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Gender Experiences of Transgender Youth: How Changeable is the Gender Experience of Binary vs. Nonbinary Identifying Transgender Youth and What Factors Are Involved? Abstract: Objectives: Nonbinary gender identities are becoming increasingly visible in transgender healthcare and research. However, little is known about the various gender identities of transgender adolescents - whether they are stable or fluid and which factors influence their gender experience. The present study investigates these different aspects of gender in transgender adolescents with various gender identities. Method: The sample comprised a recent cohort of 114 adolescents diagnosed with gender dysphoria (GD) attending the Hamburg Gender Identity Service for Children and Adolescents (Hamburg GIS). We used the Gender Diversity Questionnaire to assess the different aspects of gender. Results: In total, 83 % of the sample reported a binary (BI) and 17 % a nonbinary gender identity or were still questioning their gender identity (NBGQ). 15-18 % of the transgender adolescents reported gender fluidity. The NBGQ group reported significantly higher levels of gender fluidity or more often that their gender identity was still open to change, respectively, than the BI group. Puberty (79 %), physical distress (70 %), and social media (36 %) were the most frequently mentioned factors influencing their gender experience. Conclusions: The present study underscores that gender experience is not binary and fixed for all transgender adolescents, but that, in some cases, it may be nonbinary or fluid. This heterogeneity, the possible fluidity, and the puberty-related physical distress may challenge treatment decisions in transgender adolescents diagnosed with GD. This situation highlights the importance of developing individualized treatment plans.

Background: In Germany geriatric outpatient care is predominantly done by family doctors and general practitioners (GP). There are regionally different concepts for additional specialized geriatric outpatient care but they have not yet been validated and established. Still, it remains unclear whether a geriatric patient has to be diagnosed rather in a specialized outpatient or inpatient setting. The aim of the present study is the profiling of geriatric outpatients to find key distinctions from geriatric patients that have to be admitted to hospital., Methods: Retrospective data analysis of patients sent to a specialized geriatric outpatient clinic by their GP, compared with data of geriatric inpatients sent to hospital by their GP during the same time period. Study parameters comprised elements of the comprehensive geriatric assessment as well as results of routinely applied laboratory tests., Results: Patients sent to the specialized geriatric outpatient clinic showed better results of functional assessments. Regression analysis: improvement of Barthel Index, GFR and total protein increased the chance of outpatient treatment., Conclusion: Early identification of geriatric patients who can be treated in a specialized outpatient setting would ease the burden for GPs by interdisciplinary cooperation and prevent cost-intensive readmissions to hospital., (© 2022. The Author(s).)

Objective: The review systematically reviews the literature on co-occurring gender dysphoria/gender variance and autism spectrum disorder among children and adolescents., Methods: A systematic literature search was conducted for the years 1946 to December 2018., Results: 144 publications could be identified in the literature search. Out of these, 22 publications met the inclusion criteria for the systematic review. 4.7 to 13.3 % of the children and adolescents with primarily diagnosed gender dysphoria/variance examined in the studies also had an autism diagnosis. In samples of children and adolescents with primarily diagnosed autism gender variance was overrepresented with a prevalence of 4 to 6.5 %., Conclusion: The results of the systematic review point towards an overrepresentation of co-occurring gender dysphoria/variance and autism spectrum disorder. Methodological and clinical implications are discussed., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

Transgender in adolescence is currently a widely discussed topic, additionally reflected by an increasing prevalence in clinical practice. The present review of the available literature on transgender, trans* , gender dysphoria or gender incongruence in youth reports results on the long-term results of medical interventions for the psychological well-being, prevalence, referral rates and sex ratio, developmental pathways, current developments and the role of the social environment. Finally, implications for clinical care and future research will be discussed., Competing Interests: Erklärung zu finanziellen Interessen Forschungsförderung erhalten: nein; Honorar/geldwerten Vorteil für Referententätigkeit erhalten: nein; Bezahlter Berater/interner Schulungsreferent/Gehaltsempfänger: nein; Patent/Geschäftsanteile/Aktien (Autor/Partner, Ehepartner, Kinder) an Firma: nein. Erklärung zu nichtfinanziellen Interessen Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

