Estradiol increases cortical and trabecular bone accrual and bone strength in an adolescent male-to-female mouse model of gender-affirming hormone therapy

The effects of gender-affirming hormone therapy on the skeletal integrity and fracture risk in transitioning adolescent trans girls are unknown.To address this knowledge gap,we developed a mouse model to simulate male-to-female transition in human adolescents in whom puberty is first arrested by using gonadotrophin-releasing hormone analogs with subsequent estradiol treatment.Puberty was suppressed by orchidectomy in male mice at 5 weeks of age.At 3 weeks post-surgery,male-to-female mice were treated with a high dose of estradiol(~0.85 mg)by intraperitoneal silastic implantation for 12 weeks.Controls included intact and orchidectomized males at 3 weeks post-surgery,vehicle-treated intact males,intact females and orchidectomized males at 12 weeks post-treatment.Compared to male controls,orchidectomized males exhibited decreased peak bone mass accrual and a decreased maximal force the bone could withstand prior to fracture.Estradiol treatment in orchidectomized male-to-female mice compared to mice in all control groups was associated with an increased cortical thickness in the mid-diaphysis,while the periosteal circumference increased to a level that was intermediate between intact male and female controls,resulting in increased maximal force and stiffness.In trabecular bone,estradiol treatment increased newly formed trabeculae arising from the growth plate as well as mineralizing surface/bone surface and bone formation rate,consistent with the anabolic action of estradiol on osteoblast proliferation.These data support the concept that skeletal integrity can be preserved and that long-term fractures may be prevented in trans girls treated with GnRHa and a sufficiently high dose of GAHT.Further study is needed to identify an optimal dose of estradiol that protects the bone without adverse side effects.

Wernicke's encephalopathy in a rectal cancer patient with atypical radiological features:A case report

BACKGROUND Wernicke's encephalopathy is a disease caused by thiamine deficiency.The lesions usually involve the periphery of the aqueduct,midbrain,tectum,third ventricle,papillary body,and thalamus.It is very rare to affect the vermis and cerebellar hemispheres.CASE SUMMARY We report a 77-year-old female patient admitted to the emergency department of our hospital for 2 d of unconsciousness.Brain magnetic resonance imaging showed increased diffusion weighted imaging signals in the bilateral thalamus,periventricular regions of the third ventricle,corpora quadrigemina,vermis,and cerebellar hemispheres.Wernicke's encephalopathy was considered.She was given thiamine therapy and became conscious after the treatment.CONCLUSION Wernicke's encephalopathy may have various imaging manifestations.Clinicians should keep in mind that Wernicke’s encephalopathy may occur in patients who experience prolonged periods of malnutrition.