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Psychologica. sequela. following second-trimester termina.ion of pregna.cy: a.longitudina. study

a.Ta.OBSTETRICIa.ET GYNECOLOGICa.SCa.DINa.ICA 2024年第9期103卷 1868-1876页

作者： Da.ood, Yousif de Vries, Ja.a.M. van leeuwen, Elisa.eth van Eekelen, Rik de Ba.ker, Berna.ette S. Boelen, Pa.l a. Pa.krt, Eva Univ Amsterdam Dept Med Biol Amsterdam UMC Amsterdam Netherlands Univ Amsterdam Dept Obstet & Gynaecol Amsterdam UMC Amsterdam Netherlands Amsterdam Reprod & Dev Res Inst Amsterdam Netherlands Dept Epidemiol & Data Sci Amsterdam UMC Locat VUmc Amsterdam Netherlands Univ Med Ctr Rotterdam Erasmus MC Sophia Childrens Hosp Dept Paediat Surg Rotterdam Netherlands ARQ Natl Psychotrauma Ctr Diemen Netherlands Univ Utrecht Dept Clin Psychol Utrecht Netherlands

IntroductionThe decision to termina.e a.pregna.cy due to feta. a.oma.ies ca. ha.e a.significa.t emotiona. impa.t, especia.ly in second-trimester termina.ions. Previous studies on the psychologica. consequences of pregna.cy termina.ion ha.e ha. limita.ions, a.d little is known a.out the outcomes for pa.tners a.d the impa.t of feta. dona.ion. Therefore, we a.med to investiga.e the psychologica. effects of second-trimester pregna.cy termina.ion a.d identify fa.tors a.socia.ed with outcomes in both women a.d men, including dona.ion of feta. rema.ns to *** a.d Methodsa.longitudina. cohort study wa. conducted a. the a.sterda. UMC in the Netherla.ds, involving women a.d pa.tners who underwent termina.ion a. or before 23 weeks a.d 6 da.s of gesta.ion. Questionna.res were a.ministered a. termina.ion, 6 weeks, a.d 4 months a.ter. We utilized va.ida.ed questionna.res to a.sess psychologica. morbidity (grief, post-tra.ma.ic stress a.d postna.a. depression a.d qua.ity of life [QoL]), a.d fa.tors tha. could potentia.ly influence *** 241 pa.ticipa.ts, women displa.ed more pronounced psychologica. distress tha. men, though both groups improved over time. Four months a.ter termina.ion, 27.4% of women a.d 9.1% of men showed signs of pa.hologica. grief. Scores indica.ive for postna.a. depression occurred in 19.8% women a.d 4.1% of men. a.prior psychia.ric history wa. a.consistent predictor of poorer outcomes. Feta. dona.ion to the Dutch Feta. Bioba.k wa. a.socia.ed with reduced likelihood of symptoms of complica.ed grief four months a.ter ***-trimester termina.ion of pregna.cy for feta. a.oma.ies ca. lea. to psychologica. morbidity, pa.ticula.ly in women. However, there is a.nota.le improvement over time for both groups. Individua.s with prior psychia.ric history a.pea. more vulnera.le post-termina.ion. a.so, feta. dona.ion to science did not ha.e a.nega.ive impa.t on psychologica. well-being. Women experience more psychologica. di

关键词： feta. a.oma.ies feta. dona.ion psychologica. well-being termina.ion of pregna.cy

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Screening for subclinica. synovia. prolifera.ion in ha.mophilia. a.systema.ic review a.d meta.a.a.ysis compa.ing physica. exa.ina.ion a.d ultra.ound

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Ha.MOPHILIA 2023年第2期29卷 445-455页

作者： van leeuwen, Flora.H. P. Timmer, Merel a. de Jong, Pim a. Fischer, Ka.helijn Foppen, Wouter Univ Utrecht Univ Med Ctr Utrecht Dept Radiol & Nucl Med Utrecht Netherlands Univ Utrecht Univ Med Ctr Utrecht Ctr Benign Hematol Thrombosis & Haemostasis Van Creveldklin Utrecht Netherlands Heidelberglaan 100 NL-3584 CX Utrecht Netherlands

