Cirugías de afirmación de género en mujeres trans: resultados estéticos, sexuales y urinarios de una serie inicial de vaginoplastias / Gender affirmation surgeries in transgender women: Aesthetic, sexual, and urinary results of an initial series of vaginoplasties

Introducción y objetivos: La disforia de género se asocia a elevada comorbilidad de salud mental, como depresión y suicidio. Las «cirugías de afirmación de género» mejoran la sexualidad y el bienestar psicosocial. El objetivo de la vaginoplastia es que los genitales se asemejen en forma y función a una vagina con una profundidad de al menos 11cm y un clítoris sensible. Además, la uretra debe acortarse y permitir la micción en posición sentada. Nuestro objetivo es describir los resultados estéticos, sexuales y urinarios.Pacientes y métodoEstudio retrospectivo de todas las pacientes operadas de genitoplastia feminizante en el Hospital Sótero del Río entre 2018 y 2019 que cumplían requisitos de WPATH. Se evaluaron dimensiones vaginales, sensibilidad del neoclítoris, conformidad estética y sexual de la neovagina, cuestionarios Índice de Función Sexual Femenina (FSFI) y la Escala de Autoimagen Genital Femenina (FGSIS), IPSS-QoL, uroflujometría y residuo posmiccional.ResultadosSe identificaron 10 mujeres operadas de genioplastia feminizante. La profundidad promedio neovaginal fue de 14,2cm. No hubo lesión rectal ni reoperación. Hubo 100% de sensibilidad del neoclítoris y 88% de conformidad con el ancho neovaginal. La FGSIS promedió 25,4 puntos y el FSFI promedió 16 puntos. El IPSS fue de 6,7 puntos, el Qmax promedio fue de 22ml/s y el residuo posmiccional promedio fue de 22ml. No hubo estenosis del neomeato.ConclusionesLa genitoplastia feminizante es una cirugía compleja, exigente y no completamente estandarizada. Sin embargo, es un procedimiento relativamente seguro que logra adecuados resultados estéticos, sexuales y urinarios. (AU)

Introduction and objectives: Gender dysphoria is associated with mental health comorbidity, such as depression and suicide. “Gender affirming surgeries” improve sexuality and psychosocial well-being. The goal of vaginoplasty is for the genitalia to resemble in form and function to a biological vagina with a depth of at least 11 cm and a sensitive clitoris. In addition, the urethra must be shortened and allow voiding in a sitting position. Our objective is to describe the aesthetic, sexual and urinary results.Patients and methodRetrospective study of all patients undergoing feminizing genitoplasty, at Hospital Sótero del Río between 2018 and 2019, that met WPATH requirements. Vaginal dimensions, neo-clitoral sensitivity, aesthetic and sexual satisfaction of the neovagina, questionnaires Female Sexual Function Index (FSFI) and the Female Genital Self-Image Scale (FGSIS), IPSS-QoL, uroflowmetry and post-void residue were evaluated.Results10 women who underwent feminizing genitoplasty were identified. The neovaginal depth average was 14.2 cm. There was no rectal injury or reoperation. There was 100% of Neoclitoris sensitivity and 88% satisfaction with the neovaginal width.The FGSIS averaged 25.4 points and the FSFI averaged 16 points. The IPSS was 6.7 points, the average Qmax was 22 ml/s and post-void residual volume average was 22 ml. There was no neomeatal stenosis.ConclusionsFeminizing Genitoplasty is a complex, demanding and not completely standardized surgery. However, it is a relatively safe procedure that achieves adequate aesthetic, sexual and urinary results. (AU)

Preoperative portal vein or portal and hepatic vein embolization: DRAGON collaborative group analysis.

