increase in aggression-related constructs, while one study reported a decrease. In all studies reporting changes, the follow-up period was less than 12 months, indicating that gender-affirming testosterone therapy could have a short-term impact on aggression-related constructs. However, the available studies carried a risk of bias, which indicates a need for further research.

Observation Model for Indoor Positioning.

The IEEE 802.11mc WiFi standard provides a protocol for a cellphone to measure its distance from WiFi access points (APs). The position of the cellphone can then be estimated from the reported distances using known positions of the APs. There are several "multilateration" methods that work in relatively open environments. The problem is harder in a typical residence where signals pass through walls and floors. There, Bayesian cell update has shown particular promise. The Bayesian grid update method requires an "observation model" which gives the conditional probability of observing a reported distance given a known actual distance. The parameters of an observation model may be fitted using scattergrams of reported distances versus actual distance. We show here that the problem of fitting an observation model can be reduced from two dimensions to one. We further show that, perhaps surprisingly, a "double exponential" observation model fits real data well. Generating the test data involves knowing not only the positions of the APs but also that of the cellphone. Manual determination of positions can limit the scale of test data collection. We show here that "boot strapping," using results of a Bayesian grid update method as a proxy for the actual position, can provide an accurate observation model, and a good observation model can nearly double the accuracy of indoor positioning. Finally, indoors, reported distance measurements are biased to be mostly longer than the actual distances. An attempt is made here to detect this bias and compensate for it.

Doubling the Accuracy of Indoor Positioning: Frequency Diversity.

Determination of indoor position based on fine time measurement (FTM) of the round trip time (RTT) of a signal between an initiator (smartphone) and a responder (Wi-Fi access point) enables a number of applications. However, the accuracy currently attainable-standard deviations of 1-2 m in distance measurement under favorable circumstances-limits the range of possible applications. An emergency worker, for example, may not be able to unequivocally determine on which floor someone in need of help is in a multi-story building. The error in position depends on several factors, including the bandwidth of the RF signal, delay of the signal due to the high relative permittivity of construction materials, and the geometry-dependent "noise gain" of position determination. Errors in distance measurements have unusal properties that are exposed here. Improvements in accuracy depend on understanding all of these error sources. This paper introduces "frequency diversity," a method for doubling the accuracy of indoor position determination using weighted averages of measurements with uncorrelated errors obtained in different channels. The properties of this method are verified experimentally with a range of responders. Finally, different ways of using the distance measurements to determine indoor position are discussed and the Bayesian grid update method shown to be more useful than others, given the non-Gaussian nature of the measurement errors.

A multiscale mathematical model of cell dynamics during neurogenesis in the mouse cerebral cortex.

BACKGROUND: Neurogenesis in the murine cerebral cortex involves the coordinated divisions of two main types of progenitor cells, whose numbers, division modes and cell cycle durations set up the final neuronal output. To understand the respective roles of these factors in the neurogenesis process, we combine experimental in vivo studies with mathematical modeling and numerical simulations of the dynamics of neural progenitor cells. A special focus is put on the population of intermediate progenitors (IPs), a transit amplifying progenitor type critically involved in the size of the final neuron pool. RESULTS: A multiscale formalism describing IP dynamics allows one to track the progression of cells along the subsequent phases of the cell cycle, as well as the temporal evolution of the different cell numbers. Our model takes into account the dividing apical progenitors (AP) engaged into neurogenesis, both neurogenic and proliferative IPs, and the newborn neurons. The transfer rates from one population to another are subject to the mode of division (proliferative, or neurogenic) and may be time-varying. The model outputs are successfully fitted to experimental cell numbers from mouse embryos at different stages of cortical development, taking into account IPs and neurons, in order to adjust the numerical parameters. We provide additional information on cell kinetics, such as the mitotic and S phase indexes, and neurogenic fraction. CONCLUSIONS: Applying the model to a mouse mutant for Ftm/Rpgrip1l, a gene involved in human ciliopathies with severe brain abnormalities, reveals a shortening of the neurogenic period associated with an increased influx of newborn IPs from apical progenitors at mid-neurogenesis. Our model can be used to study other mouse mutants with cortical neurogenesis defects and can be adapted to study the importance of progenitor dynamics in cortical evolution and human diseases.