IntroductionUltra.ound is increa.ingly used a. a.dition to physica. exa.ina.ion for detection of subclinica. joint cha.ges in ha.mophilia. However, the a.ded va.ue of ultra.ound to physica. exa.ina.ion for detecting synovia. prolifera.ion is not fully esta.lished. a.mTo determine the dia.nostic a.cura.y of swelling a. physica. exa.ina.ion for ultra.ound-detected synovia. prolifera.ion in ha.mophilia. MethodsPubMed a.d EMBa.E were sea.ched up to 2 a.gust 2022. Studies reporting origina. da.a.on occurrence of swelling a. physica. exa.ina.ion a.d synovia. prolifera.ion on ultra.ound of index joints in persons with ha.mophilia.were included. Risk of bia. a.d a.plica.ility were a.sessed using the Qua.ity a.sessment of Dia.nostic a.cura.y Studies 2 (QUa.a.-2) tool. Dia.nostic a.cura.y pa.a.eters of swelling a. physica. exa.ina.ion for ultra.ound-detected synovia. prolifera.ion were determined. Summa.y sensitivity a.d specificity were ca.cula.ed using a.biva.ia.e ra.dom-effects model. ResultsFifteen studies reporting on swelling a. physica. exa.ina.ion a.d synovia. prolifera.ion on ultra.ound in 2890 joints of 627 pa.ients were included. Preva.ence of subclinica. synovia. prolifera.ion ra.ged between 0% a.d 55%. Sensitivity of swelling wa. low [summa.y estima.e .34;95% confidence interva. (CI) .24-.46], while specificity wa. high (summa.y estima.e .97;CI .92-.99). Predictive va.ues va.ied widely due to inter-study differences in preva.ence of synovia. prolifera.ion. ConclusionJoint swelling ha. low sensitivity for presence of ultra.ound-detected synovia. prolifera.ion in ha.mophilia. suggesting underestima.ion of synovia. prolifera.ion by physica. exa.ina.ion a.one. Consequently, ultra.ound screening ma. genera.e importa.t informa.ion on synovia. cha.ges which would otherwise rema.n undetected.

关键词： ha.mophilia physica. exa.ina.ion synovitis systema.ic review [Publica.ion Type] ultra.onogra.hy

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Exploring the rela.ionship of sa.iva.y pH a.d flow ra.e with tooth wea. severity: a.cross-sectiona. study

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JOURNa. OF DENTISTRY 2025年 152卷 105499-105499页

作者： Ma.a.ia.a. Victor I. Pereira.Cenci, Ta.ia.a.Gennip, Lucky L. a. van leeuwen, Stepha.ie J. M. van Wa.boomers, X. Fra.k Looma.s, Ba. a. C. Radboudumc Dept Surg PO Box 9101 Nijmegen NL-6500HB Netherlands

Ba.kground: Tooth wea. is the loss of denta. ha.d tissue due to chemica. a.d mecha.ica. processes, a.d its preva.ence ra.ges from 13 to 80 % in the genera. popula.ion. Ma.a.ement depends on understa.ding potentia. risk fa.tors;however, the role of sa.iva.a. one of them is not completely understood. The a.m of this study wa. to explore the rela.ionship between sa.iva.y pH a.d flow, a.d tooth wea. in pa.ients referred to a.specia.ized denta. clinic for tooth wea. ma.a.ement. Methodology: Da.a.used in this study included stimula.ed (SWS) a.d unstimula.ed whole sa.iva.y (UWS) pH a.d flow ra.e. Dependent va.ia.les were the a.era.e occlusa. Tooth Wea. Index (TWI) a.d the a.era.e of the surfa.es with the ma.imum Tooth Wea. Eva.ua.ion System 2.0 score (TWES). Univa.ia.e a.d multiva.ia.e linea. regression models were utilized, including a.multiva.ia.e a.a.ysis without outliers. Sex a.d a.e were a.ded a. confounders. Results: a.tota. of 159 pa.ients were included in this study. The a.era.e a.e of the individua.s wa. 37.1 (+/- 9.1) yea.s a.d 34 (21 %) were fema.e. Univa.ia.e models showed a.sta.istica.ly significa.t a.socia.ion between both TWI a.d SWS pH. Multiva.ia.e models showed tha. the nega.ive a.socia.ions between SWS ((3 = -0.20, C.I. = -0.36 - -0.03 [TWI];(3 = -0.12, C.I. = -0.22 - -0.02 [TWES]) a.d UWS pH ((3 = -0.12, C.I. = -0.26 - 0.02 [TWI];(3 = -0.09, C.I. = -0.18 - 0.00 [TWES]) a.d tooth wea. were la.gely una.fected by confounders. These a.socia.ions were a.so robust a.a.nst outliers. a.relevant a.socia.ion with flow ra.e wa. not detected. Conclusion: This study shows tha. sa.iva.y pH wa. inversely a.socia.ed with tooth wea. severity even a.ter correction for confounders, such a. flow ra.e, a.e, a.d sex. This a.socia.ion wa. especia.ly significa.t for SWS. a.though no ca.sa. rela.ionship ca. be esta.lished, the results suggest a.role of sa.iva.y pH in tooth wea. in pa.ients with modera.e to severe tooth wea.. No a.socia.ion wa. found between tooth wea. a.d flow

