A team approach to the indication for gender reassignment surgery in transsexuals resulting in long-term outcome improvement

At the University of Basel (Switzerland), a multidisciplinary team was established for pre-operative selection and treatment of patients with gender dysphoria. As a result, the indications for surgical gender reassignment could be judged with considerably greater accuracy than previously possible. In the 9-year period of this prospective study only 14 of 57 patients with gender dysphoria were selected for surgical treatment. At the time of this survey, six patients are still under psychiatric preoperative evaluation, and six further male-to-female transsexuals are under hormonal treatment awaiting surgery. Following the operation, only one of nine male-to-female patients is socially unstable and that patient's quality of life is worse than prior to gender reassignment. Of the female-to-male transsexuals, all four are stable in their professional and family relations. In conclusion, a comprehensive evaluation of patients with gender dysphoria and the conclusive indications established within the team considerably improved the postoperative outcome of gender reassignmen

Mirroring everyday clinical practice in clinical trial design: a new concept to improve the external validity of randomized double-blind placebo-controlled trials in the pharmacological treatment of major depression

Background: Randomized, double-blind, placebo-controlled trials constitute the gold standard in clinical research when testing the efficacy of new psychopharmacological interventions in the treatment of major depression. However, the blinded use of placebo has been found to influence clinical trial outcomes and may bias patient selection. Discussion: To improve clinical trial design in major depression so as to reflect clinical practice more closely we propose to present patients with a balanced view of the benefits of study participation irrespective of their assignment to placebo or active treatment. In addition every participant should be given the option to finally receive the active medication. A research agenda is outlined to evaluate the impact of the proposed changes on the efficacy of the drug to be evaluated and on the demographic and clinical characteristics of the enrollment fraction with regard to its representativeness of the eligible population. Summary: We propose a list of measures to be taken to improve the external validity of double-blind, placebocontrolled trials in major depression. The recommended changes to clinical trial design may also be relevant for other psychiatric as well as medical disorders in which expectations regarding treatment outcome may affect the outcome itself

Tevatron-for-LHC Report of the QCD Working Group

The experiments at Run 2 of the Tevatron have each accumulated over 1 fb{sup -1} of high-transverse momentum data. Such a dataset allows for the first precision (i.e. comparisons between theory and experiment at the few percent level) tests of QCD at a hadron collider. While the Large Hadron Collider has been designed as a discovery machine, basic QCD analyses will still need to be performed to understand the working environment. The Tevatron-for-LHC workshop was conceived as a communication link to pass on the expertise of the Tevatron and to test new analysis ideas coming from the LHC community. The TeV4LHC QCD Working Group focused on important aspects of QCD at hadron colliders: jet definitions, extraction and use of Parton Distribution Functions, the underlying event, Monte Carlo tunes, and diffractive physics. This report summarizes some of the results achieved during this workshop

The Cyanobacterial Hepatotoxin Microcystin Binds to Proteins and Increases the Fitness of Microcystis under Oxidative Stress Conditions

Microcystins are cyanobacterial toxins that represent a serious threat to drinking water and recreational lakes worldwide. Here, we show that microcystin fulfils an important function within cells of its natural producer Microcystis. The microcystin deficient mutant ΔmcyB showed significant changes in the accumulation of proteins, including several enzymes of the Calvin cycle, phycobiliproteins and two NADPH-dependent reductases. We have discovered that microcystin binds to a number of these proteins in vivo and that the binding is strongly enhanced under high light and oxidative stress conditions. The nature of this binding was studied using extracts of a microcystin-deficient mutant in vitro. The data obtained provided clear evidence for a covalent interaction of the toxin with cysteine residues of proteins. A detailed investigation of one of the binding partners, the large subunit of RubisCO showed a lower susceptibility to proteases in the presence of microcystin in the wild type. Finally, the mutant defective in microcystin production exhibited a clearly increased sensitivity under high light conditions and after hydrogen peroxide treatment. Taken together, our data suggest a protein-modulating role for microcystin within the producing cell, which represents a new addition to the catalogue of functions that have been discussed for microbial secondary metabolites

Development and psychometric properties of the Suicidality:Treatment Occurring in Paediatrics (STOP) Suicidality Assessment Scale (STOP-SAS) in children and adolescents

Background: To create a self-reported, internet-based questionnaire for the assessment of suicide risk in children and adolescents.Methods: As part of the EU project `Suicidality: Treatment Occurring in Paediatrics' (STOP project), we developed web-based Patient Reported Outcome Measures (PROMs) for children and adolescents and for proxy reports by parents and clinicians in order to assess suicidality. Based on a literature review, expert panels and focus groups of patients, we developed the items of the STOP Suicidality Assessment Scale (STOP-SAS) in Spanish and English, translated it into four more languages, and optimized it for web-based presentation using the HealthTracker (TM) platform. Of the total 19 questions developed for the STOP-SAS, four questions that assess low-level suicidality were identified as screening questions (three of them for use with children, and all four for use with adolescents, parents and clinicians). A total of 395 adolescents, 110 children, 637 parents and 716 clinicians completed the questionnaire using the HealthTracker (TM), allowing us to evaluate the internal consistency and convergent validity of the STOP-SAS with the clinician-rated Columbia Suicide Severity Rating Scale (C-SSRS). Validity was also assessed with the receiver operating characteristic (ROC) area of the STOP-SAS with the C-SSRS.Results: The STOP-SAS comprises 19 items in its adolescent, parent, and clinician versions, and 14 items in its children's version. Good internal consistency was found for adolescents (Cronbach's alpha: 0.965), children (Cronbach's alpha: 0.922), parents (Cronbach's alpha: 0.951) and clinicians (Cronbach's alpha: 0.955) versions. A strong correlation was found between the STOP-SAS and the C-SSRS for adolescents (r:0.670), parents (r:0.548), clinicians (r:0.863) and children (r:0.654). The ROC area was good for clinicians' (0.917), adolescents' (0.834) and parents' (0.756) versions but only fair (0.683) for children's version.Conclusions: The STOP-SAS is a comprehensive, web-based PROM developed on the HealthTracker (TM) platform, and co-designed for use by adolescents, children, parents and clinicians. It allows the evaluation of aspects of suicidality and shows good reliability and validity.</p

First update of the living European guideline (EuroGuiDerm) on atopic eczema

First update of the living European guideline (EuroGuiDerm) on atopic eczem

European guideline (EuroGuiDerm) on atopic eczema - part II: non-systemic treatments and treatment recommendations for special AE patient populations.

