Gender Differences in the Electrophysiological Characteristics of Atrioventricular Conduction System and their Clinical Implications

Objective - The underlying mechanisms of the differences in sex distribution of patients with atrioventricular (AV) nodal re-entrant tachycardia and Wolff-Parkinson-White syndrome are poorly understood. The objective of this study was to determine potential gender differences in the electrophysiological properties of the normal AV conduction system that may be attributable to differences in sex distribution. Design - The AV conduction properties were studied in 96 patients (52 men and 44 women) who underwent electrophysiological testing, 32 patients with atrial tachycardia, 39 with idiopathic ventricular tachycardia and 25 with unexplained palpitations or syncope. Results - The AH (83 &#45 15 ms) and His-ventricular intervals in men (42 &#45 6 ms) were significantly longer than in women (78 &#45 14, 38 &#45 6 ms, p < 0.05, respectively), as was the PR interval (160 &#45 17 vs 152 &#45 13 ms, p = 0.02). The effective refractory period of AV node in men (349 &#45 75 ms) was longer than in women (297 &#45 45 ms, p = 0.03). However, no significant difference was observed between men and women with respect to the incidence of AV nodal dual pathway and the maximum AH interval achieved during premature stimulation or incremental pacing. The AV block cycle length was significantly longer in men (371 &#45 76 ms) than in women (330 &#45 52 ms, p = 0.02). A longer ventriculoatrial block cycle length was also found in men than in women although not at a significant level (436 &#45 107 vs 384 &#45 90 ms, p = 0.08). In addition, men (23%) were twice as likely to have ventriculoatrial dissociation during ventricular pacing as women were (11%, p = 0.2). Conclusion - The data show that gender-related differences in AV conduction properties may be responsible for the differences in sex distribution observed in patients with AV nodal re-entrant tachycardia and those with ventricular pre-excitation.     

Comparison of Exeter stem offset size for total hip arthroplasty between males and females: A retrospective series of 780 hips

BackgroundMany orthopaedic surgeons use a ‘standard’ stem offset length, typically 37.5 mm and 44 mm for females and males respectively, in total hip arthroplasty. With increasingly personalized surgery, ‘standard’ one-size-fits-all stem lengths may be outdated. This study aims to test whether pre-operative templating affects stem length choice and whether ‘standard’ stem sizes are therefore outdated.MethodsWe performed a retrospective chart review of all total hip arthroplasty patients using Stryker's Exeter cemented femoral hip system in our centre between 2016 and 2020. Demographic and surgical data were collected. Data from surgeons who templated pre-operatively were compared to data from those who did not.Results780 patients were included (309 male, 471 female), average age 71.4 years (range 23–96). We found a significant difference between male and female offset lengths; more males had an offset length of 44 mm and more females had an offset length of 37.5 mm (p = 0.004). Among surgeons who did not template pre-operatively, 20.6% of female patients and 10.3% of male patients had other ‘non-standard’ offset lengths. Among surgeons who did template pre-operatively, the proportion of both female and male patients who had other ‘non-standard’ offset lengths was significantly higher (43.1% and 23.4%, respectively p < 0.05)ConclusionsThe difference between templating and non-templating surgeons' stem choice revealed significant individual variability between males and females. ‘Standard’ offset lengths for males and females were still used in the majority of our cohort. However, with the emergence of mainstream robotic arthroplasty, we feel that pre-operative templating has become a minimum standard.     

Dominance and gender in the physician-patient interaction

The goal of this review is to show that physician-patient interactions differ in the degree of dominance asymmetry between the physician and the patient, that physician's dominance behavior is related to negative patient outcomes, and that physician gender affects how physician dominance is perceived by patients. The article provides (1) an overview of existing findings on dominance in the physician-patient interaction, (2) a summary of gender differences in dominance with an emphasis on the physician-patient interaction, and (3) an explanation on why it might be more important for women doctors than for men doctors to adhere to a non-dominant interaction style.     

