Clinical significance of skeletal age assessment in children / 国际儿科学杂志

Bone development is influenced by a number of factors,including nutrition,hormonal secretions,and genetics.Skeletal age assessment(SAA) is a clinical procedure,which is used in determining the skeletal age(SA) of children and adolescents.The selection of evaluation methods,the difference of evaluation techniques,and the influence of disease can affect the accuracy of SAA.Currently,the main clinical methods for SAA are the Greulich-Pyle(GP) and Tanner-Whitehouse(TW)methods.The GP method has the advantage of being quick and easy to use.The method of TW,however,seems to be more reliable than the GP method.In China,the CHN method is also used.With the development of technology,the computer automatic SAA and ultrasonic SAA are gradually applied in clinical practice.The SAA plays an important role in the diagnosis and treatment of endocrine diseases,such as short stature and precocious puberty,and also in the children's growth and development.In order to improve the accuracy of SAA,this article reviews the related methods,techniques and clinical applications.

Related factors of mortality for patients with diabetic ketoacidosis / 中华内分泌外科杂志

Objective To study the factors related to the mortality of diabetic ketoacidosis (DKA).Methods From Jan.2011 to Dec.2015,109 hospitalized patients with diabetic ketoacidosis were selected as the subjects,which included 39 cases of type 1 diabetes and 70 cases of type 2 diabetes.DKA patients were aging from 20 to 45 years,including 39 males and 70 females,with the average age of 42.The death group had 17 cases,including 6 males and 11 females with the average age of 56.The survival group had 92 cases,including 33 males and 59 females,with the average age of 41.Age,12 h blood glucose,sex,12 h disturbance of consciousness,BMI,hypernatremia,12 h shock,hyperlipidemia,12 h insulin dosage,hyperkalemia,fever,diabetes mellitus,family history of diabetes,infection and the combined use of basic disease were sorted out and analyzed.Results Among the 109 patients with DKA,17 died and the mortality rate was 15.6％.The causes of deaths included acute myocardial infarction in 4 cases,left ventricular dysfunction in 5 cases,3 case of cardiac arrest,acute renal insufficiency in 3 case,and cerebrovascular disease in 3 case.Univariate regression analysis showed that age,12h blood glucose,12h disturbance of consciousness,12h shock,12h insulin dosage,infection,combined with underlying diseases may be risk factors for DKA patients with poor prognosis.Multivariate logistic analysis showed that age(OR=2.954,95％ CI:3.081-8.261,P=0.002),12 h blood glucose ＜16.7 mmol/L (OR=1.592,95％ CI:1.915-4.920,P=0.006),infection (OR=2.621,95％ CI:1.814-3.945,P=0.030),combined with underlying disease (OR=2.913,95％ CI:3.014-9.405,P=0.000)were independent risk factors for DKA mortality.Conclusion By stratifying the mortality risk of DKA patients,the prognosis of DKA patients can be improved rationally and effectively.

Avaliação do nível de atividade física em adolescentes com diabetes mellitus tipo 1 e sua correlação com variáveis metabólicas / Evaluation of the physical activity level of teenagers with tipe one diabetes mellitus and it's correlation with metabolic variables