BACKGROUND: The extent of liver resection for tumours is limited by the expected functional reserve of the future liver remnant (FRL), so hypertrophy may be induced by portal vein embolization (PVE), taking 6 weeks or longer for growth. This study assessed the hypothesis that simultaneous embolization of portal and hepatic veins (PVE/HVE) accelerates hypertrophy and improves resectability. METHODS: All centres of the international DRAGON trials study collaborative were asked to provide data on patients who had PVE/HVE or PVE on 2016-2019 (more than 5 PVE/HVE procedures was a requirement). Liver volumetry was performed using OsiriX MD software. Multivariable analysis was performed for the endpoints of resectability rate, FLR hypertrophy and major complications using receiver operating characteristic (ROC) statistics, regression, and Kaplan-Meier analysis. RESULTS: In total, 39 patients had undergone PVE/HVE and 160 had PVE alone. The PVE/HVE group had better hypertrophy than the PVE group (59 versus 48 per cent respectively; P = 0.020) and resectability (90 versus 68 per cent; P = 0.007). Major complications (26 versus 34 per cent; P = 0.550) and 90-day mortality (3 versus 16 per cent respectively, P = 0.065) were comparable. Multivariable analysis confirmed that these effects were independent of confounders. CONCLUSION: PVE/HVE achieved better FLR hypertrophy and resectability than PVE in this collaborative experience.

Rheumatic Heart Disease: Pathogenesis and Vaccine.

Rheumatic fever (RF) and rheumatic heart disease (RHD) follow untreated S. pyogenes throat infections in children who present susceptible genes that favor the development of autoimmune reactions. In this review, we focus on the genes that confer susceptibility and on the autoimmune reactions that occur due to molecular mimicry between human-tissue proteins and streptococcal M protein. Polyarthritis is the initial manifestation, which can evolve to carditis and severe valve damage; these culminate in rheumatic heart disease (RHD) or Sydenham's chorea, which affects the central nervous system. A perspective on vaccine development to prevent the disease is also discussed.

Microbiome and Asthma: What Have Experimental Models Already Taught Us?

Asthma is a chronic inflammatory disease that imposes a substantial burden on patients, their families, and the community. Although many aspects of the pathogenesis of classical allergic asthma are well known by the scientific community, other points are not yet understood. Experimental asthma models, particularly murine models, have been used for over 100 years in order to better understand the immunopathology of asthma. It has been shown that human microbiome is an important component in the development of the immune system. Furthermore, the occurrence of many inflammatory diseases is influenced by the presence of microbes. Again, experimental models of asthma have helped researchers to understand the relationship between the microbiome and respiratory inflammation. In this review, we discuss the evolution of murine models of asthma and approach the major studies involving the microbiome and asthma.

HCV viremia drives an increment of CD86 expression by myeloid dendritic cells.

The host immune response, including innate and adaptive immunity, plays a critical role in determining the outcome of viral infection. Nevertheless, little is known about the exact reasons for the failure of the host immune system in controlling hepatitis C virus (HCV) infection. Impairment of dendritic cells (DCs) function is probably one of the mechanisms responsible for immune evasion of HCV. In this study, the frequency and phenotype of DCs subsets were analyzed in three groups: HCV-infected individuals who developed viral persistence (1), HCV-infected individuals who spontaneously cleared the virus (2) and HCV-seronegative uninfected subjects (3). The results showed that the frequency of DCs subsets was not statistically significant between groups. Plasmacytoid DCs circulating exhibited an immature phenotype characterized by low expression of CD86. On the other hand, CD86 expression in myeloid DCs was significantly higher in chronic infected individuals compared to healthy controls (P=0.037). A positive correlation was observed between CD86(+) myeloid DC (mDC) and HCV viral load (r=0.4121, P=0.0263). These results suggest that HCV did not have an inhibitory effect on mDC maturation and the HCV viremia drives the increase of CD86 expression in mDC. The regulation of DCs maturation and migration lies at the level of intracellular signaling. HCV can activate or block intracellular signaling pathways and alter DC function. In conclusion, the present study suggests that imbalance of DC maturation by the virus represents a mechanism of evasion of the immune system despite the fact that HCV viremia appears to exert a "stimulatory" effect on cell-surface immune phenotype.

Erratum to ‘‘Rhinoconjunctivitis elicited by skin prick test’’

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Pre- and posttransplant monitoring of alloantibodies by complement-dependent cytotoxicity and luminex methodologies in liver transplantation.

