Complete corporeal preservation clitoroplasty: new insights into feminizing genitoplasty

Q2Q2Pacientes sometidos a Genitoplastia feminizanteIntroduction: 46,XX Congenital adrenal hyperplasia (CAH) remains the first cause of genital virilization and current surgical techniques aim to restore female aspect of genitalia while preserving dorsal neurovascular bundle but not at the expense of not preserving erectile tissue. We aim to report our experience with a new surgical technique for clitoroplasty, completely preserving corporeal bodies, neurovascular bundles without dismembering the clitoris, in four patients with over a year follow up. Materials and Methods: After IRB approval four patients with 46,XX CAH and Prader 5 and 3 external genitalia, underwent feminizing genitoplasty. Complete preservation of erectile tissue was accomplished without a need to dissect dorsal neurovascular bundle. Glans size allowed no need for glanular reduction and there was no need to dismember the corporeal bodies. Results: Four patients 12 to 24-months-old underwent complete corporeal preservation clitoroplasty (CCPC), mean age was 18.5 months, mean follow up was 10.25 months. Vaginoplasty was performed in all patients with partial urogenital mobilization (PUM) and Urogenital Sinus flap (UF), only one severely virilized patient required a parasagittal pre-rectal approach to mobilize the vagina. We had no complications until last follow up. Conclusion: To our knowledge, we are introducing the concept of CCPC without the need of disassembling the corporeal bodies, neurovascular bundle and glans. It stands as a new alternative for feminizing genitoplasty with complete preservation of erectile tissue and no dissection of neurovascular bundle. Although there is still lacking long-term follow-up, it represents a new step in conservative reconfiguration of the external virilized female genitalia.https://orcid.org/0000-0002-9675-5963https://orcid.org/0000-0003-0363-5485https://orcid.org/0000-0002-2231-4321Revista Internacional - IndexadaBS

The Influence of Construction Materials on Life-Cycle Energy Use and Carbon Dioxide Emissions of Medium Size Commercial Buildings

