[Beyond NICE: Updated Systematic Review on the Current Evidence of Using Puberty Blocking Pharmacological Agents and Cross-Sex-Hormones in Minors with Gender Dysphoria]

Beyond NICE: Updated Systematic Review on the Current Evidence of Using Puberty Blocking Pharmacological Agents and Cross-Sex-Hormones in Minors with Gender Dysphoria Abstract: Objective: The suppression of physiological puberty using puberty-blocking pharmacological agents (PB) and prescribing cross-sex hormones (CSH) to minors with gender dysphoria (GD) is a current matter of discussion, and in some cases, PB and CSH are used in clinical practice for this particular population. Two systematic reviews (one on PB, one on CSH treatment) by the British National Institute for Clinical Excellence (NICE) from 2020 indicated no clear clinical benefit of such treatments regarding critical outcome variables. In particular, these two systematic NICE reviews on the use of PB and CSH in minors with GD detected no clear improvements of GD symptoms. Moreover, the overall scientific quality of the available evidence, as discussed within the above-mentioned two NICE reviews, was classified as "very low certainty" regarding modified GRADE criteria. Method: The present systematic review presents an updated literature search on this particular topic (use of PB and CSH in minors with GD) following NICE principles and PICO criteria for all relevant new original research studies published since the release of the two above-mentioned NICE reviews (updated literature search period was July 2020-August 2023). Results: The newly conducted literature search revealed no newly published original studies targeting NICE-defined critical and important outcomes and the related use of PB in minors with GD following PICO criteria. For CSH treatment, we found two new studies that met PICO criteria, but these particular two studies had low participant numbers, yielded no significant additional clear evidence for specific and clearly beneficial effects of CSH in minors with GD, and could be classified as "low certainty" tfollowing modified GRADE criteria. Conclusions: The currently available studies on the use of PB and CSH in minors with GD have significant conceptual and methodological flaws. The available evidence on the use of PB and CSH in minors with GD is very limited and based on only a few studies with small numbers, and these studies have problematic methodology and quality. There also is a lack of adequate and meaningful long-term studies. Current evidence doesn't suggest that GD symptoms and mental health significantly improve when PB or CSH are used in minors with GD. Psychotherapeutic interventions to address and reduce the experienced burden can become relevant in children and adolescents with GD. If the decision to use PB and/or CSH is made on an individual case-by-case basis and after a complete and thorough mental health assessment, potential treatment of possibly co-occurring mental health problems as well as after a thoroughly conducted and carefully executed individual risk-benefit evaluation, doing so as part of clinical studies or research projects, as currently done in England, can be of value in terms of generation of new research data. The electronic supplement (ESM) 1 is an adapted and abreviated English version of this work.

Eleven strategies for making reproducible research and open science training the norm at research institutions

Reproducible research and open science practices have the potential to accelerate scientific progress by allowing others to reuse research outputs, and by promoting rigorous research that is more likely to yield trustworthy results. However, these practices are uncommon in many fields, so there is a clear need for training that helps and encourages researchers to integrate reproducible research and open science practices into their daily work. Here, we outline eleven strategies for making training in these practices the norm at research institutions. The strategies, which emerged from a virtual brainstorming event organized in collaboration with the German Reproducibility Network, are concentrated in three areas: (i) adapting research assessment criteria and program requirements; (ii) training; (iii) building communities. We provide a brief overview of each strategy, offer tips for implementation, and provide links to resources. We also highlight the importance of allocating resources and monitoring impact. Our goal is to encourage researchers - in their roles as scientists, supervisors, mentors, instructors, and members of curriculum, hiring or evaluation committees - to think creatively about the many ways they can promote reproducible research and open science practices in their institutions.

