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.

Medicalizing gender: from intersex to DSD, from the laboratory to patient groups

The subject of this research, the medicalization of the gendered body, is a shifting object. It has changed its medical name from Intersex to DSD (Disorders -or Divergence- of Sex Development), since the beginning of this research project. Loosely speaking it addresses the gendered components of the body, and their subsequent consideration. Drawing closer, it addresses how modern medicine treats people who manifest variations of one of the gendered components of the body, inserting their bodies into pathological categories now called DSD. This shifting terrain of different modes of viewing the gendered body has grown to include many variations, no longer solely interested in the mythical hermaphrodite. The locus of this investigation is in the interaction between these patient groups and doctors in Italy.

Monitoring and Assessment of Desertification and Land Degradation: Knowledge Management, Institutions and Economics: White Paper of the DSD Working Group 3

The White Paper is a review of leading scientific knowledge on the role of knowledge management, institutions and economics in monitoring and assessment of land degradation and desertification. It provides key recommendations for more effective policies and actions for combating desertification both withn the UNCCD and beyond. This White Paper is the result of an international collaboration and consultation led jointly by the Association of DesertNet International and the United Nations University - Institute for Water, Environment and Health (UNU-INWEH), of the Dryland Science for Development Consortium (DSD). The findings were presented at the First UNCCD Scientific Conference held during the COP-9 in Buenos Aires, 2009.

[Hermaphroditos in Greek mythology--DSD in moderne medicine]

We report a case of 34 year old woman how has been hospitalized at the age of 6 month with persistent vomitus. The vomitus was found to be caused by adrenal insufficiency with lack of all hormones of steroidobiosynthesis. The phenotypical femal child was diagnosed to have congenital lipoid adrenal hyperplasia with 46,XY DSD. 24 years later a homozygote mutation in the StAR-gene (L260P), which was first described in Switzerland, has been identified.

Human MAMLD1 Gene Variations Seem Not Sufficient to Explain a 46,XY DSD Phenotype

MAMLD1 is thought to cause disordered sex development in 46,XY patients. But its role is controversial because some MAMLD1 variants are also detected in normal individuals, several MAMLD1 mutations have wild-type activity in functional tests, and the male Mamld1-knockout mouse has normal genitalia and reproduction. Our aim was to search for MAMLD1 variations in 108 46,XY patients with disordered sex development, and to test them functionally. We detected MAMDL1 variations and compared SNP frequencies in controls and patients. We tested MAMLD1 transcriptional activity on promoters involved in sex development and assessed the effect of MAMLD1 on androgen production. MAMLD1 expression in normal steroid-producing tissues and mutant MAMLD1 protein expression were also assessed. Nine MAMLD1 mutations (7 novel) were characterized. In vitro, most MAMLD1 variants acted similarly to wild type. Only the L210X mutation showed loss of function in all tests. We detected no effect of wild-type or MAMLD1 variants on CYP17A1 enzyme activity in our cell experiments, and Western blots revealed no significant differences for MAMLD1 protein expression. MAMLD1 was expressed in human adult testes and adrenals. In conclusion, our data support the notion that MAMLD1 sequence variations may not suffice to explain the phenotype in carriers and that MAMLD1 may also have a role in adult life.

High-Rate, Multisymbol-Decodable STBCs From Clifford Algebras

It is well known that space-time block codes (STBCs) obtained from orthogonal designs (ODs) are single-symbol decodable (SSD) and from quasi-orthogonal designs (QODs) are double-symbol decodable (DSD). However, there are SSD codes that are not obtainable from ODs and DSD codes that are not obtainable from QODs. In this paper, a method of constructing g-symbol decodable (g-SD) STBCs using representations of Clifford algebras are presented which when specialized to g = 1, 2 gives SSD and DSD codes, respectively. For the number of transmit antennas 2(a) the rate (in complex symbols per channel use) of the g-SD codes presented in this paper is a+1-g/2(a-9). The maximum rate of the DSD STBCs from QODs reported in the literature is a/2(a-1) which is smaller than the rate a-1/2(a-2) of the DSD codes of this paper, for 2(a) transmit antennas. In particular, the reported DSD codes for 8 and 16 transmit antennas offer rates 1 and 3/4, respectively, whereas the known STBCs from QODs offer only 3/4 and 1/2, respectively. The construction of this paper is applicable for any number of transmit antennas. The diversity sum and diversity product of the new DSD codes are studied. It is shown that the diversity sum is larger than that of all known QODs and hence the new codes perform better than the comparable QODs at low signal-to-noise ratios (SNRs) for identical spectral efficiency. Simulation results for DSD codes at variousspectral efficiencies are provided.

