Body satisfaction and physical appearance in gender dysphoria

Gender dysphoria (GD) is often accompanied by dissatisfaction with physical appearance and body image problems. The aim of this study was to compare body satisfaction with perceived appearance by others in various GD subgroups. Data collection was part of the European Network for the Investigation of Gender Incongruence. Between 2007 and 2012, 660 adults who fulfilled the criteria of the DSM-IV gender identity disorder diagnosis (1.31:1 male-to-female [MtF]:female-to-male [FtM] ratio) were included into the study. Data were collected before the start of clinical gender-confirming interventions. Sexual orientation was measured via a semi-structured interview whereas onset age was based on clinician report. Body satisfaction was assessed using the Body Image Scale. Congruence of appearance with the experienced gender was measured by means of a clinician rating. Overall, FtMs had a more positive body image than MtFs. Besides genital dissatisfaction, problem areas for MtFs included posture, face, and hair, whereas FtMs were mainly dissatisfied with hip and chest regions. Clinicians evaluated the physical appearance to be more congruent with the experienced gender in FtMs than in MtFs. Within the MtF group, those with early onset GD and an androphilic sexual orientation had appearances more in line with their gender identity. In conclusion, body image problems in GD go beyond sex characteristics only. An incongruent physical appearance may result in more difficult psychological adaptation and in more exposure to discrimination and stigmatization

Effect of medical interventions on gender dysphoria and body image : a follow-up study.

Objective: The aim of this study from the European Network for the Investigation of Gender Incongruence is to investigate the status of all individuals who had applied for gender confirming interventions from 2007 to 2009, irrespective of whether they received treatment. The current article describes the study protocol, the effect of medical treatment on gender dysphoria and body image, and the predictive value of (pre) treatment factors on posttreatment outcomes. Methods: Data were collected on medical interventions, transition status, gender dysphoria (Utrecht Gender Dysphoria Scale), and body image (Body Image Scale for transsexuals). In total, 201 people participated in the study (37% of the original cohort). Results: At follow-up, 29 participants (14%) did not receive medical interventions, 36 hormones only (18%), and 136 hormones and surgery (68%). Most transwomen had undergone genital surgery, and most transmen chest surgery. Overall, the levels of gender dysphoria and body dissatisfaction were significantly lower at follow-up compared with clinical entry. Satisfaction with therapy responsive and unresponsive body characteristics both improved. High dissatisfaction at admission and lower psychological functioning at follow-up were associated with persistent body dissatisfaction. Conclusions: Hormone-based interventions and surgery were followed by improvements in body satisfaction. The level of psychological symptoms and the degree of body satisfaction at baseline were significantly associated with body satisfaction at follow-up

Mesorectal radiotherapy for early stage rectal cancer: A novel target volume

With the introduction of population-based bowel cancer screening, rectal cancer is diagnosed at earlier stages, yet standard treatment still requires the same extensive surgery that is used for more advanced stages. Organ preserving treatment is rapidly developing and is subject of investigation in numerous clinical trials. The STAR-TREC trial is an international, multi-centre randomised trial investigating organ preservation using (chemo)radiotherapy. Patients with small mrT1-3bN0V0M0 tumours are randomized between three arms: standard TME, organ preservation with SCRT or with CRT. In this trial, the clinical target volume has been tailored to the early staged disease of the included patients. This mesorectal irradiation volume includes the mesorectum and pre-sacral lymph nodes at the level of the tumour, two centimetres below and cranially up to the S2-3 interspace level. In contrast to conventional irradiation volumes, the lateral lymph nodes and the nodes along the superior rectal artery are excluded. As a result, the dose to the bowel, bladder, anal sphincter and the neurovascular plexus in the lower pelvis is substantially decreased, especially when combined with modern irradiation techniques, such as dynamic arc therapy. These lower doses are expected to lead to decreasing acute and late toxicity and beneficial functional outcomes. The implementation of this novel target volume will be accompanied by an extensive quality assurance program in the STAR-TREC trial. We describe the rationale behind the novel, mesorectal only radiotherapy treatment used in the STAR-TREC trial specifically tailored for early stage disease, with the goal of organ preservation

