Regarding the GQS, most of the videos were evaluated as moderate quality (51%). Compared with the poor-content video group, the rich-content video group had a significantly higher GQS score (P = .004). There was no significant difference between the poor-content and rich-content groups regarding information reliability (P > .05). CONCLUSIONS Video content on YouTube relating to aligner orthodontics was generally insufficient. The quality of videos was moderate, but the reliability of information was generally poor. Specialists should refer patients to reliable sources of information.Objective Every year 500,000 youths in the U.S. with chronic disease turn 18 and eventually require transfer to adult subspecialty care. Evidence-based interventions on the organization of transfer of care are limited, although engagement and retention in adult clinic are considered appropriate outcomes. Sustained continuity of care improves patient satisfaction and reduces hospitalization.  https://www.selleckchem.com/Androgen-Receptor.html  Methods We conducted a prospective non-randomized cohort study of patients with pediatric endocrine conditions, age 16-26 years, enrolled upon referral to the adult endocrine clinic of a physician trained in both adult and pediatric endocrinology (Med+Peds Endocrinologist). Patients differed based on whether their referral originated from another pediatric endocrinologist (traditional transfer) or if the Med+Peds Endocrinologist previously saw the patient in his pediatric endocrine clinic (guided transfer). Rather than relying on arbitrary age criteria, guided transfer to adult clinic occurred when physician and patient considered it appropriate. The primary outcome was show rate at the first and second adult visits. Results Of 36 patients, 21 were referred by another pediatric endocrinologist and 15 underwent guided transfer. For traditional transfer, show rate to the first and second visit was 38% compared to 100% in the guided transfer group (p = 0.0001). Subgroup analysis of 27 patients with diabetes revealed that both groups had similar initial HbA1c (p = 0.38) and the guided transfer group maintained HbA1c. Conclusions Most traditional transfers were unsuccessful. Guided transfer was significantly more effective, with every patient successfully transferring, and could be implemented with adult endocrinologists willing to see patients in the pediatric clinic.PURPOSE Comprehensive evidence comparing different medications for acromegaly is scarce. The aim of this study was to perform a network meta-analysis based on evidence from both randomized trials and observational studies of medical treatments for acromegaly. METHODS Electronic databases were searched for both observational studies and randomized trials that enrolled acromegaly patients treated with medications of interest. Simulated trials were generated by a machine learning algorithm, and then synthesized with Bayesian random-effects network meta-analyses. The main outcome was the rate of insulin-like growth factor-I (IGF-I) control after medical treatment. RESULTS We included 90 studies (100 arms, 4523 patients) before matching. After matching, 28 simulated trials were generated. Balance of matched arms was checked by spatial distance and correlation matrix. Co-treatment with somatostatin receptor ligands and pegvisomant was the most effective treatment compared with other treatments. In unselected patients, pegvisomant was better than octreotide long-acting release (logOR, 0.85, 95% credibility interval [CrI], 0.05 to 1.65) or lanreotide (logOR, 1.09, 95% CrI, 0.05 to 2.14) and the mean absolute IGF-I control rate ranged from 40% to 60%. While in partially responsive patients, co-treatment with somatostatin receptor ligands and pegvisomant was similar to pegvisomant monotherapy, ranking as the most two effective treatments, and the mean absolute IGF-I control rate was over 60%. CONCLUSIONS Our analysis suggested that the combination of data from observational studies and randomized trials in network meta-analysis was feasible. The findings of this network meta-analysis provided robust evidence supporting the current guidelines in treatment strategy for acromegaly.Objective-To describe patient characteristics at presentation, management, and fertility preservation rates among a cohort of Israeli children and adolescents with gender dysphoria (GD). Methods-We performed a retrospective chart review of 106 consecutive children and adolescents with GD ( less then 18 years) referred to and followed at the multidisciplinary Israeli Pediatric Gender Dysphoria Clinic from 3/2013-12/2018. Results-Of the 106 patients, 10 were prepubertal (9 prepubertal transgender females) and 96 were pubertal (38 pubertal transgender females). The GD population increased 11-fold since the establishment of our clinic in 2013. The subject's median age at referral was 15.5 years (range 4.6-18 years). At the time of referral, 91 (95%) of the pubertal group had completed sexual maturation in their assigned gender at birth. Thirteen (13.5%) patients had attempted suicide and 11 (11.5%) reported having had suicidal thoughts. Fourteen (45%) pubertal transgender females and three (6.5%) pubertal transgender males completed fertility preservation. Gonadotropin-releasing-hormone analog treatment was prescribed in 77 (80%) patients at a mean age of 15.9±1.6 years. Gender-affirming hormones were prescribed in 61 (64%) patients at a mean age of 16.5±1.3 years. No severe side effects were recorded. Two (2%) of the pubertal group expressed regret about medical treatment. Conclusions-Children and adolescents with gender dysphoria are presenting for medical attention at increasing rates. Israeli adolescents with gender dysphoria have high fertility preservation rates. perhaps attributable to cultural perspectives. Taking advantage of the option to preserve fertility can be achieved when proper counseling is both available and promoted by medical personnel.Background Primary generalized glucocorticoid resistance (PGGR) is a rare hereditary disease characterized by generalized partial target-tissue insensitivity to glucocorticoids. So far, few cases have been reported, and more cases, especially of other races, are needed to fully understand this disease. Methods and Results This study presented a novel glucocorticoid receptor mutation in a PGGR pedigree. The index patient is a 14-year-old male with fatigue, hypokalemia, hypertension and polyuria. Eleven family members were available for the genetic screen. Next-generation sequencing and Sanger sequencing revealed a de novo homozygous mutation within exon 6 (c.1652C>A, p.551S>Y), whereas eight family members carrying a heterozygous mutation were all phenotypically silent. The affinity of the hGR for the ligand was 1.97-fold lower in the patient than in the family members. Mutant hGRα (551Y) displayed a 3.2-fold reduction in its ability to transactivate glucocorticoid-responsive genes. When exposed to the same concentration of dexamethasone, hGRα (551Y) displayed a reduced ability to translocate into the nucleus and decreased levels of hGR dimer formation and could not effectively activate the hGR receptor to induce the glucocorticoid response element (GRE) to regulate the transcription of related genes.