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1.
Purpose of Review
The study’s purpose was to assess recent findings for the pros and cons of ectopic reservoir placement in the field of penile prostheses.Recent Findings
Recent studies have demonstrated that ectopic reservoir placement is safe and durable when compared to traditional space of Retzius placement. It has also shown marked acceptance among polled implanters. The risk of deep pelvic complications after both placement and removal of ectopic reservoirs appears to be negligible when performed by experienced implanters, even in men who have had major pelvic surgery. The theoretical concerns relating to reservoir palpability and herniation have not been demonstrated in ongoing studies.Summary
Ectopic placement of penile prosthesis reservoirs is emerging as the main stream technique of contemporary prosthetic urology practices.2.
Ara A. Salibian Nathan Levitt Lee C. Zhao Rachel Bluebond-Langner 《Current Sexual Health Reports》2018,10(3):186-195
Purpose of Review
The review is aimed at determining critical factors in the preoperative and postoperative care of transgender patients undergoing gender-affirming surgery. General and procedure-specific considerations are summarized to improve the longitudinal perioperative care of transgender patients.Recent Findings
Surgical providers should follow World Professional Association for Transgender Health (WPATH) guidelines regarding eligibility for surgery. Important elements in preoperative evaluation include mental health screening, fertility discussion, and adjustment of hormone replacement therapy. Postoperative considerations include proper cancer screening, mental health support, appropriate outcomes assessment, and awareness of potential procedure specific complications.Summary
Proper perioperative care for transgender patients undergoing gender-affirming surgery involves a multidisciplinary approach to healthcare to create a comprehensive treatment environment at an institutional level.3.
Michael R. Kauth Janelle Marra Zander Keig Jillian C. Shipherd 《Current Sexual Health Reports》2017,9(3):121-127
Purpose of the Review
Health care for transgender veterans in the United States (U.S.) Veterans Health Administration (VHA) is relatively new and for active duty service members (ADSMs) in the military is quite recent. Prevalence of transgender veterans and ADSMs, health conditions, and healthcare provision in VHA and military facilities are reviewed.Recent Findings
There are approximately 134,300 transgender veterans and 15,000 ADSMs. Based on diagnostic codes, more than 5000 transgender veterans receive care in VHA. Transgender veterans experience higher rates of most mental and physical health conditions compared to non-transgender veterans. Comprehensive health care is provided at VHA facilities, except surgical interventions for gender confirmation, and is beginning to be provided in military facilities.Summary
While VHA and military facilities have increased access to health care for transgender veterans and ADSMs, determining outcomes of care is premature. Healthcare delivery efforts alone are unlikely to erase health disparities experienced by this group.4.
Eric Chung 《Current Sexual Health Reports》2017,9(2):84-89
Purpose of Review
To review the concept of erectile hydraulics and the scientific advances in modern inflatable penile prosthesis implant.Recent Findings
Penile erection requires the presence of nitric oxide, relaxation of the penile vasculature, and engorgement of corpora cavernosa sinusoids. It is generally accepted that the development of erectile dysfunction is frequently attributed to both psychogenic factors as well as physiological alterations in neural, vascular, hormonal and endothelial function. Despite the advent of oral and intracavernosal erectile drugs, penile prosthesis implant remains a relevant and desired option as many men became refractory to medical therapy and/or seek a more effective and permanent solution.Summary
The inflatable penile prosthesis is considered a superior option to malleable prosthesis as it closely replicates a normal penile erection. While the ideal penile prosthesis is probably yet to be developed, scientific advances in prosthesis design, device technology, and surgical techniques have made the penile prosthesis more natural, durable and reliable device.5.
Purpose of Review
The goal of this paper is to give current understanding of non-binary/genderqueer identities, non-binary mental health trends and identity development, unique experiences of non-binary individuals, and recommendations for clinicians and researchers.Recent Findings
About one third of individuals who identify as transgender primarily identify as non-binary. Recent studies found that non-binary people are at higher risk for suicide, experience more psychological distress, and experience higher levels of depression and anxiety. New studies on identity development of non-binary individuals provide explicit and fluid understandings of gender identity development outside of male/female, man/woman, and boy/girl.Summary
Overall, little research is focused on non-binary individuals even though non-binary people make up a significant portion of the transgender community and experience even greater negative mental health risks. Non-binary people face several challenges in a society that is structured around binary gender identities. We encourage psychologists to challenge the dominant binary assumption about gender and create environments that include and affirm non-binary individuals.6.
