Total phallic construction techniques in transgender men: An updated narrative review

From 2012, the World Professional Association Transgender Health defined a structured therapeutic path and standards of care for transgender patients undergoing genital gender affirming surgery (GGAS). The main goal of GGAS in transgender males is to provide patients with an aesthetically appealing appearance of the neophallus that should allow standing micturition and enabling penetrative intercourse along with erogenous and tactile sensitivity. The optimal procedure should be safe, reproducible and performed in the fewest number of surgical stages. The ideal technique for total phallic construction (TPC) has not yet been demonstrated; TPC remains challenging and, from a functional point of view, it is also make more demanding as yet there are no perfect replacement materials for erectile and urethral tissues. Several procedures and different type of flaps (pedicled and free-flaps) have been proposed and investigated over time to address TPC with significant advances over the years especially after microsurgical procedures introduction. Due to its high complexity TPC is not free from complications. Local tissue ischaemic complications, complete and partial flap loss, donor site morbidity and urethral complications (fistulae and strictures) are reported. This narrative review aims to provide the readers with a contemporary overview of surgical procedures for TPC in transgender males focusing on key surgical steps, as well as surgical and functional outcomes

Comparison of LISA and Atom Interferometry for Gravitational Wave Astronomy in Space

One of the atom interferometer gravitational wave missions proposed by Dimopoulos et al.1 in 2008 was called AGIS-Sat. 2. It had a suggested gravitational wave sensitivity set by the atom state detection shot noise level that started at 1 mHz, was comparable to LISA sensitivity from 1 to about 20 mHz, and had better sensitivity from 20 to 500 mHz. The separation between the spacecraft was 1,000 km, with atom interferometers 200 m long and shades from sunlight used at each end. A careful analysis of many error sources was included, but requirements on the time-stability of both the laser wavefront aberrations and the atom temperatures in the atom clouds were not investigated. After including these considerations, the laser wavefront aberration stability requirement to meet the quoted sensitivity level is about 1\times10-8 wavelengths, and is far tighter than for LISA. Also, the temperature fluctuations between atom clouds have to be less than 1 pK. An alternate atom interferometer GW mission in Earth orbit called AGIS-LEO with 30 km satellite separation has been suggested recently. The reduction of wavefront aberration noise by sending the laser beam through a high-finesse mode-scrubbing optical cavity is discussed briefly, but the requirements on such a cavity are not given. Unfortunately, such an Earth-orbiting mission seems to be considerably more difficult to design than a non-geocentric mission and does not appear to have comparably attractive scientific goals.Comment: Submitted to Proc. 46th Rencontres de Moriond: Gravitational Waves and Experimental Gravity, March 20 - 27, 2011, La Thuile, Ital

The social return on investment (SROI) of four microfinance projects

The paper develops an SROI (Social Return on Investment) analysis of four microfinance institutions (MFIs) located in Spain, Italy and Bosnia-Herzegovina. This work is part of the MeMI Project (\u201cMeasuring Microfinance Impact in the EU. Policy recommendations for Financial and Social Inclusion\u201d) funded by the EIBURS. It is an attempt to translate microcredit outcome indicators into a social return, quantified in monetary terms. After preliminary focus group analyses and staff interviews, data on outcomes of selected microcredit lines have been collected through a questionnaire administered to the borrowers. By comparing the monetary value of these outcomes (translated into an estimated impact) with the amount of related investment, we find that SROI is greater than 2 for all the credit lines analysed, meaning that every euro invested in microcredit generates at least 2 euros of social return. We also find SROI ranging between 2.33 and 6.97, mirroring the differences between MFIs in terms of target, operating model and country-level financial environment. Although the analysis is conducted on a limited number of cases and SROI calculation can be sharpened, it shows how different factors and outcomes drive the social return generated by microcredit

Hoarding and Emotional Reactivity: The Link Between Negative Emotional Reactions and Hoarding Symptomatology

Hoarding disorder (HD) is characterized by difficulty discarding, clutter, and frequently excessive acquiring. Theories have pointed to intense negative emotional reactions (e.g., sadness) as one factor that may play a critical role in HD\u27s etiology. Preliminary work with an analogue sample indicated that more intense negative emotions following emotional films were linked with greater hoarding symptoms. Symptom provocation imaging studies with HD patients have also found evidence for excessive activation in brain regions implicated in processing emotions. The current study utilized a sample with self-reported serious hoarding difficulties to examine how hoarding symptoms related to both general and hoarding-related emotional reactivity, taking into account the specificity of these relationships. We also examined how two cognitive factors, fear of decision-making and confidence in memory, modified this relationship. 628 participants with self-identified hoarding difficulties completed questionnaires about general emotional reactivity, depression, anxiety, decision-making, and confidence in memory. To assess hoarding-related emotional reactivity, participants reported their emotional reactions when imagining discarding various items. Heightened general emotional reactivity and more intense emotional reactions to imagined discarding were associated with both difficulty discarding and acquisition, but not clutter, controlling for age, gender, and co-occurring mood and anxiety symptoms. Fear of decision-making and confidence in memory interacted with general emotional reactivity to predict hoarding symptoms. These findings provide support for cognitive-behavioral models of hoarding. Experimental research should be conducted to discover whether emotional reactivity increases vulnerability for HD. Future work should also examine whether emotional reactivity should be targeted in interventions for hoarding

