Prevalence of Psoriasis and Perceived Association with Hormone Therapy in Transgender Adults

Purpose

The role of hormone therapy (HT) in the etiology and progression of psoriasis in the transgender population is unclear.

Methods

The prevalence of psoriasis in transmasculine (TM) and transfeminine (TF) adults and perceived links between psoriasis and gender-affirming HT is examined using a cross-sectional survey of 696 transgender individuals.

Results

Ever diagnosis of psoriasis was reported by 17 TM persons (4.9%; 95% confidence interval [CI]: 2.6-7.2) and 13 TF persons (3.7%; 95% CI: 1.7-5.7). Prevalence of current psoriasis in TM persons was 2.6% (95% CI: 0.9-4.3) and 1.1% (95% CI: 0.03-2.3) among TF persons. Notably, among participants who had ever had psoriasis, 17% perceived a link between their psoriasis and gender-affirming HT.

Conclusions

Prevalence of psoriasis among transgender persons resembled estimates in the general population. Potential associations between psoriasis and its severity with gender-affirming HT warrant further longitudinal research.

Self-referencing circular dichroism ion yield measurements for improved statistics using femtosecond laser pulses

The combination of circular dichroism with laser mass spectrometry via the measurement of ion yields is a powerful tool in chiral recognition, but the measured anisotropies are generally weak. The method presented in this contribution reduces the measurement error significantly. A common path optical setup generates a pair of counter-rotating laser foci in the interaction region of a time-of-flight spectrometer. As the space focus condition is fulfilled for both foci individually, this becomes a twin-peak ion source with well separated and sufficiently resolved mass peaks. The individual control of polarization allows for in situ correction of experimental fluctuations measuring circular dichroism. Our robust optical setup produces reliable and reproducible results and is applicable for dispersion sensitive femtosecond laser pulses. In this contribution, we use 3-methyl-cyclopentanone as a prototype molecule to illustrate the evaluation procedure and the measurement principle.

Strong Differential Photoion Circular Dichroism in Strong-Field Ionization of Chiral Molecules

We investigate the differential ionization probability of chiral molecules in the strong-field regime as a function of the helicity of the incident light. To this end, we analyze the fourfold ionization of bromochlorofluoromethane (CHBrClF) with subsequent fragmentation into four charged fragments and different dissociation channels of the singly ionized methyloxirane. By resolving for the molecular orientation, we show that the photoion circular dichroism signal strength is increased by 2 orders of magnitude.

Genetic Gains for Grain Yield in CIMMYT's Semi-Arid Wheat Yield Trials Grown in Suboptimal Environments

Wheat (Triticum aestivum L.) is a major staple food crop grown worldwide on >220 million ha. Climate change is regarded to have severe effect on wheat yields, and unpredictable drought stress is one of the most important factors. Breeding can significantly contribute to the mitigation of climate change effects on production by developing drought-tolerant wheat germplasm. The objective of our study was to determine the annual genetic gain for grain yield (GY) of the internationally distributed Semi-Arid Wheat Yield Trials, grown during 2002-2003 to 2013-2014 and developed by the Bread Wheat Breeding program at the CIMMYT. We analyzed data from 740 locations across 66 countries, which were classified in low-yielding (LYE) and medium-yielding (MYE) environments according to a cluster analysis. The rate of GY increase (GYC) was estimated relative to four drought-tolerant wheat lines used as constant checks. Our results estimate that the rate of GYC in LYE was 1.8% (38.13 kg ha-1 yr-1), whereas in MYE, it was 1.41% (57.71 kg ha-1 yr-1). The increase in GYC across environments was 1.6% (48.06 kg ha-1 yr-1). The pedigrees of the highest yielding lines through the coefficient of parentage analysis indicated the utilization of three primary sources-'Pastor', 'Baviacora 92', and synthetic hexaploid derivatives-to develop drought-tolerant, high and stably performing wheat lines. We conclude that CIMMYT's wheat breeding program continues to deliver adapted germplasm for suboptimal conditions of diverse wheat growing regions worldwide.

