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Objective: Medical treatments that aim to modify the appearance of the genitals in children who are born with a difference of sex development/intersex (DSD/I*) condition are highly controversial. Human Rights bodies worldwide have argued that such treatments are conflicting with the child's right of personal autonomy and should be legally restricted to the unique situation where the child's physical health is in danger., Design: We here review the current status of legal initiatives in Europe that have addressed the issue of medical treatments in minors who have a DSD for which they have not been able to give personal informed consent due to their young age., Patients: The management of a 3 years old child who has congenital adrenal hyperplasia (CAH) and grows up with atypical-looking genitals is discussed., Results: In spite of extensive psychosocial support to the child and family from birth onwards, and good medical control of CAH, the child develops signs of emotional distress, suspected to be attributable to the genital difference. Our discussions include perspectives from the multidisciplinary DSD team caring for the child, a human rights specialist, and an intersex activist. From our discussions, we conclude that with evolving medical care, new ethical and human rights challenges are raised. A truly holistic human rights approach should not only consider physical but also mental health and psychosocial and psychosexual adaptation of the child to the medical condition, when reflecting on the acceptability of medical treatments in minors for which no personal informed consent can be obtained due to their young age. In addition it is paramount to include the meaningful participation of the child in the clinical management at the earliest possible stage., Conclusions: Continued convergence of clinical management and the human rights framework can be realised based on constructive discussions involving all stakeholders, and with the best interest of the child - and adult that they will become - as a common goal., (© 2023 John Wiley & Sons Ltd.)

Fungi of the genus Trichoderma are of high importance for biotechnological applications, in biocontrol and for production of homologous and heterologous proteins. However, sexual crossing under laboratory conditions has so far only been achieved with the species Trichoderma reesei , which was so far only isolated from tropical regions. Our isolation efforts aimed at the collection of Trichoderma strains from Austrian soils surprisingly also yielded 12 strains of the species T. reesei , which was previously not known to occur in Europe. Their identity was confirmed with tef1 - and rpb2 -sequencing and phylogenetic analysis. They could clearly be distinguished from tropical strains including the common laboratory wildtypes by UP-PCR and genetic variations adjacent to the mating type locus. The strains readily mated with reference strains derived from CBS999.97. Secreted cellulase and xylanase levels of these isolates were up to six-fold higher than those of QM6a indicating a high potential for strain improvement. The strains showed different responses to injury in terms of induction of sporulation, but a correlation to alterations in the nox1 -gene sequence was not detected. Several synonymous SNPs were found in the sequence of the regulator gene noxR of the soil isolates compared to QM6a. Only in one strain, non-synonymous SNPs were found which impact a PEST sequence of NoxR, suggesting altered protein stability. The availability of sexually fertile strains from middle Europe naturally producing decent amounts of plant cell wall degrading enzymes opens up novel perspectives for non-GMO strain improvement and biological pretreatment of plant biomass for bioethanol production. Moreover, the varied response of these strains to injury in terms of sporulation, which is independent of Nox1 and NoxR suggests that additional regulators impact this phenomenon in T. reesei. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to test a conceptual model of retrospectively assessed change in sexual interest and sexual enjoyment in the past 10 years among coupled older adults in Norway, Denmark, Belgium and Portugal. To which degree do structural influences, personal characteristics, and interpersonal factors predict the dynamics of sexual interest and enjoyment in partnered persons? Methods: Data were collected as a cross-sectional postal survey, with national probability-based samples of the population aged 60-75 years recruited by phone registers in Norway (676 men and 594 women), Denmark (530 men and 515 women), Belgium ( 318 men and 672 women), and Portugal (236 men and 273 women). Results: Across countries, personal characteristics—primarily general health status—were the most important predictors of change in sexual interest and sexual enjoyment in men. Change in sexual interest and enjoyment among women (except for Portuguese women) was best predicted by interpersonal factors. Conclusions: Good health, an active sex life throughout the lifespan, direction of relationship, and feeling emotionally close to partner during sex are important factors in maintaining sexual interest and enjoyment among partnered older adults in Europe. [ABSTRACT FROM AUTHOR]

