Masculinization

男性化
  • 文章类型: Journal Article
    不良结果途径(AOP)框架已在毒理学学科中获得广泛接受,作为辅助化学危害评估的工具。尽管AOP开发活动有所增加,在实现大量完全认可的AOPs方面进展缓慢,部分原因是根据AOP开发人员手册构建完整的AOP的挑战性任务。为了促进在开源AOP-wiki平台上更多地吸收新的知识单元,最近提出了一种务实的方法。这种方法涉及通过系统方法考虑个人发展的关键事件关系(KERs),因为它们代表知识的基本单位,可以从完整生物体的低复杂度测试数据中推断出因果关系。然而,更广泛采用的KER发展统一方法将是可取的。使用AOP开发人员手册作为指南,开发了将“雄激素受体(AR)活性降低”与“肛门生殖器距离减少(AGD)”联系起来的KER,以证明适用于需要系统文献检索方法的KER的未来发展的方法。
    The Adverse Outcome Pathway (AOP) framework has gained widespread acceptance in toxicological disciplines as a tool for aiding chemical hazard assessment. Despite increased activity in AOP development, progress towards a high volume of fully endorsed AOPs has been slow, partly due to the challenging task of constructing complete AOPs according to the AOP Developer\'s Handbook. To facilitate greater uptake of new knowledge units onto the open-source AOP-wiki platform, a pragmatic approach was recently proposed. This approach involves considering Key Event Relationships (KERs) for individual development through systematic approaches, as they represent essential units of knowledge from which causality can be inferred; from low complexity test data to adverse outcomes in intact organisms. However, more broadly adopted harmonized methodologies for KER development would be desirable. Using the AOP Developer\'s Handbook as a guide, a KER linking \'decreased androgen receptor (AR) activity\' with \'reduced anogenital distance (AGD)\' was developed to demonstrate a methodology applicable for future developments of KERs requiring systematic literature retrieval approaches.
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  • 文章类型: Journal Article
    背景和目的使胸部男性化的手术是希望使自己的身体外观符合性别认同的变性人经常追求的手术。在我们的研究中,手术男性化的结果,包括通过改良的椭圆形切口进行皮下乳房切除术,吸脂术,减少惰性乳头-乳晕移植,并对缝针进行了分析。材料与方法在这项前瞻性队列研究中,对32例乳房大,乳头肥大和乳晕的跨性别者进行了上述男性化手术。我们的统计验证机构美学结果评估评分(IAOAS)用于分析随访期结束时的结果。结果平均随访24.5个月。最终IAOAS的平均值为23.1。发现并发症的发生率与使用乳房粘合剂有关。总之,32例患者中有22例(68.75%)预后评分优异,而10例患者(31.25%)的预后评分良好(p=0.025)。结论Top手术对于跨男性患者实现其期望的男性性别认同至关重要。必须使他们完全满意地执行此程序。我们的皮下乳房切除术和吸脂术的单阶段综合方法,减少惰性乳头和乳晕移植物,这有助于迅速过渡到男性角色,是我们研究所进行底层手术的先决条件。
    Background and Objectives  Surgery to masculinize the chest is a frequently sought-after procedure by transmen who wish to conform their physical appearance to their gender identity. In our study, the outcomes of surgical masculinization comprising subcutaneous mastectomy through a modified elliptical incision, liposuction, reduced inert nipple-areola grafting, and quilting stitches were analyzed. Materials and Methods  Thirty-two transmen with large breasts and hypertrophied nipples and areolae underwent the above-mentioned masculinizing procedure in this prospective cohort study. Our statistically validated institutional aesthetic outcome assessment score (IAOAS) was used to analyze the outcomes at the end of the follow-up period. Results  The average period of follow-up was 24.5 months. The average final IAOAS was 23.1. The rate of complications was found to be associated with using breast binders. In all, 22 of 32 patients (68.75%) had an excellent outcome score, while 10 patients (31.25%) had a good outcome score ( p  = 0.025). Conclusion  Top surgery is crucial for transmasculine patients to achieve their desired gender identity as males. It is imperative that this procedure is performed to their complete satisfaction. Our single-staged comprehensive approach of subcutaneous mastectomy and liposuction with reduced inert nipple and areola grafts, which aids in a swift transition to a male role, is a prerequisite for bottom surgery at our institute.
