Search

Background An increasing number of nonbinary patients are receiving gender-affirming procedures due to improved access to care. However, the preferred treatments for nonbinary patients are underdescribed. The purpose of this study was to investigate the goals and treatments of nonbinary patients. Methods A retrospective study of patients who self-identified as nonbinary from our institutional Gender Health Program was conducted. Patient demographics, clinical characteristics, surgical goals, and operative variables were analyzed. Results Of the 375 patients with gender dysphoria, 67 (18%) were nonbinary. Over half of the nonbinary patients were assigned male at birth (n = 57, 85%) and nearly half preferred the gender pronoun they/them/theirs (n = 33, 49%). A total of 44 patients (66%) received hormone therapy for an average of 2.5 ± 3.6 years, primarily estrogen (n = 39). Most patients (n = 46, 69%) received or are interested in gender-affirming surgery, of which, almost half were previously on hormone therapy (n = 32, 48%). The most common surgeries completed or desired were facial feminization surgery (n = 15, 22%), vaginoplasty (n = 15, 22%), mastectomy (n = 11, 16%), and orchiectomy (n = 9, 13%). Nonbinary patients who were assigned male at birth (NB-AMAB) were more often treated with hormones compared to nonbinary patients assigned female at birth (NB-AFAB) (72% vs. 30%, p = 0.010). Conversely, patients who were AFAB were more likely to complete or desire surgical intervention than those who were AMAB (100% vs. 63.0%, p < 0.021). Conclusion Majority of nonbinary patients were assigned male at birth. NB-AFAB patients all underwent surgical treatment, whereas NB-AMAB patients were predominantly treated with hormone therapy. [ABSTRACT FROM AUTHOR]

Taste bud cell differentiation is extremely important for taste sensation. Immature taste bud cells cannot function during taste perception transmission to the nerve. In this study, we investigated whether hedgehog signaling affected taste bud cell differentiation and whether transient receptor potential vanilloid 1 (TRPV1) played a key role in dry mouth. The induction of dry mouth due to salivary gland resection (SGR) was confirmed on the basis of reduced salivation and disrupted fungiform papillae. The expression of keratin 8 (K8) of taste bud cells, neurofilament (NF), sonic hedgehog (Shh), and glioma-associated oncogene homolog 1 (Gli1) around taste bud cells was downregulated; however, the expression of TRPV1, P2X purinoceptor 3 (P2X3), and hematopoietic stem cell factor (c-Kit) was upregulated at the NF ends in the dry mouth group. To investigate the effect of TRPV1 defect on dry mouth, we induced dry mouth in the TRPV-/- group. The K8, NF, and P2X3 expression patterns were the same in the TRPV1 wild-type and TRPV1-/- dry mouth groups. However, Shh and c-Kit expression decreased regardless of dry mouth in the case of TRPV1 deficiency. These results indicated that TRPV1 positively regulated proliferation during taste bud cell injury by blocking the Shh/Gli1 pathway. In addition, not only cell proliferation but also differentiation of taste bud cells could not be regulated under TRPV1-deficiency conditions. Thus, TRPV1 positively regulates taste bud cell innervation and differentiation; this finding could be valuable in the clinical treatment of dry mouth-related taste dysfunction. [ABSTRACT FROM AUTHOR]

Facial feminization surgery (FFS) refers to a set of procedures aimed at altering the features of a masculine face to achieve a more feminine appearance. In the second part of this twopart series, assessment and operations involving the midface, mandible, and chin, as well as soft tissue modification of the nasolabial complex and chondrolaryngoplasty, are discussed. Finally, we provide a review of the literature on patient-reported outcomes in this population following FFS and suggest a path forward to optimize care for FFS patients. [ABSTRACT FROM AUTHOR]