Multigroup-Decodable STBCs from Clifford Algebras

A Space-Time Block Code (STBC) in K symbols (variables) is called g-group decodable STBC if its maximum-likelihood decoding metric can be written as a sum of g terms such that each term is a function of a subset of the K variables and each variable appears in only one term. In this paper we provide a general structure of the weight matrices of multi-group decodable codes using Clifford algebras. Without assuming that the number of variables in each group to be the same, a method of explicitly constructing the weight matrices of full-diversity, delay-optimal g-group decodable codes is presented for arbitrary number of antennas. For the special case of Nt=2a we construct two subclass of codes: (i) A class of 2a-group decodable codes with rate a2(a−1), which is, equivalently, a class of Single-Symbol Decodable codes, (ii) A class of (2a−2)-group decodable with rate (a−1)2(a−2), i.e., a class of Double-Symbol Decodable codes. Simulation results show that the DSD codes of this paper perform better than previously known Quasi-Orthogonal Designs.

The role of androgens in fetal growth: observational study in two genetic models of disordered androgen signalling.

OBJECTIVE: To examine the role of androgens on birth weight in genetic models of altered androgen signalling. SETTING: Cambridge Disorders of Sex Development (DSD) database and the Swedish national screening programme for congenital adrenal hyperplasia (CAH). PATIENTS: (1) 29 girls with XY karyotype and mutation positive complete androgen insensitivity syndrome (CAIS); (2) 43 girls and 30 boys with genotype confirmed CAH. MAIN OUTCOME MEASURES: Birth weight, birth weight-for-gestational-age (birth weight standard deviation score (SDS)) calculated by comparison with national references. RESULTS: Mean birth weight SDS in CAIS XY infants was higher than the reference for girls (mean, 95% CI: 0.4, 0.1 to 0.7; p=0.02) and was similar to the national reference for boys (0.1, -0.2 to 0.4). Birth weight SDS in CAH girls was similar to the national reference for girls (0.0, -0.2 to 0.2) and did not vary by severity of gene mutation. Birth weight SDS in CAH boys was also similar to the national reference for boys (0.2, -0.2 to 0.6). CONCLUSION: CAIS XY infants have a birth weight distribution similar to normal male infants and birth weight is not increased in infants with CAH. Alterations in androgen signalling have little impact on birth weight. Sex dimorphism in birth size is unrelated to prenatal androgen exposure.

UK guidance on the initial evaluation of an infant or an adolescent with a suspected disorder of sex development

It is paramount that any child or adolescent with a suspected disorder of sex development (DSD) is assessed by an experienced clinician with adequate knowledge about the range of conditions associated with DSD. If there is any doubt, the case should be discussed with the regional team. In most cases, particularly in the case of the newborn, the paediatric endocrinologist within the regional DSD team acts as the first point of contact. The underlying pathophysiology of DSD and the strengths and weaknesses of the tests that can be performed should be discussed with the parents and affected young person and tests undertaken in a timely fashion. This clinician should be part of a multidisciplinary team experienced in management of DSD and should ensure that the affected person and parents are as fully informed as possible and have access to specialist psychological support. Finally, in the field of rare conditions, it is imperative that the clinician shares the experience with others through national and international clinical and research collaboration. © 2011 Blackwell Publishing Ltd.

Correlação entre a espessura da parede vesical e os achados urodinâmicos em pacientes com lesão medular traumática. Avaliação da influência das alterações morfológicas da bexiga nos resultados da injeção de toxina botulínica tipo-A no detrusor

Medir a espessura da parede vesical (EPV) através da ultrassonografia, correlacioná-la com os parâmetros urodinâmicos e avaliar o papel destes parâmetros para lesão do trato urinário superior. Avaliar também o papel das alterações da forma da bexiga nos resultados de injeção de toxina botulínica tipo-A (BTX-A) no detrusor em pacientes com lesão medular traumática (LMT). Trata-se de dois estudos. O primeiro é um estudo transversal de 272 pacientes com LMT submetidos à ultrassonografia renal e de bexiga e estudo urodinâmico. A parede anterior da bexiga foi medida e comparada com os dados urodinâmicos. A cistografia foi realizada em 57 pacientes. O segundo foi um estudo prospectivo avaliando os resultados da injeção de BTX-A no detrusor em 27 pacientes considerando os achados urodinâmicos (pré e pós procedimento) e as deformidades da bexiga (cistografia). A média da EPV foi de 3,94 mm e foi estatisticamente maior em pacientes com hiperatividade detrusora neurogênica associada à dissinergia vesicoesfincteriana (HDN/DVE), em comparação com aqueles sem DVE (p<0,001). Essa média também foi maior em pacientes com complacência < 20 mL/cmH2O, comparada aos pacientes com complacência ≥ 20 mL/cmH2O (p<0,001). A média da pressão detrusora máxima (Pdet Max) foi estatisticamente maior nos pacientes com refluxo vesicoureteral (RVU) em comparação com aqueles sem RVU (100,7 vs 61,2 cmH2O respectivamente, p=0,022). Pacientes com complacência < 20 mL/cmH2O apresentaram prevalência de hidronefrose 4,2 vezes maior, comparada aos pacientes com complacência ≥ 20 mL/cmH2O. Não houve associação estatística entre EPV e hidronefrose ou RVU. Vinte e sete pacientes foram submetidos à injeção de BTX-A no detrusor. A média de tempo de continência urinária foi de 8 meses. Nove pacientes (33,3%) tinham forma vesical alterada e 8 casos (29,6%) tinham divertículos. A capacidade cistométrica máxima, Pdet max, volume reflexo e complacência não apresentaram diferença significativa na presença de divertículos ou alteração da forma. O aumento da EPV está associado à complacência < 20 mL/cmH2O e HDN/DVE em pacientes com LMT. No entanto, não houve relação entre a EPV e hidronefrose ou RVU. Baixa complacência e HDN/DVE são os principais fatores de risco para dano ao trato urinário superior. A presença de divertículos ou alteração da forma vesical não influenciou nos resultados após injeção de BTX-A no detrusor.

