Advice on the Management of Ambiguous Genitalia to a Young Endocrinologist from Experienced Clinicians

The birth of a child with ambiguous genitalia is a challenging and distressing event for the family and physician and one with life-long consequences. Most disorders of sexual differentiation (DSD) associated with ambiguous genitalia are the result either of inappropriate virilization of girls or incomplete virilization of boys. It is important to establish a diagnosis as soon as possible, for psychological, social, and medical reasons, particularly for recognizing accompanying life-threatening disorders such as the salt-losing form of congenital adrenal hyperplasia. In most instances, there is sufficient follow-up data so that making the diagnosis also establishes the appropriate gender assignment (infants with congenital adrenal hyperplasia, those with androgen resistance syndromes), but some causes of DSD such as steroid 5 alpha-reductase 2 deficiency and 17 beta-hydroxysteroid dehydrogenase deficiency are associated with frequent change in social sex later in life. In these instances, guidelines for sex assignment are less well established.

Revision of the Neotropical genus Yagra Oiticica (Lepidoptera: Castniidae)

The Castniidae, or butterfly moths, are characteristically colourful diurnal moths, distributed throughout the tropics except in Africa. The Neotropical representatives forage almost exclusively on monocotyledonous plants and many species are crop pests with more than 60% of the Neotropical castniids found or endemic in Brazil. Research studies that focus on taxonomy, systematics, and morphology of this group are scarce. In this study, Yagra Oiticica, a small genus restricted to south-eastern South America, is revised and the diagnostic morphological characters of male and female genitalia are illustrated. This research is part of long-term study on the Castniidae for future phylogenetic analysis.

Revision of the Neotropical moth genera Mallodeta Butler and Erruca Walker, revalidated (Noctuidae, Arctiinae, Arctiini, Euchromiina)

Mallodeta Butler and Erruca Walker, revalidated, are redescribed and revised. Mallodeta henceforth includes only its type-species, Glaucopis (Lycorea) clavata Walker, and Erruca is resurrected with seven species: E. deyrolii Walker (type-species), E. consors (Walker), new combination, E. erythrarchos (Walker), new combination, E. cardinalis (Hampson), new combination, E. hanga (Herrich-Schaffer), new combination, E. cruenta (Perty), new combination and E. sanguipuncta (Druce), new combination. Six new synonyms are established, four specific and two generic (junior synonyms in parentheses): Zygaena capistrata Fabricius (=Mallodeta cubana Gaede), Glaucopis (Lycorea) clavata Walker (=M. simplex Rothschild), Erruca deyrolii Walker (=Laemocharis aecyra Herrich-Schaffer and Glaucopis (Hyda) sortita Walker), and Erruca Walker (=Aristodaema Wallengren and Rezia Kirby). Lectotypes are designated to the following species: Erruca deyrolii Walker, Laemocharis deyrollei Herrich-Schaffer, Laemocharis hanga Herrich-Schaffer, Laemocharis aecyra Herrich-Schaffer, Laemocharis norma Herrich-Schaffer, Cosmosoma cardinalis Hampson and Mallodeta sanguipuncta Druce. Illustrations of adults and male and female genitalia of Mallodeta and Erruca are provided, as well as a key to the species of the latter.

Orobothriurus (Scorpiones: Bothriuridae) phylogeny, Andean biogeography, and the relative importance of genitalic and somatic characters

The genus Orobothriurus Maury, 1976 (Bothriuridae Simon, 1880) displays an Andean pattern of distribution, most of its species occurring at high altitudes (over 2000-2500 m to a maximum altitude record of 4910 m) from central Peru to Argentina. The recent discovery of several new species and the uncertain phylogenetic position of Orobothriurus lourencoi Ojanguren Affilastro, 2003, required a reanalysis of Orobothriurus phylogeny. Thirty bothriurid taxa, including all species of Orobothriurus and Pachakutej Ochoa, 2004, were scored for 65 morphological characters and analysed with parsimony under equal and implied weighting. The resulting topology justifies the establishment of a new genus, Rumikiru Ojanguren Affilastro et al., in press, for O. lourencoi and a closely related, new species, Rumikiru atacama Ojanguren Affilastro et al., in press. It also offers new insights about the phylogeny and biogeography of Orobothriurus and related genera. Characters from the male genitalia (i.e. hemispermatophore), comprising approximately 26% of the morphological matrix, were found to be less homoplastic than those from somatic morphology, contradicting suggestions that genitalia are uninformative or potentially misleading in phylogenetic studies.