The application of next-generation sequencing in research and particularly in clinical routine requires highly accurate variant calling. Here we describe UVC, a method for calling small variants of germline or somatic origin. By unifying opposite assumptions with sublation, we discovered the following two empirical laws to improve variant calling: allele fraction at high sequencing depth is inversely proportional to the cubic root of variant-calling error rate, and odds ratios adjusted with Bayes factors can model various sequencing biases. UVC outperformed other variant callers on the GIAB germline truth sets, 192 scenarios of in silico mixtures simulating 192 combinations of tumor/normal sequencing depths and tumor/normal purities, the GIAB somatic truth sets derived from physical mixture, and the SEQC2 somatic reference sets derived from the breast-cancer cell-line HCC1395. UVC achieved 100% concordance with the manual review conducted by multiple independent researchers on a Qiagen 71-gene-panel dataset derived from 16 patients with colon adenoma. UVC outperformed other unique molecular identifier (UMI)-aware variant callers on the datasets used for publishing these variant callers. Performance was measured with sensitivity-specificity trade off for called variants. The improved variant calls generated by UVC from previously published UMI-based sequencing data provided additional insight about DNA damage repair. UVC is open-sourced under the BSD 3-Clause license at https://github.com/genetronhealth/uvc and quay.io/genetronhealth/gcc-6-3-0-uvc-0-6-0-441a694 [ABSTRACT FROM AUTHOR]

Facial feminization surgery (FFS) incorporates aesthetic and craniofacial surgical principles and techniques to feminize masculine facial features and facilitate gender transitioning. A detailed understanding of the defining male and female facial characteristics is essential for success. In this first part of a two-part series, we discuss key aspects of the general preoperative consultation that should be considered when evaluating the prospective facial feminization patient. Assessment of the forehead, orbits, hairline, eyebrows, eyes, and nose and the associated procedures, including scalp advancement, supraorbital rim reduction, setback of the anterior table of the frontal sinus, rhinoplasty, and soft tissue modifications of the upper and midface are discussed. In the second part of this series, bony manipulation of the midface, mandible, and chin, as well as soft tissue modification of the nasolabial complex and chondrolaryngoplasty are discussed. Finally, a review of the literature on patient-reported outcomes in this population following FFS is provided. [ABSTRACT FROM AUTHOR]

The purpose of this study is twofold: (1) to determine the feasibility of optical coherence tomography (OCT) to differentiate normal and diseased tissue of the neck region intraoperatively and (2) to evaluate how accurately a cohort of test subjects can identify various tissue types when shown a sample set of OCT images. In this in vivo, prospective, single institutional study, an OCT imaging system (Niris, Imalux, Cleveland, OH) was used to image parathyroid, thyroid, lymph node, and fat tissue in 76 patients during neck surgery. Biopsies were performed for comparison of OCT images with histology in select cases (n = 20). Finally, a group of either surgeons or scientists familiar with OCT (n = 17) were shown a sample of OCT images and asked to identify the tissue. A total of 437 OCT images were analyzed, and characteristic features of each tissue type were identified. OCT demonstrated distinct differences in structural architecture and signal intensity that allows differentiation between thyroid and parathyroid tissues, lymph nodes, and fat. OCT images were also compared with histology with good correlation. There was no difference in correctly identifying OCT-imaged tissue type between surgeons and scientists. This study is the first in vivo OCT imaging study to evaluate both normal and diseased tissues that may be encountered during neck surgery. OCT has the potential to become a valuable intraoperative tool to differentiate diseased and normal thyroid tissue intraoperatively to obtain an "optical biopsy" in real time without fixation, staining, or tissue resection. [ABSTRACT FROM AUTHOR]

Objectives/hypothesis: The objective of this study were to determine if any of the 10 attributes of the standardized letter of recommendation (SLOR) correlate significantly with objective measures of each applicant and to determine whether professor characteristics were associated with reported SLOR attributes.Study Design: Retrospective cohort study.Methods: We reviewed 339 SLORs from 187 otolaryngology residency applicants. The 10 SLOR attributes were converted into a percentile score and statistically analyzed.Results: All 10 SLOR attributes had a mean ± standard deviation above the 80th percentile (0.82-0.93 ± 0.08-0.52) and negative skewness. United States Medical Licensing Examination step 1 and 2 scores correlated most strongly with match potential (B = 93.1,P < .001 and B = 96.3, P = .002, respectively). Students from top 40 National Institutes of Health-funded institutions had a significant difference in length of relationship with their letter writer (B = -0.51, P = .02) and interpersonal communication skills (B = -12.9, P = .011). Alpha Omega Alpha (AOA) and non-AOA members differed in medical knowledge (B = 21.0, P = .007), research (B = -8.80, P = .036), and commitment to otolaryngology (B = -25.89, P = .020). Total number of research experiences correlated most strongly with medical knowledge (B = -16.55, P = .011). There was a significant difference in means between length of relationship and professorial rank (F[4, 339] = 3.61, P = .023), administrative position (F[5, 339] = 5.43, P = .002), and institution of the letter writer (P < .001).Conclusions: Overall, the lack of correlation between SLOR attributes and objective measures suggests that the SLOR adds little to the residency application. Professor characteristics were similarly not associated with any of the 10 SLOR attributes; however, there were significant differences in the length of relationship between the professor and students with respect to professor rank, administrative rank, and institution of the letter writer.Level Of Evidence: NA Laryngoscope, 130:603-608, 2020. [ABSTRACT FROM AUTHOR]