Drug screen in iPSC-Neurons identifies nucleoside analogs as inhibitors of (G4C2)n expression in C9orf72 ALS/FTD

An intronic (G₄C₂)_n expansion in C9orf72 causes amyotrophic lateral sclerosis and frontotemporal dementia primarily through gain-of-function mechanisms: the accumulation of sense and antisense repeat RNA foci and dipeptide repeat (DPR) proteins (poly-GA/GP/GR/PA/PR) translated from repeat RNA. To therapeutically block this pathway, we screen a library of 1,430 approved drugs and known bioactive compounds in patient-derived induced pluripotent stem cell-derived neurons (iPSC-Neurons) for inhibitors of DPR expression. The clinically used guanosine/cytidine analogs decitabine, entecavir, and nelarabine reduce poly-GA/GP expression, with decitabine being the most potent. Hit compounds nearly abolish sense and antisense RNA foci and reduce expression of the repeat-containing nascent C9orf72 RNA transcript and its mature mRNA with minimal effects on global gene expression, suggesting that they specifically act on repeat transcription. Importantly, decitabine treatment reduces (G₄C₂)_n foci and DPRs in C9orf72 BAC transgenic mice. Our findings suggest that nucleoside analogs are a promising compound class for therapeutic development in C9orf72 repeat-expansion-associated disorders.

The life cycle-dependent transcriptional profile of the obligate intracellular amoeba symbiont Amoebophilus asiaticus

Free-living amoebae often harbor obligate intracellular bacterial symbionts. Amoebophilus (A.) asiaticus is a representative of a lineage of amoeba symbionts in the phylum Bacteroidota. Here, we analyse the transcriptome of A. asiaticus strain 5a2 at four time points during its infection cycle and replication within the Acanthamoeba host using RNA sequencing. Our results reveal a dynamic transcriptional landscape throughout different A. asiaticus life cycle stages. Many intracellular bacteria and pathogens utilize eukaryotic-like proteins (ELPs) for host cell interaction and the A. asiaticus 5a2 genome shows a particularly high abundance of ELPs. We show the expression of all genes encoding ELPs and found many ELPs to be differentially expressed. At the replicative stage of A. asiaticus, ankyrin repeat proteins and tetratricopeptide/Sel1-like repeat proteins were upregulated. At the later time points, high expression levels of a type 6 secretion system that likely prepares for a new infection cycle after lysing its host, were found. This study reveals comprehensive insights into the intracellular lifestyle of A. asiaticus and highlights candidate genes for host cell interaction. The results from this study have implications for other intracellular bacteria such as other amoeba-associated bacteria and the arthropod symbionts Cardinium forming the sister lineage of A. asiaticus.

Effect of timing, technique and molecular features on brain control with local therapies in oncogene-driven lung cancer

BACKGROUND

The improved efficacy of tyrosine kinase inhibitors (TKI) mandates reappraisal of local therapy (LT) for brain metastases (BM) of oncogene-driven non-small-cell lung cancer (NSCLC).

PATIENTS AND METHODS

This study included all epidermal growth factor receptor-mutated (EGFR⁺, n = 108) and anaplastic lymphoma kinase-rearranged (ALK⁺, n = 33) TKI-naive NSCLC patients diagnosed with BM in the Thoraxklinik Heidelberg between 2009 and 2019. Eighty-seven patients (62%) received early LT, while 54 (38%) received delayed (n = 34; 24%) or no LT (n = 20; 14%). LT comprised stereotactic (SRT; n = 40; 34%) or whole-brain radiotherapy (WBRT; n = 77; 66%), while neurosurgical resection was carried out in 19 cases.

RESULTS

Median overall survival (OS) was 49.1 months for ALK⁺ and 19.5 months for EGFR⁺ patients (P = 0.001), with similar median intracranial progression-free survival (icPFS) (15.7 versus 14.0 months, respectively; P = 0.80). Despite the larger and more symptomatic BM (P < 0.001) of patients undergoing early LT, these experienced longer icPFS [hazard ratio (HR) 0.52; P = 0.024], but not OS (HR 1.63; P = 0.12), regardless of the radiotherapy technique (SRT versus WBRT) and number of lesions. High-risk oncogene variants, i.e. non-del19 EGFR mutations and 'short' EML4-ALK fusions (mainly variant 3, E6:A20), were associated with earlier intracranial progression (HR 2.97; P = 0.001). The longer icPFS with early LT was also evident in separate analyses of the EGFR⁺ and ALK⁺ subsets.

CONCLUSIONS

Despite preferential use for cases with poor prognostic factors, early LT prolongs the icPFS, but not OS, in TKI-treated EGFR⁺/ALK⁺ NSCLC. Considering the lack of survival benefit, and the neurocognitive effects of WBRT, patients presenting with polytopic BM may benefit from delaying radiotherapy, or from radiosurgery of multiple or selected lesions. For SRT candidates, the improved tumor control with earlier radiotherapy should be weighed against the potential toxicity and the enhanced intracranial activity of newer TKI. High-risk EGFR/ALK variants are associated with earlier intracranial failure and identify patients who could benefit from more aggressive management.