Background: Surgery is performed in many individuals with disorders/differences of sex development (DSD). Irreversibility of some surgical procedures, lack of information about the procedures, and lack of follow-up care for physical and psychological outcomes, lead to wish for more knowledge from both surgeons and patients. After the consensus conference in 2006, multidisciplinary care is provided to a higher degree with psychological support and more restricted surgical procedures. Outcome studies after genital surgery often lack of patient's perspective., Objective: To describe surgical procedures in relation to diagnosis, to evaluate the outcomes of surgery through genital examination, and through patient's and observer's satisfaction with the anatomical and functional result after genital surgery., Study Design: In a cross-sectional clinical study performed in six European countries in 2014/15, we have included 500 participants where surgery was performed, from a total of 1040 adolescents (≥16years) and adults with a DSD. Diagnoses included Turner syndrome (n = 301), mixed gonadal dysgenesis (45,XO/46,XY; n = 45), Klinefelter syndrome (n = 218), XYY (n = 1), 46, XY DSD (n = 222) and 46, XX DSD (n = 253). Study protocol included clinical report files, an optional gynecological or urological examination, patient reported outcomes including received surgical interventions, satisfaction with appearance and function after surgery, and impact of the surgical procedure on life., Results: Five hundred participants had received genital or breast surgery, with the highest rate in 46, XY DSD and the lowest in Turner syndrome. Altogether; 240 participants had feminizing surgery, 112 had masculinizing surgery, and 217 underwent gonadectomy. Physicians evaluated anatomical appearance at genital examination as poor in less than 10%. Dissatisfaction with anatomical appearance was reported by 22% of the participants, dissatisfaction with function by 20%. Being (very) dissatisfied with anatomical appearance and function was reported by 13% of the study participants. Most participants reported no impact, or positive impact, of the surgical procedures on their lives, but 29% experienced a negative effect of gonadectomy on their life., Discussion: There might be a selection bias and/or a recall bias for participating in our studies. Due to poor data quality about surgical procedures performed in the past, we also relied on participants memory about surgical procedures in their past. Ideally, patient reported outcomes should be evaluated both before and after surgical procedures., Conclusion: A vast majority are satisfied with appearance and function, but still genital or breast surgery have a long-lasting effect on patient's life. Self-reported satisfaction is usually lower than the observer's evaluation regarding both appearance and function., Competing Interests: Conflicts of interest The authors have no competing interests., (Copyright © 2020 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.)

Introduction: The last two decades have seen an exponential growth in the distribution and availability of child pornographic material on the Internet and social networks. The medical community is involved in assisting the investigating authorities in relation to estimating the age and sexual maturity of the alleged victims., Objective: To determine the efficacy of using Tanner stages as a method for esti mating chronological age in alleged child pornography cases based on published evidence., Material and Method: Systematic review study in PubMed and Scopus databases following PRISMA guideli nes. Articles describing the outcome of using Tanner stages to estimate chronological age in alleged child pornography cases were identified. For screening, those written in English or Spanish published from January 1, 2000, to April 30, 2020, were considered. The following data were extracted from the articles included: type of study; material and methods used; Tanner items examined; evaluators' characteristics; results; estimated chronological age versus real age; observer-dependent variations (bias); and conclusions., Results: Seven studies were included. Three were literature reviews and four were case studies with expert testimony and observer bias. This method is ineffective when the alleged victim, in both sexes, shows sexual maturation in Tanner stages 3-5. In stages 1-2, it may be useful to state that the victim is under 18 years old, but not to determine their chronological age., Conclusion: Scientific evidence discourages the use of Tanner stages to estimate the chronological age of the vic tim from images in alleged child pornography cases. Pediatricians, and other medical professionals, should avoid making a testimony that is not scientifically based.

Reliable markers are needed to identify the lineages in the invasive clam genus Corbicula. Previous studies have demonstrated that mitochondrial (mt) DNA poorly resolves Corbicula phylogeny, owing to its androgenetic reproductive mode. Moreover, hybridization and mitochondrial/nuclear mismatches occur. We developed the first eleven polymorphic markers to detect these phenomena and to investigate the nuclear identity of Corbicula populations. These microsatellite loci revealed three main lineages in Western Europe. One locus allowed rapid discrimination of these three lineages on agarose gel, saving time and money. Moreover, the eleven markers were successfully cross-amplified in the invasive Corbicula lineages found in North America., (© 2011 Blackwell Publishing Ltd.)