Effects of gender-affirming hormone therapy on gray matter density, microstructure and monoamine oxidase A levels in transgender subjects.

MAO-A catalyzes the oxidative degradation of monoamines and is thus implicated in sex-specific neuroplastic processes that influence gray matter (GM) density (GMD) and microstructure (GMM). Given the exact monitoring of plasma hormone levels and sex steroid intake, transgender individuals undergoing gender-affirming hormone therapy (GHT) represent a valuable cohort to potentially investigate sex steroid-induced changes of GM and concomitant MAO-A density. Here, we investigated the effects of GHT over a median time period of 4.5 months on GMD and GMM as well as MAO-A distribution volume. To this end, 20 cisgender women, 11 cisgender men, 20 transgender women and 10 transgender men underwent two MRI scans in a longitudinal design. PET scans using [11C]harmine were performed before each MRI session in a subset of 35 individuals. GM changes determined by diffusion weighted imaging (DWI) metrics for GMM and voxel based morphometry (VBM) for GMD were estimated using repeated measures ANOVA. Regions showing significant changes of both GMM and GMD were used for the subsequent analysis of MAO-A density. These involved the fusiform gyrus, rolandic operculum, inferior occipital cortex, middle and anterior cingulum, bilateral insula, cerebellum and the lingual gyrus (post-hoc tests: pFWE+Bonferroni < 0.025). In terms of MAO-A distribution volume, no significant effects were found. Additionally, the sexual desire inventory (SDI) was applied to assess GHT-induced changes in sexual desire, showing an increase of SDI scores among transgender men. Changes in the GMD of the bilateral insula showed a moderate correlation to SDI scores (rho = - 0.62, pBonferroni = 0.047). The present results are indicative of a reliable influence of gender-affirming hormone therapy on 1) GMD and GMM following an interregional pattern and 2) sexual desire specifically among transgender men.

Coexpression of Gene Transcripts with Monoamine Oxidase A Quantified by Human In Vivo Positron Emission Tomography.

The monoamine oxidase A (MAO-A) is integral to monoamine metabolism and is thus relevant to the pathophysiology of various neuropsychiatric disorders; however, associated gene-enzyme relations are not well understood. This study aimed to unveil genes coexpressed with MAO-A. Therefore, 18 179 mRNA expression maps (based on the Allen Human Brain Atlas) were correlated with the cerebral distribution volume (VT) of MAO-A assessed in 36 healthy subjects (mean age ± standard deviation: 32.9 ± 8.8 years, 18 female) using [11C]harmine positron emission tomography scans. Coexpression analysis was based on Spearman's ρ, over-representation tests on Fisher's exact test with false discovery rate (FDR) correction. The analysis revealed 35 genes in cortex (including B-cell translocation gene family, member 3, implicated in neuroinflammation) and 247 genes in subcortex (including kallikrein-related peptidase 10, implicated in Alzheimer's disease). Significantly over-represented Gene Ontology terms included "neuron development", "neuron differentiation", and "cell-cell signaling" as well as "axon" and "neuron projection". In vivo MAO-A enzyme distribution and MAOA expression did not correlate in cortical areas (ρ = 0.08) while correlation was found in subcortical areas (ρ = 0.52), suggesting influences of region-specific post-transcriptional and -translational modifications. The herein reported information could contribute to guide future genetic studies, deepen the understanding of associated pathomechanisms and assist in the pursuit of novel therapeutic targets.

A BRIDGE partnership model for health management education in the Slovak Republic.

An innovative Health Management Education Partnership (HMEP) was initiated to develop management education initiatives through the exchange of information and ideas. Health education efforts, projects and activities exist between the University of Scranton and three strategic partners in the Slovak Republic: Trnava University, the Health Management School and the University of Matej Bel. The BRIDGE model (Building Relationships in Developing and Growing Economies) utilizes several innovative educational initiatives and strategic projects including a professional journal, faculty development, professional development, curriculum development, certification and accreditation, faculty-students exchange and development of educational materials and modules. The BRIDGE organizational structure is reviewed as well as specific workplan objectives to operationalize the HMEP encouraging mutual cooperation, collaboration and sustainability of efforts. The model stresses implementation, monitoring, and evaluation of all initiatives through a strong community effort, focus on research, deployment of educational resources, curriculum modification, development of interpartnership activities, conferences, workshops, fieldwork experiences and study tours. Applied management practices enhance market-oriented solutions to health care delivery problems emphasizing a focus on privatization and entrepreneurship through education.

Qualitative evaluation of a health management education partnership.

Results of ongoing cooperation of four educational institutions in the field of Health Management Education in Slovakia are reviewed. The specific benefit of multilateral collaboration for the situation in central Europe is discussed in the context of a Health Management Education Partnership (HMEP). The project is based on a grant from the United States Agency for International Development (USAID) with assistance from the American International Health Alliance (AIHA). The U.S. partner is the University of Scranton, Scranton, Pennsylvania. Three organizations are involved in the partnership from the Slovak Republic: Trnava University, University of Matej Bel in Banska Bystrica and the Health Management School (HMS) in Bratislava, each having specific priority and focus in health management education. The HMEP program is designed to reach about 30 teachers of health administration as well as 200 undergraduates, senior and middle managers from health service organizations every year. The collaborative endeavor stimulates the communication and creation of personal and human relations, not only on an individual and institutional level, but on a community as well as national and international level. The project supports the development of knowledge and skills, professional identity and educational processes in health management. The emphasis is on increasing the quality of education and training in Slovakia through multilateral collaboration, curricula development, professional development, symposia, support of consultancies and accreditation. Specific areas of content are designed to address health policy, law, ethics, insurance and quality improvement.

Accreditation processes in the Slovak Republic.

This article provides a conceptual framework for understanding changes occurring in the accreditation process for institutions of higher learning in the Slovak Republic. Health sector transformation is occurring rapidly throughout the Central and Eastern European region as former socialist states are experimenting with market-oriented approaches. Educators and universities are playing an important role in the development of knowledge, skills and abilities of current and future health practitioners. Accreditation is viewed as an important process in the continuing development of quality health service management curricula and preparing competent practitioners for the health care field. Historical considerations are examined as well as future directions for accreditation in the Slovak Republic.

The changes of in vitro 131I-iodine uptake in the thyroid gland of rats exposed to septal lesions and immobilization stress.

The in vitro uptake of 131I by the thyroid gland was investigated in rats after immobilization stress with special respect to animals lesioned in the septal area. Lesions in a septal area performed 10 days before decreased the iodide accumulation in the thyroid, while stress by immobilization increased it to the control basal value. Repeated immobilization in control rats did not produce any changes in the iodide uptake in vitro. ACTH injected in vivo stimulated the iodide 131I uptake in vitro by thyroid glands of hypophysectomized rats. It is concluded that immobilization stress in rats with septal lesions increases 131I-iodide uptake in vitro and that the increase was probably influenced by both catecholamines and glucocorticoids.