Introduction: Gender Dysphoria (GD) refers to a distress resulting from an incongruence between the individual's sex characteristics and the experience of their gender (Gender Incongruence, GI). The interaction between medical treatment of GI/GD and social support in the long-term has not been investigated sufficiently so far., Material & Methods: Using an online questionnaire, the present study investigated n=117 individuals with GI/GD assigned male and n=52 assigned female at birth that had been referred to one of the specialized clinics of the European Network for the Investigation of Gender Incongruence (ENIGI) in Belgium, the Netherlands, and Germany.They filled out a questionnaire at 2 time points within a follow-up time of 4 to 6 years after clinical entry (between 2007 and 2009). Two hierarchical regression analyses explored the effects of the sex assigned at birth, the treatment progress and social support on mental distress and satisfaction with life at follow-up in the sample., Results: A female sex assigned at birth and higher degrees of social support significantly predicted the reduction in mental distress at follow-up. An advanced stage of the individual treatment and higher social support significantly predicted an increase in overall satisfaction with life., Discussion: The results illustrate the importance of social support with regard to the outcome of medical treatment of GI/GD., Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: Sedentary behaviour is a health risk factor independent of physical activity. Interventions that aim to reduce sitting at the workplace are particularly important as office workers spend a large proportion of their working hours sitting. This systematic review examines whether these interventions (SB or PA interventions during work time) reduce sitting time among office workers and which variables moderate intervention effects., Methods: A systematic literature search was conducted from April to May 2016 in the following databases: PubMed, PsycINFO and SPORTDiscus. In total, we identified 17 studies that assessed the time spent in sedentary behaviour at the office workplace. To summarize the study results, we applied a best-evidence synthesis. Additionally, we evaluated potential moderators, such as intervention strategies., Results: Multi-component interventions and sit-stand workstations were most promising sedentary reduction interventions. The analysis of moderators highlighted that the proportion of positive intervention effects was higher in interventions based on the strategies "environmental restructuring", "adding objects to the environment" and "instructions on how to carry out the behaviour". Furthermore, interventions focusing on sedentary behaviour only and studies using objective measurement tools showed more often positive interventions effects., Conclusions: There are many promising interventions to reduce sitting time at the office workplace. However, there is insufficient evidence if the effects of these interventions are sustainable in the long term. Moreover, the considerable heterogeneity of included studies limits the validity of our findings. Future intervention studies should build on a theoretical planning approach and use subjective as well as objective evaluation measures., Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

Objective: The Restless Legs Syndrome (RLS) is a clinically relevant condition in geriatric patients. An association between iron deficiency and RLS is largely acknowledged. The clinical and therapeutic management of iron deficiency-associated RLS has been, however, poorly evaluated in geriatric patients., Methods: Data from all RLS inpatients admitted to a geriatric unit between 2009 and 2011 were retrospectively collected on demographics and clinical characteristics, iron status, drug treatment including iron substitution, as well as comprehensive geriatric assessment (CGA) scores., Results: RLS was diagnosed in 56 of the 4,063 admitted patients during the two years. Of the RLS cases, 20 (36%) showed iron deficiency. Thirteen of these were treated with iron substitution according to the existing guidelines. Both RLS patients with and without iron deficiency showed a significant clinical improvement between admission to discharge according to the CGA scores., Conclusion: Iron substituted geriatric patients with iron deficiency-associated RLS substantially benefited from the treatment, similarly to RLS patients without iron deficiency. A multidimensional assessment, careful iron metabolism examination and adequate treatment choice should be equally importantly considered in geriatric patients with RLS.

Background: Vaulting is the least studied equestrian sports regarding the occurrence of injuries. As its sequences of motion do not compare to riding, vaulting must be assessed separately. Material and Methods: This retrospective, questionnaire-aided survey was aimed to gain insight into the overall frequency of injuries among equestrian vaulters. The second part of the study looked into the knee injuries that occurred. Survey forms were sent to 60 vaulting and equestrian clubs all over Germany, making for a response rate of 63 %. Results: 95 % of 624 responding athletes were female. The pool of participants consisted of both amateur and professional level vaulters with a mean age of 15 years. The survey showed a mean number of 4.1 injuries sustained during the observation period, i. e. the entire time an athlete had been active in the sport up to the data collection. The lower extremities were the most commonly injured area with a total proportion of 45 %, followed by injuries to the spine and the head with 30 %, and the upper extremities with 25 %. Contusions accounted for the highest number of reported injuries. Other frequently reported injuries included muscle strain to the head and spine, fractures to the upper extremity and ligament damage to the lower extremity. 14 % of the participants experienced at least one knee injury. The medial collateral ligament (27 %) was found to be most prone to lesions, followed by the anterior cruciate ligament (23 %) and the medial meniscus (22 %). Half of all knee injuries occurred during dismounts, especially when swing-offs or flanks led to faulty landings. Conclusions: The results show that the lower extremity is the most commonly affected area. The ligamentous injuries affecting the lower extremity mainly result from dismounts. A specific training aimed at improving landing techniques might therefore prove beneficial in preventing injuries. The frequency of contusions and fractures to the upper extremity suggests that these injuries are related to falls., (© Georg Thieme Verlag KG Stuttgart · New York.)