Background
The origin of worm-like bodies and their relationship with Birbeck granules is poorly understood.Objectives
To clarify the origin of worm-like bodies and their relationship with Birbeck granules.Materials and methods
Over 800 electron micrographs of histiocytic disorders and several appendage tumours were reviewed in order to check for worm-like bodies and Birbeck granules.Results
Worm-like bodies were most often encountered in mildly-to moderately-proliferative histiocytic tumours. Birbeck granules were observed in more malignant conditions. Narrow endoplasmic reticulum (Nrer), which resembles worm-like bodies, was abundant in worm-like body-rich cells and coexisted with Birbeck rods. Nrer is thought to be one of the candidates that gives rise to worm-like bodies. An ultrastructural similarity exists between worm-like bodies (and octopus body formation) and the so-called “lupus erythematosus virus”.Conclusion
The presence of Nrer is often concomitant with other organelle markers, and could be a candidate for the origin of worm-like bodies.7.
Background
Atopic dermatitis is a chronic disabling inflammatory skin disorder, typically characterized by intensely itching, oozing, crusted, eroded vesicles or papules developing on erythematous plaques. Conventional treatments, both topical and systemic, may produce unsuccessful and unsatisfactory results.Objectives
we aimed to assess the efficacy of apheretic treatments in patients with severe, recalcitrant AD, in particular, the pruritic component.Patients and methods
four patients affected by recalcitrant and debilitating atopic dermatitis, who had previously received conventional topical and systemic therapies with poor clinical improvement, were treated with extracorporeal photopheresis or therapeutic plasma exchange.Results
a satisfactory response to apheresis was observed with a reduction of pruritus and skin lesions.Conclusion
In our experience, apheretic therapies might be used as monotherapy but, more effectively, in combination with topical and/or systemic treatments. Indeed, they proved to be a safe “enhancer” for increasing the efficacy of conventional therapeutics.8.
Richard Green 《Current Sexual Health Reports》2017,9(2):79-83
Purpose of Review
Review evidence in the controversial management of prepubertal gender dysphoric children where some clinicians and parents advocate transition to live as a child of the non-natal sex.Recent Findings
Earlier reports, primarily of males, demonstrated that most cross-gender behaving children, with what was called Gender Identity Disorder, matured into gay or lesbian adults, and only a small minority were transgender. However, recent practice by some clinicians advocates gender transition for prepubertal children believed to be sufficiently gender dysphoric to live as the non-natal sex. Can the subgroups be distinguished for this decision to be made? Can clinical judgment result in short term and longer term benefit to those who transition? Are there risks to facilitating gender transition as well as efforts to promote more comfort with natal sex?Summary
Many unknowns pervade the advocacy of transitioning prepubertal gender dysphoric children and the advocacy of promoting more comfort with natal sex. Complex research designs will help answer these questions.9.
Purpose of Review
Sexual and gender minority (SGM) populations, including lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals, continue to experience significant health and healthcare disparities. One mechanism proposed to address these disparities is improving the education of healthcare professionals. This narrative review summarizes recent trends specifically in medical education related to LGBTQ/SGM populations and highlights examples of curricular innovations.Recent Findings
Efforts are described in all levels of medical education. The predominant contributions to literature include documenting the current state of education and patient care, including further defining gaps. There are many reports of educational efforts in various institutions, with reports of outcomes mostly in the domain of activity acceptability and learner self-efficacy. Interventions have been developed by both faculty and learners with broad acceptability and perceived value.Summary
Existing publications continue to point out needed research in LGBTQ/SGM medical education. We also identify areas for additional innovation efforts.10.
Background
Acne is a chronic inflammatory disease associated with scar development in many patients.Objectives
To check whether early inflammatory events in the epidermis via keratinocytes influence the development of scars in acne patients.Methods
We investigated several immunological markers involved in epidermal innate immunity in both clinically normal skin and inflammatory early papules in acne patients prone to scars or not.Results
In normal skin of acne patients prone to scars vs not prone to scars, TLR-4, IL-2, IL-10, TIMP-2 and JUN were significantly overexpressed and the MMP-9 protein level was decreased. Similar results were obtained in early inflammatory papules (no more than three days), except for TLR-4.Conclusion
These results suggest for the first time a link between the early events of inflammation with levels of activation of innate immunity in normal epidermis of acne patients and the development of scars. These markers could be a target for drugs in the field of scar prevention.11.