The ciliary protein Rpgrip1l in development and disease.

RPGRIP1L is an evolutionary highly conserved gene encoding a protein that localises at the transition zone of primary cilia. Mutations in RPGRIP1L result in ciliopathies, severe human diseases caused by dysfunctional cilia. Patients with mutations in this gene often suffer from an impaired development of not only one but various organs. To elucidate the function of Rpgrip1l in human development and the mechanisms underlying ciliopathies, different model organisms are used. In this review article, we summarise the findings of these investigations comprising novel functions of Rpgrip1l and the most promising therapeutic approaches.

Nipple-Areolar Complex Position in Female-to-Male Transsexuals After Non-skin-excisional Mastectomy: A Case-Control Study in Japan.

BACKGROUND: Mastectomy is performed in female-to-male transsexual (FTM TS) patients as a surgical treatment to make a female thorax resemble a male thorax; however, no studies have examined the nipple-areolar complex (NAC) position in FTM TS patients after mastectomy. PATIENTS AND METHODS: The NAC position in 41 FTM TS patients before and after non-skin-excisional mastectomy was examined and compared with that in 50 age- and BMI-matched biologically male subjects as controls. The factors affecting the NAC position after the operation were also examined and verified by multiple regression analysis. RESULTS AND CONCLUSIONS: After non-skin-excisional mastectomy, the NAC in the FTM TS patients was positioned significantly more medially (horizontal NAC position ratio {('internipple distance'/'width of thorax') × 100} [HNPR]: preoperatively, 70.07% ± 4.19%; postoperatively, 63.28% ± 3.79%) and cranially (vertical NAC position ratio {('distance from sternal notch to nipple height'/'distance from sternal notch to umbilicus') × 100} [VNPR]: preoperatively, 43.87% ± 3.68%; postoperatively, 41.37% ± 3.15%). Postoperatively, the NAC in the FTM TS patients was located significantly more medially than that in the control subjects (HNPR: 63.28% ± 3.79% to 66.79% ± 4.82%), although the height of the NAC was the same. Multiple regression analysis revealed that the NAC position on breasts characterized by ptosis, a high projection, and lateral leaning (low skin elasticity and a substantial amount of skin between the nipples) tended to be positioned more medially after non-skin-excisional mastectomy. Laterally deviated eccentric circular type mastectomy may be a good option for FTM TS patients who have moderately sized breasts with such features. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

A fuzzy multi-objective optimization approach for treated wastewater allocation.

In face of the new climate and socio-environmental conditions, conventional sources of water are no longer reliable to supply all water demands. Different alternatives are proposed to augment the conventional sources, including treated wastewater. Optimal and objective allocation of treated wastewater to different stakeholders through an optimization process that takes into account multiple objectives of the system, unlike the conventional ground and surface water resources, has been widely unexplored. This paper proposes a methodology to allocate treated wastewater, while observing the physical constraints of the system. A multi-objective optimization model (MOM) is utilized herein to identify the optimal solutions on the pareto front curve satisfying different objective functions. Fuzzy transformation method (FTM) is utilized to develop different fuzzy scenarios that account for potential uncertainties of the system. Non-dominated sorting genetic algorithm II (NSGA-II) is then expanded to include the confidence level of fuzzy parameters, and thereby several trade-off curves between objective functions are generated. Subsequently, the best solution on each trade-off curve is specified with preference ranking organization method for enrichment evaluation (PROMETHEE). Sensitivity analysis of criteria's weights in the PROMETHEE method indicates that the results are highly dependent on the weighting scenario, and hence weights should be carefully selected. We apply this framework to allocate projected treated wastewater in the planning horizon of 2031, which is expected to be produced by wastewater treatment plants in the eastern regions of Tehran province, Iran. Results revealed the efficiency of this methodology to obtain the most confident allocation strategy in the presence of uncertainties.

