Medial malleolus malunion with secondary tibiotalar and syndesmotic incongruence - two case reports and «box resection¼ for its treatment / Mal unión del maléolo medial con incongruencia tibiotalar y sindesmótica: «resección en caja¼ para su tratamiento

Abstract: Introduction: Ankle fractures are among the most common injuries treated by orthopaedic surgeons. Malunion is one of the possible complications, and corrective surgery is often used to avoid long-term disability. However, few studies address medial malleolus malunion and the best revision surgery technique is controversial. We describe a new surgical technique, the «box resection¼. Material and methods: We present two cases of medial malleolus malunion with secondary talus lateral translation and syndesmotic incongruence. In order to restore a congruent tibiotalar joint, we performed the described technique. Results: We record significant improvement of AOFAS Score and range of motion in both cases, with resolution of pain symptoms. Postoperative radiographs show a congruent mortise with syndesmosis reduction. Conclusion: The box resection allowed immediate talus medial translation to its original position. It is a simple and effective solution, with a good functional outcome.

Resumen: Introducción: La consolidación viciosa del maléolo interno es una posible complicación en las fracturas maleolares. Su tratamiento es difícil y controvertido, por el momento no hay una solución estándar. Proponemos una nueva técnica quirúrgica para el tratamiento de estos casos que denominamos «resección en caja¼. Material y métodos: Presentamos dos casos de consolidación viciosa del maléolo interno, asociados con traslación lateral del astrágalo y incongruencia de la sindesmosis, donde aplicamos la técnica quirúrgica descrita. Resultados: En ambos casos, obtuvimos una mejora significativa en el puntaje AOFAS y en el rango de movilidad, así como en la resolución de las molestias por dolor. Las radiografías muestran mortajas congruentes y anatómicas, con una reducción satisfactoria de la sindesmosis. Conclusión: La técnica de «resección en caja¼ es simple y eficaz produciendo un buen resultado clínico y funcional.

Fronto-Temporal N200 Event-Related Component in Dyslexic Malay Children During Audio–Visual Paired Stimuli

@#Introduction: Shifted attention can be studied in paired stimuli using different experimental paradigms. Pre-existing literatures showed that children with dyslexia have difficulty in learning. Hence, there might be a relationship between learning difficulty and shifted attention. We investigated shifted attention and topographic distribution of the N200 component using audio–visual paired stimuli in an event-related potential (ERP) study among dyslexic Malay children. Methods: A 128 ERP net designed for children was used for the study. A total of 24 age-matched children were divided into control (n=12) and dyslexic (n=12) groups. A modified audio–visual paired stimuli paradigm was used for the ERP study. Congruent (animal-matched sound) and incongruent (animal-not matched sound) stimuli were used. All participants were instructed to press key ‘1’ and ‘2’ when congruent and incongruent stimuli are presented, respectively. Amplitudes and latencies of the N200 ERP component were analysed at 19 electrode locations in the 10-20 system. A topographic map was analysed for the N200 component for both groups. Results: There was no significant differences in the N200 amplitudes and latencies between children with dyslexia and control children at any sites. The topographic map distribution revealed that the dyslexic group had right frontal and left temporal N200 voltage distribution during the incongruent stimuli. Conclusion: We conclude that Malay children with dyslexia have no difficulties/intact in shifted attention. Moreover, children with dyslexia have diverted left temporal areas during auditory sound attention.

A Preliminary Survey on Clinical Practice for Children and Adolescents with Gender Dysphoria in Japan: Current Situation and Challenges

Little is known about the treatment of gender dysphoria among children and adolescents in Japan. This preliminary survey aims to improve understanding of current clinical practice for treatment of children with gender dysphoria. Subjects were 315 certified child and adolescent psychiatrists in Japan. The questionnaire asked about clinical experiences concerning gender dysphoria and gender identity-related concerns. A total of 128 psychiatrists responded to the questionnaire. Mean length of clinical experience was 24.2±10.0 years in total and 16.9±11.5 years as child and adolescent psychiatry specialists. Among the respondents, 74 (57.8%) had seen children and adolescents with DSM-5 gender dysphoria, and 87 (67.7%) had examined cases with gender identity-related concerns. The mean number of experienced cases with gender dysphoria was 1.80±2.3 per respondent. We found that even among certified child and adolescent psychiatrists in Japan, experience with treatment of children with gender dysphoria was limited.

