Search

The study aimed to evaluate adult endocrinologists' perspectives on caring for patients with congenital adrenal hyperplasia (CAH) and views on their transition from pediatric to adult care. An online survey was conducted among adult clinical endocrinologists at Harvard Medical School-affiliated hospitals from March to October 2022. Most participants (25/34, 73.5 %) treat patients with CAH and expressed moderate to high confidence (23/32, 71.9 %) in their care. Those that did not treat or accept referrals cited insufficient expertise, knowledge, and resources as reasons. Only half of respondents correctly answered at least 50 % of standard of care questions. The main transition of care barrier identified was the absence of standardized policies (12/34, 35.3 %). Participants, though involved in care of patients with CAH, had varied responses to standard of care questions and transition of care barriers, emphasizing the need for standardized transition protocols and additional training to ensure up-to-date clinical knowledge. [ABSTRACT FROM AUTHOR]

Many transgender young adults are unaware of the role of pre-exposure prophylaxis (PrEP) in HIV prevention. Our aim was to understand where transgender and gender-diverse young adults receive health information about HIV and PrEP and their preferences for future learning. Semistructured, qualitative individual and group interviews were done with 14 transgender and gender-diverse young adults. Interviews were transcribed verbatim and analyzed using thematic analysis. Four themes emerged from the interviews related to (1) making trustworthy education materials, (2) the importance of communities, (3) knowledge needed about PrEP, and (4) a lack of early and diverse classroom education. Transgender and genderdiverse persons are at higher risk for HIV than their cisgender peers, yet they have information gaps and hold misconceptions about preventative measures like PrEP. Such misconceptions may be addressed by early, inclusive conversations about HIV transmission and prevention. [ABSTRACT FROM AUTHOR]

Background: Danazol is a synthetic progestin with androgenic effects that is approved by the Food and Drug Administration for treatment of endometriosis, benign fibrocystic breast disease, and hereditary angioedema. In recent years, increasing numbers of transgender and nonbinary individuals seeking menstrual suppression have been offered danazol due to its potential to both induce amenorrhea and cause reversible androgenic side effects including pigmentation of vellus hairs and voice changes, which may be desirable in this population. There are currently no studies assessing use of danazol within the transgender population for menstrual suppression. Objective: This study's primary aim was to evaluate the use of danazol as a menstrual suppression agent in transgender patients. Design: This was a retrospective multisite cohort study of all individuals who had been on danazol at two tertiary care centers between 2000 and 2022. Methods: All patients prescribed danazol were identified using a search of the electronic medical records. For demographic purposes, comparisons were made between those who did and did not use danazol for the purpose of menstrual suppression. A detailed chart review was then performed to analyze the experiences of menstrual suppression in transgender and nonbinary patients. Results: Most transgender and nonbinary patients on danazol for menstrual suppression remained on it at their most recent follow-up visit, and many charts noted improvements in gender dysphoria, pelvic pain, dysmenorrhea, endometriosis, and heavy menstrual bleeding. Most transgender patients achieved amenorrhea. Conclusion: Danazol may be a reasonable option for menstrual suppression in transgender and nonbinary patients. Our findings show its potential to not only induce amenorrhea but cause desired androgenic symptoms and improve gender dysphoria, pelvic pain, dysmenorrhea, endometriosis, and heavy bleeding. While the androgenic effects of danazol are less desirable in cisgender populations, it is an attractive option for menstrual suppression in transgender and nonbinary patients. Plain language summary: Using danazol to stop periods in transgender individuals Danazol has previously been used to help treat pain and bleeding related to endometriosis. However, danazol can have certain androgenic side effects (acne, deepening of the voice) that cisgender women (individuals who were assigned female at birth and identify with the female gender) often find undesirable, but that could be desirable in transgender patients seeking to affirm their gender by stopping periods. Our study looked at danazol use for period suppression, as well as for other reasons. We found that most transgender patients using danazol for period suppression found it to be successful and remained on it at follow-up appointments, and that many transgender patients saw improved gender dysphoria, pelvic pain, pain during periods, endometriosis, and heavy period bleeding. These findings suggest that danazol may be a good option for menstrual suppression in transgender individuals as any experienced androgenic effects may help with gender dysphoria, whether individuals are not yet ready to start testosterone or do not desire testosterone therapy at all. [ABSTRACT FROM AUTHOR]