Innovative developments in the pharmacotherapy of juvenile idiopathic arthritis and especially biologics allow the formulation of new therapeutic targets, such as the rapid induction of remission with shortening of the period of active disease and therefore preventing damage and disability. These new therapies also represent a challenge to the monitoring of drug safety, the pharmacovigilance. For this purpose the Society for Paediatric and Adolescent Rheumatology has set up an early register to record achievements in treatment improvement and in addition to independently assess information on drug safety, acute tolerance and long-term safety.

In Germany, the situation of health care services for children and adolescents with gender dysphoria is insufficient. In 2006 a specialized multiprofessional outpatient clinic was founded at the University Medical Center Hamburg-Eppendorf. Goals were improvement of health services for gender dysphoric children, development of treatment concepts, and gain of knowledge through research. After finishing a thorough interdisciplinary assessment an individualized, case-by-case treatment starts. Besides psychotherapy an interdisciplinary treatment (e. g. puberty suppression and cross-sex hormones) is provided if indicated. During childhood a watchful waiting and carefully observing attitude is necessary. If a marked increase of gender dysphoria occurs during the first phases of puberty development, puberty suppression and later cross sex-hormones might be indicated.

Given the increasing demand for counselling in gender dysphoria in childhood in Germany, there is a definite need for empirical data on characteristics and developmental trajectories of this clinical group. This study aimed to provide a first overview by assessing demographic characteristics and developmental trajectories of a group of gender variant boys and girls referred to the specialised Gender Identity Clinic in Hamburg. Data were extracted from medical charts, transcribed and analysed using qualitative content analysis methods. Categories were set up by inductive-deductive reasoning based on the patients' parents' and clinicians' information in the files. Between 2006 and 2010, 45 gender variant children and adolescents were seen by clinicians; 88.9% (n = 40) of these were diagnosed with gender identity disorder (ICD-10). Within this group, the referral rates for girls were higher than for boys (1:1.5). Gender dysphoric girls were on average older than the boys and a higher percentage of girls was referred to the clinic at the beginning of adolescence (> 12 years of age). At the same time, more girls reported an early onset age. More girls made statements about their (same-sex) sexual orientation during adolescence and wishes for gender confirming medical interventions. More girls than boys revealed self-mutilation in the past or present as well as suicidal thoughts and/or attempts. Results indicate that the presentation of clinically referred gender dysphoric girls differs from the characteristics boys present in Germany; especially with respect to the most salient age differences. Therefore, these two groups require different awareness and individual treatment approaches.

Background: In the last few years, the therapy of cervical carcinoma has progressed substantially due to the use of simultaneous platinum- containing radiochemotherapy. However, there are no data which evaluate an individualized treatment adapted to tumor biology, in spite of the fact that patients show remarkably different responses to chemotherapy. Therefore this preclinical phase I study aims at finding therapeutic alternatives to the current cytostatic drugs to treat cervical carcinoma., Material and Methods: In a tumor chemosensitivity assay, 8 drugs were tested on freshly isolated tumor cells of 16 patients [carbo- and cisplatin, topotecan, paclitaxel as well as the 2 tyrosine kinase inhibitors imatinib (Glivec) and gefitinib (Iressa (R) ) and the 2 monoclonal antibodies cetuximab (Erbitux) and trastuzumab (Herceptin (R) )]., Results: Overall the test was evaluable for 16 specimens (100%). Ten of 15 tumor samples (66.6%) were sensitive to imatinib. A sensitive therapeutic response could be demonstrated in all tested FIGO stages. An interindividual comparison could establish sensitivity to cetuximab in 12.5% of cases, to gefitinib in 6.25%, to trastuzumab in 6.6%, to cisplatin in 13.3%, to carboplatin in 7.6%, to paclitaxel in 93.8% and to topotecan in 25%., Conclusion: Imatinib seems to be an efficacious therapeutic option for patients with cervical carcinoma, independently of tumor subtype., (Copyright 2008 S. Karger AG, Basel.)