Este estudo teve como objetivo identificar o nível de atividade física (NAF) praticado por adolescentes com diabetes mellitus tipo 1 (DM1), e verificar a relação do nível atividade física praticado com o controle glicêmico, lipídico e dosagem de insulina desses pacientes. Este é um estudo observacional transversal, sendo as variáveis em análise de natureza quantitativa. Foi utilizado um instrumento de consulta, denominado Questionário de Atividade Física para Adolescentes (QAFA) e realizado um levantamento dos resultados de exames através de consulta aos prontuários. Foram analisados 33 pacientes divididos em grupo 1 (NAF < 300 minutos/semana) com 11 sujeitos e grupo 2 (NAF ≥ 300 minutos/semana) 22 sujeitos. Todos os pacientes estavam em uso de insulina e não houve diferença na dose diária entre os grupos. Em relação aos parâmetros glicêmicos e lipídicos observamos os seguintes valores (resultados expressos em média e desvio padrão): CT= 167,1 ­ DP=45,1; TG=90,1 ­ DP=72,4; HDL=54,2 ­ DP=13,5; VLDL=16,1 ­ DP=8,06; LDL=90,2 ­ DP=28,2; GJ= 207,4 ­ DP=118,7; GPP=268,9 ­ DP=156,3 (mg/dL); HbA1c= 9,61% - DP=1,99. Analisados os pacientes como um todo, houve correlação inversa e significante entre o NAF e as concentrações de VLDL e TG (P < 0,05). Nos pacientes com idade entre 12 e 14 anos observamos correlação inversa e significante entre o NAF e as variáveis VLDL, TG e HbA1c (P < 0,05). Concluímos que os indivíduos mais ativos apresentam as variáveis metabólicas com padrões mais próximos ao preconizado. Este resultado fornece evidências de que a realização de um programa de exercício é importante nesta fase do desenvolvimento, podendo influenciar os adolescentes na gestão da doença, mas que é necessário uma intervenção mais rigorosa, sistematizada e orientada por um profissional da área da educação física como coadjuvante ao tratamento medicamentoso e nutricional.

The objective of this study was to identify the physical activity level (PAL) practiced by teenagers with Type 1 Diabetes Mellitus, and observe relations between physical activity, glycemic control, lipidic concentrations and insulin daily dose. This is an observational, cross-sectional study and the variables are in quantitative analysis. We used a reference tool, called Physical Activity Questionnaire for Adolescents (PAQA) and we conducted a survey of the results of examinations by medical records. We analyzed 33 patients divided into group 1 (PAL <300 minutes/week) with 11 subjects and group 2 (PAL ≥ 300 minutes /week) 22 subjects. All patients were using insulin and there was no difference in daily doses between groups. In relation to glycemic and lipidic parameters, it was observed the following values (results expressed as mean and standard deviation): CT= 167,1 ­ DP=45,1; TG=90,1 ­ DP=72,4; HDL=54,2 ­ DP=13,5; VLDL=16,1 ­ DP=8,06; LDL=90,2 ­ DP=28,2; GJ= 207,4 ­ DP=118,7; GPP=268,9 ­ DP=156,3 (mg/dL); HbA1c= 9,61% - DP=1,99. Analyzing patients as a whole, there was an inverse and significant correlation between the FAL and the concentrations of VLDL and TG (P < 0,05). We observed an inverse and significant correlation between the FAL and the variables of VLDL, TG and HbA1c (P < 0,05) in patients aged between 12 and 14 years. We conclude that the most active subject had lipidic variables closer to the recommended standards. This result provides evidences that the execution of an exercise program is important at this stage of development, and may influence adolescents in disease management, but it is necessary a more rigorous intervention and guided by a professional in the field of physical education as an adjunct to medication and nutrition.