A hymenopterists' guide to the Hymenoptera Anatomy Ontology: utility, clarification, and future directions

Hymenoptera exhibit an incredible diversity of phenotypes, the result of similar to 240 million years of evolution and the primary subject of more than 250 years of research. Here we describe the history, development, and utility of the Hymenoptera Anatomy Ontology (HAO) and its associated applications. These resources are designed to facilitate accessible and extensible research on hymenopteran phenotypes. Outreach with the hymenopterist community is of utmost importance to the HAO project, and this paper is a direct response to questions that arose from project workshops. In a concerted attempt to surmount barriers of understanding, especially regarding the format, utility, and development of the HAO, we discuss the roles of homology, "preferred terms", and "structural equivalency". We also outline the use of Universal Resource Identifiers (URIs) and posit that they are a key element necessary for increasing the objectivity and repeatability of science that references hymenopteran anatomy. Pragmatically, we detail a mechanism (the "URI table") by which authors can use URIs to link their published text to the HAO, and we describe an associated tool (the "Analyzer") to derive these tables. These tools, and others, are available through the HAO Portal website (http://portal.hymao.org). We conclude by discussing the future of the HAO with respect to digital publication, cross-taxon ontology alignment, the advent of semantic phenotypes, and community-based curation.

Revision of Nanophareus, a mysterious harvestman genus from Chile, with descriptions of three new species (Opiliones: Laniatores: Gonyleptidae)

The Chilean genus Nanophareus Roewer, 1929 is revised and three new species are described: N. araucanus sp. nov. (type locality: Parque Nacional La Campana, Valparaiso, Chile); N. bipartitus sp. nov. (type locality: Parque Nacional La Campana, Valparaiso, Chile); N. bosqenublado sp. nov. (type locality: Parque Nacional Fray Jorge, Coquimbo, Chile). The type species, N. palpalis Roewer, 1929, is redescribed and a lectotype is designated. A cladistic analysis was performed using these three new species plus N. palpalis and 14 more laniatorid species, and a data matrix of 72 characters: Seven from the ocularium, 22 from the dorsal scutum, one from the venter, one from the chelicera, eight from the pedipalp, 24 from male legs, and nine from male genitalia. Two equally most parsimonious trees were found (L = 210; C.I. = 0.41; R.I. = 0.51). Nanophareus was recovered as nested within a paraphyletic subfamily Pachylinae. The genus Nanophareus was found to be monophyletic based on the following exclusive synapomorphies: An external row of enlarged tubercles inserted among small ones on lateral margin of the dorsal scutum (innapplicable in N. bosqenublado); the ventro-basal margin of pedipalpal tibia curved 90 degrees in lateral view; and retrolateral seta of the pedipalpal tibia with a socket apically bifid (socket and seta longer than pedipalpal tibia length).

A NEW GENUS AND SPECIES OF PHILOPTERIDAE (PHTHIRAPTERA: ISCHNOCERA) FROM THE TRUMPETERS (AVES: GRUIFORMES: PSOPHIIDAE)

A new chewing louse genus and species belonging to the Philopteridae, namely, Palmaellus inespectatus n. gen., n. sp., is described. The new genus is distinguished from the other ischnoceran genera hitherto described by its peculiar characters of the dorsal anterior head plate with 2 postero-lateral projections, pterothorax and abdomen with scarce chaetotaxy, male genitalia with simple mesomere and paramere lacking inner digitiform projection, and the genital region of female with postero-vulvar plates bearing setae. It is a parasite of the trumpeters, an avian family endemic to South America's Amazon Basin.