Gender Imbalance and Outcomes in Living Donor Renal Transplantation in The United States

In living donor kidney transplantation there are disproportionately more female-to-male donations and fewer male-to-female donations. Given the rapid increase in living donor transplantation, we studied gender demographics and outcomes of these transplants. We analyzed living donor kidney transplants in the Scientific Registry of Transplant Recipients (SRTR) database between 1990 and 1999. There were 30 258 living donor transplants [26 510 (87%) biologically related; 2367 (8%) spousal; 1381 (5%) nonspousal unrelated]. Females comprised 68% of spousal and 56% of related and unrelated nonspousal donors (p < 0.0001). The distributions of gender pairings in nonspousal groups (related and unrelated) were significantly imbalanced (p < 0.0001). Opposite-sex pairs demonstrated more female-to-male donations among living related (64%, p < 0.0001), unrelated nonspousal (65%, p < 0.0001), and spousal pairs (68%). The higher incidence of end-stage renal disease among males and the slight predominance of females in the general population did not explain these gender disparities. Male recipients of male donor kidneys demonstrated significantly higher graft survival than other combinations (p < 0.006). Gender disparities in living donor transplantation result from a higher proportion of wife-to-husband donations and disproportionate female-to-male donations among biological relatives and unrelated pairs. There appears to be a graft survival advantage for male recipients of male donor kidneys.     

Conference proceeding from the 50th Annual Meeting of the Canadian Association of Paediatric Surgeons: “CAPS Serving Canada – Gender,Diversity, and CAPS”

Gender and diversity in the workforce are hot topics in both the public and professional spheres. Medicine has not been immune to these discussions, with many recent publications highlighting the lack of equal representation of women and minorities within medicine and surgery. This paper will review the history and current state of gender and minority representation in the Canadian Association of Pediatric Surgeons (CAPS) as presented at the 50th Annual Meeting of CAPS in September 2018 in Toronto, Ontario, Canada.     

Surgical Reconstruction for Male-to-Female Sex Reassignment

Background

The primary challenge of male-to-female reassignment surgery is to create natural-appearing female genitalia with neovaginal dimensions adequate for intercourse, neoclitoris sensitivity, and minimal risk of complications. Surgical positioning is an important component of the procedure that successfully minimizes the risk of morbidity.

Objective

We modified various vaginoplasty techniques to better position the urethral neomeatus in the proper anatomic location to minimize the chance for complications and enhance aesthetic satisfaction.

Design, setting, and participants

We retrospectively reviewed data stored in a prospective database for 24 consecutive patients who underwent male-to-female gender reassignment at a German university clinic between January 2007 and March 2011.

Surgical procedure

First, orchiectomy and penile disassembly are performed with the patient in the supine position. Both corpora cavernosa are resected with the patient in the lithotomy position, and neovaginal construction is accomplished with the incorporation of the penile urethra into the penile shaft skin. The glans is preserved and resized to form the neoclitoris. The assembled neovagina is inverted, inserted into the expanded rectoprostatic space, and secured to the sacrospinous ligament. Scrotal skin is tailored to create the labia.

Outcome measurements and statistical analysis

Complications and patient satisfaction with neovaginal depth, appearance, neoclitoral sensation, and capacity for sexual intercourse were evaluated.

Results and limitations

The mean neovaginal depth was 11 cm (range: 10–14 cm); median follow-up was 39.7 mo (range: 19–69 mo). All patients reported satisfactory vaginal functionality. One patient noted stenosis after 4 yr that was histologically confirmed as lichen sclerosus. Neoclitoral sensation was good or excellent in 97% of patients; 33% reported regular intercourse. No major complications were observed. Because this is a retrospective review to describe a complex reconstructive surgery and illustrate these techniques in the accompanying intraoperative surgery-in-motion video, no control group was undertaken.

Conclusions

Gender reassignment can be performed with minimal complications using penile skin with incorporated penile urethra and intraoperative repositioning of the patient to achieve adequate neovaginal dimensions for intercourse and neoclitoral sensation.     

Classification and guidelines of hemorrhoidal disease: Present and future

Classification and guidelines of hemorrhoidal disease are based on the subdivision in Grades of prolapse followed by any aspect related to both the treatment and its technique. When taking the proposals for classification and guidelines issued by prolific scientific societies into consideration, it is evident that strong contradictions and interpretative limits emerge in finding the best treatment to be adopted. After a critical examination of these limitations, a methodological proposal is shared to achieve a new classification, which plays a part in forming a new guideline for hemorrhoidal disease, identifying its evolution, dynamism of the prolapse, symptomatology, enteropathogenesis and gender characteristics.     

Gender diversity in chiropractic leadership: a cross-sectional study

BackgroundThe purpose of this cross-sectional study was to compare the number of males and females in leadership positions, and whether there is a relationship between gender and degrees held in those positions, within chiropractic academic institutions, national regulatory bodies and the most widely representative national professional associations in the United States and Canada.MethodsPublicly accessible websites from chiropractic institutions and organizations were used to collect data. Pearson χ² tests of independence were conducted to determine the relationship between gender (male vs. female) and other variables, including position (principal vs secondary), and chiropractic and other advanced professional degrees.ResultsA total of 107 leaders were identified across institutions and organizations. Under one-third of leaders (30.8%) were identified as female. Males were more likely to be in principal leadership roles (86.2%) and more likely to be in a secondary leadership position (62.8%).ConclusionMale leaders significantly outnumber female leaders in both principal and secondary leadership positions within American and Canadian chiropractic institutions. Strategies should be developed to include gender diversity within all chiropractic organizations.     

