Long-Term Follow-Up of Transsexual Persons Undergoing Sex Reassignment Surgery: Cohort Study in Sweden

CONTEXT: The treatment for transsexualism is sex reassignment, including hormonal treatment and surgery aimed at making the person's body as congruent with the opposite sex as possible. There is a dearth of long term, follow-up studies after sex reassignment. OBJECTIVE: To estimate mortality, morbidity, and criminal rate after surgical sex reassignment of transsexual persons. DESIGN: A population-based matched cohort study. SETTING: Sweden, 1973-2003. PARTICIPANTS: All 324 sex-reassigned persons (191 male-to-females, 133 female-to-males) in Sweden, 1973-2003. Random population controls (10:1) were matched by birth year and birth sex or reassigned (final) sex, respectively. MAIN OUTCOME MEASURES: Hazard ratios (HR) with 95% confidence intervals (CI) for mortality and psychiatric morbidity were obtained with Cox regression models, which were adjusted for immigrant status and psychiatric morbidity prior to sex reassignment (adjusted HR [aHR]). RESULTS: The overall mortality for sex-reassigned persons was higher during follow-up (aHR 2.8; 95% CI 1.8-4.3) than for controls of the same birth sex, particularly death from suicide (aHR 19.1; 95% CI 5.8-62.9). Sex-reassigned persons also had an increased risk for suicide attempts (aHR 4.9; 95% CI 2.9-8.5) and psychiatric inpatient care (aHR 2.8; 95% CI 2.0-3.9). Comparisons with controls matched on reassigned sex yielded similar results. Female-to-males, but not male-to-females, had a higher risk for criminal convictions than their respective birth sex controls. CONCLUSIONS: Persons with transsexualism, after sex reassignment, have considerably higher risks for mortality, suicidal behaviour, and psychiatric morbidity than the general population. Our findings suggest that sex reassignment, although alleviating gender dysphoria, may not suffice as treatment for transsexualism, and should inspire improved psychiatric and somatic care after sex reassignment for this patient group

Chronic Citalopram Administration Causes a Sustained Suppression of Serotonin Synthesis in the Mouse Forebrain

BACKGROUND:Serotonin (5-HT) is a neurotransmitter with important roles in the regulation of neurobehavioral processes, particularly those regulating affect in humans. Drugs that potentiate serotonergic neurotransmission by selectively inhibiting the reuptake of serotonin (SSRIs) are widely used for the treatment of psychiatric disorders. Although the regulation of serotonin synthesis may be an factor in SSRI efficacy, the effect of chronic SSRI administration on 5-HT synthesis is not well understood. Here, we describe effects of chronic administration of the SSRI citalopram (CIT) on 5-HT synthesis and content in the mouse forebrain. METHODOLOGY/PRINCIPAL FINDINGS:Citalopram was administered continuously to adult male C57BL/6J mice via osmotic minipump for 2 days, 14 days or 28 days. Plasma citalopram levels were found to be within the clinical range. 5-HT synthesis was assessed using the decarboxylase inhibition method. Citalopram administration caused a suppression of 5-HT synthesis at all time points. CIT treatment also caused a reduction in forebrain 5-HIAA content. Following chronic CIT treatment, forebrain 5-HT stores were more sensitive to the depleting effects of acute decarboxylase inhibition. CONCLUSIONS/SIGNIFICANCE:Taken together, these results demonstrate that chronic citalopram administration causes a sustained suppression of serotonin synthesis in the mouse forebrain. Furthermore, our results indicate that chronic 5-HT reuptake inhibition renders 5-HT brain stores more sensitive to alterations in serotonin synthesis. These results suggest that the regulation of 5-HT synthesis warrants consideration in efforts to develop novel antidepressant strategies

Surface Energy of Extracted and Non-extracted Norway Spruce Wood Particles Studied by Inverse Gas Chromatography (IGC)

The surface energy of extracted and nonextracted Norway spruce wood particles was studied by means of inverse gas chromatography (IGC). The measurements were performed at infinite-dilution, using a series of dispersive n-alkanes and Lewis acid-base probes. Results from the n-alkane series indicate that the removal of extractives from the spruce wood particles increases their Lifshitz-van der Waals (dispersive) surface free energy component. The interaction process between the acid-base probes and the wood particles is complex and complicates the IGC analysis. The acid-base characteristics are interpreted by comparing the specific interaction between the acid-base probes and the different wood particles at one single temperature. This analysis indicates that the extraction of the spruce wood particles results primarily in increased interaction with predominantly Lewis base probes. In contrast, the extraction results primarily in decreased interaction with predominantly Lewis acid probes. Hence, it is indicated that the wood substance without extractives exhibits greater acidic (electron-accepting) character and less basic (electron-donating) character, than wood substance containing extractives

X-ray computed tomography on chemically modified wood

Mapping and visualization of structural changes due to the modification of wood would increase the understanding of chemical modification processes and facilitate optimization of the process parameters. The 2D and 3D microstructure of acetylated and furfurylated softwood and hardwood were visualized using X-ray computed tomography and some anatomical features were investigated such as total porosity, cell wall thickness and maximum opening of tracheid lumens. The wetting properties of chemically modified samples were related to the microstructural properties. Significant changes in the wood structure were observed for furfurylated sapwood samples mainly indicated by a change in tracheid shape and filling of tracheids by furan polymer, whereas no microstructural changes were noted for acetylated samples. Furfurylation significantly decreased the porosity of the sample in both earlywood and latewood regions; whereas for acetylated samples the total porosity of modified and unmodified samples was rather similar. This is in line with results of wetting showing that furfurylation reduced both swelling and capillary uptake in contrast to acetylation which reduced mostly swelling