Cancer screening and management in the transgender population:Review of literature and special considerations for gender affirmation surgery

BACKGROUND Literature focused on cancer screening and management is lacking in the transgender population.AIM To action to increase contributions to the scientific literature that drives the creation of cancer screening and management protocols for transgender and gender nonconforming(TGNC)patients.METHODS We performed a systematic search of PubMed on January 5th,2022,with the following terms:“TGNC”,OR“transgender”,OR“gender non-conforming”,OR“gender nonbinary”AND“cancer screening”,AND“breast cancer”,AND“cervical cancer”,AND“uterine cancer”,AND“ovarian cancer”,AND“prostate cancer”,AND“testicular cancer”,AND“surveillance”,AND“follow-up”,AND“management”.70 unique publications were used.The findings are discussed under“Screening”and“Management”categories.RESULTS Screening:Current cancer screening recommendations default to cis-gender protocols.However,long-term genderaffirming hormone therapy and loss to follow-up from the gender-specific specialties contribute to a higher risk for cancer development and possible delayed detection.The only known screening guidelines made specifically for this population are from the American College of Radiology for breast cancer.Management:Prior to undergoing Gender Affirmation Surgery(GAS),discussion should address cancer screening and management in the organs remaining in situ.Cancer treatment in this population requires consideration for chemotherapy,radiation,surgery and/or reconstruction.Modification of hormone therapy is decided on a case-by-case basis.The use of prophylactic vs aesthetic techniques in surgery is still debated.CONCLUSION When assessing transgender individuals for GAS,a discussion on the future oncologic risk of the sex-specific organs remaining in situ is essential.Cancer management in this population requires a multidisciplinary approach while the care should be highly individualized with considerations to social,medical,surgical and gender affirming surgery related specifications.Special considerations have to be made during planning for GAS as surgery will alter the anatomy and may render the organ difficult to sample for screening purposes.A discussion with the patient regarding the oncologic risk of remaining organs is imperative prior to GAS.Other special considerations to screening such as the conscious or unconscious will to unassociated with their remaining organs is also a key point to address.We currently lack high quality studies pertinent to the cancer topic in the gender affirmation literature.Further research is required to ensure more comprehensive and individualized care for this population.

Impact of gender-affirming hormone therapy on the development of COVID-19 infections and associated complications:A systematic review

BACKGROUND Severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)can produce a wide range of clinical manifestations from asymptomatic to life-threatening.Various researchers have worked to elucidate the pathogenic mechanisms underlying these variable presentations.Differences in individual responses to systemic inflammation and coagulopathy appear to be modulated by several factors,including sex steroid hormones.Transgender men or non-binary individuals who undergo gender-affirming hormone therapy(GAHT)are a unique population of interest for exploring the androgen-mediated coronavirus disease 2019(COVID-19)hypothesis.As the search for reliable and effective COVID-19 treatments continues,understanding the risks and benefits of GAHT may mitigate COVID-19 related morbidity and mortality in this patient population.AIM To investigate the potential role of GAHT in the development of COVID-19 infections and complications.METHODS This systematic review implemented an algorithmic approach using PRISMA guidelines.PubMed,Scopus,Google Scholar top 100 results,and archives of Plastic and Reconstructive Surgery was on January 12,2022 using the key words“gender”AND“hormone”AND“therapy”AND“COVID-19”as well as associated terms.Non-English articles,articles published prior to 2019(prior to COVID-19),and manuscripts in the form of reviews,commentaries,or letters were excluded.References of the selected publications were screened as well.RESULTS The database search resulted in the final inclusion of 14 studies related to GAHT COVID-19.Of the included studies,only two studies directly involved and reported on COVID-19 in transgender patients.Several clinical trials looked at the relationship between testosterone,estrogen,and progesterone in COVID-19 infected cis-gender men and women.It has been proposed that androgens may facilitate initial COVID-19 infection,however,once this occurs,testosterone may have a protective effect.Multiple clinical studies have shown that low baseline testosterone levels in men with COVID-19 are associated with worsening outcomes.The role of female sex hormones,including estrogen and progesterone have also been proposed as potential protective factors in COVID-19 infection.This was exemplified in multiple studies investigating different outcomes in pre-and post-menopausal women as well as those taking hormone replacement therapy.Two studies related specifically to transgender patients and GAHT found that estrogen and progesterone could help protect men against COVID-19,and that testosterone hormone therapy may increase the risk of contracting COVID-19.CONCLUSION Few studies were found related to the role of GAHT in COVID-19 infections.Additional research is necessary to enhance our understanding of this relationship and provide better care for transgender patients.