Contributo do iPad® para o desenvolvimento de crianças com necessidades educativas especiais

Dissertação apresentada à Escola Superior de Educação de Lisboa para obtenção do grau de Mestre em Ciências da Educação, Especialidade Intervenção Precoce

A traffic differentiation add-on to the IEEE 802.15.4 protocol: implementation and experimental validation over a real-time operating system

The IEEE 802.15.4 is the most widespread used protocol for Wireless Sensor Networks (WSNs) and it is being used as a baseline for several higher layer protocols such as ZigBee, 6LoWPAN or WirelessHART. Its MAC (Medium Access Control) supports both contention-free (CFP, based on the reservation of guaranteed time-slots GTS) and contention based (CAP, ruled by CSMA/CA) access, when operating in beacon-enabled mode. Thus, it enables the differentiation between real-time and best-effort traffic. However, some WSN applications and higher layer protocols may strongly benefit from the possibility of supporting more traffic classes. This happens, for instance, for dense WSNs used in time-sensitive industrial applications. In this context, we propose to differentiate traffic classes within the CAP, enabling lower transmission delays and higher success probability to timecritical messages, such as for event detection, GTS reservation and network management. Building upon a previously proposed methodology (TRADIF), in this paper we outline its implementation and experimental validation over a real-time operating system. Importantly, TRADIF is fully backward compatible with the IEEE 802.15.4 standard, enabling to create different traffic classes just by tuning some MAC parameters.

A many-core co-processor for embedded parallel computing on FPGA

Single processor architectures are unable to provide the required performance of high performance embedded systems. Parallel processing based on general-purpose processors can achieve these performances with a considerable increase of required resources. However, in many cases, simplified optimized parallel cores can be used instead of general-purpose processors achieving better performance at lower resource utilization. In this paper, we propose a configurable many-core architecture to serve as a co-processor for high-performance embedded computing on Field-Programmable Gate Arrays. The architecture consists of an array of configurable simple cores with support for floating-point operations interconnected with a configurable interconnection network. For each core it is possible to configure the size of the internal memory, the supported operations and number of interfacing ports. The architecture was tested in a ZYNQ-7020 FPGA in the execution of several parallel algorithms. The results show that the proposed many-core architecture achieves better performance than that achieved with a parallel generalpurpose processor and that up to 32 floating-point cores can be implemented in a ZYNQ-7020 SoC FPGA.

Sparse matrix multiplication on a reconfigurable many-core architecture

Sparse matrix-vector multiplication (SMVM) is a fundamental operation in many scientific and engineering applications. In many cases sparse matrices have thousands of rows and columns where most of the entries are zero, while non-zero data is spread over the matrix. This sparsity of data locality reduces the effectiveness of data cache in general-purpose processors quite reducing their performance efficiency when compared to what is achieved with dense matrix multiplication. In this paper, we propose a parallel processing solution for SMVM in a many-core architecture. The architecture is tested with known benchmarks using a ZYNQ-7020 FPGA. The architecture is scalable in the number of core elements and limited only by the available memory bandwidth. It achieves performance efficiencies up to almost 70% and better performances than previous FPGA designs.

Using dynamic reconfiguration to reduce the area of a JPEG decoder on FPGA

Partial dynamic reconfiguration of FPGAs can be used to implement complex applications using the concept of virtual hardware. In this work we have used partial dynamic reconfiguration to implement a JPEG decoder with reduced area. The image decoding process was adapted to be implemented on the FPGA fabric using this technique. The architecture was tested in a low cost ZYNQ-7020 FPGA that supports dynamic reconfiguration. The results show that the proposed solution needs only 40% of the resources utilized by a static implementation. The performance of the dynamic solution is about 9X slower than the static solution by trading-off internal resources of the FPGA. A throughput of 7 images per second is achievable with the proposed partial dynamic reconfiguration solution.