Clinical analysis for 51 cases of primary hyperparathyroidism / 中华全科医师杂志

Objective To study clinical characteristics,causes of misdignosis and diagnostic and therapeutic methods for primary hyperparathyroidism (PHPT).Methods Retrospective analysis was done for 51 patients of PHPT,47 confirmed by biopsy after surgical operation and 4 without operation diagnosed based on their serum levels of calcium,alkaline phosphatase ( ALP),intact parathyroid hormone ( iPTH ),and computed tomography (CT) or 99mtechnetium sestamibi (99mTcMIB1) imaging at the First Affiliated Hospital of Sun Yat-sen University,Guangzhou during June 1997 to November 2010.Results Bone-related complications were the most common clinical manifestation,accounting for 51％ (26/51 ) of the cases,and adenoma,a benign,enlarged and hyperactive parathyroid gland,in 34 of 47 cases ( 72％ ).In orthotopic lesions,the right inferior was affected in 19 of 46 cases (41％),followed by the left inferior in 13 cases (28％),while 5 of 51 cases (10％) with ectopic parathyroid gland.PHPT was easily misdiagnosed as urolithiasis,rheumatic disease,primary osteoporosis,etc,accounting for 92％ of the cases in our study.Preoperative serum levels of calcium,ALP and iPTH in the patients varied with their clinical type and pathological classification,the highest in patients with urolithiasis-bone-related complications [ (3.22 ±0.35) mmol/L,(1455 ± 1091 ) U/L and (1669 ± 515 ) ng/L,respectively ] and in patients with parathyroid carcinoma [ (3.46 ± 0.40) mmol/L,( 1410 ± 426) U/L and ( 1861 ± 768) ng/L,respectively ].Sensibility of preoperative localization diagnosis using ultrasonography,CT and 99mTcMIBI was 88％ (35/40),97％ (30/31) and 97％ (31/32),respectively.Conclusions PHPT is frequently misdiagnosed as other diseases.Measurement of serum calcium should be included in routine physical examinations,supplemented with measurement of serum ALP and iPTH,as well as medical imaging,which can help avoid misdiagnosis.CT combined with 99mTcMIBI imaging can improve accuracy of preoperative localization diagnosis.

Contaminantes ambientais e os interferentes endócrinos / Environmental contaminants and endocrine disruptors

A toxicidade de diversos poluentes ambientais em seres humanos e demais espécies tem sido habitualmente investigada quanto aos seus efeitos teratogênicos e cancerígenos. Nas últimas décadas, muitos contaminantes têm demonstrado efeitos adversos sobre o sistema endócrino. Atualmente, cerca de onze milhões de substâncias químicas são conhecidas em todo mundo, sendo três mil delas produzidas em larga escala. Numerosos compostos químicos de uso doméstico, industrial e agrícola possuem comprovada atividade hormonal. Entre os produtos químicos com atividade estrogênica, destacam-se hormônios presentes em cosméticos, anabolizantes utilizados em rações animais, fitoestrógenos e poluentes orgânicos persistentes (POPs). Esses agentes que estão presentes nos efluentes industriais, residenciais e das estações de tratamento de água e esgoto representam uma importante fonte de contaminação ambiental. O Programa Internacional de Segurança Química (International Programme on Chemical Safety - IPCS) define como interferente endócrino substâncias ou misturas presentes no ambiente capazes de interferir nas funções do sistema endócrino, causando efeitos adversos em um organismo intacto ou na sua prole. No presente artigo, os autores apresentam uma revisão da literatura atual sobre o papel desses elementos nas doenças endócrinas e metabólicas, os prováveis mecanismos de ação envolvidos, discutindo-se perspectivas futuras em termos de investigação e estratégias para prevenção e redução dos seus possíveis danos.

The toxicity of various pollutants has been routinely investigated according to their teratogenic and carcinogenic effects. In the last few decades, however, many of such pollutants have been shown to adversely affect the endocrine system of human beings and other species. Currently, more than eleven million chemical substances are known in the world, and approximately 3,000 are produced on a large scale. Numerous chemical composites of domestic, industrial and agricultural use have been shown to influence hormonal activity. Examples of such chemical products with estrogenic activity are substances used in cosmetics, anabolizing substances for animal feeding, phytoestrogens and persistent organic pollutants (POPs). These agents are seen in residential, industrial and urban sewerage system effluents and represent an important source of environmental contamination. The International Programme on Chemical Safety (IPCS) defines as endocrine disruptors substances or mixtures seen in the environment capable of interfering with endocrine system functions resulting in adverse effects in an intact organism or its offspring. In this article the authors present a current literature review about the role of these pollutants in endocrine and metabolic diseases, probable mechanisms of action, and suggest paths of investigation and possible strategies for prevention and reduction of its possible damages.