In vitro nanoparticle dosimetry for adherent growing cell monolayers covering bottom and lateral walls

Background

Even though a continuously high number of in vitro studies on nanoparticles are being published, the issue of correct dose matter is often not sufficiently taken into account. Due to their size, the diffusion of nanoparticles is slower, as compared to soluble chemicals, and they sediment slowly. Therefore, the administered dose of particles in in vitro experiments is not necessarily the same (effective) dose that comes into contact with the cellular system. This can lead to misinterpretations of experimental toxic effects and disturbs the meaningfulness of in vitro studies. In silico calculations of the effective nanoparticle dose can help circumventing this problem.

Results

This study addresses more complex in vitro models like the human intestinal cell line Caco-2 or the human liver cell line HepaRG, which need to be differentiated over a few weeks to reach their full complexity. During the differentiation time the cells grow up the wall of the cell culture dishes and therefore a three-dimensional-based in silico model of the nanoparticle dose was developed to calculate the administered dose received by different cell populations at the bottom and the walls of the culture dish. Moreover, the model can perform calculations based on the hydrodynamic diameter which is measured by light scattering methods, or based on the diffusion coefficient measured by nanoparticle tracking analysis (NTA). This 3DSDD (3D-sedimentation-diffusion-dosimetry) model was experimentally verified against existing dosimetry models and was applied to differentiated Caco-2 cells incubated with silver nanoparticles.

Conclusions

The 3DSDD accounts for the 3D distribution of cells in in vitro cell culture dishes and is therefore suitable for differentiated cells. To encourage the use of dosimetry calculating software, our model can be downloaded from the supporting information.

Electronic supplementary material

The online version of this article (10.1186/s12989-018-0278-9) contains supplementary material, which is available to authorized users.

Soluble monomers, dimers and HLA-G-expressing extracellular vesicles: the three dimensions of structural complexity to use HLA-G as a clinical biomarker

The HLA-G molecule belongs to the family of nonclassical human leukocyte antigen (HLA) class I. At variance to classical HLA class I, HLA-G displays (i) a low number of nucleotide variations within the coding region, (ii) a high structural diversity, (iii) a restricted peptide repertoire, (iv) a limited tissue distribution and (v) strong immune-suppressive properties. The physiological HLA-G surface expression is restricted to the maternal-fetal interface and to immune-privileged adult tissues. Soluble forms of HLA-G (sHLA-G) are detectable in various body fluids. Cellular activation and pathological processes are associated with an aberrant or a neo-expression of HLA-G/sHLA-G. Functionally, HLA-G and its secreted forms are considered to be key players in the induction of short- and long-term tolerance. Thus, its unique expression profile and tolerance-inducing functions render HLA-G/sHLA-G an attractive biomarker to monitor the systemic health/disease status and disease activity/progression for clinical approaches in disease management and treatments. Here, we place emphasis on (i) the current status of the tolerance-inducing functions by HLA-G/sHLA-G, (ii) the current complexity to implement this molecule as a meaningful clinical biomarker regarding the three dimensions of structural diversity (monomers, dimers and HLA-G-expressing extracellular vesicles) with its functional implications, and (iii) novel and future approaches to detect and quantify sHLA-G structures and functions.

The 2014 liver ultrasound tracking benchmark

The Challenge on Liver Ultrasound Tracking (CLUST) was held in conjunction with the MICCAI 2014 conference to enable direct comparison of tracking methods for this application. This paper reports the outcome of this challenge, including setup, methods, results and experiences. The database included 54 2D and 3D sequences of the liver of healthy volunteers and tumor patients under free breathing. Participants had to provide the tracking results of 90% of the data (test set) for pre-defined point-landmarks (healthy volunteers) or for tumor segmentations (patient data). In this paper we compare the best six methods which participated in the challenge. Quantitative evaluation was performed by the organizers with respect to manual annotations. Results of all methods showed a mean tracking error ranging between 1.4 mm and 2.1 mm for 2D points, and between 2.6 mm and 4.6 mm for 3D points. Fusing all automatic results by considering the median tracking results, improved the mean error to 1.2 mm (2D) and 2.5 mm (3D). For all methods, the performance is still not comparable to human inter-rater variability, with a mean tracking error of 0.5–0.6 mm (2D) and 1.2–1.8 mm (3D). The segmentation task was fulfilled only by one participant, resulting in a Dice coefficient ranging from 76.7% to 92.3%. The CLUST database continues to be available and the online leader-board will be updated as an ongoing challenge.