Background:. Benign breast surgery aims to treat the physical and psychological discomfort that may be associated with excess breast tissue. In this investigation, we present the first systematic examination and comparison of the determinants of pain and related symptomology in cisgender women and transmasculine individuals presenting for benign breast surgery. Methods:. To complete this study, we abstracted the intake forms of 128 transmasculine and 62 cisgender female patients who presented for benign breast surgery between August 2016 and July 2020. Results:. Increasing chest size was associated with significantly increased odds of reporting rash (OR 1.10 95% CI [1.01–1.10], P < 0.03), difficulty playing sports (OR 1.19 95% CI [1.09–1.29], P < 0.001), and difficulty finding clothes that fit (OR 1.21, 95% CI [1.11–1.33], P < 0.001). For individuals who bound their chests, size was also associated with difficulty exercising in a binder (OR 1.14 [1.01–1.29], P < 0.03). Looking separately at the two populations, the only factors that remained associated with pain in multivariate models were BMI (β = 0.10 [0.01–0.18], P < 0.03) for cisgender women and history of binding (β = 1.95 [0.37–3.52], P < 0.02) for transmasculine people. Conclusions:. Pain does not seem to be associated with chest size in either cisgender female or transmasculine patients seeking benign breast surgery. The association between chest binding and pain in transmasculine people supports the provision of gender-affirming chest surgery to eliminate the need to bind and reduce both physical and psychological distress.

COVID-19 has continued to bring devastation to children and families, even 1 year into the pandemic. The rise of the Black Lives Matter movement has also led to renewed attention to systemic racism in the United States and awareness of how the pandemic has further exacerbated health inequities that disproportionately affect communities of color. Pediatric hospital social workers have played a key role since the beginning of the pandemic in responding to the resulting behavioral health crisis and helping to address social disparities. There is a need to understand how the roles and experiences of pediatric social workers have evolved during the first year of the pandemic. In this qualitative study, a series of practice-setting based focus groups were conducted with social workers to capture (a) what has changed or stayed the same since the beginning of COVID-19, (b) thoughts and experiences on diversity, equity, and inclusion with particular attention to race and racism, and (c) perspectives about the long-term implications of COVID-19 on the profession of social work. The Framework Method was used to analyze data, from which six superordinate themes emerged: burnout/coping; the impact of patient acuity; awareness of racial inequity in patient care; awareness of social determinants of health; social worker inclusion in hospital decision-making and policy reform; and grief/racial inequity. An overview of what has stayed the same, what has changed, and what the future may hold for pediatric hospital social workers is reviewed. [ABSTRACT FROM AUTHOR]

This study reports a case of partial atrioventricular canal defect with an anomalous left circumflex coronary artery in an elderly veteran presenting with unexplained dyspnea on exertion. This is a rare finding in this population and emphasizes the importance of a broad differential diagnosis and meticulous evaluation when more common conditions have been excluded. (Level of Difficulty: Intermediate.)