Amy L. Gower G. Nic Rider Barbara J. McMorris Marla E. Eisenberg 《Current Sexual Health Reports》2018,10(4):246-254
Purpose of Review
This paper examines recent research on bullying victimization among lesbian, gay, bisexual, transgender, and queer (LGBTQ) youth to identify critical issues and advocate for future research priorities.Recent Findings
Recent studies have begun to document the importance of bullying in general, and bias-based bullying (rooted in stigma) in particular, on the health and well-being of this vulnerable subgroup of adolescents, as well as drivers of disparities. Current research demonstrates the importance of multiple, overlapping identities, key difference among LGBTQ youth, and the role of protective factors for youth who are the targets of bullying.Summary
Researchers, clinicians, and those working with and on behalf of LGBTQ youth must measure and acknowledge the multiple reasons for which LGBTQ youth are the targets of bullying. Intervention and prevention efforts should focus on improving the supportiveness of the climates within which LGBTQ youth live.12.
Objective
A meta-analysis of 3 major German studies conducted between 1989 and 1994 with cyclosporine in severe psoriasis was performed to allow an integrated evaluation of the efficacy and tolerability of cyclosporine in this indication.Design and Setting
All 3 studies were prospective, randomized, parallel group studies. The studies were conducted in 61 dermatologic centers in Germany.Patients and Interventions
The studies involved 597 patients with severe plaque type psoriasis. Treatment consisted of cyclosporine (at a dosage of 1.25, 2.5 or 5 mg/kg/day), etretinate (at a mean daily dose of 0.53 mg/kg/day) or placebo in a total of 756 treatment cycles with a maximum duration of 12 weeks.Main outcome measures: The main outcome measures were the psoriasis area and severity index (PASI) and
serum creatinine level.Results
The meta-analysis revealed that cyclosporine given in a dosage of 2.5 and 5 mg/kg/day was significantly superior to etretinate. In addition cyclosporine 1.25 mg/kg/day proved to be significantly more effective than placebo. An increase in serum creatinine level that required intervention occurred in 3.4% of cyclosporine treatment cycles.Conclusion
Cyclosporine is highly effective and well tolerated in the short term treatment of severe psoriasis.13.
Background
Topical administration of ketoprofen to treat local subcutaneous pain significantly reduces gastrointestinal and cardiovascular adverse effects associated with oral delivery. However, this benefit must be weighed against the risk of photosensitisation/phototoxicity.Objective
To substantiate the safety and efficacy of topical ketoprofen delivery from a patch.Methods
Experiments were performed, and published information analysed, (a) to confirm the superior skin permeability and pharmacological activity of ketoprofen, and (b) to demonstrate the lower incidence of ketoprofen photosensitisation/phototoxicity when delivered from a topical patch.Results
Ketoprofen’s photodegradation products were more photoallergic than the drug itself. The period postketoprofen treatment that skin should be protected from UV radiation (while the drug is cleared from the application site) was estimated.Conclusions
Photosensitisation to ketoprofen can be mitigated by a patch formulation, which protects the drug from direct UV exposure during skin application, and reduces the formation of even more photoallergic photodegradation products.14.
Background
Peripheral T-cell lymphomas, not otherwise specified (PTCL-NOS), are a rare condition characterised by specific histology, nodal presentation, and a poor prognosis. In total, 10-18% of patients present with cutaneous involvement which is regarded as a poor prognostic marker. However, cutaneous PTCL-NOS lesions have been rarely reported in the literature.Objectives
We sought to describe PTCLNOS cases characterised by erythrodermic dissemination to the skin.Materials & methods
Three cases of PTCL-NOS were investigated; all male, with a mean and median age of 55 and 51 years, respectively.Results
All patients underwent aggressive chemotherapeutic protocols with only transient improvement of the disease, and died within two years of follow-up.Conclusions
Dermatologists should be reminded that erythroderma and lymph node enlargement do not represent an exclusive paradigm for erythrodermic cutaneous T-cell lymphoma, and that these features can be due to a systemic lymphoma that should be considered in the differential diagnosis.15.