Inactivating Mutations of the Human Luteinizing Hormone Receptor in Both Sexes

The human luteinizing hormone/chorionic gonadotropin receptor (LHCGR) plays a fundamental role in male and female reproductive physiology. Over the past 15 years, several homozygous or compound heterozygous loss-of-function mutations in the LHCGR gene have been described in males and females. In genetic males, mutations in LHCGR were associated with distinct degrees of impairment in pre- and postnatal testosterone secretion resulting in a phenotypic spectrum. Patients with the severe form of LH resistance have predominantly female external genitalia and absence of secondary sex differentiation at puberty. Patients with milder forms have predominantly male external genitalia with micropenis and/or hypospadias or only infertility without ambiguity. The undermasculization is associated with low basal, as well as human CG-stimulated, testosterone levels and elevated LH levels after pubertal age, without abnormal step-up in testosterone biosynthesis precursors. The testes have only slightly reduced size but mature Leydig cells are absent or scarce (Leydig cell hypoplasia). Genetic females with inactivating LHCGR mutations have female external genitalia, spontaneous breast and pubic hair development at puberty, and normal or late menarche followed by oligoamenorrhea and infertility. Estradiol and progesterone levels are normal for the early to midfollicular phase, but do not reach ovulatory or luteal phase levels. Serum LH levels are high whereas follicle-stimulating hormone levels are normal or only slightly increased. Pelvic ultrasound has demonstrated a small or normal uterus and normal or enlarged ovaries with cysts. The inactivating mutations of the LHCGR have provided important insights into distinct physiological roles of LH in reproduction of both sexes.

Congenital Adrenal Hyperplasia Due to 21 Hydroxylase Deficiency: From Birth to Adulthood

The most frequent form of congenital adrenal hyperplasia (CAH) is steroid 21-hydroxylase deficiency, accounting for more than 90% of cases. Affected patients cannot synthesize cortisol efficiently. Thus the adrenal cortex is stimulated by corticotropin (ACTH) and overproduces cortisol precursors. Some precursors are diverted to sex hormone biosynthesis, causing signs of androgen excess including ambiguous genitalia in newborn females and rapid postnatal growth in both sexes. In the most severe "salt wasting" form of CAH (similar to 75% of severe or "classic" cases), concomitant aldosterone deficiency may lead to salt wasting with consequent failure to thrive, hypovolemia, and shock. Newborn screening minimizes delays in diagnosis, especially in males, and reduces morbidity and mortality from adrenal crises. CAH is a recessive disorder caused by mutations in the CYP21 (CYP21A2) gene, most of which arise from recombination between CYP21 and a nearby pseudogene, CYP21P (CYP21A1P). Phenotype is generally correlated with genotype. Classic CAH patients require chronic glucocorticoid treatment at the lowest dose that adequately suppresses adrenal androgens and maintains normal growth and weight gain, and most require mineralocorticoid (fludrocortisone). Transition of care of older patients to adult physicians should be planned in advance as a structured, ongoing process.

Description of Two New Sand Fly Species Related to Nyssomyia antunesi (Diptera, Psychodidae, Phlebotominae)

Both sexes of two new Brazilian phlebotomine sand flies of the genus Nyssomyia Barretto 1962 [= Lutzomyia (Nyssomyia) sensu Barretto], Nyssomyia delsionatali n. sp. and Nyssomyia urbinattii n. sp., presenting close affinity with Nyssomyia antunesi (Coutinho), are described and illustrated. N. delsionatali n. sp was captured on the edge of a riparian Amazonian forest on the Juruena river in the northwest of Mato Grosso state and N. urbinattii n. sp in a riparian Amazonian forest on the Teles Pires river between Mato Grosso and Para states. Some measurements of both sexes of N. antunesi and illustration of the male genitalia and the female spermathecae as well as an identi_cation key for males and females of the genus Nyssomyia are provided.

DSD Due to 5 alpha-Reductase 2 Deficiency - from Diagnosis to Long Term Outcome

Most of the patients with 5 alpha-RD 2 deficiency are reared in the female social sex due to their severely undervirilized external genitalia but similar to 60% who have not been submitted to orchiectomy in childhood undergo male social sex change at puberty. In our cohort of 30 cases from 18 families, all subjects were registered in the female social sex except for two children-one who had an affected uncle and the other who was diagnosed before being registered. The majority of the patients were satisfied with the long-term results of their treatment and surprisingly, penile length was not associated with satisfactory or unsatisfactory sexual activity. Steroid 5 alpha-RD2 deficiency should be included in the differential diagnosis of all newborns with 46,XY DSD with normal testosterone production before gender assignment or any surgical intervention because these patients should be considered males at birth.