Prognostic factors in young women with cutaneous melanoma

BackgroundGender is an established prognostic factor in cutaneous melanoma; women as a group have a better overall prognosis than men. However, the investigators hypothesized that melanoma in young women may have distinct clinicopathologic features and biologic behavior compared with melanoma in older women, possibly related to tanning bed use and excessive acute episodes of sun exposure.MethodsA retrospective analysis was performed of a large multicenter study that accrued patients between 1996 and 2003 and included patients aged 18 to 70 years with cutaneous melanoma ≥1 mm Breslow thickness and no evidence of regional or distant metastatic disease. All women with follow-up data were included. Univariate and multivariate analyses as well as Kaplan-Meier (KM) analysis were performed to test for differences in clinicopathologic variables, disease-free survival (DFS), and overall survival (OS) between female patients ≤40 and >40 years of age.ResultsA total of 1,056 female patients were divided into 2 groups: those >40 years of age (n = 757 [71.7%]) and those ≤40 years of age (n = 299 [28.3%]). Overall, there were no differences in Breslow thickness, ulceration, or sentinel lymph node status between groups. Compared with older women, younger women were more likely to have truncal melanomas (39.5% vs 29.5%, P = .0017) and less likely to have regression of the primary tumor (6.4% vs 11.5%, P = .0208). The mean number of sentinel lymph nodes removed was 2.82 for younger women and 2.29 for older women (P < .0001). Multivariate analysis revealed that Breslow thickness, ulceration, and tumor-positive sentinel lymph node were associated with worse DFS in both the younger and older groups; truncal location was associated with worse DFS in the younger group only. The same factors were predictive of OS in both groups, except that ulceration was not significant in the younger patient group. In the younger patient group, the 5-year KM DFS rates were 78.1% for truncal melanomas and 92.5% for nontruncal melanoma locations (P = .0009); the corresponding 5-year KM OS rates were 76.6% and 93.9% (P = .0003). In the older patient group, the 5-year KM DFS rates were 84.1% for truncal and 82.8% for nontruncal melanomas (P = NS), and the corresponding 5-year KM OS rates were 81.6% and 87.5% (P = .0049).ConclusionsAlthough women with cutaneous melanoma tend to have a better prognosis than men, women ≤40 years of age with primary melanoma of the trunk may represent a subgroup at higher risk for disease recurrence and metastasis.     

The impact of gendered experiences on female medical students’ specialty choice: A systematic review

BackgroundWomen make up 50% of American medical school graduates, yet are not equally represented in the vast spectrum of medical specialties. Many fields within medicine remain male dominated. This systematic review will explore social factors that affect female medical students’ specialty choice.HypothesisGendered experiences influence the specialty choice of female medical students, resulting in their concentration in a specific cohort of specialties.MethodsStudies were gathered by searching MEDLINE/Pubmed and EBSCOhost for sociological factors that impact female medical students’ specialty choice.Results34 articles were selected for this systematic review. Factors that contribute to gender segregation within medical specialties include gender discrimination, socialization, lifestyle considerations, negative perceptions of male-dominated medical specialties and lack of female role models.ConclusionThis systematic review supported the hypothesis that gendered experiences impact women's medical specialty choice, and thus result in their concentration in specialties such as family medicine, pediatrics and obstetrics and gynecology.     

Gender Differences in Early Outcomes Following Hand-Assisted Laparoscopic Roux-en-Y Gastric Bypass Surgery