Background
Low grade inflammation is associated with both chronic spontaneous urticaria (CSU) and atherosclerosis. Data regarding an association between urticarial inflammation and atherosclerosis and subsequent cardiovascular events are scarce. It has been demonstrated that matrix GLA protein (MGP), a biomarker of arterial calcification, is increased in patients with atherosclerosis.Objectives
To evaluate circulating levels of markers of arterial calcification and acute phase response (APR) in patients with CSU.Methods
Concentrations of MGP and IL-6 were measured in venous blood samples of patients with long-lasting moderate-severe CSU.Results
There were no significant differences in serum MGP concentration between healthy subjects and CU patients. Serum IL-6 concentration was significantly higher in CSU patients as compared with healthy subjects.Conclusions
The results confirm that CSU is accompanied by a low grade systemic inflammatory state. However, the long lasting urticarial inflammation was not paralleled by an increased circulating level of the calcification marker matrix Gla protein.16.
Background
MicroRNA levels in sera or hair may potentially be useful biomarkers for various diseases. The diagnosis of nail diseases is sometimes difficult, and nail psoriasis without skin lesions is indistinguishable from nail changes caused by other diseases.Objectives
We evaluated nail microRNA levels as biomarkers for the diagnosis of psoriasis patients.Materials & methods
MicroRNA levels were examined in psoriasis patients with (11 patients) and without (six patients) nail changes. Normal control nails were collected from 17 healthy subjects. Eight patients with other diseases who also had nail changes were also included as disease controls.Results
Microarray, real-time PCR, and in situ hybridisation indicated that the expression levels of nail miR- 4454 were decreased in psoriasis patients with nail changes, compared to those patients with other diseases involving nail change, or healthy subjects. The miR-4454 levels in nails showed a significant inverse correlation with the Nail Psoriasis Severity Index (NAPSI) score, suggesting that nail miR-4454 levels reflect nail condition.Conclusion
The levels of microRNAs in nails may be suitable biomarkers for diagnosis or evaluation of disease activity of psoriasis.17.
Florence?Hacard Clemmie?Martin Virginie?Verdu Arlette?Montagnon Frédéric?Augey Marion?Braire-Bourrel Jean-Fran?ois?Nicolas Frédéric?Berard Audrey?Nosbaum
Background
Therapeutic patient education (TPE) allows patients to better understand their disease and cope with treatment. TPE programmes have not yet been evaluated for chronic spontaneous urticaria (CSU).Objectives
To investigate the cognitive and behavioural impact of TPE on CSU patients.Materials and methods
CSU patients were selected who completed a TPE programme. A pre-post comparison was performed using a skill/knowledge questionnaire, based on six educational objectives, before and after the intervention. The course of CSU was also analysed, according to daily hive count and itch intensity.Results
All of the 61 enrolled patients improved their knowledge and skills following TPE, with greatest improvement in itch management and use of alternatives to scratching. CSU activity was reduced at the end of the programme in 60% of patients.Conclusions
TPE improves knowledge and skills for CSU patients. Further research is needed to demonstrate the positive impact of TPE on CSU activity.18.
Background
With increasing pressure on health care resources, it is necessary to demonstrate that new treatments are both effective and cost effective.Objective
The purpose of this study was to assess the cost effectiveness of pimecrolimus (Elidel) compared to usual therapy in the treatment of both adults and children with atopic eczema in Canada.Methods
Analysis was performed using a decision model which estimated the incremental cost per quality adjusted life year (QALY) gained from both a societal and health care perspective.Results
For children, Elidel leads an incremental cost per QALY of $38,000 from a societal perspective. For adults, the incremental cost per QALY was $35,000.Conclusion
Elidel will lead to an overall increase in costs but with an improvement in clinical outcomes. The cost effectiveness ratios for Elidel were consistently below $50,000 per QALY gained. Given previous funding decisions in Canada, Elidel may be considered a cost-effective use of health care resources.19.
Background
Primary angiosarcoma of the breast is a rare malignant tumour that presents in young women as a painless mass or a sensation of fullness in the breast.Objectives
To report two cases of primary breast angiosarcoma presenting with unusual and misleading cutaneous lesions.Materials and methods
A clinical investigation including ultrasound, MRI and histological examination.Results
In the first patient, the lesion appeared as a superficial, acquired angioma; in the second as an indolent superficial haematoma.Conclusion
This type of primary presentation is exceptional and the benign appearance of the lesion, combined with a lack of breast mass, is misleading. The benign appearance and the pathological aspect of these lesions can lead to misdiagnosis. Comparison of clinical and pathological data is necessary to prevent delay in diagnosis. We believe that all acquired angiomatous lesions developing on the breasts of young women should raise suspicion of angiosarcoma.20.