关键词： Sa.iva Risk fa.tors Flow ra.e Tooth wea. pH Tooth erosion

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Multispectra. Fluorescence Ima.ing a. a.Tool to Distinguish Pelvic Lympha.ic Dra.na.e Pa.terns During Robot-a.sisted Lymph Node Dissection in Prosta.e Ca.cer

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a.Na.S OF SURGICa. ONCOLOGY 2025年第2期32卷 1372-1381页

作者： Berrens, a.ne-Cla.re Buckle, Tessa.van Oosterom, Ma.thia. N. Slof, Leon J. van leeuwen, Pim J. Wit, Esther M. K. de Ba.ros, Hilda.a. Nieuwenhuijzen, Ja.ko a. Bekers, Elise M. Donswijk, Ma.rten L. van leeuwen, Fijs W. B. van der Poel, Henk G. Antoni van Leeuwenhoek Hosp Netherlands Canc Inst Dept Urol Amsterdam Netherlands Leiden Univ Med Ctr Intervent Mol Imaging Lab Leiden Netherlands Amsterdam Univ Med Ctr VUmc Dept Urol Amsterdam Netherlands Antoni van Leeuwenhoek Hosp Netherlands Canc Inst Dept Pathol Amsterdam Netherlands Antoni van Leeuwenhoek Hosp Netherlands Canc Inst Dept Nucl Med Amsterdam Netherlands

Ba.kgroundThe inva.ive na.ure of extended pelvic lymph node dissection (ePLND) prompts the need for a.terna.ive lympha.ic ma.ping technologies. To cha.ge the focus to "spa.ing nodes tha. a.e not involved," the first step is to resea.ch the fea.ibility of intra.pera.ively distinguishing the lymph dra.na.e pa.terns of the prosta.e from hea.thy *** performed a.prospective study (NCT05120973) tha. included 16 pa.ients who underwent a.robot-a.sisted ra.ica. prosta.ectomy + ePLND + sentinel node (using indocya.ine green-99mTc-na.ocolloid). a.ter genera. a.esthesia. a.second fluorescent dye (fluorescein) wa. injected unila.era.ly in two deposits into the intra.ermis of the upper leg (n = 8) or a.domina. wa.l (n = 8), beca.se these a.e the most common loca.ions of lymphedema.in prosta.e ca.cer surgery. To distinguish between the dra.na.e pa.terns, in vivo a.d ex vivo multispectra. fluorescence ima.ing wa. performed by using a.fluorescence *** green a.d fluorescein were visible in the sa.e regions within the ePLND-templa.e a.d co-a.cumula.ed in lymph vessels in vivo. a. histopa.hology, fluorescein wa. seen in only 10 of 370 lymph nodes (possibly owing to tra.er properties), none of which overla.ped with indocya.ine green a.d none were tumor-positive. a.ministra.ion of fluorescein did not result in discomfort or a.norma. postopera.ive *** ima.ing ca. be used to distinguish lympha.ic dra.na.e pa.terns. Our in vivo findings indica.e tha. within the ePLND-templa.e, lympha.ic dra.na.e pa.terns of the prosta.e a. lea.t pa.tly overla. with those of upper leg a.d a.domina. wa.l. The properties of fluorescein render it unsuita.le for confirma.ion of fluorescence a. histopa.hology.

关键词： Fluorescence guided surgery Ima.e-guided surgery Indocya.ine green Lymphedema Lymph node dissection Prosta.e ca.cer Robot-a.sisted surgery Sentinel node

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Who invests in energy retrofits? Mining Dutch homeowners' da.a

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ENERGY POLICY 2024年 189卷

作者： a.ha.ova. a. Derkenba.va. E. van leeuwen, E. Kra.zl, L. Vega. S. Ha.leck Hofstede, G. J. Tech Univ Wien Inst Energy Syst & Elect Drives Energy Econ Grp EEG Gusshausstr 25-CF0451 A-1040 Vienna Austria Wageningen Univ & Res Dept Social Sci Hollandseweg 1 NL-6706 KN Wageningen Netherlands Amsterdam Inst Adv Metropolitan Solut Kattenburgerstraat 5B-027W NL-1018 JA Amsterdam Netherlands North West Univ UARM 11 Hoffman St ZA-2351 Potchefstroom South Africa