Background Male gender has been associated with a higher morbidity and mortality rate after bariatric surgery including laparoscopic and open procedures. This study focused on hand-assisted laparoscopic Roux-en-Y gastric bypass and morbidity and mortality among genders. Methods Hand-assisted laparoscopic Roux-en-Y gastric bypass operations (N = 319) were evaluated from October 2003 to March 2006. Comparison between males (N = 54) and females (N = 265) were conducted using t test or Fishers exact test and chi-square analysis. Results Patients’ average age was 42.3 ± 10.3 and the average body mass index (BMI) was 49.2 ± 7.9. There was no significant difference between males and females in age or BMI. Males had a significantly greater average weight than females (p < 0.001) and were significantly more likely to experience sleep apnea (p = 0.006) and have heart disease (p = 0.017). For operative risk factors, males had a significantly longer anesthesia time (p = 0.003), operative time (p = 0.027), and length of roux limb (p = 0.038). At 6 and 12 months postsurgery, there was no significant difference between males and females with complications. Although BMI did not differ significantly, males continued to weigh significantly more than females and lost significantly more pounds than did females at both 6 and 12 months postoperation. Conclusion Given their larger size and tendency to accumulate fat in the abdominal compartment that increases the technical difficulty of the procedure, males are historically associated with a higher morbidity and mortality following bariatric surgery. Based on the current study, however, there is no difference in outcome among genders following hand-assisted laparoscopic Roux-en-Y gastric bypass.     

Of mice and men: pathophysiology of male osteoporosis

In both old and young men osteoporosis is a severe but frequently neglected condition. This review deals with the multifactorial pathogenesis of impaired bone strength in men. Male bones are not only influenced by androgens, but, somewhat surprisingly – according to the current state of knowledge –female sex hormones may be the major players in calcified tissue remodelling. As a matter of principle, gender shapes bone geometry on a life-long basis. In men, age-dependant bone loss is outweighed by increased periosteal apposition. Contrary to women, the male gender-specific resorption pattern is mainly based on trabecular thinning. Therefore the connectivity remains rather intact, which again positively influences the biomechanical tissue properties and the resistance to fractures. Since affected patients often present with a family history of fractures or low bone density, the genetics of male osteoporosis is one of the main fields of interest in current bone research. Several gene polymorphisms involving the α1 chain of type 1 collagen (COLIA-1), aromatase, vitamin D receptor (VDR), low-density lipoprotein receptor-related protein 5 (LPR5) and the lactase phlorizin hydrolase (LCT) have recently been described. But apart from such exciting research novelties, the classical every-day violaters of both male and female bone health (vitamin D deficiency, low calcium intake and inadequate life-style) must still be taken into account.     

Aide entre conjoints. Dynamiques de genre dans les couples adultes avec handicap

Family care for disabled adults is more often provided by women, but spousal care more often by men. Hands-on care is equally provided by male and female spouses, but care for daily life is provided twice as much by male than by female spouses. The article describes and tries to explain this paradox. Three hypotheses have been explored: gender differences in disability prevalence; gender differences in couple life with equivalent disability; gender differences in spousal care for disabled people living in couples. The study is limited to the adult population, i.e. to disabled people of 18–59 years old. Data come from the French HSM-HAS Health Survey (INSEE, 2008). Results show gender similarities in disability prevalence, in couple life and in hands-on care. Care in daily life, on the contrary, is much more provided by male spouses, even after controlling for disability characteristics. Especially women with few restrictions get more help from their male spouse than men in the same situation. The difference seems to be more related to the initial gender division of activities than to gendered willingness for care when disability arrives. Domestic activities can be taken over by a household member, professional activities cannot. It is not disability but preexisting division of activities that create differences in spousal care.     

Gender differences as an influence on patients’ satisfaction rates in spinal surgery of elderly patients

There is an increased rate of lumbar spinal operations in elderly patients due to lumbar spinal stenosis. Many factors affect the decision of the patient and surgeon to perform the operation, among which are the age of the patient, comorbidities and willingness to undergo surgery. However, the gender of the patient is rarely taken into consideration as a factor for performing the operation. The satisfaction of the patient is an important factor to assess the operative success retrospectively. Therefore, we assessed the differences caused by gender on the satisfaction of elderly patients following lumbar spinal surgery. Three hundred and sixty-seven elderly patients (>65 years) treated in our institution from 1990 to 2000 for lumbar spinal stenosis and who underwent laminectomy without fusion filled in a questionnaire prior to operation regarding their gender, demographic status, comorbidities, activities of daily living (ADL) using the Barthel index, and pain according to visual analogue scale. At follow-up, a telephone interview on 298 patients was structured and included the same pre-operative questions and additional questions regarding the satisfaction rate from surgery.Two hundred and ninety-eight patients responded to our telephone interview with a minimum follow-up of 1 year (mean: 64 months). After surgery, both women and men showed improvement in their ADL, and reduction in pain perception. The number of very satisfied patients was similar in both groups, but women were significantly more dissatisfied with the operation. The surgical parameters, including complications, did not differ between the groups. Gender differences were found to influence the satisfaction rate of lumbar spinal stenosis surgery. Women tend to have less satisfactory results than men. The reasons for that are probably multifactorial and are not related to the surgery per se.