This thesis studies the influence of construction materials on the life-cycle energy consumption and carbon dioxide (CO2) emissions of medium sized low energy consumption commercial buildings. When describing buildings by materials, there is a tendency to label them according to the main structural material used. However, the vast majority of commercial buildings use a large number of materials. Hence it is not clear which materials or combinations of materials can achieve the best performance, in terms of lifecycle energy use and CO2 emissions. The buildings analysed here were based on an actual six-storey 4250m2 (gross floor area) building, with a mixed-mode ventilation system, currently under construction at the University of Canterbury in Christchurch. While the actual building is being constructed in concrete, the author has designed two further versions in which the structures and finishes are predominantly steel or timber. Despite having different structural materials, large quantities of finishes materials are common to all three buildings; large glazed curtain walls and sun louvers, stairs balustrade and most of the offices internal finishes. A fourth building was also produced in which all possible common finishes' of the timber building were replaced by timber components. This building is labelled as Timber-plus and was included to assess the difference of the three initial 'common finishes' buildings against a building that might be expected to have a low or even negative total embodied CO2 emission in structure and finishes. In order to highlight the influence of materials, each building was designed to have a similar indoor climate with roughly the same amount of operational energy for heating and cooling over its full life. Both energy use and CO2 emissions have been assessed over three main stages in the life (and potential environmental impact) of a building: initial production of the building materials (initial embodied energy and initial embodied CO2 emissions); operation of the building (mainly in terms of its energy use); and the refurbishment and maintenance of the building materials over the building's effective life (recurrent embodied energy and CO2 emissions). Calculation of embodied energy and embodied CO2 emissions are based on materials' estimates undertaken by a Quantity Surveyor. DesignBuilder software was used to estimate whole life-cycle energy used and CO2 emitted in the operation of the buildings over a period of 60 years. Two different methods for embodied energy and embodied CO2 calculation were applied to the four buildings. The first method was by multiplying the volume of each material in the schedule calculated by the Quantity Surveyor by the New Zealand specific coefficients of embodied energy and embodied CO2 produced by Andrew Alcorn (2003). The second method was analysing the same schedule of materials with GaBi professional LCA software. Materials' inventories in GaBi are average German industry data collected by PE Europe between 1996 and 2004 (Alcorn, 2003; Nebel & Love, 2008). The energy results of the thesis show that when using the Alcorn coefficients, the total embodied energy (initial plus recurrent embodied energy) averaged 23% and operating energy consumption averaged 77% of the total life-cycle energy consumption for the four buildings. Using the GaBi coefficients, total embodied energy averaged 19% and operating energy consumption averaged 81% of the total life-cycle energy consumption of the four buildings. Using the Alcorn coefficients, the difference between the highest (steel building) and lowest (timber-plus building) life-cycle energy consumption represents a 22% increment of the highest over the lowest. Using the GaBi coefficients, the difference between the lowest (timber-plus building) and the highest (timber building) life-cycle energy consumption represents a 15% increment of the highest over the lowest. The CO2 results shows that when using the Alcorn coefficients, the total embodied CO2 emissions averaged 7% and operating CO2 emissions averaged 93%. Using the GaBi coefficients, total embodied CO2 emissions averaged 16% and operating CO2 emissions averaged 84% of the life-cycle CO2 emissions of the four buildings. Using the Alcorn coefficients, the difference between the highest (steel building) and lowest (timber-plus building) life-cycle CO2 emissions represents a 27% increment of the highest over the lower. Using the GaBi coefficients, the difference between the highest (timber building) and the lowest (timber-plus building) lifecycle CO2 emissions represents a 9% increment of the highest over the lowest. While for the case of embodied energy the Alcorn results averaged 32% higher than the GaBi, in the case of embodied CO2 the Alcorn results averaged 62% lower than the GaBi. Major differences in the results produced when using the two different sets of embodied energy and CO2 coefficients are due mainly to their different approaches to the CO2 sequestration in timber materials. While the Alcorn coefficients account for the CO2 sequestration of timber materials, the GaBi coefficients do not. This is particularly noteworthy as the CO2 sequestration of timber has been neglected in previous research. It was established that embodied energy can significantly influence the life-cycle energy consumption and CO2 emissions of contemporary low energy buildings. Using the Alcorn coefficients, the steel building embodied the equivalent of 27 years of operating energy consumption and 12 years of operating CO2 emissions. At the other end of the spectrum the timber-plus building embodied the equivalent of 11 years of operating energy consumption and has stored the equivalent of 3.6 years of operating CO2 emissions. Using the GaBi coefficients, the steel building embodied the equivalent of 19 years of operating energy consumption and 14 years of operating CO2 emissions, while the timber-plus building embodied the equivalent of 8 years of operating energy consumption and 8 years of operating CO2 emissions. These findings are of significance, for example, in the assessment and weighting of the embodied energy and embodied CO2 components of building sustainable rating tools

Is hypospadias a spectrum of different diseases? MAMLD1 gen : A new candidate gene for hypospadias

Las hipospadias resultan de un arresto en el desarrollo normal de la uretra, creando un meato ectópico proximal en la cara ventral del pene. Estudios moleculares y un mejor conocimiento de la embriogénesis del tubérculo genital demuestran una compleja interacción de genes, hormonas y el ambiente con el desarrollo de hipospadias. Es posible que esta entidad sea la expresión fenotípica común de varias enfermedades diferentes. Recientemente se describió un nuevo gen candidato en el desarrollo de hipospadias llamado MAMLD1, involucrado en la producción normal de testosterona durante la embriogénesis.Q4Artículo de revisión155-160Hypospadias is the result of an abnormal development of the urethra causing an ectopic and more proximal placement of the meatus in the ventral side of the penis. Recent molecular studies, and a better understanding of the normal development of the genital tubercle, have demonstrated a complex interaction between genes, hormones and the environment with the development of hypospadias. It is possible that hypospadias is the phenotypic expression of different diseases. Recently a new candidate gene for hypospadias has been discovered, called MAMLD1, which is involved in the normal production of testosterone during foetal development