Description of Rhodnius montenegrensis n. sp (Hemiptera: Reduviidae: Triatominae) from the state of Rondonia, Brazil

We present here a multisource approach that takes advantage of several disciplines to address a taxonomic issue. A triatomine related to Rhodnius robustus Larrousse, 1927 was recently found in the state of Rondonia, Brazil. The name Rhodnius montenegrensis n. sp. is suggested because it was found in the municipality of Monte Negro. The main differences between these two species can be detected in the female and male genitalia, but there are also noticeable differences in their eggs. Molecular analysis using PCR-RFLP technique and Bayesian inferences based on a fragment of the Cytochrome b (Cyt b) gene corroborated the morphological findings. We used this integrative approach to address the taxonomic decision for a new Rhodnius species and its relationship with others of this genus. Results obtained herein stress that morphology must be used as the major approach for obtaining phenotypic information, and molecular data should be taken as a complementary tool.

A novel microdeletion syndrome at 3q13.31 characterised by developmental delay, postnatal overgrowth, hypoplastic male genitals, and characteristic facial features

Background Congenital deletions affecting 3q11q23 have rarely been reported and only five cases have been molecularly characterised. Genotype. phenotype correlation has been hampered by the variable sizes and breakpoints of the deletions. In this study, 14 novel patients with deletions in 3q11q23 were investigated and compared with 13 previously reported patients. Methods Clinical data were collected from 14 novel patients that had been investigated by high resolution microarray techniques. Molecular investigation and updated clinical information of one cytogenetically previously reported patient were also included. Results The molecular investigation identified deletions in the region 3q12.3q21.3 with different boundaries and variable sizes. The smallest studied deletion was 580 kb, located in 3q13.31. Genotype. phenotype comparison in 24 patients sharing this shortest region of overlapping deletion revealed several common major characteristics including significant developmental delay, muscular hypotonia, a high arched palate, and recognisable facial features including a short philtrum and protruding lips. Abnormal genitalia were found in the majority of males, several having micropenis. Finally, a postnatal growth pattern above the mean was apparent. The 580 kb deleted region includes five RefSeq genes and two of them are strong candidate genes for the developmental delay: DRD3 and ZBTB20. Conclusion A newly recognised 3q13.31 microdeletion syndrome is delineated which is of diagnostic and prognostic value. Furthermore, two genes are suggested to be responsible for the main phenotype.

Descriptions of Thereza murutinga sp. nov. and Pristocnemis caipira sp. nov., and new records of Caelopyginae (Opiliones: Laniatores: Gonyleptidae)

Two new species of Caelopyginae are described: Pristocnemis caipira sp. nov. from Parque Nacional da Serra da Canastra, Minas Gerais, Brazil, and Thereza murutinga sp. nov., from Parati, Rio de Janeiro, Brazil. Pristocnemis caipira sp. nov. is diagnosed by shallow grooves on the dorsal scutum, a lower number of tarsal segments, presence of a spine on the anal operculum, large, pointed tubercles on the lateral margins of the dorsal scutum, and an absence of white patches on the dorsal scutum. Thereza murutinga sp. nov. is diagnosed by the combination of the following characters: incomplete median longitudinal groove on area III and absent on area II, prosoma much smaller than opisthosoma, and a large white patch covering the prosoma and whole areas of the opisthosomal scutum. A cladistic analysis including the two new species was performed to investigate their relationship within the subfamily. We obtained 927 trees of 185 steps (CI=0.4, RI=0.74), which corroborated the generic assignments of the new species, but infrageneric relationships remained unsolved. In addition, male genitalia of Ampheres luteus (Giltay) and genera Pristocnemis and Thereza are redescribed, new distribution records for Caelopyginae species are presented, and biogeographical implications are discussed.

Women's Poorer Satisfaction With Their Sex Lives Following Gynecologic Cancer Treatment

Gynecologic cancer treatment can lead to anatomical changes in the genitalia that may impair sexual response. As a result, the authors aimed to assess women's self-perceptions of their sex lives following gynecologic cancer treatment and the impact of such treatment on sexual function. Thirty sexually active women were examined. At the first meeting with a physician sex therapist, women were asked about their satisfaction with their sexual activities prior to and after gynecologic cancer treatment, either with a partner or alone, and how many times per month they had sexual intercourse prior to the cancer diagnosis and after treatment. Women reported significantly worse sex lives and a significantly lower frequency of sexual relations following cancer treatment. All participants reported pain on vaginal penetration and feeling uncomfortable in discussing their sexual difficulties with the oncologist. The findings show that women experienced impaired sexual function, as well as poorer quality of sexual function, following gynecologic cancer treatment. Nurses should provide basic guidelines about sexual function to all patients who undergo treatment for gynecologic cancer.