A new method for improved standardisation in three-dimensional computed tomography cephalometry

Interest for three-dimensional computed tomography cephalometry has risen over the last two decades. Current methods commonly rely on the examiner to manually point-pick the landmarks and/or orientate the skull. In this study, a new approach is presented, in which landmarks are calculated after selection of the landmark region on a triangular model and in which the skull is automatically orientated in a standardised way. Two examiners each performed five analyses on three skull models. Landmark reproducibility was tested by calculating the standard deviation for each observer and the difference between the mean values of both observers. The variation can be limited to 0.1 mm for most landmarks. However, some landmarks perform less well and require further investigation. With the proposed reference system, a symmetrical orientation of the skulls is obtained. The presented methods contribute to standardisation in cephalometry and could therefore allow improved comparison of patient data

Gender change and stigmatization in late-treated Indonesian children, adolescent, and adult patients with DSD

In Indonesia clinical management of Disorders of Sex Development (DSD) is challenged by limited knowledge and limited diagnostic and treatment facilities. Prior to this study, most patients remained untreated and grew up with ambiguous bodies and doubts about their gen-der. We investigated patients’ experiences of being raised in ambiguity. 118 Indonesian patients, ages 6 – 41, with 46XX DSD (n=27), 46XY DSD (n=77) and chromosomal DSD (n=14) were compared to 118 control subjects matched for gender, age, and living area. Questionnaires for gen-der identity, gender role behavior and social stigmatiza-tion were translated or designed. The psychometric properties were satisfactory. For patient and control group comparisons, Mann-Whitney U and Fisher’s Exact tests were applied.The results showed that 7% of the children, 8% of the adolescents and 44% of the adults changed gender, parti-cularly non-diagnosed and non-treated patients with 46XY DSD (81%). 95% of the patients changed gender from female to male, including untreated patients with 46,XX CAH-SV. Compared to control groups, cross-gender role behavior was seen in young girls with 46XX CAH-SV (p=.047) and adolescent girls with different types of DSD (p=.01). In girls with DSD, confusion with gender identity was seen (young girls p=.004; adolescent girls p=.01). Adult men reported past cross-gender role behavior (p=.01) and past problems in gender identification (p=.01) prior to female-to-male gender change.Children with genital ambiguity (p<.006) and cross gender behavior (p<0.001) and adults with ambiguous bodies (p=.001) and adults who changed gender (p<0.03) suffered stigmatization. Rejection or isolation elicited depression and withdrawal from social activities in girls (p=.002), women (p=.009) and youngsters who had changed gender (p=.02). We conclude that a high percentage of our patients changed gender. The wish for gender change was parti-cularly seen in patients with progressive masculinization. Patients with DSD who had visible ambiguity in physical and behavioral appearance suffered stigmatization. Teas-ing and rejection led to strong emotional reactions. Early clinical evaluation and treatment, patient and parent edu-cation, and teaching coping strategies will improve qual-ity of life

Gender change and stigmatization in late-treated Indonesian children, adolescent, and adult patients with DSD

In Indonesia clinical management of Disorders of Sex Development (DSD) is challenged by limited knowledge and limited diagnostic and treatment facilities. Prior to this study, most patients remained untreated and grew up with ambiguous bodies and doubts about their gen-der. We investigated patients’ experiences of being raised in ambiguity. 118 Indonesian patients, ages 6 – 41, with 46XX DSD (n=27), 46XY DSD (n=77) and chromosomal DSD (n=14) were compared to 118 control subjects matched for gender, age, and living area. Questionnaires for gen-der identity, gender role behavior and social stigmatiza-tion were translated or designed. The psychometric properties were satisfactory. For patient and control group comparisons, Mann-Whitney U and Fisher’s Exact tests were applied. The results showed that 7% of the children, 8% of the adolescents and 44% of the adults changed gender, parti-cularly non-diagnosed and non-treated patients with 46XY DSD (81%). 95% of the patients changed gender from female to male, including untreated patients with 46,XX CAH-SV. Compared to control groups, cross-gender role behavior was seen in young girls with 46XX CAH-SV (p=.047) and adolescent girls with different types of DSD (p=.01). In girls with DSD, confusion with gender identity was seen (young girls p=.004; adolescent girls p=.01). Adult men reported past cross-gender role behavior (p=.01) and past problems in gender identification (p=.01) prior to female-to-male gender change. Children with genital ambiguity (p<.006) and cross gender behavior (p<0.001) and adults with ambiguous 1Diponegoro University, Faculty of Psychology, Semarang, Indonesia Full list of author information is available at the end of the article bodies (p=.001) and adults who changed gender (p<0.03) suffered stigmatization. Rejection or isolation elicited depression and withdrawal from social activities in girls (p=.002), women (p=.009) and youngsters who had changed gender (p=.02). We conclude that a high percentage of our patients changed gender. The wish for gender change was parti-cularly seen in patients with progressive masculinization. Patients with DSD who had visible ambiguity in physical and behavioral appearance suffered stigmatization. Teas-ing and rejection led to strong emotional reactions. Early clinical evaluation and treatment, patient and parent edu-cation, and teaching coping strategies will improve qual-ity of life

Reproducibility of landmark identification on different CT images of the head in three-dimensional cephalometry