Recommendations for the use of testosterone in male transgender / Recomendações para o uso da testosterona em homens transgêneros

Abstract Gender incongruence is defined as a condition in which an individual self-identifies and desires to have physical characteristics and social roles that connote the opposite biological sex. Gender dysphoria is when an individual displays the anxiety and/or depression disorders that result from the incongruity between the gender identity and the biological sex. The gender affirmation process must be performed by a multidisciplinary team. The main goal of the hormone treatment is to start the development of male physical characteristics by means of testosterone administration that may be offered to transgender men who are 18 years old or over. The use of testosterone is usually well tolerated and improves the quality of life. However, there is still lack of evidence regarding the effects and risks of the long-term use of this hormone. Many different pharmacological formulations have been used in the transsexualization process. The most commonly used formulation is the intramuscular testosterone esters in a short-term release injection, followed by testosterone cypionate or testosterone enanthate. In the majority of testosterone therapy protocols, the male physical characteristics can be seen in almost all users after 6 months of therapy, and themaximum virilization effects are usually achieved after 3 to 5 years of regular use of the hormone. To minimize risks, plasmatic testosterone levels should be kept within male physiological ranges (300 to 1,000 ng/dl) during hormonal treatment. It is recommended that transgender men under androgen therapy be monitored every 3 months during the 1st year of treatment and then, every 6 to 12 months.

Resumo Incongruência de gênero é umacondição na qual o indivíduo se identifica, deseja viver e ser aceito como uma pessoa do gênero oposto ao designado por ocasião do nascimento. Na disforia de gênero o indivíduo manifesta ansiedade e sofrimento pelo desejo de viver e ser aceito como uma pessoa do gênero oposto ao designado ao nascimento. O processo transsexualizador requer trabalho em equipe multiprofissional. O objetivo do tratamento hormonal é induzir o aparecimento de características sexuais masculinas secundárias por meio da administração da testosterona em indivíduos com idade igual ou superior a 18 anos. O tratamento de estimulação androgênica costuma ser bem tolerado. Entretanto, ainda não existemevidências sobre os efeitos e riscos do uso da testosterona a longo prazo. Diferentes preparações farmacológicas da testosterona têm sido utilizadas. As mais utilizadas têm sido as injeções intramusculares de administração a curto prazo de ésteres, seguidas do cipionato de testosterona e do enantato de testosterona. Na maioria dos protocolos de tratamento observa-se o aparecimento de características corporais masculinas nos primeiros 6 meses, e a obtenção do máximo efeito da estimulação androgênica, após 3 a 5 anos de uso regular da testosterona. Recomenda-se a manutenção dos níveis plasmáticos de testosterona dentro dos limites fisiológicos para o sexo masculino (300 a 1.000 ng/dl), a fim de minimizar os riscos. A monitorização dos homens transgênero é recomendada a cada 3meses durante o primeiro ano de tratamento e a seguir, a cada 6 a 12 meses.

Understanding Gender and Transgender

In the binary of gender, women and femininity came to be associated with motherhood, nurturing, and beauty whilst men and masculinity were associated with productivity, protection, and strength. No longer are we to systematically categorize an individual's gender in terms of polar opposite of femininity and masculinity, but instead we must acknowledge all that resides in between those two poles and allow for identity terms that best express their sense of self. The term ‘transgender has become an umbrella term for a broader and more encompassing array of gender narratives outside of the binary norm of gender. Gender dysphoria is managed and treatable through psychotherapy and through the social and medical transition of gender. The support of transgender individuals' preferred gender through social acknowledgment, gender expression, hormone therapy, and surgery has been proven to alleviate symptoms of gender dysphoria in transgender people, enabling them to incorporate back into society.

Humor gráfico y comprensión de deseos / Graphic Humor and Understanding of Desires

El presente artículo tiene como propósito documentar la comprensión de los deseos a partir de dos aproximaciones: situaciones que utilizan el humor gráfico y situaciones clásicas de preferencias con niños entre 2.8 y 3 años. Se trabaja con el método microgenético combinado con un estudio en series de tiempo durante 10 sesiones de aplicación (dos meses y medio). Se realizan dos tipos de análisis, uno intragrupo y uno intraindividual que permite capturar los diversos caminos por los cuales transitan los niños al enfrentarse a las tareas. Los resultados arrojan la identificación de tres tendencias en los desempeños: estable, descendente y ascendente. Igualmente, se pone en evidencia la importancia de trabajar otras vías para el estudio de los procesos cognitivos en términos metodológicos y se confirma el humor gráfico como alternativa para el estudio de los estados mentales.

This paper aims to document the understanding of desires from two approaches, one is graphic humor and the other is preferences with children between two years eight months and three years. Methodologically, we work with the microgenetic method combined with a time-series study over 10 sessions for two months. Two types of analysis are used, an intra-group and through an intra-subject one; the latter captures the various ways which children go when faced with tasks. The results identify three trends in performance: stable trend, downward trend, and upward trend. They also show the importance of working on other ways for the study of cognitive processes in terms of methodology and these results confirm graphic humor as an alternative for the study of mental states.