BACKGROUND: This study evaluated the influence of circulating anti-HLA antibodies on outcomes of 97 liver allografts from deceased donors. METHODS: Human leukocyte antigen (HLA) antibody screening was performed by both complement-dependent cytotoxicity (CDC) and multiparameter Luminex microsphere-based assays (Luminex assay). RESULTS: The agreements between T- and B- cell CDC and Luminex assays were 67% and 77% for pre- and posttransplant specimens, respectively. Graft dysfunction was not associated with either positive pretransplant CDC or Luminex panel-reactive antibody (PRA) values. Likewise, positive posttransplant T- or B- cell CDC PRA values were not associated with graft dysfunction. In contrast, posttransplant Luminex PRA values were significantly higher among patients with graft dysfunction compared with subjects with good outcomes (P = .017). CONCLUSION: Posttransplant monitoring of HLA antibodies with Luminex methodology allowed identification of patients at high-risk for poor graft outcomes.

Spirometric values in elderly asthmatic patients are not influenced by obesity.

BACKGROUND: Studies have suggested that asthma in obese individuals differs from the classic asthma phenotype, presenting as a disease that is more difficult to control. OBJECTIVE: The objective of the present study was to determine whether obesity, age or a combination of the two are associated with worse spirometry parameters in patients with asthma. METHODS: This was an observational cross-sectional study involving patients over 18 years of age who had been diagnosed with asthma (allergic or nonallergic). We evaluated the results of their spirometric tests. The patients were classified in accordance with two criteria: body mass index (BMI) and age. Based on their BMIs, the patients were divided into three groups: normal weight, overweight and obese. Patients were also separated into two categories by age: 18-59 years of age; and ≥ 60 years of age. RESULTS: We evaluated 451 patients with asthma and their spirometry tests. In the present study, the pulmonary function parameters were negatively correlated with BMI and age (P < 0.05). We found that there was a statistically significant correlation between spirometric values and BMI among patients 18-59 years of age (P < 0.001), however, among patients over 60, we did not observe this negative association. CONCLUSIONS AND CLINICAL RELEVANCE: The spirometric values decreased significantly in proportion to the increase of BMI and age in patients with asthma, especially among young adults. There was no negative correlation between BMI and FEV(1) in the group ≥ 60 years of age, suggesting that perhaps the time of disease is a major factor in the loss of lung function than weight gain in the elderly.

Genes, autoimmunity and pathogenesis of rheumatic heart disease.

Pathogenesis of rheumatic heart disease (RHD) remains incompletely understood. Several genes associated with RHD have been described; most of these are involved with immune responses. Single nucleotide polymorphisms in a number of genes affect patients with RHD compared to controls. Molecular mimicry between streptococcal antigens and human proteins, including cardiac myosin epitopes, vimentin and other intracellular proteins is central to the pathogenesis of RHD. Autoreactive T cells migrate from the peripheral blood to the heart and proliferate in the valves in response to stimulation with specific cytokines. The types of cells involved in the inflammation as well as different cytokine profiles in these patients are being investigated. High TNF alpha, interferon gamma, and low IL4 are found in the rheumatic valve suggesting an imbalance between Th1 and Th2 cytokines and probably contributing to the progressive and permanent valve damage. Animal model of ARF in the Lewis rat may further contribute towards understanding the ARF.

Non-human leukocyte antigen antibodies reactive with endothelial cells could be involved in early loss of renal allografts.

Preformed donor-specific human leukocyte antigen (HLA) antibodies have been associated with allograft dysfunction and failure. However, recipients of HLA-identical kidneys can develop acute humoral rejection, implicating putative pathogenic antibodies that are directed against non-HLA antigens. We investigated the presence of endothelial cell-reactive antibodies in 11 patients who experienced early loss of their transplanted kidneys owing to humoral rejection and 1 loss from renal venal thrombosis. We examined the potential efficacy of intravenous immunoglobulin to block the binding of these antibodies, as previously suggested for anti-HLA antibodies.