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  • 文章类型: Journal Article
    蚊子,Gambusiaaffinis,是同名的幼虫捕食蚊子。它们在其他潜在捕食者无法居住的栖息地中定居和生存的能力使它们能够自然地管理它们所在的大多数地面池中的幼虫蚊子种群。然而,住宅现场废水处理系统(OWTS)的废水似乎限制了鱼类捕食者的存在。这在路易斯安那州尤其成问题,法规允许将OWTS废水排放到开放式排水运输工具中。为了确定污水对污染地区的蚊子生物控制能力的影响,我们评估了来自两个污水暴露地点和两个没有污水暴露地点的人群的身体状况指标,确定污水污染的排水对鱼类的致命影响,并测量了废水存在下的猎物消耗率。从受废水影响的地点收集的雌性鱼的躯体状况有所减轻,大多数接受检查的雌性鱼的男性化肛门鳍类似于雄性gonopodium结构。在从控制地点收集的鱼类中未发现此特性,并且尚未与OWTS或路易斯安那州相关。来自控制地点的鱼在污水污染的水位<70%时存活。猎物清除率随稀释而增加。现场污水处理系统出水对蚊子的短期和长期持久性都有显著影响,他们的身体组成,生殖健康,和幼虫蚊子的消耗。这些影响可能使蚊子幼虫免于抑制,并可能增加污水污染地区蚊子传播病原体的威胁。
    Mosquitofish, Gambusia affinis, are eponymous larval mosquito predators. Their ability to colonize and survive in habitats that are uninhabitable by other potential predators allows them to naturally manage larval mosquito populations in most ground pools they are present in. However, effluent from residential onsite wastewater treatment systems (OWTSs) appears to limit the presence of fish predators. This is especially problematic in Louisiana, where regulations allow the discharge of OWTS effluent into open drainage conveyances. To determine the effect of effluent on the capacity of mosquitofish for biocontrol in contaminated areas, we assessed the body condition metrics of populations from two effluent-exposed sites and two sites not exposed to effluent, determined the lethal effect of effluent-contaminated drainage water on fish, and measured the prey consumption rates in the presence of effluent. Female fish collected from effluent-impacted sites had a reduced somatic body condition and most females examined displayed masculinized anal fins resembling the male gonopodium structure. This trait was not seen in fish collected from the control sites and has not yet been documented in association with OWTSs or in the state of Louisiana. Fish from the control sites survived at effluent-contaminated water levels < 70%, and the prey clearance rates increased with dilution. Onsite wastewater treatment system effluent has significant effects on both the short- and long-term persistence of mosquitofish, their body composition, reproductive health, and larval mosquito consumption. These effects likely release mosquito larvae from suppression and may increase the threat of mosquito-transmitted pathogens in effluent-contaminated locations.
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  • 文章类型: Journal Article
    雌雄异株植物的性别主要由遗传因素决定,但它也可以通过环境线索如外源植物激素转化。赤霉素(GA)是众所周知的开花和性发育的诱导剂,然而,赤霉素在雌雄异株菠菜(SpinaciaoleraceaL.)中诱导的性别转换的途径仍然难以捉摸。基于使用T11A和SSR19分子标记的GA3应用前后的性别检测,我们通过外源施用GA3证实并提高了GA对单个雌性植物的男性化效应,显示完全转化和功能性雄蕊。对赤霉素不敏感(SpGAI)的沉默,一个单一的DELLA家族蛋白,是一个中央GA信号抑制因子,结果类似的男性化。我们还表明,SpGAI可以与菠菜KNOX转录因子SHOTMERISTEMLESS(SpSTM)物理相互作用,这是拟南芥中花分生组织身份调节剂STM的同源物。SpSTM的沉默也使菠菜中的雌花男性化。此外,SpSTM可以直接结合SpPI的内含子,从而抑制发育中雌花中的SpPI表达。总的来说,我们的结果表明,GA通过菠菜中的SpGAI-SpSTM-SpPI调节模块诱导女性男性化过程。这些见解可能有助于阐明雌雄异株植物性别转换系统的分子机制,同时也阐明了单性花产生的生理基础,从而在植物中建立了雄花。
    The sex of dioecious plants is mainly determined by genetic factors, but it can also be converted by environmental cues such as exogenous phytohormones. Gibberellic acids (GAs) are well-known inducers of flowering and sexual development, yet the pathway of gibberellin-induced sex conversion in dioecious spinach (Spinacia oleracea L.) remains elusive. Based on sex detection before and after GA3 application using T11A and SSR19 molecular markers, we confirmed and elevated the masculinization effect of GA on a single female plant through exogenous applications of GA3, showing complete conversion and functional stamens. Silencing of GIBBERELLIC ACID INSENSITIVE (SpGAI), a single DELLA family protein that is a central GA signaling repressor, results in similar masculinization. We also show that SpGAI can physically interact with the spinach KNOX transcription factor SHOOT MERISTEMLESS (SpSTM), which is a homolog of the flower meristem identity regulator STM in Arabidopsis. The silencing of SpSTM also masculinized female flowers in spinach. Furthermore, SpSTM could directly bind the intron of SpPI to repress SpPI expression in developing female flowers. Overall, our results suggest that GA induces a female masculinization process through the SpGAI-SpSTM-SpPI regulatory module in spinach. These insights may help to clarify the molecular mechanism underlying the sex conversion system in dioecious plants while also elucidating the physiological basis for the generation of unisexual flowers so as to establish dioecy in plants.