Introduction: There has been an exponential increase in referrals for transmasculine patients seeking genital affirmation surgery. Despite transgender men’s equal interest in metoidioplasty and phalloplasty, research has primarily focused on phalloplasty. Aim: To summarize and investigate the relationship between surgical technique, complications, and patient-satisfaction. Methods: We performed a systematic review and meta-analysis of surgical techniques and physician- and patient-reported outcomes of gender-affirming clitoral release and metoidioplasty (PROSPERO# 158722) with literature from PubMed, Google Scholar, and ScienceDirect. Data were extracted using PRISMA guidelines. All searches, extractions, and grading were independently completed by 2 authors. Main Outcome Measures: Main measures were surgical technique, patient satisfaction, voiding, urethral stricture, and urethral fistula. Results and Conclusion: A total of 7 non-overlapping articles on metoidioplasty were identified, with a total of 403 patients. We identified 4 metoidioplasty techniques: Hage, Belgrade, labial ring flap, and extensive metoidioplasty. All techniques included urethral lengthening. The reported neophallus length ranged from 2 cm to 12 cm, with the smallest neophallus occurring with the labial ring flap technique and extensive metoidioplasty the largest. Across techniques, voiding while standing was reported in most patients, with the lowest rate reported with the labial ring flap (67%). Complications were impacted by surgical technique, with the lowest rates of fistula and stricture occurring with the Belgrade technique. Fistula rates ranged from 5% to 37%, while stricture ranged from 2% to 35% of patients. The Belgrade technique reported significantly lower rates of fistula and stricture (P = .000). The patient-reported outcomes were described for the Belgrade technique and extensive metoidioplasty. Both techniques showed high aesthetic and sexual satisfaction. Transgender individuals can achieve an aesthetically and sexually satisfactory neophallus using a variety of metoidioplasty techniques; however, urethral outcomes vary significantly by technique. The Belgrade technique reported the best outcomes, although data remains limited. Patient priorities should be used to determine surgical technique.Jolly D, Wu CA, Boskey ER, et al. Is Clitoral Release Another Term for Metoidioplasty? A Systematic Review and Meta-Analysis of Metoidioplasty Surgical Technique and Outcomes. Sex Med 2021;9:100294

Background:. The value of gender-affirming genital surgery (GAGS) has been established for certain transgender or gender non-conforming patients. This study aimed to determine the availability of GAGS by state and region in the United States, and to query possible associations of access to care with healthcare legislation and local market size. Methods:. This was a cross-sectional study reporting on the distribution of hospitals and private practices offering GAGS in the United States. A list of prospective gender surgeons was compiled from 18 online databases. All surgeons were individually verified and were excluded if they did not perform phalloplasty, metoidioplasty, or vaginoplasty. Pertinent legislative and transgender or gender non-conforming population data were derived from the Movement Advancement Project and the Williams Institute. Results:. Seventy-one practices in the United States offered GAGS in 2019. Forty-seven percent of states did not have a practice offering GAGS. A large prospective transgender or gender non-conforming market size increased the odds of GAGS availability in a state more than did local healthcare legislation supporting insurance coverage for gender-affirming care in 2019. Conclusions:. Access to gender-affirming genital surgery was highly disparate in 2019. Factors that predicted access to care, including state healthcare legislation and prospective market sizes, may indicate strategies for overcoming disparities.

Background:. Transgender women seeking gender-affirming breast augmentation often present with differences in preoperative chest measurements and contours in comparison with cisgender women. These include a more robust pectoralis muscle and limited glandular tissue, raising important considerations in determining the optimal anatomical plane for implantation. Abundant literature has described advantages and drawbacks of the available planes for breast augmentation in cisgender women. Certain drawbacks may be more pronounced for transgender women, given their distinct anatomy. The subfascial plane offers lower complication rates than the subglandular plane when using smooth implants, and avoids implant animation and displacement associated with the subpectoral plane. To our knowledge, existing studies have not yet addressed this discussion in the transfeminine population. The goal of this article is to highlight potential benefits of the subfascial plane for gender-affirming breast augmentation, utilizing a case series of 3 transfeminine patients, and to review the literature on surgical techniques and outcomes in this population. Methods:. A retrospective chart review of patients presenting to a single surgeon for gender-affirming breast augmentation in 2019 was performed. A narrative literature review on surgical techniques and outcomes for gender-affirming breast augmentation was conducted. Results:. Three cases of gender-affirming breast augmentation using subfascial implant placement are described. From the literature search, 12 articles inclusive of 802 transfeminine patients were identified. Conclusions:. The subfascial plane represents an option for implant placement in gender-affirming breast augmentation that merits further investigation. There is a need for more research comparing surgical techniques and outcomes in the transfeminine population.