BD Affirm VP Ⅲ芯片检测在阴道炎病原体诊断中的效能

目的:观察BD Affirm VP Ⅲ芯片检测在阴道炎病原体诊断中的效能。方法:选取2018年3月至2019年3月该院收治的104例疑似阴道炎患者进行前瞻性研究。所有患者均取阴道分泌物,依次行BD Affirm VPⅢ芯片检测和常规镜检,以病原体培养诊断结果作为金标准,比较BD Affirm VPⅢ芯片检测与常规镜检在细菌性阴道炎、真菌性阴道炎、滴虫性阴道炎诊断中的效能。结果:金标准诊断结果显示,104例患者中45例病原体培养阳性,其中22例细菌性阴道炎,15例真菌性阴道炎,8例滴虫性阴道炎;59例病原体培养阴性。BD Affirm VPⅢ芯片检测诊断细菌性阴道炎的灵敏度、准确度均高于常规镜检,差异有统计学意义(P<0.05);BD Affirm VPⅢ芯片检测诊断真菌性阴道炎的灵敏度、准确度均高于常规镜检,差异有统计学意义(P<0.05);BD Affirm VPⅢ芯片检测诊断滴虫性阴道炎的灵敏度、特异度、准确度与常规镜检比较,差异均无统计学意义(P>0.05)。结论:BD Affirm VPⅢ芯片检测诊断细菌性阴道炎和真菌性阴道炎的效能高于常规镜检诊断。

AFFIRM试验

本专辑接续上期内容,继续对心律失常的基础研究与临床治疗等相关内容进行介绍。载文11篇,选译自《内科》杂志2004年第94卷第4期“不整脈診”专辑,由大连医科大学附属第一医院内科医师翻译,柯若仪教授审校。

芬美意公司的AFFIRM~技术

当进食时,食物会释放出挥发性的气味分子,然后通过呼吸进入嗅觉器官。嗅觉器官位于鼻子的上方及眼睛的后面。我们嘴里感觉到的触觉和味觉是和嗅觉信号紧密相关的,我们通常把这三种感觉同时存在时的感受称作味道。其中嗅觉是能使我们鉴别食物感觉的最重要的一种,这也是我们在鼻子塞住后很难鉴别食物味道的原因(比如感冒时)。

Trope, Reason, and Affirmation in Nietzsche＇s and Novalis＇ Theories of Language

This paper analyzes the role of six tropes （metonymy, synecdoche, metaphor, analogy, allegory, and irony） in Nietzsche＇s and Novalis＇ writings on language and cognition, using the comparison to show how a negative element in Nietzsche＇s attitude towards the tropic nature of cognition underlies well-known problems in his response to nihilism. These problems include ambiguities in Nietzsche＇s attitude to truth, and the question of how well he can carry through his project of affirming the individual on the basis of a creative reinterpretation of experience. I maintain that Novalis understands language and cognition to be tropic in a similar way as Nietzsche does, and that these writers provide similar critiques of discursive reason on the basis of what they view as its stultifying rigidity and misleading claims to a ＂literal＂ form of objectivity. However, I argue that Novalis avoids Nietzsche＇s difficulties by maintaining that a creative element in cognition does not rule out a variant of a correspondence notion of truth. Although Novalis＇ account thus falls foul of Nietzsche＇s goal of providing an immanent affirmation of human experience, the comparison shows that a Nietzschean attempt to provide a convincing model of individual self-affirmation should integrate a more positive role for trope, which can support a satisfying conception of the value of human creativity.

Dislocated Character Affirmation——A Case Study of Young Female Gamers' Identity in Online Games

What are the real intentions of young women to play online games? Can they benefit more than just entertainment? Based on a 2-year followup survey of a young female online gamer, this paper explores the inner experiences of a young female gamers. Findings indicate that young female Chinese gamers attach importance to the choice of characters in the world of online games and that they establish a sense of identity in virtual space through character affirmation and interactions with other gamers. For young female gamers, who are eager to temporarily escape from reality, playing online games is a positive psychological compensation and a process for building self-confidence.