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  • 文章类型: Journal Article
    盐度,是海洋生物生存不可或缺的非生物因素,为应对当前的全球变暖趋势,全球表现出各种变化。在这项研究中,慢性低盐度应激对硬骨鱼性别分化的影响采用半舌肌研究,具有遗传和环境性别决定系统的经济重要鱼类。采用20ppt的人工模拟海水和30ppt的环境海水对幼体C.semilaevis进行了栽培实验。在整个实验过程中,评估了生长性能,并检查了性腺发育的组织学,LS组男性化率显着降低.为了获得更多的见解,在LS和CT组中,使用从源自受精后55天(dpf)的性腺和100dpf幼体的53个文库获得的原始读段进行转录组分析。进一步进行GO/KEGG浓缩,涉及生殖能力的术语和途径,生殖细胞增殖,免疫功能,类固醇代谢等.,并提出了HPI和HPG轴之间可能的串扰。进行了WGCNA和两个枢纽基因,hspb8-like和histoneH2A.V在男性化率的变化中具有重要意义。我们的发现为不断变化的海洋环境中GSDESD物种的性别分化研究提供了坚实的参考。以及对半毛栽培环境管理的实践指导意义。
    Salinity, being an indispensable abiotic factor crucial for the survival of marine organisms, has demonstrated diverse alterations globally in response to the current trend of global warming. In this study, the effect of chronic low salinity stress on teleosts\' sex differentiation was investigated using Cynoglossus semilaevis, an economically important fish with both genetic and environmental sex determination system. The cultivation experiment was conducted employing artificially simulated seawater of 20 ppt and ambient sea water of 30 ppt to rear juveniles C. semilaevis. Throughout the experiment, the growth performance was assessed and the histology of gonadal development was examined, a significantly lower masculinization rate was observed in LS group. To gain further insights, transcriptome analysis was conducted using raw reads obtained from 53 libraries derived from gonads of 55 days post fertilization (dpf) and 100 dpf juveniles in both LS and CT groups. GO/KEGG enrichment were further proceeded, Terms and pathways involved in reproduction ability, germ cell proliferation, immune function, steroid metabolism etc., were illuminated and a possible crosstalk between HPI and HPG axis was proposed. WGCNA was conducted and two hub genes, hspb8-like and Histone H2A.V were exhibited to be of great significance in the changes of masculinization rate. Our findings provided solid reference for sex differentiation study of GSD + ESD species in a constantly changing ocean environment, as well as practice guiding significance for the environmental management for the culture of C. semilaevis.