The evidence- and consensus-based guideline on atopic eczema was developed in accordance with the EuroGuiDerm Guideline and Consensus Statement Development Manual. Four consensus conferences were held between December 2020 and July 2021. Twenty-nine experts (including clinicians and patient representatives) from 12 European countries participated. This second part of the guideline includes recommendations and detailed information on basic therapy with emollients and moisturizers, topical anti-inflammatory treatment, antimicrobial and antipruritic treatment and UV phototherapy. Furthermore, this part of the guideline covers techniques for avoiding provocation factors, as well as dietary interventions, immunotherapy, complementary medicine and educational interventions for patients with atopic eczema and deals with occupational and psychodermatological aspects of the disease. It also contains guidance on treatment for paediatric and adolescent patients and pregnant or breastfeeding women, as well as considerations for patients who want to have a child. A chapter on the patient perspective is also provided. The first part of the guideline, published separately, contains recommendations and guidance on systemic treatment with conventional immunosuppressive drugs, biologics and janus kinase (JAK) inhibitors, as well as information on the scope and purpose of the guideline, and a section on guideline methodology

Deconfining Phase Transition as a Matrix Model of Renormalized Polyakov Loops

We discuss how to extract renormalized from bare Polyakov loops in SU(N) lattice gauge theories at nonzero temperature in four spacetime dimensions. Single loops in an irreducible representation are multiplicatively renormalized without mixing, through a renormalization constant which depends upon both representation and temperature. The values of renormalized loops in the four lowest representations of SU(3) were measured numerically on small, coarse lattices. We find that in magnitude, condensates for the sextet and octet loops are approximately the square of the triplet loop. This agrees with a large $N$ expansion, where factorization implies that the expectation values of loops in adjoint and higher representations are just powers of fundamental and anti-fundamental loops. For three colors, numerically the corrections to the large $N$ relations are greatest for the sextet loop, $\leq 25$; these represent corrections of $\sim 1/N$ for N=3. The values of the renormalized triplet loop can be described by an SU(3) matrix model, with an effective action dominated by the triplet loop. In several ways, the deconfining phase transition for N=3 appears to be like that in the $N=\infty$ matrix model of Gross and Witten.Comment: 24 pages, 7 figures; v2, 27 pages, 12 figures, extended discussion for clarity, results unchange

Gesundheit und Leistungsfähigkeit von Milchkühen im ökologischen Landbau interdisziplinär betrachtet – eine (Interventions-) Studie zu Stoffwechselstörungen und Eutererkrankungen unter Berücksichtigung von Grundfuttererzeugung, Fütterungsmanagement und Tierhaltung

Im Mittelpunkt des Projektes stand die Stoffwechsel- und Eutergesundheit von ökologisch gehaltenen Milchkühen im prä- und peripartalen Zeitraum sowie in den ersten 100 Laktationstagen und deren Beeinflussung durch die Futter- und Nährstoffversorgung und die Haltungsumwelt im umfassenden Sinn. In einer bundesweiten Feldstudie auf 106 ökologisch wirtschaftenden Milchviehbetrieben erfolgten Erhebungen mit dem Ziel einer Risikomodellierung zu Stoffwechsel- und Eutererkrankungen. Vor diesem Hintergrund wurden die Produktionssysteme von der Pflanzenzusammensetzung im Grünland und im Ackerfutter über die Grobfutterproduktion, Futterqualität und Rationsgestaltung, Haltungsumwelt bis hin zur Tiergesundheit und Milchqualität analysiert, um hier einzelbetriebliche Risikoeinschätzungen vorzunehmen, Optimierungspotenziale aufzuzeigen und Handlungsempfehlungen abzuleiten, die anschließend betriebsindividuell implementiert wurden. Die Effektivität des so geschaffenen präventiv orientierten Tiergesundheitsmanagements wurde anhand der Entwicklung ausgewählter Kennzahlen der Euter- und Stoffwechselgesundheit geprüft. Es konnte gezeigt werden, dass sich mit dieser Vorgehensweise auch unter Praxisbedingungen die Tiergesundheitssituation signifikant verbes-sern lässt. Die Feldstudie wurde mit experimentellen Untersuchungen ergänzt, die sich speziellen Fragen der Analyse von nXP in Grasprodukten, des Kraftfuttereinsatzes, der Wahl der geeigneten Rasse, dem Infektionsgeschehen, der Nutzung von Haltungstechniken im Fütterungsmanagement und der Verbesserung der Grasnarbe widmeten. Die im Projekt generierten, aufgrund ihrer Ableitung aus der Praxis widerspruchsarmen Erkenntnisse wurden über vielfältige Formen des Wissenstransfers an die Akteure in der Ökologischen Milchviehhaltung vermittelt. Ein Merkblatt zur Euter- und Stoffwechselgesundheit bei Biomilchkühen und ein modular aufgebautes Wissenstransferkonzept wurden erarbeitet, um die Projektergebnisse nachhaltig nutzen zu können