Clima.e cha.ge a.d energy cha.lenges necessita.e a.deeper understa.ding of the drivers behind household energy-efficient retrofitting (EER) to inform policy. This study dissects the determina.ts influencing homeowner investments in four EER mea.ures-window double-gla.ing, insula.ion of roofs, wa.ls, a.d floors, sola. pa.el a.option, a.d hea. pump insta.la.ion-a.med a. cra.ting ta.geted policy recommenda.ions. We explored the determina.ts by employing a.combina.ion of three methods: a.systema.ic litera.ure review to pinpoint a.socia.ed fa.tors, principa. component a.a.ysis to explore Dutch na.iona. survey da.a. a.d bina.y logistic regression on the principa. components. Our findings indica.e a.lower propensity for EER a.option a.ong older, long-term homeowners, suggesting the need for governmenta. fina.cia. incentives a.d technica. a.sista.ce to bolster energy efficiency in this demogra.hic. Conversely, homeowners enga.ed in their communities demonstra.e a.higher likelihood of investing in sola. pa.els a.d insula.ion. Policyma.ers should, therefore, levera.e community dyna.ics to enha.ce EER upta.e, empha.izing informa.ion dissemina.ion a.d colla.ora.ive initia.ives. Our study underscores the importa.ce of ta.lored support a.d the mobiliza.ion of community networks a. critica. to a.vancing household energy efficiency a.d broa.er susta.na.ility goa.s. These a.d other insights ca. a.so inform energy policies in other countries.

关键词： Energy-efficient retrofitting Energy-rela.ed investment decisions Principa. component a.a.ysis Homeowners ' decision-ma.ing Energy efficiency mea.ures

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Effects of wild boa. (Sus scrofa. rooting on a.a.doned ca.ca.eous gra.sla.d in Ha.nich Na.iona. Pa.k, Germa.y

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GLOBa. ECOLOGY a.D CONSERVa.ION 2025年 59卷

作者： van leeuwen, Bob O. Tuinder, Quiniver Fa.tma.n, Thoma. Scherer, Gwydion Kla.m, a.isa.Schellenberg, Ma.len Vergeer, Philippine Ja.sen, Pa.rick a. Wageningen Univ & Res Plant Ecol & Nat Conservat Grp Droevendaalsesteeg 3a NL-6700 AA Wageningen Netherlands Wageningen Univ & Res Wildlife Ecol & Conservat Grp Droevendaalsesteeg 3a NL-6708 PB Wageningen Netherlands Osnabruck Univ Dept Biodivers & Landscape Ecol Barbarastr 11 D-49076 Osnabruck Germany Inst Biodivers & Landscape Ecol IBL Kleimannbrucke 98 D-48157 Munster Germany Hainich Natl Pk Dept Nat Conservat & Res Bei Marktkirche 9 D-99947 Bad Langensalza Germany Univ Utrecht Dept Biol Padualaan 8 NL-3584 CH Utrecht Netherlands Bargerveen Fdn Toernooiveld 1 NL-6525 ED Nijmegen Netherlands Radboud Univ Nijmegen Dept Ecol Houtlaan 4 NL-6525 XZ Nijmegen Netherlands

Ca.ca.eous gra.sla.ds a.e semi-na.ura. biodiverse ecosystems tha. hold high conserva.ion va.ue, but a.e threa.ened throughout Europe. a.a.doned ca.ca.eous gra.sla.ds become a.forested unless succession is reset. We tested the idea.tha. wild boa. (Sus scrofa. rooting a.tivity could serve a. a.mea.s to reset succession a.d thereby ma.nta.n cha.a.teristic herba.eous pla.t diversity in ca.ca.eous gra.sla.ds. We compa.ed va.cula. pla.t a.unda.ce a.d environmenta. pa.a.eters between plots rooted by wild boa. a.d undisturbed plots in unma.a.ed ca.ca.eous gra.sla.ds in Ha.nich Na.iona. Pa.k, Germa.y. We found tha. rooted plots ha. lower gra.s cover a.d higher herb cover, a.d a.significa.tly higher species richness, Sha.non diversity index a.d evenness. Indica.or species a.a.ysis differentia.ed 23 species for rooted plots, a.d 8 for undisturbed plots. Of 17 cha.a.teristic species for ca.ca.eous gra.sla.ds, two were significa.t indica.ors in rooted plots, a.d one in undisturbed plots, while 14 did not differentia.e between the trea.ments. Our findings suggest tha. wild boa. rooting a.tivity in Ha.nich Na.iona. Pa.k ma. ma.nta.n cha.a.teristic ca.ca.eous gra.sla.d vegeta.ion, by resetting ea.ly gra.sla.d succession a.d enha.cing heterogeneity, which in turn helps susta.ning biodiversity.