Understanding the subtleties of frustrated Lewis pair activation of carbonyl compounds by N-Heterocyclic carbene/alkyl gallium pairings

This study reports the use of the trisalkylgallium GaR3 (R=CH2 SiMe3 ), containing sterically demanding monosilyl groups, as an effective Lewis-acid component for frustrated Lewis pair activation of carbonyl compounds, when combined with the bulky N-heterocyclic carbene 1,3-bis(tert-butyl)imidazol-2-ylidene (ItBu) or 1,3-bis(tert-butyl)imidazolin-2-ylidene (SItBu). The reduction of aldehydes can be achieved by insertion into the C=O functionality at the C2 (so-called normal) position of the carbene affording zwitterionic products [ItBuCH2 OGaR3 ] (1) or [ItBuCH(p-Br-C6 H4 )OGaR3 ] (2), or alternatively, at its abnormal (C4) site yielding [aItBuCH(p-Br-C6 H4 )OGaR3 ] (3). As evidence of the cooperative behaviour of both components, ItBu and GaR3 , neither of them alone are able to activate any of the carbonyl-containing substrates included in this study NMR spectroscopic studies of the new compounds point to complex equilibria involving the formation of kinetic and thermodynamic species as implicated through DFT calculations. Extension to ketones proved successful for electrophilic α,α,α-trifluoroacetophenone, yielding [aItBuC(Ph)(CF3 )OGaR3 ] (7). However, in the case of ketones and nitriles bearing acidic hydrogen atoms, C-H bond activation takes place preferentially, affording novel imidazolium gallate salts such as [{ItBuH}(+) {(p-I-C6 H4 )C(CH2 )OGaR3 }(-) ] (8) or [{ItBuH}(+) {Ph2 C=C=NGaR3 }(-) ] (12)

Estudo das necessidades nutricionais de cães machos reprodutores

O objetivo do trabalho foi definir as necessidades nutricionais de cães machos reprodutores através de publicações científicas e, a partir destas, verificar alimentos completos e suplementos comerciais que atendam essa categoria. Foram identificadas oito publicações com 124 cães avaliados. Os nutrientes avaliados foram: Vitamina E, Selênio, Ômega 3 e Ômega 6. Os parâmetros usuais na avaliação de qualidade de sêmen foram: volume; motilidade, vigor espermático e concentração espermática. O estudo mostrou que o ideal para cães machos reprodutores será seguir as tabelas oficiais de exigências nutricionais, uma dieta com: 3.750 kcal/kg; proteína bruta de 24%; Cálcio de 1,113%; Fósforo de 0,905%; Selênio de 0,408%; Vitamina E de 40 mg/kg e Ômegas 3 e 6 de 5500 e 300 mg, respectivamente. Para suplementação, além das exigências nutricionais, recomenda-se: Vitamina E: 50 mg/kg; Selênio: 0,60 mg/kg; Ômega 3: 7,2 mg/kg; Ômega 6: 25 mg/kg de peso corporal durante média de 60 dias. Foram encontrados cinco alimentos completos comerciais que atendem as necessidades. Os alimentos necessitam de suplementação. Foram identificados três suplementos que atenderam, as recomendações estimadas

The predictive and prognostic potential of plasma telomerase reverse transcriptase (TERT) RNA in rectal cancer patients