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  • 文章类型: Journal Article
    被诊断出带有Y连锁标记物(sdY和OmyY1)的雄性虹鳟鱼养殖种群,目的是在生产水平使用之前检测新动物。为了实现可靠的诊断,考虑以下步骤:(1)PCR扩增看家β-肌动蛋白基因以确定样品的DNA质量,(2)在已知性别的男性和女性样本中通过PCR扩增来验证Y连锁标记,(3)基于在琼脂糖凝胶上可视化的男性特异性(XY基因型)和新男性特异性(XX基因型)PCR产物带模式,对男性化少年进行分子性别鉴定。评估标记的有效性和一致性。持家基因鉴定了具有阴性PCR扩增的样品,揭示了差的DNA质量。与sdY标记相比,OmyY1标记在男性和女性之间呈现更独特的PCR产物条带模式,并鉴定出更高的真男性比例(灵敏度分别为1.0和0.91)。OmyY1标记由于其一致且独特的PCR产物条带模式,准确地识别了198个男性化个体中的105个新标记。在这两个标记中,存在中高正一致性(γ指数=0.7)。结论是,OmyY1标记显示出可靠检测新标记的最佳性能,这对于在鱼类养殖中生产全雌性后代的认证育种者至关重要。
    A cultured stock of masculinized rainbow trout was diagnosed with Y-linked markers (sdY and OmyY1) aiming to detect neomales before their use at the production level. To achieve a reliable diagnosis, the following steps were considered: (1) PCR amplification of the housekeeping β-actin gene to determine the DNA quality of samples, (2) validation of the Y-linked markers by their PCR amplification in male and female samples with known sex, and (3) molecular sexing of the masculinized juveniles based on male-specific (XY genotype) and neomale-specific (XX genotype) PCR product band patterns visualized on agarose gel. The validity and concordance of the markers were assessed. The housekeeping gene identified samples with negative PCR amplification revealing a poor DNA quality. The OmyY1 marker presented a more distinctive PCR product band pattern between males and females than the sdY marker and identified a higher proportion of true males (sensitivity = 1.0 and 0.91, respectively). The OmyY1 marker accurately identified 105 neomales of the 198 masculinized individuals on account their consistent and distinctive PCR product band pattern. Among both markers, there was a medium high positive concordance (γ index = 0.7). It is concluded that the OmyY1 marker shows the best performance to reliably detect neomales, a step that is essential to have certified breeders for the production of all-female progenies in fish farming.
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  • 文章类型: Journal Article
    饲养密度直接影响鱼类福利,which,反过来,影响水产养殖的生产力。先前的研究表明,鱼类性发育过程中的高密度饲养会引起压力,导致人口中男性偏向性别比例的趋势。近年来,研究已经定义了环境与表观遗传学之间相互作用的相关性,在最终表型中起关键作用。然而,暴露于禁闭的个体的潜在表观遗传机制仍在阐明。通过使用斑马鱼(Daniorerio),DNA甲基化启动子区和六个基因的基因表达模式,即dnmt1,cyp19a1a,dmrt1、cyp11c1、hsd17b1和hsd11b2参与DNA维持甲基化,繁殖,并对压力进行了评估。斑马鱼幼虫在该物种的两个重叠性别分化时期(受精后7至18和18至45天,dpf)。结果表明,在18至45dpf的高密度鱼类种群中,男性化明显。成年后,dnmt1基因在卵巢中差异低甲基化,其表达在高密度鱼的睾丸中显著下调。Further,cyp19a1a基因在密度升高的鱼类卵巢中显示基因表达下调,正如以前在其他研究中观察到的那样。我们提出dnmt1作为潜在的睾丸表象标记,而卵巢cyp19a1a的表达作为潜在的生物标志物,用于预测在发育的早期阶段源于高密度的应激。这些发现强调了成年后长期影响饲养密度的重要性,传达了对鱼类孵化场放养协议的警告。
    Rearing density directly impacts fish welfare, which, in turn, affects productivity in aquaculture. Previous studies have indicated that high-density rearing during sexual development in fish can induce stress, resulting in a tendency towards male-biased sex ratios in the populations. In recent years, research has defined the relevance of the interactions between the environment and epigenetics playing a key role in the final phenotype. However, the underlying epigenetic mechanisms of individuals exposed to confinement remain elucidated. By using zebrafish (Danio rerio), the DNA methylation promotor region and the gene expression patterns of six genes, namely dnmt1, cyp19a1a, dmrt1, cyp11c1, hsd17b1, and hsd11b2, involved in the DNA maintenance methylation, reproduction, and stress were assessed. Zebrafish larvae were subjected to two high-density conditions (9 and 66 fish/L) during two periods of overlapping sex differentiation of this species (7 to 18 and 18 to 45 days post-fertilization, dpf). Results showed a significant masculinization in the populations of fish subjected to high densities from 18 to 45 dpf. In adulthood, the dnmt1 gene was differentially hypomethylated in ovaries and its expression was significantly downregulated in the testes of fish exposed to high-density. Further, the cyp19a1a gene showed downregulation of gene expression in the ovaries of fish subjected to elevated density, as previously observed in other studies. We proposed dnmt1 as a potential testicular epimarker and the expression of ovarian cyp19a1a as a potential biomarker for predicting stress originated from high densities during the early stages of development. These findings highlight the importance of rearing densities by long-lasting effects in adulthood conveying cautions for stocking protocols in fish hatcheries.