关键词： Biodiversity conserva.ion Disturba.ce Ecosystem engineering Gra.sla.d succession Rewilding

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Lea.ning Stra.egy with Ba.low Twins Objective for Emotion-Robust Spea.er Verifica.ion System

Learning Strategy with Barlow Twins Objective for Emotion-Ro...

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2025 IEEE Interna.iona. Conference on a.oustics, Speech, a.d Signa. Processing, ICa.SP 2025

作者： Mikha.lovskii, Dmitrii V. Kunikoshi, a.i van leeuwen, Da.id a. Kim, Ja.bok Radboud University Nijmegen Netherlands ReadSpeaker B.V. Netherlands

ISBN: (纸本)9798350368741

a.recent trend of the a.toma.ic spea.er verifica.ion (a.V) systems is to use spea.er representa.ions extra.ted from deep lea.ning-ba.ed spea.er encoders. Those representa.ions a.e robust a.a.nst linguistic va.ia.ion but sensitive to emotiona. fluctua.ion tha. potentia.ly degra.es the performa.ce of a.V systems. To ta.kle this issue, we a.plied a.correla.ion-ba.ed objective function ca.led Ba.low Twins objective to spea.er representa.ion lea.ning for the a.V ta.k with expressive speech. This helps the lea.ned representa.ions from the sa.e spea.er become simila. despite their emotiona. sta.e. Our experiment showed tha. our representa.ion lea.ning using Ba.low Twins objective improves the sta.da.d devia.ion of the EERs between different emotions from 2.43 to 1.52 a.d the tota. EER from 10.77% to 6.47% on the CREMa.D da.a.et. The study a.so eva.ua.es the system's genera.iza.ion performa.ce a.ross out-of-doma.n da.a.ets, demonstra.ing improved sta.da.d devia.ion of the EERs a.d tota. EER of the ba.eline system in a.l da.a.ets while observing the performa.ce drop on synthetic emotiona. da.a.where emotiona. misma.ch occurs. © 2025 IEEE.

关键词： a.toma.ic spea.er verifica.ion Ba.low Twins objective emotiona. speech SSL

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a.sessing the Ca.bon Footprint of Telemedicine: a.Systema.ic Review

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HEa.TH SERVICES INSIGHTS 2024年 17卷

作者： van der Zee, Ca.per Cha.g-Wolf, Jennifer Koopma.scha., Ma.c a. van leeuwen, Redmer Wisse, Robert P. L. Univ Med Ctr Utrecht Ophthalmol Dept Utrecht Netherlands Erasmus Univ Erasmus Sch Hlth Policy & Management Rotterdam Netherlands Dutch Workgroup Sustainable Ophthalmol Utrecht Netherlands

Ba.kground: Hea.thca.e is responsible for 4% to 10% of ca.bon emissions worldwide, of which 22% is rela.ed to tra.sport. Telemedicine emerged a. a.potentia. solution to reduce the footprint, for exa.ple, by reducing tra.el. However, a.need to understa.d which va.ia.les to include in ca.bon footprint estima.ions in telemedicine limits our understa.ding of the beneficia. impa.t telemedicine might ha.e on our environment. This pa.er a.ms to systema.ica.ly a.sess the reported ca.bon footprint a.d include va.ia.les a.sessed by the litera.ure, compa.ing telemedicine with usua. ***: The systema.ic review followed the PRISMa.guidelines in PubMed, Medline, Emba.e a.d Scopus. a.qua.ity a.sessment wa. performed using a.tra.spa.ency checklist for ca.bon footprint ca.cula.ors. Ca.bon emissions were eva.ua.ed ba.ed on four ca.egories, including pa.ient tra.el, a.d strea.lined life cycle a.sessment (LCa. for a.sessing included va.ia.les relevant to ***: We included 33 a.ticles from 1117 records for a.a.ysis. The a.era.e tra.spa.ency score wa. 38% (ra.ge 18%-68%). The media. roundtrip tra.el dista.ce for ea.h pa.ient wa. 131 km (interqua.tile ra.ge [IQR]: 60.8-351), or 25.6 kgCO2 (IQR: 10.6-105.6) emissions. There is high va.ia.ce a.ong included va.ia.les. Sa.ed emissions a.e structura.ly underestima.ed by not including externa. fa.tors such a. a.strea.lined ***: Telemedicine a.ds in reducing emissions, with tra.el dista.ce being the most significa.t contributor. a.ditiona.ly, we recommend a.counting for the LCa.since it highlights importa.t nua.ces. This review furthers the deba.e on a.sessing ca.bon footprint sa.ings due to telemedicine.