Background: Preoperative chemoradiotherapy (CRT) followed by surgery is the standard care for locally advanced rectal cancer, but tumour response to CRT and disease outcome are variable. The current study aimed to investigate the effectiveness of plasma telomerase reverse transcriptase (TERT) levels in predicting tumour response and clinical outcome. Methods: 176 rectal cancer patients were included. Plasma samples were collected at baseline (before CRT\ubcT0), 2 weeks after CRT was initiated (T1), post-CRT and before surgery (T2), and 4\u20138 months after surgery (T3) time points. Plasma TERT mRNA levels and total cell-free RNA were determined using real-time PCR. Results: Plasma levels of TERT were significantly lower at T2 (Po0.0001) in responders than in non-responders. Post-CRT TERT levels and the differences between pre- and post-CRT TERT levels independently predicted tumour response, and the prediction model had an area under curve of 0.80 (95% confidence interval (CI) 0.73\u20130.87). Multiple analysis demonstrated that patients with detectable TERT levels at T2 and T3 time points had a risk of disease progression 2.13 (95% CI 1.10\u20134.11)-fold and 4.55 (95% CI 1.48\u201313.95)-fold higher, respectively, than those with undetectable plasma TERT levels. Conclusions: Plasma TERT levels are independent markers of tumour response and are prognostic of disease progression in rectal cancer patients who undergo neoadjuvant therapy

Re-irradiation in clinical practice:Results of an international patterns of care survey within the framework of the ESTRO-EORTC E²-RADIatE platform

Background: Re-irradiation is an increasingly utilized treatment for recurrent, metastatic or new malignancies after previous radiotherapy. It is unclear how re-irradiation is applied in clinical practice. We aimed to investigate the patterns of care of re-irradiation internationally. Material/Methods: A cross-sectional survey conducted between March and September 2022. The survey was structured into six sections, each corresponding to a specific anatomical region. Participants were instructed to complete the sections of their clinical expertise. A total of 15 multiple-choice questions were included in each section, addressing various aspects of the re-irradiation process. The online survey targeted radiation and clinical oncologists and was endorsed by the European Society for Radiotherapy and Oncology (ESTRO) and the European Organisation for Research and Treatment of Cancer (EORTC).Results: 371 physicians from 55 countries across six continents participated. Participants had a median professional experience of 16 years, and the majority (60%) were affiliated with an academic hospital. The brain region was the most common site for re-irradiation (77%), followed by the pelvis (65%) and head and neck (63%). Prolonging local control was the most common goal (90–96% across anatomical regions). The most common minimum interval between previous radiotherapy and re-irradiation was 6–12 months (45–55%). Persistent grade 3 or greater radiation-induced toxicity (77–80%) was the leading contraindication. Variability in organs at risk dose constraints for re-irradiation was observed. Advanced imaging modalities and conformal radiotherapy techniques were predominantly used. A scarcity of institutional guidelines for re-irradiation was reported (16–19%). Participants from European centers more frequently applied thoracic and abdominal re-irradiation. Indications did not differ between academic and non-academic hospitals. Conclusion: This study highlights the heterogeneity in re-irradiation practices across anatomical regions and emphasizes the need for high-quality evidence from prospective studies to guide treatment decisions and derive safe cumulative dose constraints.</p

The levels and predictors of physical activity engagement within the treatment seeking transgender population: a matched control study

Background: Physical activity has been found to alleviate mental health problems and could be beneficial for at-risk populations, such as transgender people. This study had three aims. First, to explore the amount of physical activity that treatment seeking transgender people engage in, and to compare this to matched cisgender people. Second, to determine whether there was a difference in physical activity depending on cross-sex hormone use. Third, to determine factors which predict physical activity among treatment seeking transgender people. Method: Transgender (n=360) and cisgender people (n=314) were recruited from the UK. Participants were asked to complete questionnaires about physical activity, symptoms of anxiety and depression, self-esteem, body satisfaction and transphobia. Results: Transgender people engaged in less physical activity than cisgender people. Transgender people who were on cross-sex hormones engaged in more physical activity than transgender people who were not. In transgender people on cross-sex hormones, high body satisfaction was the best statistical predictor of physical activity while high self-esteem was the best statistical predictor in people who were not. Conclusion: Transgender people are less active than cisgender people. Cross-sex hormone treatment appears to be able to indirectly increase physical activity within this population, which may be beneficial for mental well-being