Desnervação capsular percutânea ou aberta no tratamento da dor na displasia coxofemoral canina / Percutaneous versus open hip denervation in the treatment of canine pain hip dysplasia

A desnervação capsular (DC) se baseia na desperiostização da borda acetabular e tem sido utilizada como uma das técnicas de alívio da dor articular em cães displásicos. Compararam-se as técnicas de DC percutânea e aberta, aplicadas em 25 cães, que apresentaram diagnóstico clínico e radiográfico de displasia coxofemoral, totalizando 31 cirurgias. Os efeitos das técnicas foram comparados, em período de 180 dias, por meio de avaliação subjetiva de claudicação e dor, perimetria da coxa, graus máximos de flexão e extensão da articulação coxofemoral e amplitude de movimento articular. Os graus de claudicação e dor apresentaram decréscimo significativo ao longo do período avaliado em ambos os grupos, sem apresentarem diferenças quando comparados entre si. Com relação à perimetria da coxa, flexão, extensão e amplitude de movimento articular, foi observado o aumento dos valores numéricos destas variáveis ao longo do estudo. Baseado nos achados, concluiu-se que a abordagem percutânea ou aberta na DC produz similitude nas variáveis avaliadas, e ambas trazem bons resultados.

Joint capsule denervation is based on removal of sensitive fibers from the acetabular edge and has been used as one of the techniques to joint pain relief in the canine dysplastic hip. This study compared the techniques of percutaneous and open hip denervation in 25 dogs that showed clinical and radiographic signs of hip dysplasia, totaling 31 surgeries. The effects of the techniques were evaluated and compared in a period of 180 days following surgery, including subjective evaluation of lameness and pain, thigh girth, maximum degree of hip flexion and extension and range of motion (ROM). Degree of lameness and pain significantly decreased during the study period for both groups, and no difference could be observed between groups. Thigh girth, degree of flexion, extension and ROM presented an increase in the numerical values throughout the study. Based on these findings, it is concluded that the percutaneous or open approach for capsular denervation produced similar results.

Microsatellites retain phylogenetic signals across genera in eucalypts (Myrtaceae)

The utility of microsatellites (SSRs) in reconstructing phylogenies is largely confined to studies below the genus level, due to the potential of homoplasy resulting from allele size range constraints and poor SSR transferability among divergent taxa. The eucalypt genus Corymbia has been shown to be monophyletic using morphological characters, however, analyses of intergenic spacer sequences have resulted in contradictory hypotheses- showing the genus as either equivocal or paraphyletic. To assess SSR utility in higher order phylogeny in the family Myrtaceae, phylogenetic relationships of the bloodwood eucalypts Corymbia and related genera were investigated using eight polymorphic SSRs. Repeat size variation using the average square and Nei's distance were congruent and showed Corymbia to be a monophyletic group, supporting morphological characters and a recent combination of the internal and external transcribed spacers dataset. SSRs are selectively neutral and provide data at multiple genomic regions, thus may explain why SSRs retained informative phylogenetic signals despite deep divergences. We show that where the problems of size-range constraints, high mutation rates and size homoplasy are addressed, SSRs might resolve problematic phylogenies of taxa that have diverged for as long as three million generations or 30 million years.

Insconsistência simbólica e fragilidades identitárias / Symbolic inconsistency and identity fragilities

Para analisar as subjetividades juvenis, leva-se em conta a relação entre os actings outs dos jovens (drogas, vandalismo, deliquência) e o desenvolvimento dos sentimentos de desamparo e de inconsistência de si. Estes, por sua vez, estariam associados a um processo sociopsíquico mais amplo, presente nas sociedades contemporâneas, que diz respeito à inconsistência ou ineficâcia simbólica, no nível societal, e às suas conseqüências no plano das identificações juvenis. A juventude é uma porção social tanto mais vulnerável quanto mais estiver destituída de valores referenciais e privada de âncoras identificatórias estáveis.

In order to analyze the juvenile subjectivity's it must have to take in accountthe relation between the acting outs of youngsters (such as drugs, delinquen-cy) and the development of feelings like despair and self incongruence. The-se feelings, would rather be associated to a wider social and psychic processin the contemporary societies wich is tide to inconsistency or simbolic inef-ficiency, in the social level and their consequences in juvenile identificationlevel. The juvenile is a social part that is more vulnerable when the lack ofvalues and references, and also identicatory anchors is presented