Cephalometry is the scientific measurement of the head and is a widely used technique in orthodontics and craniofacial surgery. In a previous study, a new method for three-dimensional computed tomography (3D CT) cephalometry was investigated, in which landmarks are semi-automatically calculated from a 3D triangulated surface model of the skull. It was shown that high intra- and interobserver reproducibility can be achieved when several analyses are performed on the same 3D model. However, when the head is oriented in a different way during CT scanning, a different triangulated surface will be obtained. Therefore, the reproducibility of landmark identification on different CT images of the patient's head was studied. Pre- and postoperative images were used to construct two triangulated models of the skull, a registration procedure was carried out to orient them in the same way and 15 landmarks, situated on the non-operated part of the skull, were calculated. The effect of the altered orientation during scanning was investigated by calculating the distances between the pre- and postoperative landmarks. The mean distance over 12 patients and 15 landmarks varies between 0.60 and 0.67 mm, depending on the number of smoothing iterations applied on the surfaces. For 10 smoothing iterations, the mean distance over the patients varies between 0.20 and 1.33 mm (mean = 0.60 mm) and the maximum distance over the patients varies between 0.33 and 3.57 mm (mean = 1.33 mm). These variations should be kept in mind when comparing pre- and postoperative data of patients treated with craniofacial surgery

Determining Pain Detection and Tolerance Thresholds Using an Integrated, Multi-Modal Pain Task Battery

Human pain models are useful in the assessing the analgesic effect of drugs, providing information about a drug's pharmacology and identify potentially suitable therapeutic populations. The need to use a comprehensive battery of pain models is highlighted by studies whereby only a single pain model, thought to relate to the clinical situation, demonstrates lack of efficacy. No single experimental model can mimic the complex nature of clinical pain. The integrated, multi-modal pain task battery presented here encompasses the electrical stimulation task, pressure stimulation task, cold pressor task, the UVB inflammatory model which includes a thermal task and a paradigm for inhibitory conditioned pain modulation. These human pain models have been tested for predicative validity and reliability both in their own right and in combination, and can be used repeatedly, quickly, in short succession, with minimum burden for the subject and with a modest quantity of equipment. This allows a drug to be fully characterized and profiled for analgesic effect which is especially useful for drugs with a novel or untested mechanism of action. Perioperative Medicine: Efficacy, Safety and Outcom

Social stigmatisation in late identified patients with disorders of sex development in Indonesia

Objectives To assess social stigmatisation related to atypical appearance of the body, including, but not limited to the external genitalia, among Indonesian patients with a disorder of sex development (DSD). Until recently, diagnostic evaluation, information about the underlying causes of DSD and treatment options were sparsely available for these patients. Methods Eighty-one parents of children and adolescents with DSD (aged 6–17 years) and 34 adult patients with DSD (aged 18–41 years) completed the Social Stigmatisation Scale towards DSD, an instrument developed to assesses the frequency of stigmatisation and the level of stress associated with these experiences. Open-ended questions investigated detailed information on stigmatisation as well as parents’ and patients’ emotional and behavioural reactions to these experiences. Differences in stigmatisation were explored across sex of rearing, gender change history, treatment status and DSD characteristics that could be easily identified by others (e.g., masculinisation of the body in women). Results Social stigmatisation was reported by patients with atypical appearance of their genitalia, atypical appearance of their body aside from their genitals, among those who displayed cross-gender behaviour and those who changed gender. Among participants reared as women and among children and adolescents who changed gender, social stigmatisation was associated with ostracism, depressive symptoms and social isolation. Conclusions Patients unable to conceal their condition (those with visible physical atypicality and those who changed gender) experienced social stigmatisation. Stigmatisation was stressful and related to isolation and withdrawal from social interaction. Education about DSD, self-empowerment and medical interventions to prevent atypical physical development may remove barriers to acceptance by others for affected individuals

Parenting children with a cleft lip with or without palate or a visible infantile hemangioma: A cross-sectional study of distress and parenting stress

Objective: Parents of children with a medical condition and a visible difference can experience challenging situations. We evaluated distress and parenting stress in parents of children with a cleft lip with or without cleft palate (CL +/- P) or a visible infantile hemangioma (IH). Setting: This cross-sectional study took place in an academic medical hospital in Rotterdam, the Netherlands. Participants: Three-hundred nine parents (mean age = 40.30, 56.00% mothers) of children with CL +/- P and 91 parents (mean age = 36.40, 58.24% mothers) of children with IH. Main Outcome Measures: The Dutch version of the Parenting Stress Index - Short Form and the subscales Anxiety, Depression, and Hostility of the Symptom Checklist - 90. Results: One sample t tests and mixed linear modeling were used. On average, parents of children with CL +/- P and of children with IH showed significantly lower parenting stress compared to normative data. Anxiety was significantly lower in parents of children with CL +/- P than that in the norm group. Visibility of the condition was not related to distress or parenting stress. Child behavioral problems were positively related to parenting stress, depression, and hostility. Conclusions: Parents of children with CL +/- P and IH report less distress and parenting stress compared to the norm. On average, these parents seem well adjusted. A practical implication is to monitor parents of children with behavioral problems.Stress and Psychopatholog