We report a case of esophageal perforation by impacted portions of a wild boar. The 77-year-old patient was admitted 5 days after an opulent dinner. He complained of dysphagia and retrosternal pain and showed signs of severe sepsis. Endoscopy revealed meat and bone portions impacted in the esophagus. Surprisingly, impactation had not happened near any of the anatomical narrowings, but in the middle third. A CT scan showed penetration of the foreign body into the mediastinum and purulent mediastinitis. The patient underwent transthoracic esophagectomy and drainage of the severe, purulent mediastinal infection. Postoperative multi organ failure required a prolonged treatment in the intensive care unit. After recovery the gastrointestinal continuity was restored with gastric pull-up in the anterior mediastinum. The further course was uneventful.

Background: The mandible is a very uncommon place for a metastasis of a gastric carcinoma. Normally the area of the temporomandibular joint (TMJ) remains unaffected. The separate vascularization is discussed as one reason among others. Primary reconstruction after resection of the condyle is often problematic because an early onset of adjuvant systemic therapy is required. In this case, the insertion of a Quinn joint prosthesis is presented after resection of a TMJ metastasis., Case: We report a hematogenic metastatic gastric adenocarcinoma in a 51-year old male who initially presented with increasing disclusion in the left molar region. Suspecting a metastatic adenocarcinoma of the TMJ, a condylectomy with immediate replacement by a total joint prosthesis was performed via a preauricular approach. Corresponding to the clinically and radiologically suspected diagnosis, the decalcified histological specimen presented as a metastatic gastric adenocarcinoma within the intracapsular region., Results: The healing period of the implanted modified Quinn prosthesis was fast and uncomplicated after resection of this, to our knowledge, first documented metastatic gastric adenocarcinoma of the intracapsular region. After early restoration of joint function and patient satisfaction, the required radiochemotherapy of further unresectable bony metastases could be started in time., Discussion: This example of an extremely rare case of a metastasis shows that such a total joint prosthesis appears to be a very good alternative to extended autogenous reconstruction or an unsatisfactory primary resection. Due to the mating of the spherical condylar head and glenoid fossa, the modified Quinn prosthesis is very suitable for total joint replacement after extended resection or in multiply preoperated cases.

Aim: Until now scintimammography did not achieve any definite role in the assessment of breast lesions. Purpose of this study was to elaborate its use as well as the limitations of scintimammography after 500 examinations completed., Methods: Scintigraphic findings were correlated with the histopathologic outcome of 219 patients, who underwent surgery or biopsy for histopathological confirmation. The results were determined with respect to palpability of the lesion and tumour size. Additionally, a distinct analysis was performed for the patient subpopulation with indeterminate results of previously performed physical examination, mammography, and sonography., Results: Overall sensitivity for scintimammography was 82.1% at a specificity of 87.5%. For palpable lesions sensitivity was 91.7% which was evidently higher as compared to 64.9% for non palpable lesions. For palpable lesions specificity was 81.1% and 88.6% for non palpable lesions. According to tumour size sensitivity ranged between 65.2% for carcinoma with a diameter < 1 cm and 93.7% for carcinoma > 1 cm. In the patients subgroup with indeterminate preliminary diagnosis (n = 143) sensitivity decreased to 71.7% at a specificity of 87.8%. Patients undergoing neoadjuvant chemotherapy showed decreasing sestamibi uptake as early as 8 days after therapy if tumour response was evident. However, small residual invasive tumours in patients with complete remission could not be visualised., Conclusion: Scintimammography is neither suited for screening, nor early diagnosis of breast cancer, nor for the further evaluation of small and unclear mammographic findings. Scintimammography should not be used whenever histopathological clarification of a suspicious lesion is necessary. It is useful to further investigate patients with unclear or probably benign findings in physical examination and/or mammography and to monitor tumour response to neoadjuvant chemotherapy.

The case of a 35-year-old man with progressive dementia from the age of 17 is presented. Clinical examination showed mild extrapyramidal and cerebellar signs and rare myoclonus. Neuropsychological evaluation disclosed severe cognitive deficits. Magnetic resonance imaging (MRI) revealed moderate generalized atrophy with abnormal iron deposition in the basal ganglia. Positron emission tomography (PET) with 18-fluorodeoxyglucose (18-FDG) demonstrated clear temporoparietal hypometabolism. The clinical symptoms and course are typical for the rare adult type of neuronal ceroid lipofuscinoses (Kufs' disease). The diagnosis is supported by the electron microscope detection of an abnormal accumulation of lipid vacuoles and lipofuscin in the eccrine sweat glands and the rectal ganglia cells.