Trichoderma harzianum: Inhibition of mycotoxin producing fungi and toxin biosynthesis

A quarter of the world-wide crop is spoiled by filamentous fungi and their mycotoxins and weather extremes associated with the climate change lead to further deterioration of the situation. The ingestion of mycotoxins causes several health issues leading in the worst case to cancer in humans and animals. Common intervention strategies against mycotoxin producing fungi, such as the application of fungicides, may result in undesirable residues and in some cases to a stress induction of mycotoxin biosynthesis. Moreover, development of fungicide resistances has greatly impacted pre- and postharvest fungal diseases. Hence there is the need to develop alternative strategies to reduce fungal infestation and thus mycotoxin contamination in the food chain. Such a strategy for natural competition of important plant-pathogenic and mycotoxin producing fungi could be Trichoderma harzianum, a mycoparasitic fungus. Especially in direct comparison to certain tested fungicides, the inhibition of different tested fungal species by T. harzianum was comparable, more sustainable and in some cases more effective, too. Besides substantially reduced growth rates, a transcriptional based inhibition of mycotoxin biosynthesis in the competed Aspergillus species could be shown. Furthermore it could be clearly observed by high-resolution Scanning Electron Microscopy (SEM) that T. harzianum actively attaches to the competitor species followed by subsequent enzymatic lysis of those mycelial filaments. The analyzed isolate of T. harzianum MRI349 is not known to produce mycotoxins. In this study it could be successfully proven that T. harzianum as a biological competitor is an effective complement to the use of fungicides.

The role of NAFLD in cardiometabolic disease: an update

Non-alcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease in the world, yet the complex pathogenesis remains to be fully elucidated. The prevalence of NAFLD has risen precipitously in recent years and is now a leading indication for liver transplantation. New waitlist registrants with non-alcoholic steatohepatitis–induced cirrhosis increased by 170% from 2004 to 2013. In addition, patients with NAFLD are at increased risk of both cardiovascular disease and type II diabetes. In this update, recent studies contributing to the understanding of the place of NAFLD in cardiometabolic disease will be discussed.

Combined SPECT Imaging of Regional Cerebral Blood Flow (99mTc-HexamethylPropyleneamine Oxime, HMPAO) and Blood Volume (99mTc-RBC) to Assess Regional Cerebral Perfusion Reserve in Patients with Cerebrovascular Disease

In 53 patients with cerebrovascular disease (CVD), regional cerebral blood flow (CBF) and blood volume (CBV) were imaged by SPECT within one session. Slice division (CBF: CBV) yielded distribution of regional cerebral perfusion reserve (CPR). Semiquantitative evaluation was obtained from manually set ROIs by interhemispherical ratios (for CBF, CBV and CPR), using 2 SD from a normal group (n = 10) as a threshold. Sensitivities were 59% for CBF, 94% for CBV and 83% for CPR. Combined sensitivity was 98%. Establishing three constellations for CBF, CBV and CPR, regionally normal CBFs but quantitatively increased CBVs (+69%) and decreased CPRs (−31 %) were found in relatively early stages of CVD. Very advanced cases showed decreased CBFs (−65%), CBVs (−40%), CPRs (−49%) and a surrounding penumbra. In 87% (46/53 patients), such Theologically postulated constellations could be demonstrated. We conclude that combined CBF and CBV SPECT, assisted by CPR images, is a promising tool to detect CVD and to assess its individual regional severity.

Cancer in Transgender People: Evidence and Methodological Considerations

Transgender people comprise a diverse group of individuals whose gender identity or expression differs from that originally assigned to them at birth. Some, but not all, transgender people elect to undergo medical gender affirmation, which may include therapy with cross-sex hormones and/or surgical change of the genitalia and other sex characteristics. As cross-sex hormones administered for the purposes of gender affirmation may be delivered at high doses and over a period of decades, the carcinogenicity of hormonal therapy in transgender people is an area of considerable concern. In addition, concerns about cancer risk in transgender patients have been linked to sexually transmitted infections, increased exposure to well-known risk factors such as smoking and alcohol use, and the lack of adequate access to screening. Several publications have identified cancer as an important priority in transgender health research and called for large-scale studies. The goals of this article are to summarize the evidence on factors that may differentially affect cancer risk in transgender people, assess the relevant cancer surveillance and epidemiologic data available to date, and offer an overview of possible methodological considerations for future studies investigating cancer incidence and mortality in this population.