Obsessive-compulsive disorder and its related disorders: a reappraisal of obsessive-compulsive spectrum concepts

Obsessive-compulsive disorder (OCD) is a clinical syndrome whose hallmarks are excessive, anxiety-evoking thoughts and compulsive behaviors that are generally recognized as unreasonable, but which cause significant distress and impairment. When these are the exclusive symptoms, they constitute uncomplicated OCD. OCD may also occur in the context of other neuropsychiatric disorders, most commonly other anxiety and mood disorders. The question remains as to whether these combinations of disorders should be regarded as independent, cooccurring disorders or as different manifestations of an incompletely understood constellation of OCD spectrum disorders with a common etiology. Additional considerations are given here to two potential etiology-based subgroups: (i) an environmentally based group in which OCD occurs following apparent causal events such as streptococcal infections, brain injury, or atypical neuroleptic treatment; and (ii) a genomically based group in which OCD is related to chromosomal anomalies or specific genes. Considering the status of current research, the concept of OCD and OCD-related spectrum conditions seems fluid in 2010, and in need of ongoing reappraisal

Progettazione e sintesi di inibitori del recettore dendritico DC-SIGN

Il recettore delle cellule dendritiche DC-SIGN (Dendritic Cell Specific ICAM-3 Grabbing Nonintegrin) riconosce proteine altamente mannosilate o fucosilate alla superficie di molti agenti patogeni, come virus, funghi, batteri e parassiti. Almeno per alcuni di questi agenti, tra cui HIV, l'interazione con DC-SIGN sembra costituire un passaggio importante nella fase di infezione. Di conseguenza questa lectina \ue8 considerata un target interessante per la scoperta di nuovi farmaci antivirali [1]. L\u2019inibizione di DC-SIGN e\u2019 stata realizzata con sistemi multivalenti. In particolare e\u2019 stato dimostrato che polimeri dendrimerici polimannosilati sono inibitori nanomolari dell'infezione mediata da DC-SIGN da parte di modelli del virus Ebola [2,3]. Un problema importante da risolvere \ue8 pero\u2019 la stabilit\ue0 metabolica di queste strutture: esse infatti in vivo possono essere riconosciute e degradate dalle mannosidasi. Un approccio utile per migliorare la resistenza agli enzimi idrolitici prevede di utilizzare, in luogo di carboidrati, dei loro mimici capaci di interagire col recettore, ma stabili alle glicosidasi. In questo poster, descriveremo i nostri progressi nella sintesi di mimici di oligosaccaridi sia mannosilati che fucosilati progettati come potenziali inibitori monovalenti di DC-SIGN e gli studi preliminari che dimostrano la loro interazione con il recettore. Verranno inoltre illustrati i risultati preliminari relativi alla sintesi e caratterizzazione biologica di derivati polivalenti ottenuti in collaborazione con il gruppo del Dr. Javier Rojo presso il CSIC di Siviglia. Riferimenti 1. van Kooyk, Y. et al., Nat. Rev. Immunol., 2003, 3, 697-709. 2. Lasala, F.; Arce, E.; Otero, J. R.; Rojo, J.; Delgado, R. Antimicrob. Agents Chemother. 2003, 47(12), 3970. 3. Rojo, J.; Delgado, R. J. Antimicrob. Chemother. 2004, 54(3), 579

Collagenase clostridium histolyticum for the treatment of Peyronie's disease: a prospective Italian multicentric study

Peyronie's disease (PD) is a common condition which results in penile curvature making sexual intercourse difficult or impossible. Collagenase clostridium histolyticum (CCH) is the first licensed drug for the treatment of PD and is indicated in patients with palpable plaque and curvature deformity of at least 30° of curvature. However, only few monocentric studies are available in the current literature and this is the first national multicentric study focusing on this new treatment. In five Italian centres, 135 patients have completed the treatment with three injections of CCH using Ralph's shortened modified protocol. The protocol consisted of three intralesional injections of CCH (0.9 mg) given at 4-weekly intervals in addiction to a combination of home modelling, stretching and a vacuum device on a daily basis. An improvement in the angle of curvature was recorded in 128/135 patients (94.8%) by a mean (range) of 19.1 (0–40)° or 42.9 (0–67)% from baseline (p < 0.001). There was also a statistically significant improvement in all IIEF and PDQ questionnaires subdomains (p < 0.001 in all subdomains). This prospective multicentric study confirms that the three-injection protocol is effective enough to achieve a good result and to minimize the cost of the treatment