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  • 文章类型: Systematic Review
    人类活动一直在水生生态系统中施加广泛的压力和环境风险。环境压力,包括温度上升,酸化,缺氧,光污染,拥挤,对水生动物的生命组织学产生了相当大的负面影响,特别是性别分化(SDi)和由此产生的性别比例。了解鱼类的性别如何应对压力环境对于了解性的起源和维持非常重要。变化世界中自然人口的动态,以及性别控制在水产养殖中的精确应用。这篇综述对有关环境压力(ES)对SDi的影响的现有文献进行了详尽的搜索。有证据表明,所有类型的ES都可以影响SDi,并普遍导致男性或男性化的增加,据报道,有100种鱼类和121例病例。然后,这篇全面的综述旨在总结分子生物学,生理学,细胞学,和表观遗传机制,ES有助于男性发育或男性化。从多个方面分析了ES与鱼类SDi的关系,研究发现,环境性别分化(ESDi)是遗传因素和表观遗传因素共同作用的结果,自我生理调节,对环境信号的反应,这涉及到一个复杂的网络,各种激素和许多基因在多水平和多等级的双潜能性腺。在正常的男性分化和ES诱导的男性化中,应激途径和表观遗传调控起着重要作用;然而,他们如何共同监管SDi尚不清楚。有证据表明,水生动物中雄性的普遍出现或增加是对中度ES的适应。应在更多鱼类中并在野外广泛研究ES引起的性别逆转。还解决了与ESDi相关的潜在水产养殖应用和困难。最后,介绍了ESDi中的知识差距,这将指导未来研究的重点。
    Human activities have been exerting widespread stress and environmental risks in aquatic ecosystems. Environmental stress, including temperature rise, acidification, hypoxia, light pollution, and crowding, had a considerable negative impact on the life histology of aquatic animals, especially on sex differentiation (SDi) and the resulting sex ratios. Understanding how the sex of fish responds to stressful environments is of great importance for understanding the origin and maintenance of sex, the dynamics of the natural population in the changing world, and the precise application of sex control in aquaculture. This review conducted an exhaustive search of the available literature on the influence of environmental stress (ES) on SDi. Evidence has shown that all types of ES can affect SDi and universally result in an increase in males or masculinization, which has been reported in 100 fish species and 121 cases. Then, this comprehensive review aimed to summarize the molecular biology, physiology, cytology, and epigenetic mechanisms through which ES contributes to male development or masculinization. The relationship between ES and fish SDi from multiple aspects was analyzed, and it was found that environmental sex differentiation (ESDi) is the result of the combined effects of genetic and epigenetic factors, self-physiological regulation, and response to environmental signals, which involves a sophisticated network of various hormones and numerous genes at multiple levels and multiple gradations in bipotential gonads. In both normal male differentiation and ES-induced masculinization, the stress pathway and epigenetic regulation play important roles; however, how they co-regulate SDi is unclear. Evidence suggests that the universal emergence or increase in males in aquatic animals is an adaptation to moderate ES. ES-induced sex reversal should be fully investigated in more fish species and extensively in the wild. The potential aquaculture applications and difficulties associated with ESDi have also been addressed. Finally, the knowledge gaps in the ESDi are presented, which will guide the priorities of future research.