Protecting the Rights of Disabled Persons——From the Perspective of Protecting Their Right to Development with Affirmative Action as the Core

Establishing and protecting the right to development of disabled persons is not only the important part of Xi Jinping’s thought on human rights, but also a reflection of Marxism’s idea of human rights and a requirement of the rule of law in China. It is necessary to promote the protection of the right to development of disabled persons in terms of affirmative action. The Chinese government’s affirmative action requires structural characteristics, including providing the institutional basis for the affirmative action by constructing legal and non-legal institutions, providing an environment conducive for the affirmative action by shaping a more aware social ecology and providing valid guarantees for affirmative action by increasing the responsibility of local governments.

Affirmative Action的翻译问题

在我国学界,Affirmative Action的译文可谓五花八门。通过对其历史和意义的考查可以发现,"积极行动"是比较好的翻译。该术语的翻译问题表明,我国的术语规范工作任重而道远。

对左室功能障碍的房颤患者予心率控制与节律控制治疗的比较:来自AFFIRM研究的结果

左室(LV)功能障碍伴房颤(AF)患者的最佳治疗尚未确定。与LV功能正常或轻度降低的患者相比,对射血分数(EF)明显降低的患者维持窦性心律是否获益更大尚不清楚。AFFIRM(节律治疗房颤随访调查)研究中比较了以下两种策略:"节律控制",即维持窦性心律,主要使用抗心律失常药物;"心率控制",允许AF持续存在或反复发生但控制心室率。

A Commentary of the Queer People of Color Identity Affirmation Scale for Positive Attitudes

Sexual minority(SM)is gradually becoming more visible as a more open and diversity society.SM mainly includes lesbian,gay,bisexual,transgender,asexual and so on.According to SM stress theory,SM people,populations at risk,have poor mental and physical health under a long-term acute or chronic stress and pressure due to prejudice and discrimination[1].In America,among young SM,minority stress,negative psychology,substance use,and human immunodeficiency virus(HIV)risk influence each other to damage psychosomatic health[2].With an increase in SM stress,participation in health-promoting activities decreased and problems with physical health increased[3].

AFFIRM研究中,房颤治疗放弃心率控制或节律控制策略的相关临床因素

Objective: The objective of the current study was to determine the clinical factors that were associated with abandonment of a rate-control or a rhythm-control strategy in patients with atrial fibrillation(AF). Background: Although the AFFIRM Study demonstrated that outcomes are similar with a primary strategy of rate-control or rhythm-control for AF, there may be clinical or demographic factors associated with abandonment of the initial treatment strategy. Knowledge of these risk factors would be useful so that patients may be given appropriate initial therapy and, as appropriate, switched to alternative treatments earlier. Methods: Patients in the AFFIRM Study were subdivided into those who were maintained on their initial treatment strategy versus those who abandoned initial treatment strategy for alternative therapies. We determined the clinical and demographic factors associated with change in initial treatment strategy. Results: At 5 years the original treatment strategy was maintained in 85%of the patients in the rate-control arm versus 62%of those in the rhythm-control arm(P< .0001). Length of the qualifying episode of AF was associated with abandonment of both rhythm-control and rate-control strategies. Antiarrhythmic drug failure before randomization and a history of thyroid disease also were associated with abandonment of rhythm-control. Patients were more likely to maintain rate-control if they already had an implanted pacemaker or if they were older than 75 years, while an ejection fraction < 30%was associated with abandonment of the rate-control strategy. Conclusions: In patients with AF, rhythm-control strategies are abandoned significantly more often than rate-control strategies. Patients with long durations of AF on presentation or previous antiarrhythmic drug failure might be considered for rate-control as initial treatment.

Robotics in genital gender-affirming surgery

Gender-affirming genital surgery includes a constellation of pelvic procedures that can help feminize or masculinize the genitalia.Technological advances in robotic surgery can aid surgical access to and visualization of the pelvis,thereby facilitating certain procedures.In this scoping review,we will discuss the developing role of the robot in genital affirming genital surgery.Indications,techniques,and outcomes using the robot in both feminizing and masculinizing genital procedures will be reviewed.