Gender Dysphoria Publication Trends: A Bibliometric Analysis between 1900 and 2018

Objetivo: La investigación sobre la disforia de género (DG) ha crecido en las últimas décadas con un interés creciente por comprender y caracterizar las relaciones causales entre factores psicológicos, genéticos, hormonales y socioculturales. La aceptación de esta condición como no patológica ha llevado a cambios significativos en la perspectiva general y su manejo a lo largo del tiempo. Nuestro objetivo es realizar un análisis bibliométrico para evaluar las tendencias de publicación y la calidad de evidencias relacionadas con la disforia de género. Métodos: Se realizó una búsqueda sistemática y revisión crítica de la literatura entre enero de 1900 y diciembre de 2018 para hacer un análisis bibliométrico. Se utilizaron los criterios de los Ítems de Informe Preferido para Revisiones Sistemáticas y Metaanálisis (Preferred Reporting Items for Systematic Reviews and Meta-analysis, PRISMA, en inglés), y la investigación se realizó en las siguientes bases de datos: OVID, PubMed, EMBASE, Scopus, Web of Science y Google Scholar. Los términos de encabezados de temas médicos (medical subject headings, MeSh, en inglés) utilizados fueron: disforia de género; y cirugía y psicología. Los resultados se trazaron utilizando VOSviewer, versión 1.6.8. Los análisis estadísticos se realizaron con el IBM SPSS, versión 25.0. Resultados: Se identificaron un total de 1.239 manuscritos, y se seleccionaron 1.041. El número promedio de citas por año por manuscrito fue de 1,84 (rango intercuartil [RIC]: 0–2,33). El índice de impacto promedio fue de 47,8 (RIC: 20–111,6). La mediana del total de citas por manuscrito fue de 3 (RIC: 0–33.1), y el mayor número de citas por manuscrito fue de 484. La mayoría de las publicaciones se centran en los aspectos psicológicos de la DG, y hay una cantidad significativa de manuscritos relacionados con temas sociales y antropológicos. La mayoría de los artículos tienen un bajo nivel de evidencia científica. Conclusión: Existe una gran cantidad de literatura publicada sobre disforia de género; sin embargo, existe un nivel significativo de desacuerdo en muchos aspectos sobre este tema. Con respecto a la afirmación quirúrgica, hace falta información respaldada por un alto nivel de evidencia que argumente la expansión emergente de las prácticas médicas.Q4Objective: Research on gender dysphoria (GD) has been growing over the last decades with increasing interest in understanding and characterizing the causal relationships between psychological, genetics, hormonal, and sociocultural factors. Changes and acceptance of this condition as non-pathologic have led to significant changes in general perspective and its management over time. Our objective is to carry out a bibliometric analysis to know the publication trends and quality of evidence related to gender dysphoria. Methods: A systematic search and critical review of the literature was carried out between January 1900 and December 2018 to perform a bibliometric analysis. Research was done in the following databases: OVID, PubMed, EMBASE, Scopus, Web of Science and Google Scholar. The medical subject headings (MeSh) terms used were: gender dysphoria; and surgery and psychology. The results were plotted using the VOSviewer version 1.6.8. Statistical analyses were performed with the IBM SPSS, Version 25.0. Results: A total of 1,239 manuscripts were identified, out of which 1,041 were selected. The average number of cited times per year per manuscript is 1.84 (interquartile range [IQR] 0-2.33). The average impact index was 47.8 (IQR 20-111.6). The median of total citations per manuscript was 3 (IQR 0-33.1), and the highest number of citations per manuscript was 484. Most publications focus on the psychological aspects of GD, and there is a significant amount of manuscripts related to social and anthropological issues. Most articles have a low level of scientific evidence. Conclusion: There is a great amount of published literature on GD; however, there is a significant level of disagreement in many respects on this topic. Regarding surgical gender-affirmation, there is a lack of information supported by high level of evidence to uphold the emerging expansion of medical practices.https://orcid.org/0000-0002-9675-5963https://orcid.org/0000-0001-9571-6834https://orcid.org/0000-0001-5749-6340https://orcid.org/0000-0002-2231-4321Revista Nacional - IndexadaCN