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  • 文章类型: Journal Article
    戊唑醇是一种广泛用于各种作物的杀真菌剂,其靶向真菌中的固醇14-α-脱甲基酶(CYP51)。然而,由于有限的研究表明其对水生生物的生殖影响,注意力已转移到芳香化酶(CYP19)。在这里,斑马鱼在不同发育阶段暴露于0.5mg/L的戊唑醇。在性别分化阶段(受精后0-60、5-60和19-60天(dpf))长期暴露后,雄性的比例显着增加。在5-60dpf暴露期间,睾酮水平升高,17β-雌二醇和cyp19a1a表达水平降低,而性别比例在与50ng/L17β-雌二醇共同暴露时分布相等。化学活化的荧光素酶基因表达生物测定确定,男性偏向的性别分化不是由戊唑醇直接与性激素受体结合引起的。尽管排除了戊唑醇与激酶直接相互作用的可能性,但在血管内皮生长因子信号通路中蛋白表达和磷酸化水平特异性改变。选择芳香化酶用于潜在靶标分析。分子对接和芳香化酶活性测定证明了戊唑醇与芳香化酶之间的相互作用,强调戊唑醇通过诱导性别失衡对鱼类种群构成威胁。
    Tebuconazole is a widely used fungicide for various crops that targets sterol 14-α-demethylase (CYP51) in fungi. However, attention has shifted to aromatase (CYP19) due to limited research indicating its reproductive impact on aquatic organisms. Herein, zebrafish were exposed to 0.5 mg/L tebuconazole at different developmental stages. The proportion of males increased significantly after long-term exposure during the sex differentiation phase (0-60, 5-60, and 19-60 days postfertilization (dpf)). Testosterone levels increased and 17β-estradiol and cyp19a1a expression levels decreased during the 5-60 dpf exposure, while the sex ratio was equally distributed on coexposure with 50 ng/L 17β-estradiol. Chemically activated luciferase gene expression bioassays determined that the male-biased sex differentiation was not caused by tebuconazole directly binding to sex hormone receptors. Protein expression and phosphorylation levels were specifically altered in the vascular endothelial growth factor signaling pathway despite excluding the possibility of tebuconazole directly interacting with kinases. Aromatase was selected for potential target analysis. Molecular docking and aromatase activity assays demonstrated the interactions between tebuconazole and aromatase, highlighting that tebuconazole poses a threat to fish populations by inducing a gender imbalance.
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  • 文章类型: Journal Article
    背景:男性化胸壁轮廓术是大多数跨男性患者的重要手术干预措施;由于接受手术,这组患者的生活质量得到了极大的改善。这项研究的目的是评估2008年至2020年在我们大学医院进行的此类手术的结果,以及患者当前的生活质量。
    方法:在2008年至2020年期间进行手术的所有16例患者都发送了一份由Breast-Q和BODY-Q模块组成的问卷,认为适合我们的研究目的,以及BECK抑郁指数和带有反馈空间的简短的两个问题形式。根据所使用的手术技术,将患者分为双切口(DI)和乳晕(PA)组。
    结果:我们发现总并发症率为31.3%,DI组为33.3%,PA为28.6%,而50%的患者需要进行二次美学矫正。问卷产生了6个回答(37.5%)。如果有选择,参与者的评分为1至10,他们愿意再次接受手术;尽管有统计学意义的并发症和矫正率,但DI组平均为10/10,PA组平均为9/10。
    结论:男性化胸壁轮廓术具有显著的并发症风险。在我们的研究中,并发症的发生频率似乎并不取决于所使用的手术技术.此外,在我们的低容量中心发现的并发症发生率似乎与较大单位报告的并发症发生率相当.
    BACKGROUND: Masculinizing chest-wall contouring surgery is an important surgical intervention for most transmasculine patients; a vast improvement in quality of life for this group of patients has been documented as a result of receiving surgery. The aim of this study was to evaluate the results of such surgeries performed at our university hospital between 2008 and 2020, as well as the current quality of life of the patients.
    METHODS: All 16 patients operated between 2008 and 2020 were sent a questionnaire consisting of both BREAST-Q and BODY-Q modules, considered fitting for our study purposes, as well as the BECK Depression Index and a short two-question form with space for feedback. Patients were divided into groups called double incision (DI) and periareolar (PA) depending on the surgical technique used.
    RESULTS: We found an overall complication percentage of 31.3%, with the DI group scoring 33.3% and PA 28.6%, while secondary aesthetic corrections were necessary for 50% of all patients. The questionnaires yielded 6 responses (37.5%). Participants rated on a scale of 1 to 10 their willingness to undergo the operation again if given the choice; the DI group averaged 10/10, and the PA group 9/10, despite the statistically significant complication and correction rates.
    CONCLUSIONS: Masculinizing chest-wall contouring surgery has significant complication risks. In our study, frequency of complications did not appear to depend on the surgical technique used. Additionally, the complication rates found in our low volume centre seem to be comparable with those reported from bigger units.
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