关键词： Telemedicine digita. hea.th ca.bon footprint greenhouse ga.ses life cycle a.sessment

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Development a.d a.plica.ion of a.Liquid Chroma.ogra.hy-Ta.dem Ma.s Spectrometry Method for the a.a.ysis of 20 Perfluoroa.kyl Substa.ces in Fruit a.d Vegeta.les a. Sub-Pa.ts-per-Trillion Levels

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JOURNa. OF a.RICULTURa. a.D FOOD CHEMISTRY 2024年第33期72卷 18731-18741页

作者： Ka.se, Ruben van leeuwen, Stefa. Kra.schmer, Kerstin van Dooren, Bob Keppels, Rens Ma.a.em, Helga. Hoogenboom, L. Ron a. P. de Pa.ter-de Witte, Leontien Berendsen, Bjorn J. a. Wageningen Univ & Res Wageningen Food Safety Res WFSR NL-6708 WB Wageningen Netherlands

In response to the Europea. Food Sa.ety a.thority's esta.lishment of a.tolera.le weekly inta.e (TWI) for the sum of PFOa. PFNa. PFHxS, a.d PFOS, a.method wa. developed to qua.tify a.d confirm 20 PFa.s a. the sub-pa.ts-per-trillion level in fruit a.d vegeta.les. Improved sensitivity wa. a.hieved by (i) increa.ing the sa.ple inta.e, (ii) decrea.ing the solvent volume in the fina. extra.t, a.d (iii) using a.highly sensitive ma.s spectrometer. Except for PFTrDa. ta.get PFa.s could be qua.tita.ively determined with a. a.pa.ent recovery of 90-119%, limits of qua.tita.ion down to 0.5 ng/kg, a.d a.rela.ive sta.da.d devia.ion under within-la.ora.ory reproducibility conditions of <28%. The method wa. successfully a.plied to 215 fruit a.d vegeta.le sa.ples obta.ned from loca. grocery stores a.d ma.kets. Lea.y vegeta.les prove to be the ma.n vegeta.le ca.egory responsible to PFa. exposure, ma.nly of PFOa. followed by PFHpa.a.d PFHxA

关键词： PFa.s LC-MS/MS food va.ida.ion exposure

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Novel a.proa.hes to Pa.ients with Differences of Sex Development

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a.vances in Pedia.rics 2024年第1期71卷 151-167页

作者： Ochoa. Brielle Weidler, Erica.M. Pa.ks, Melissa.a. Speck, Ka.en Eliza.eth van leeuwen, Ka.hleen Department of Surgery Phoenix Children's 1919 E. Thomas Road Phoenix 85016 AZ United States Department of Gynecology Phoenix Children's 1919 E. Thomas Road Phoenix 85016 AZ United States Department of Surgery Division of Pediatric Surgery University of Michigan 1540 E. Hospital Drive SPC 4211 Ann Arbor 48109 MI United States

Pa.ients with differences of sex development (DSDs) ha.e complex a.a.omy a.d surgica. needs rela.ed to both Mulleria. a.d non-Mulleria. structures. a.proa.hes to va.ina. reconstruction for these conditions a.e guided by individua. a.a.omy, with the goa. of esta.lishing unobstructed outflow for the reproductive, urina.y, a.d ga.trointestina. tra.ts. Pa.ients ma. ha.e a.a.omy requiring va.inopla.ty for either outflow tra.t obstruction or chosen sexua. function. In this a.ticle, the a.thors focus on ma.a.ement of differences in va.ina. a.a.omy with dela.ed va.inopla.ty for the newborn with DSD.

关键词： Differences of sex development (DSDs) Mulleria. a.oma.y Outflow tra.t obstruction (OTO) Reconstruction Sha.ed decision-ma.ing Va.inopla.ty

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