[Characteristics of Nutrition in Competitive Sports, Ranging from Leisure Activities to High-Performance Athletics]

Nutrition has a crucial influence on physical and mental performance ability and is an important measure along sidetraining in high-performance athletes. However, this form of nutritionis not applicable for every athlete and in every situation. The question of optimal nutrition requires involvement with the particular type of sports, an athlete's current training stage, and athletes' individual requirements and objectives. Implementation takes time and individual motivation on the part of athletes and the specialist staff who engage intensively with the nutritional needs of athletes. In addition to adequate energy provision, it is important to divide the energy sensibly among the energy sources carbohydrates, fats, and protein. Performance athletes' higher need for protein can usually be covered in their regular diet; supplements are needed only in exceptional cases. Studies have shown that small amounts of 15 - 25 g protein are sensible after weight training, in order to stimulate muscle protein synthesis. The need for carbohydrates increases dynamically with the intensity and duration of physical exertion. A sufficient supply is crucial for achieving maximum performance. Low carb diets are unsuitable for performance athletes. So called low-glycogen training, however, can lead to better adjustment/adaptation processes in selected training stages and can increase performance ability.

A novel method for estimating transgender status using electronic medical records

PURPOSE

We describe a novel algorithm for identifying transgender people and determining their male-to-female (MTF) or female-to-male (FTM) identity in electronic medical records of an integrated health system.

METHODS

A computer program scanned Kaiser Permanente Georgia electronic medical records from January 2006 through December 2014 for relevant diagnostic codes, and presence of specific keywords (e.g., "transgender" or "transsexual") in clinical notes. Eligibility was verified by review of de-identified text strings containing targeted keywords, and if needed, by an additional in-depth review of records. Once transgender status was confirmed, FTM or MTF identity was assessed using a second program and another round of text string reviews.

RESULTS

Of 813,737 members, 271 were identified as possibly transgender: 137 through keywords only, 25 through diagnostic codes only, and 109 through both codes and keywords. Of these individuals, 185 (68%, 95% confidence interval [CI]: 62%-74%) were confirmed as definitely transgender. The proportions (95% CIs) of definite transgender status among persons identified via keywords, diagnostic codes, and both were 45% (37%-54%), 56% (35%-75%), and 100% (96%-100%). Of the 185 definitely transgender people, 99 (54%, 95% CI: 46%-61%) were MTF, 84 (45%, 95% CI: 38%-53%) were FTM. For two persons, gender identity remained unknown. Prevalence of transgender people (per 100,000 members) was 4.4 (95% CI: 2.6-7.4) in 2006 and 38.7 (95% CI: 32.4-46.2) in 2014.

CONCLUSIONS

The proposed method of identifying candidates for transgender health studies is low cost and relatively efficient. It can be applied in other similar health care systems.

A novel method for estimating transgender status using electronic medical records

PURPOSE

We describe a novel algorithm for identifying transgender people and determining their male-to-female (MTF) or female-to-male (FTM) identity in electronic medical records of an integrated health system.

METHODS

A computer program scanned Kaiser Permanente Georgia electronic medical records from January 2006 through December 2014 for relevant diagnostic codes, and presence of specific keywords (e.g., "transgender" or "transsexual") in clinical notes. Eligibility was verified by review of de-identified text strings containing targeted keywords, and if needed, by an additional in-depth review of records. Once transgender status was confirmed, FTM or MTF identity was assessed using a second program and another round of text string reviews.

RESULTS

Of 813,737 members, 271 were identified as possibly transgender: 137 through keywords only, 25 through diagnostic codes only, and 109 through both codes and keywords. Of these individuals, 185 (68%, 95% confidence interval [CI]: 62%-74%) were confirmed as definitely transgender. The proportions (95% CIs) of definite transgender status among persons identified via keywords, diagnostic codes, and both were 45% (37%-54%), 56% (35%-75%), and 100% (96%-100%). Of the 185 definitely transgender people, 99 (54%, 95% CI: 46%-61%) were MTF, 84 (45%, 95% CI: 38%-53%) were FTM. For two persons, gender identity remained unknown. Prevalence of transgender people (per 100,000 members) was 4.4 (95% CI: 2.6-7.4) in 2006 and 38.7 (95% CI: 32.4-46.2) in 2014.

CONCLUSIONS

The proposed method of identifying candidates for transgender health studies is low cost and relatively efficient. It can be applied in other similar health care systems.

Feasibility of balloon sinuplasty in patients with chronic rhinosinusitis: the Graz experience

BACKGROUND

Balloon sinuplasty (BSP) is a catheter-based technique to dilate sinus ostia and drainage pathways to create ventilation and drainage. The aim of this study was to evaluate the feasibility of BSP in routine treatment of patients suffering from chronic rhinosinusitis (CRS).

METHODOLOGY

Patients with CRS refractory to medical therapy who had been scheduled for endoscopic sinus surgery between 2009 and 2011 were included in this study.

