Gender-Affirming Facial Surgery: Lower Third of the Face

This article is intended to give the reader an overview of facial gender-affirming procedures applicable to the lower face and neck. A review of facial analysis in the context of masculine versus feminine facial features and the contributions of both soft tissue and bone to this anatomy is provided. The use of systematic facial evaluation and patient-driven concerns as a guide for presurgical planning is reviewed. Detailed descriptions of the unique surgical interventions to feminize the soft tissues and the skeletal framework of the lower face and neck are provided.

RCN should be more thoughtful

Bank name and account number; address of employer; date of completion of nurse training; RCN membership number and expiry date; even the address of the regional office: all this very personal information is available for anyone to see, everytime the RCN uses those blue plastic envelopes to send out its mailings in. 'Private and confidential' it says on the front. What a joke!

Hepatitis B vaccine: immunogenicity and follow-up including two year booster doses in high-risk health care personnel in a London teaching hospital

One hundred forty-four adult health care personnel (aged 18-62 years, median 33 years) considered at high risk of future HBV infection were vaccinated with a plasma-derived hepatitis B vaccine (20 micrograms HBVax at 0, 1, and 6 months) and followed-up for 2 years. Anti-HBs was present in only 6.9% prior to vaccination, and prescreening to detect this group would not have been cost-effective. At 9 months, 8.3% were nonresponders and a further 9% had anti-HBs levels less than 50 mIU/ml. Multivariate analysis showed that age was the single most important determinant of a poor response. In 47 of 52 individuals retested 2 years later, anti-HBs levels had fallen by 80% or more, and in four it had become undetectable. Response to a booster dose at this stage was excellent, with anti-HBs levels 3 months later much higher than at the end of the initial course. Additional booster doses of vaccine in two of the initial nonresponders at 14 and 22 months, respectively, also led to seroconversion. Although a significant proportion of health care workers in this study did not make a satisfactory response to the hepatitis B vaccine, later booster doses were very effective in subsequently increasing anti-HBs levels.

Identification of the hepatic asialo-glycoprotein receptor (hepatic lectin) as a component of liver specific membrane lipoprotein (LSP)

Liver specific membrane lipoprotein (LSP), the target for anti-LSP antibodies in various liver diseases, is thought to be comprised of fragments of the hepatocellular plasma membrane. In the present study, therefore, evidence has been sought for the presence in LSP of the hepatocyte surface receptor (hepatic lectin) that binds desialylated glycoproteins. Eight guinea-pig anti-LSP antisera (four anti-human and four anti-rabbit LSP) were found to react by ELISA and/or RIA against affinity purified human and rabbit hepatic lectin. Binding of the antisera to 125I-hepatic lectins was inhibited by the unlabelled lectins, by human and rabbit LSP and by purified rabbit liver plasma membranes but not by a 50,000-fold excess of kidney homogenate. The results indicate that hepatic lectin is a liver specific, species cross-reactive antigen comprising about 0.25% of the protein in LSP.

Development of a micro enzyme-linked immunosorbent assay for antibodies against liver-specific membrane lipoprotein

Guinea pig antisera raised against human and rabbit liver-specific membrane lipoprotein (LSP) have been used to develop a rapid, reproducible and sensitive solid-phase, enzyme-linked immunosorbent assay (ELISA). The ELISA was used in a series of cross-inhibition experiments to define and quantitate the antigenic specificities of these antisera. The results confirm previous findings that LSP contains both liver-specific and liver non-specific antigens. In addition, it is shown that both human and rabbit LSP contain liver-specific antigens that are species-specific, as well as others that are species cross-reactive. Binding to human LSP was detected by the ELISA with 11 of 13 anti-LSP-positive (by radioimmunoassay) sera from patients with HBsAg-negative chronic active hepatitis. Similar binding was also found with 10 of 11 sera from patients with systemic lupus erythematosus and with 7 of 14 with rheumatoid arthritis --all of which were negative for anti-LSP by radioimmunoassay. It is suggested that immune complexes in these sera might bind to IgG-Fc receptors in LSP and that caution should be exercised in the interpretation of data from ELISA-based studies of anti-LSP in human sera.