M-Mode Ultrasound Behavior of Rectus Femoris and Vastus Intermedius during Contraction with Anthropometric Correlations: Cross-Sectional Study

The quadriceps femoris muscle (QF) is of clinical importance since it has been correlated with pathologies at knee level, such as anterior cruciate ligament (ACL) injury, pain processes and complex clinical conditions. Among the variables that have been related to these clinical conditions are anthropometric measurements, architecture and muscular behavior of the QF. The aim of this study was to determine the relationship between the rectus femoris (RF) and vastus intermedius (VIM) muscles' behavior measured by rehabilitative ultrasound imaging (RUSI) M-mode under maximal voluntary isometric contraction (MVIC) and anthropometric measurements. This was a cross-sectional, observational study. Sixty-two asymptomatic volunteers were included (20.42 +/- 4.97 years, most women 59.7%). RUSI measurements were muscle contraction/rest thickness and contraction/relaxation velocity. Anthropometric measurements were, lower limb length, RF length, QF tendon length, distance between spines, proximal, middle and distal thigh perimeter. Statistically significant correlations (p < 0.05) were found between VIM thickness at rest and contraction with thigh perimetry, RF length and dominant lower limb length. For the RF, a correlation was found between the thickness at rest and the length of this muscle (p = 0.003). There is a correlation between anthropometric variables and muscular behavior measured by RUSI M-mode.Fisioterapi

Inconspicuous penis

El término pene no conspicuo (oculto), agrupa las patologías en las que el pene adopta un tamaño aparentemente más pequeño, ya sea porque se oculta bajo el tejido cicatricial en caso del pene atrapado, cuando presenta un pliegue de piel que reduce el ángulo penoescrotal tratándose del pene en vela, o en los casos en los que el pene es cubierto por prepucio redundante produciendo un pene enterrado. Se realiza una revisión de la definición y terminología utilizada a través de la historia, clasificación actual, etiología, diagnóstico y técnica quirúrgica empleada para la corrección del pene no conspicuo (oculto).214-222Inconspicuous penis is referred conditions where the penis looks apparently small but is truely hidden under scarring tissue or under redundant mucosa or prepubic fat. These are all different pathologies that are surgically treated. Multiple techniques have been described. The aim of the present article is to review the state of the art in management throughout history, current classification, etiology, diagnosis and surgical techniques for correcting this pathology

Effect of the TiO2 doped photocatalytic nano-additives on the hydration and microstructure of Portland and High Alumina Cements

Mortars with two different binders (Portland cement (PC) and high alumina cement (HAC)) were modified upon the bulk incorporation of nano-structured photocatalytic additives (bare TiO2, and TiO2 doped with either iron (Fe-TiO2) or vanadium (V-TiO2)). Plastic and hardened state properties of these mortars were assessed in order to study the influence of these nano-additives. Water demand was increased, slightly by bare TiO2 and Fe-TiO2, and strongly by V-TiO2, in agreement with the reduction of the particle size and the tendency to agglomerate. Isothermal calorimetry showed that hydration of the cementitious matrices was accelerated due to additional nucleation sites offered by the nano-additives. TiO2 and doped TiO2 did not show pozzolanic reactivity in the binding systems. Changes in the pore size distribution, mainly the filler effect of the nano-additives, accounted for the increase in compressive strengths measured for HAC mortars. A complex microstructure was seen in calcium aluminate cement mortars, strongly dependent on the curing conditions. Fe-TiO2 was found to be homogeneously distributed whereas the tendency of V-TiO2 to agglomerate was evidenced by elemental distribution maps. Water absorption capacity was not affected by the nano-additive incorporation in HAC mortars, which is a favourable feature for the application of these mortars