Prevalence of Biofilms on Surgical Suture Segments in Wounds of Dogs, Cats, and Horses

The formation of biofilms on surgical implants is thought to play a major role in chronic infection and wound-healing disorders and has been rarely described in veterinary medicine. Due to poor and unreliable results from bacterial culturing, histology may be an economic tool for the detection of biofilms. In this study, the prevalence of biofilms on surgical suture materials and swabs with chronic wound-healing complications in dogs, cats, and horses was assessed by histologic examination using hematoxylin and eosin, Gram, and Giemsa stains, as well as periodic acid–Schiff reaction. Of the 91 tissue samples with intralesional suture material or swab residues associated with inflammation, only 2 contained bacterial colonies arranged in an extracellular polymeric matrix consistent with a biofilm. The results of this study suggest that biofilms on suture material may occur in veterinary medicine.

[Locoregional deformation pattern of the patellar cartilage after different loading types - high-resolution 3D-MRI volumetry at 3 T in-vivo]

PURPOSE

To analyze locoregional deformation patterns indicative of contact areas in patellar cartilage after different loading exercises.

MATERIALS AND METHODS

7 healthy patellae were examined in-vivo before and immediately after standardized loading (kneeling, squatting or knee bends) and after 90 minutes of rest using a sagittal 3D-T1-w FLASH WE sequence (22 msec/ 9.8 msec/ 15°/ 0.3 × 0.3 × 1.5 mm³) at 3 T. After cartilage segmentation and 3D reconstruction, voxel-based and global precision errors (PR) were calculated. The former were used to determine significant differences in local cartilage thickness. Voxel-based 2σ-thickness difference maps were calculated to visualize locoregional deformation patterns. Global changes in volume (Vol), mean thickness (mTh) and cartilage-bone-interface area (CBIA) were calculated.

RESULTS

The voxel-based PR depended on cartilage thickness (D) ranging from 0.12 - 0.35 mm. For D ≥ 1 mm the RF was < 0.31 mm (< voxel size), and for D ≥ 2 mm, the RF was < 0.22 mm. The global PR was 83 mm³ (2.4 %) for Vol, 0.06 mm (2.0 %) for mTh and 16 mm² (1.4 %) for CBIA. The focal cartilage deformation equaled 14 % of the local thickness reduction. The deformation areas were oval and located in the peripheral medial (more vertically oriented, all exercises) and caudo-lateral (more horizontally oriented, kneeling and knee bends) aspects of the patella and were least pronounced in knee bends. Significant changes for Vol/mTh ranged from 2.1 to 3.7 %.

CONCLUSION

This MRI-based study is the first to identify in-vivo voxel-based patellar cartilage deformation patterns indicating contact and loading zones after kneeling and squatting. These zones are anatomically and functionally plausible and may represent areas where stress induced degeneration and subsequent OA can originate. The data may facilitate understanding of individual knee loading properties and help to improve and validate biomechanical models for the knee.

[Results of the use of lithium to prevent recurrence of affective psychosis]

The efficacy of lithium treatment in preventing relapse in phasal psychoses was tested by the re-examination of 99 patients at a Dresden clinic whose treatment had on average exceeded ten years. Results and progress were compared with those of patients starting treatment since the introduction of the lithium treatment in the year 1979. Phase or subphase frequency and duration, conditions of treatment, suicide attempts, unfitness for work, and registration as a disabled person were among the aspects considered.