Background: Physicians are beginning to use finasteride as treatment for hair loss, hirsutism, and various other dermatologic conditions in women. However, the reported efficacy and use of finasteride in the female population varies widely. The purpose of this study is therefore to better define the efficacy and use of finasteride in women and identify research gaps that require further investigation. Methods: A systematic review of the current literature describing finasteride use in women. Results: A total of 2,683 patients participated in 65 studies involving finasteride use in women published between January 1997 and July 2017. Most randomized controlled trials (RCTs) evaluated finasteride use in women with hirsutism (48.7%) or female pattern hair loss (34.7%). RCTs recommend finasteride treatment for women with hirsutism or polycystic ovarian syndrome. Meanwhile, other forms of hair loss were studied such as alopecia, lichen planopilaris, and frontal fibrosing alopecia, but no RCTs evaluating finasteride therapy were identified. Other prospective and retrospective studies report that finasteride may improve hair loss in women with female pattern hair loss or frontal fibrosing alopecia. Overall, doses of oral finasteride ranged from 0.5 to 5 mg/day, in females aged 6–88, over a duration of 6–12 months (57.6%), as monotherapy (88.9%), and for continuous use (96.4%). Conclusion: The studies reviewed highlight the finasteride dosage, length of treatment, and candidate conditions that can benefit from finasteride therapy. Future long‐term studies are necessary to fully assess the therapeutic mechanisms and potential consequences of finasteride use and to optimize treatment protocols. [ABSTRACT FROM AUTHOR]

Objectives/hypothesis: Intraoperative recording devices are being increasingly used to provide video for contemporary surgical training. The objective of this study was to evaluate the use of a smartphone as a low-cost alternative to obtain high-resolution video from the surgeon's perspective.Study Design: A study evaluating the feasibility of using a head-mounted smartphone with a telephoto lens for point-of-view surgical videography.Methods: Video recordings of a rhinoplasty procedure were taken using a head-mounted smartphone and two handheld cameras, a Canon Powershot SD1400 IS and a Sony HandyCam HDR-CX160. Video clips were shown to 16 blinded otolaryngology residents (n = 10) and attending physicians (n = 6) for individual video evaluation using a Likert scale (1 being poor quality, 5 being excellent quality). In addition, the study participants were asked to select which video clip they preferred when presented to them side by side.Results: The iPhone 7 was given the highest overall mean video quality rating of 3.9 ± 0.57 and was preferred over the two handheld cameras by nearly all surveyed surgeons. The Canon Powershot SD1400 IS was given a mean rating of 3.3 ± 1.0 and preferred over the SonyHandyCam HDR-CX160 by all surgeons. The Sony HandyCam HDR-CX160 was given a mean rating of 1.5 ± 0.13.Conclusions: A head-mounted smartphone equipped with a telephoto lens provides a novel method to intraoperative surgical recording. The design is simple, low cost, and allows the surgeon to capture fine anatomical detail from the desirable point-of-view perspective.Level Of Evidence: NA Laryngoscope, 129:578-581, 2019. [ABSTRACT FROM AUTHOR]

The use of a gold-catalyzed, microwave protocol to activate alcohols through an intermolecular, SN1-type reaction to directly form unsymmetrical ethers and SN-benzyloxy carbamate- (Cbz) protected amines is reported. Results have shown this reaction to be highly reproducible and tolerant of moisture, and moderate to high product yields (53-99%) were obtained. Significantly, the intermolecular catalytic amination of alcohols to directly afford Cbz-protected amines is heretofore unprecedented using gold catalysis. [ABSTRACT FROM AUTHOR]