Endochondral ossification is a highly regulated process that relies on properly orchestrated cell-cell interactions in the developing growth plate. This study is focused on understanding the role of a crucial regulator of cell-cell interactions, the membrane-anchored metalloproteinase ADAM17, in endochondral ossification. ADAM17 releases growth factors, cytokines, and other membrane proteins from cells and is essential for epidermal growth factor receptor (EGFR) signaling and for processing tumor necrosis factor alpha. Here, we report that mice lacking ADAM17 in chondrocytes (A17ΔCh) have a significantly expanded zone of hypertrophic chondrocytes in the growth plate and retarded growth of long bones. This abnormality is caused by an accumulation of the most terminally differentiated type of chondrocytes that produces a calcified matrix. Inactivation of ADAM17 in osteoclasts or endothelial cells does not affect the zone of hypertrophic chondrocytes, suggesting that the main role of ADAM17 in the growth plate is in chondrocytes. This notion is further supported by in vitro experiments showing enhanced hypertrophic differentiation of primary chondrocytes lacking Adam17. The enlarged zone of hypertrophic chondrocytes in A17ΔCh mice resembles that described in mice with mutant EGFR signaling or lack of its ligand transforming growth factor α (TGFα), suggesting that ADAM17 regulates terminal differentiation of chondrocytes during endochondral ossification by activating the TGFα/EGFR signaling axis.

Abstract Tough natural nanocomposites like bone, nacre and sea sponges contain within their hierarchy, a mineral (phosphate, silicate or carbonate) phase that interacts with an organic phase. In bone, the role of mineral ultrastructure (organization, morphology, composition) is crucial to the mechanical and biological properties of the tissue. Better understanding of mineral interaction with the organic matrix, in particular non-collagenous proteins, osteocalcin (OC) and osteopontin (OPN), can lead to better design of biomimetic materials. Using small angle x-ray scattering (SAXS) and wavelength dispersive spectroscopy (WDS) on single (OC−/− and OPN−/−) and double (OC-OPN−/−;−/−) genetic knockout mice bones, we demonstrate that both osteocalcin and osteopontin have specific roles in the biomolecular regulation of mineral in bone and together they are major determinants of the quality of bone mineral. Specifically, for the first time, we show that proteins osteocalcin and osteopontin regulate bone mineral crystal size and organization in a codependent manner, while they independently determine crystal shape. We found that OC is more dominant in the regulation of the physical properties of bone mineral, while OPN is more dominant in the regulation of the mineral composition.

In the present study, cell cultures from the nodal explants of Trianthema decandra L. were established on Murashige and Skoog's (MS) medium supplemented with different concentrations (0.5, 1, 1.5, and 2 mg/L) of indole 3-acetic acid (IAA), 2,4-dichlorophenoxyacetic acid (2,4-D) and kinetin (Kn). Induction of callus was promising in MS medium supplemented with 1.5 mg/L 2,4-D after 25 days of inoculation. Their total phenolics and flavonoids levels were estimated and compared with those of in vivo. Antimicrobial (agar well diffusion method) and antioxidant (DPPH and FRAP methods) activities were studied. Further, six-weeks-old callus grown on MS medium with 2,4-D (1.5 mg/L) were harvested, dried and extracted using absolute methanol. Methanolic extracts of callus showed maximum inhibition against B. subtilis, P. aeruginosa, and A. flavus (IZ 14.33±0.32 mm, 15.66±0.32 mm and 13.33±0.65 mm, respectively) as compared to in vivo plant extract. Similarly, in the case of DPPH activity, methanolic extract of the callus demonstrated more antioxidant potential than in vivo. At 0.8 mg/mL concentration of callus extract showed inhibition of 85.02% as compared to 83.38% of plants grown in vivo. Likewise, in the case of the FRAP method, there is no significant difference in antioxidant potential (303±3.37 ascorbic acid equivalent/mg in callus; AAE/mg) as compared to in vivo plant (310±10.01 AAE/mg). A new compound ß-ecdysterone (20-hydroxyecdysone), was isolated and identified from the callus of this plant, which was also tested for its antimicrobial and antioxidant activity. Isolated pure compound ß-ecdysterone were tested against selected strains of bacteria and fungi and prove effective E. aerogenes and K. pneumoniae with Minimum inhibitory concentration of 250 µg/mL concentration (IZ 11.00±0.00 mm and 12.00±0.00). compound does not impressive for antifungal profile. [ABSTRACT FROM AUTHOR]