[Lithium strumas and their psychiatric relevance]

Basing on 172 clinically recorded goitres among 787 patients treated with lithium (21.9%) we studied the question as to whether goitre formation due to lithium has any relevance within the concept of relapse prevention in affective disorders. A statistical comparison of essential disease parameters between the group of patients suffering from struma (goitre) and the total group shows that there is no special type or course of affective disorder with a particular affinity to the development of struma. Likewise, we can conclude from a comparison of treatment course and effectively parameters between both groups that development of struma under influence on the course of treatment or on the efficiency of prophylaxis. The results point to an irrelevance of lithium goitre in respect of psychiatric effects (this does not imply that it is irrelevant in respect of general medical aspects or endocrinology).

[Peculiarities and difficulties in the systematic drug therapy of chronic schizophrenics (schizophrenic "defect")]

Difficulties are discussed that have occurred in the medicamentous treatment of chronic patients with a so-called schizophrenic defect. The main problem was that in case of a greater drive-increasing effect component of the drug (in the concrete case "Defecton") a recrudescence of productive-schizophrenic symptoms may occur in connection with the increase in drive. The authors' own opinion (Lange) with respect to a treatening "defect", psychopathological radical of the chronic schizophrenic residual condition ("defect"), personality-dependent syndrome structure with secondary symptoms, iaterogenisation and institutiogenisation of the "defect" ("institution artefact") is discussed.

[Psychopharmacotherapy: present status and trends]

The psychotropic preparations developed and introduced in recent years are discussed in the form of a synoptical paper. The information given mainly concentrates on the attempts to find antidepressants without cardiotoxic side-effects, psychoneuroleptics without extrapyramidal side-effects and long-acting or depot preparations. The survey is restricted to psychotropics in a narrow sense (with an antipsychotic action) and to preparations that are produced in the GDR or imported or made available for the clinical testing of which the reporting clinic (Dresden) was in charge.

[Position of the delayed-action neuroleptic penfluridol (Longperidol/Janssen) in psychiatric therapy]

Longoperidol/Janssen, an orally administered neuroleptic with a five- to seven-day duration of effects, was clinically tested in six mental hospitals in the G.D.R. where the agent was administered to subjects of chronic to subacute schizophrenia. It was not possible for fully consistent results to be obtained in these tests. Workers at mental hospitals in Leipzig and Mühlhausen recommended that the drug should be imported, whereas those at the four other centers (Dresden, Halle, Jena, and Schwerin) did not consider the medication to be indispensable, although they were also able to observe the good effects of the agent.

[Clinical experiences with noxiptilin]

Noxiptilin (Elronon) proved to be a good bipolar thymoleptic agent in the clinical test at 3 special clinics. Its stimulating effect on the psychomotor function is more pronounced than its sedative action. Therefore, in cases with the anxious, agitated depressive syndrome the additional therapy with a neuroleptic agent or a sedative tranquilizer may be favourable. N. is well tolerated even at a higher age. The side effects are the same as those of other known thymoleptics.

[Significance and advantages of Orap in the ambulatory care of schizophrenic psychoses]

The authors report clinical experience from therapy with Orap-Janssen and Orap-Richter from 1968 to 1974. Excellent tolerance makes Orap particularly suitable for long-term maintenance therapy in schizophrenic psychoses. The evaluation is based on observations in 91 patients.

[Lithium tremor-combination treatment with beta receptor blockaders]

In addition to the various possibilities of influencing lithium tremor, experience gathered from the application of beta-receptor blockers is reported, and concepts investigated on the potential genesis and working mechanisms.

[Clinical experience with Leponex]

Until now the "neuroleptic threshold" (Haase) was considered to be the efficiency criterion of the antipsychotic effect of a neuroleptic substance and it was thought therefore that the extrapyramidal symptoms were a necessary although undesired side effect. The benodiazepine derivative Leponex developed by Sandox - Basel upsets this view because it has an excellent antipsychotic effect without creating definite extrapyramidal symptoms. It is noted for its quick soporfic effect after only a few minutes, for subdueing psychopathological productivity in a very impressive way, for acting rapidly on the "plus"-symptomatology typical of psychosis, as early as in the first days of treatment, and for its equally visible effect on the "minus"-symptoms, typical of psychosis, in the last third of an average period of treatment lasting 40 days. The clinic using Leponex (Dresden, Halle, Brandenburg-Görden) belonged to the clinical application programme of the Sandox - Basel firm. The article gives a summary of essential results and particulars about the treatment. A detailed evaluation of the case sheets which are at present being statistically reviewed will be given in the next paper.