Most frequently the ependymomas of the central nervous system affect the Conus medullaris and Filum terminale. Ependymomas of the thoracic spine with association of a tumor-caused syringomyelia are extremely rare. The reported 50 years old patient with a thoracic ependymoma realized first symptoms as a shoulder-arm pain caused by the tumor-syrinx. The case report indicates that MRI is the superior imaging modality for primary tumors of the central nervous system. All relevant diagnostic and therapeutic informations derived from the MRI. The article describes the clinical manifestations, the diagnostic way and therapeutic procedure in the problem region thoracic spine.

Somatic deletion mutations in the cell adhesion molecule E-cadherin are present in almost 50% of diffuse type gastric cancer. We recently generated monoclonal antibodies against an in-frame deletion of exon 9. The aim of this study was to generate and characterize monoclonal antibodies against the second mutational hot spot, in-frame deletions of exon 8. Lou/C rats were immunized using a KLH-coupled peptide that represents a unique sequence generated by fusion of exon 7 and exon 9 from an E-cadherin deletion mutation lacking exon 8. Hybridoma supernatants were tested in a solid-phase immunoassay using BSA-coupled peptide. Positive reacting hybridomas were confirmed by Western Blots, FACS analysis, and immunohistochemistry of E-cadherin negative carcinoma cells that had been transfected with mutant and wild-type E-cadherin cDNA, respectively. In addition, routine formalin fixed and paraffin embedded tissues from gastric cancer patients were analyzed using both mutation-specific and commercial monoclonal antibodies against E-cadherin, including HECD-1 and AEC. Two hybridoma supernatants, termed E-cad delta 8-1, were selected that reacted with the mutant peptide used for immunization and gave strong signals in Western Blot and FACS analysis with cells expressing mutant E-cadherin lacking exon 8. Wild-type protein expressing cells only reacted with the commercial antibodies but not with the two selected hybridoma supernatants. In contrast to AEC, monoclonal antibody HECD-1 did not react with exon 8 deleted E-cadherin, suggesting that the previously unknown epitope for this often used monoclonal antibody is located at least in part within exon 8. Four gastric cancer specimens known to express mutated E-cadherin mRNA strongly reacted with both mutation-specific supernatants and with AEC monoclonal antibody but not with HECD-1. Taken together, we succeeded in generating monoclonal antibodies reacting with mutant E-cadherin protein lacking exon 8. Furthermore, using both HECD-1 and the new mutation-specific antibodies E-cadherin immunoreactivity can for the first time be evaluated in an allele-specific manner in archival tissues.

In case of unintentional intravascular uptake, the injection of repository penicillin may produce severe embolic obturations. Several batches of respository penicillin were tested for their crystal size in ready-for-injection suspensions. The greatest crystals were found in preparations with a high proportion of benzylpenicillin-procaine. To avoid untoward reactions (Hoigné syndrome, Nicolau syndrome), the recommendations of the Central Expert Committe on Drugs must be considered. Furthermore, the measures required in case of anaphylactic shock are dealt with.

Among the variety of surgical packs described in the literature, zinc oxide-based packs have proved especially useful. Two types still currently used are the zinc oxide-eugenol pack according to Büchs and Walter and the pack modified by Behlke which contains Peruvian balsam in place of eugenol. Of 27 patients who had undergone a periodontal-surgical intervention, 6 were treated with a zinc oxide-eugenol pack, and 21 with a pack modified by Behlke. Clinical and cytological examinations were performed before intervention, at each change of pack (on the 5th, 8th and 14th days after intervention) and 4 weeks after intervention. The comparison of the results obtained shows the superiority of the pack modified by Behlke over the zinc oxide-eugenol pack.

Exfoliative cytology allows important information to be obtained about the structure and function of individual sections of tissue. Use of this particular method of examination is characterized by simplicity and freedom from strain on the subject being tested. In addition, the method yields clear and comprehensive results. Smears obtained from different regions of the oral cavities of subjects with clinically healthy oral mucous membrans and intact teeth were carefully analyzed. Also examined by clinical methods as well as by exfoliative cytology was the healthy gingiva, with parodontopathia inflammata superficialis and parodontopathia inflammata profunda serving as reference groups.