RESULTS

Forty-five consecutive patients were included in this study, in whom 112 sinuses were approached by BSP. Of the 112 sinuses, 68 (60%) were planned as a "Balloon-Only" procedure and 44 (40%) were planned as a "Hybrid" procedure. Of the 68 sinuses in the "Balloon-Only" group, in 44 sinuses BSP failed, equating to a failure rate of 65%. Forty-four sinuses were planned for "Hybrid" procedures. In 29 of these sinuses BSP failed, giving a failure rate of 66%.

CONCLUSION

According to literature, BSP can be a useful adjunct technique to standard FESS. In our experience, however, a failure rate of 65% for "Balloon-Only" and of 66% for "Hybrid" procedures occurred, which was regarded as unacceptable by the study group. Therefore, the study initially scheduled for 200 consecutive patients, was abandoned.

Cholesterol granulomas of the petrous apex; endonasal endoscopic approach

OBJECTIVE

Cholesterol granulomas are benign lesions that sometimes occur on the petrous apex (PA). We report our experience using an endoscopic endonasal approach to remove PA cholesterol granulomas.

MATERIAL AND METHODS

A retrospective patient chart analysis was conducted at a tertiary care university hospital.

RESULTS

Four patients (3 females, 1 male) were included in this study. Patients' ages ranged from 27 to 78 years. Computed tomography (CT) and magnetic resonance imaging (MRI) for diagnosis and computer-assisted navigation were performed. The most common symptom was abducens nerve palsy. The largest granuloma measured 5 x 2 cm and was located on the left side. An endoscopic endonasal approach was chosen and navigation was applied (3/4 patients) to identify the optimal area for opening the granuloma. No complications occurred, and patients were free from recurrence during the follow-up period.

CONCLUSION

The endoscopic endonasal approach to PA cholesterol granulomas is feasible and safe. Intra-operative navigation is recommended to identify the position of the internal carotid artery and determine the safest area for opening the granuloma without damaging the artery. Another advantage of this approach is an easier follow-up through diagnostic nasal endoscopy.

The influence of the heel effect in cone-beam computed tomography: artifacts in standard and novel geometries and their correction

For decades, the heel effect has been known to cause an angular dependence of the emitted spectrum of an x-ray tube. In radiography, artifacts were observed and attributed to the heel effect. However, no problems due to the heel effect were discerned in multi-slice computed tomography (MSCT) so far. With flat-detector CT (FDCT), involving larger cone angles and different system geometries, the heel effect might cause new artifacts. These artifacts were analyzed in this paper for system geometries different from the ones widely used nowadays. Simulations and measurements were performed. Simulations included symmetric as well as asymmetric detector layouts and different x-ray tube orientations with respect to the detector plane. The measurements were performed on a micro-CT system in an asymmetric detector layout. Furthermore, an analytical correction scheme is proposed to overcome heel effect artifacts. It was shown that the type of artifact greatly depends on the orientation of the x-ray tube and also on the type of detector alignment (i.e. symmetric or different types of asymmetric alignment). Certain combinations exhibited almost no significant artifact while others greatly influenced the quality of the reconstructed images. The proposed correction scheme showed good results that were further improved when also applying a scatter correction. When designing CT systems, care should be taken when placing the tube and the detector. Orientation of the x-ray tube like in most MSCT systems seems advisable in asymmetric detector layouts. However, a different type of tube orientation can be overcome with suitable correction schemes.

New measures of multimodality for the detection of a ghost stochastic resonance

Large-amplitude (10-15 K) millennial-duration warming events, the Dansgaard-Oeschger (DO) events, repeatedly occurred in the North Atlantic region during ice ages. So far, the trigger of these events is not known. To explain their recurrence pattern, a ghost stochastic resonance (GSR) scenario has been suggested, i.e., a dynamical scenario in which the events represent the subharmonic response to centennial-scale solar forcing plus noise. According to this hypothesis a multimodal phase distribution of the events is expected, which should be tested on the basis of climate records by means of time series analysis. A major obstacle in these tests, however, is the need of a statistical measure of regularity that can distinguish between a random occurrence of DO events and a GSR scenario. Here we construct and compare three new measures of phase multimodality. In a Monte Carlo simulation with a simple conceptual model of DO events we simulate probability distributions of the measures under both scenarios for realizations of only 11 DO events. Based on these distributions we find that our measures are able to distinguish between a random occurrence and a GSR scenario. We further apply our measures to analyze the recurrence pattern of the last 11 DO events in the North Greenland Ice Core Project deep ice core from Greenland.