Ehlers-Danlos syndrome:prevalence and outcomes in gender affirming surgery-a single institution experience

Aim:Patients with Ehlers-Danlos Syndrome(EDS)are considered to have an increased risk for wound healing complications.Surgeons may therefore be hesitant to offer elective surgeries,including gender-affirming surgeries(GAS),to EDS patients.At our center,we frequently encountered patients presenting for GAS evaluation with the co-existing diagnosis of EDS.This study aims to establish the prevalence of EDS diagnosis in our GAS patients and compare their post-operative complications to patients without EDS diagnosis.Methods:This is a single-institution retrospective case-control study on all patients who underwent GAS from 2016-2020.Data include EDS diagnosis,demographics,operation,and complications(including minor wound healing issues).Results:Of 1363 patients presenting for GAS,36(2.6%)had EDS diagnoses and were matched with 108 control patients.Major complications requiring surgical intervention in the OR occurred in 6 patients(4.2%),(2.8% EDS vs.5.4%controls;P=0.63),while 8.3% of EDS and 14% of controls required minor interventions(P=0.38).The rate of wound healing issues of any severity was 28% in EDS vs.47% in control groups(P=0.04).Conclusion:The prevalence of EDS diagnosis in our patient population is 132 times the highest reported prevalence in the general population.Wound healing issues and the need for additional post-operative interventions in the group with EDS diagnosis were not significantly different from the control group.Our findings suggest that patients with a diagnosis of EDS undergoing GAS have comparable outcomes to patients without EDS.Concerns for post-operative complications should not be a barrier to offering GAS to patients presenting with an EDS diagnosis.

上行社会比较对大学生学习内卷的影响:焦虑的中介与自我肯定的调节作用

目的:探讨上行社会比较与大学生学习内卷的关系,并考察焦虑和自我肯定在其中的中介和调节作用。方法:采用上行社会比较量表、焦虑量表、自我肯定问卷和大学生学习内卷问卷对826名在校大学生进行问卷调查。结果:①上行社会比较和大学生学习内卷呈显著的正相关(r=0.22,P<0.01);②焦虑在上行社会比较与大学生学习内卷之间起部分中介作用(β=0.33,P<0.01),中介作用占总效应的13.64%;③自我肯定对中介模型的前半段起显著的调节作用(β=-0.25,P<0.01),当自我肯定水平越高,上行社会比较对焦虑的影响越弱;④自我肯定对直接路径起显著的调节作用(β=-0.07,P<0.05),当自我肯定水平越高,上行社会比较对大学生学习内卷的影响越弱。结论:上行社会比较能显著正向预测大学生学习内卷,焦虑在上行社会比较和大学生学习内卷之间起着部分中介作用,上行社会比较-焦虑-大学生学习内卷这一中介路径的前半段和直接路径受到自我肯定的调节。

虚拟化身性别对数学任务表现的影响:一个有中介的调节模型

本研究探讨了虚拟化身性别对数学任务表现的影响及其影响机制。实验采用2(化身性别:男/女)×2(自我肯定:高/低)的两因素组间设计,因变量为数学工作自我概念和数学任务表现。结果表明:虚拟化身性别和自我肯定均对数学工作自我概念和数学任务表现有显著主效应,且两者交互影响两个因变量。同时,研究还发现了有中介的调节作用模型,自我肯定显著地调节了虚拟化身性别与数学任务表现的关系,且该调节关系通过数学工作自我概念的中介作用来进一步影响数学任务表现。

从“后种族社会”论的由来看美国社会的分裂

种族歧视是美国历史上一个不可抹去的污点。然而,随着奥巴马在2008年当选总统,美国社会上出现了一股“后种族社会”论的思潮。“后种族社会”论的源头可以追溯到20世纪60年代,当时联邦政府推出了《平权法案》,旨在改善少数族裔在就业和教育方面处于劣势的状况。而白人群体则宣称,针对少数族裔整体的歧视已经被铲除,升学和就业需靠自身努力,而不应该依赖政府的政策。虽然否定美国依然存在种族歧视的观点有明显缺陷,但诸多白人仍坚持这一看法,因为其有助于推翻《平权法案》。同时,强调种族歧视依然存在并以此来支持《平权法案》的阵营,也不会从自己的立场后退。上述现象反映了美国社会在种族问题上难以弥合的分裂。