Preliminary experience with a transcranial magnetic resonance-guided focused ultrasound surgery system integrated with a 1.5-T MRI unit in a series of patients with essential tremor and Parkinson's disease.

OBJECTIVE Transcranial magnetic resonance-guided focused ultrasound surgery (tcMRgFUS) is one of the emerging noninvasive technologies for the treatment of neurological disorders such as essential tremor (ET), idiopathic asymmetrical tremor-dominant Parkinson's disease (PD), and neuropathic pain. In this clinical series the authors present the preliminary results achieved with the world's first tcMRgFUS system integrated with a 1.5-T MRI unit. METHODS The authors describe the results of tcMRgFUS in a sample of patients with ET and with PD who underwent the procedure during the period from January 2015 to September 2017. A monolateral ventralis intermedius nucleus (VIM) thalamic ablation was performed in both ET and PD patients. In all the tcMRgFUS treatments, a 1.5-T MRI scanner was used for both planning and monitoring the procedure. RESULTS During the study period, a total of 26 patients underwent tcMRgFUS thalamic ablation for different movement disorders. Among these patients, 18 were diagnosed with ET and 4 were affected by PD. All patients with PD were treated using tcMRgFUS thalamic ablation and all completed the procedure. Among the 18 patients with ET, 13 successfully underwent tcMRgFUS, 4 aborted the procedure during ultrasound delivery, and 1 did not undergo the tcMRgFUS procedure after stereotactic frame placement. Two patients with ET were not included in the results because of the short follow-up duration at the time of this study. A monolateral VIM thalamic ablation in both ET and PD patients was performed. All the enrolled patients were evaluated before the treatment and 2 days after, with a clinical control of the treatment effectiveness using the graphic items of the Fahn-Tolosa-Marin tremor rating scale. A global reevaluation was performed 3 months (17/22 patients) and 6 months (11/22 patients) after the treatment; the reevaluation consisted of clinical questionnaires, neurological tests, and video recordings of the tests. All the ET and PD treated patients who completed the procedure showed an immediate amelioration of tremor severity, with no intra- or posttreatment severe permanent side effects. CONCLUSIONS Although this study reports on a small number of patients with a short follow-up duration, the tcMRgFUS procedure using a 1.5-T MRI unit resulted in a safe and effective treatment option for motor symptoms in patients with ET and PD. To the best of the authors' knowledge, this is the first clinical series in which thalamotomy was performed using tcMRgFUS integrated with a 1.5-T magnet.

Shape, Position and Dimension of the Nipple Areola Complex in the Ideal Male Chest: A Quick and Simple Operating Room Technique.

INTRODUCTION: The anatomical features of the chest identify an individual as male or female and even the smallest details of these features determine the appropriate appearance for each gender. In female-to-male patients, the creation of an aesthetically pleasing male chest is the most important step. Incorrect positioning of the nipple areola complex (NAC) on the chest wall and suboptimal shaping and sizing of the NAC are common pitfalls in male NAC creation. PATIENTS AND METHODS: We have analyzed the anatomical chest features of 26 water polo players, to verify our hypothesis of the relationship between the pectoralis major muscle and NAC and to create a method for repositioning the NAC that is applicable in the operating room, is easy, practical and reproducible without the use of formulas and based on an easily identifiable landmark. RESULTS: In our reference group, the NAC has a constant relationship with the pectoralis major muscle, positioned on average 3 cm medial to the lateral border of the pectoralis muscle and 2.5 cm above the inferior pectoralis major insertion. This supports our hypothesis and our surgical technique. We use the index finger to find a vertical axis and a line 2.5 cm above the inferior pectoralis shadow to find the horizontal axis. We also introduce a modification to the receiving site to recreate an oval areola more similar to that of an ideal male chest. CONCLUSIONS: Our anatomical study and statistical analysis support a consistent relationship between the position and shape of the NAC and the borders of the pectoral muscle. We have used this relationship to develop our "trick," which is easily applicable in the operating room to find the NAC position without using formulas and numbers. This method allowed us to place the NAC in a position very close to that of a typical male subject, and it permitted us to reduce the surgery time. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .