Advanced bone age as an indicator facilitates the diagnosis of precocious puberty / Idade óssea avançada como um indicador de facilitação do diagnóstico de puberdade precoce

Abstract Objective: Diagnosis of central precocious puberty has always been challenging in clinical practice. As an important method in the diagnosis of central precocious puberty, luteinizing hormone-releasing hormone stimulation test is complex and time-consuming. In many cases, clinical traits are inconsistent with luteinizing hormone-releasing hormone stimulation test results, therefore not reliable for diagnosis. In this study, the authors intended to find an indicator that predicts the results of the luteinizing hormone-releasing hormone stimulation test among subjects with early pubertal signs. Methods: Cases of 382 girls with early breast development before 8 years old and luteinizing hormone-releasing hormone stimulation test before 9 years old were included and underwent follow-up tests. Patients with peak luteinizing hormone level ≥5 IU/L were considered positive in the luteinizing hormone-releasing hormone stimulation test. Anthropometric data, body mass index, bone age evaluation, blood hormones levels of luteinizing hormone, estradiol, follicle-stimulating hormone, and uterine and ovarian volumes were analyzed. Results: Subjects with positive results in the initial test demonstrated early bone maturation, accelerated growth, and elevated basal blood luteinizing hormone, estradiol, and follicle-stimulating hormone levels, when compared with subjects with negative results in the initial test. Subjects with positive results in the follow-up test presented a more advanced bone age and more accelerated linear growth, when compared with subjects with negative results in the follow-up test. Conclusions: According to the statistical analysis, advanced bone age is the most effective predictor of the result of luteinizing hormone-releasing hormone stimulation test.

Resumo Objetivo: O diagnóstico da puberdade precoce central sempre foi complicado na prática clínica. Como um importante método no diagnóstico de puberdade precoce central, o teste de estimulação do hormônio liberador do hormônio luteinizante é complexo e demorado. Em muitos casos, as características clínicas são incompatíveis com os resultados do teste de estimulação do hormônio liberador do hormônio luteinizante e, assim, não são confiáveis para o diagnóstico. Neste estudo, visamos constatar um indicador que previsse os resultados do teste de estimulação do hormônio liberador do hormônio luteinizante entre indivíduos com sinais puberais precoces. Métodos: Foram incluídos casos de 382 meninas com desenvolvimento precoce das mamas antes dos 8 anos de idade e teste de estimulação do hormônio liberador do hormônio luteinizanteantes dos 9 anos e elas foram submetidas a testes de acompanhamento. Os resultados das pacientes com nível máximo de hormônio luteinizante ≥ 5 IU/L foram consideradas positivos no teste de estimulação do hormônio liberador do hormônio luteinizante. Foi feita uma análise dos dados antropométricos, do índice de massa corporal, da avaliação da idade óssea, dos níveis sanguíneos de hormônio luteinizante, volumes uterinos e ovarianos de estradiol (E2) e do hormônio folículo-estimulante. Resultados: Os indivíduos com resultado positive no teste inicial demonstraram maturação precoce do osso, crescimento acelerado e níveis sanguíneos elevados de hormônio luteinizante, estradiol e hormônio folículo-estimulante, em comparação aos indivíduos com resultados negativos no teste inicial. Os indivíduos com resultados positivos no teste de acompanhamento apresentaram um maior avanço na idade óssea e crescimento linear mais acelerado, em comparação aos indivíduos com resultados negativos no teste de acompanhamento. Conclusões: De acordo com a análise estatística, a idade óssea avançada é o indicador mais efetivo do resultado do teste de estimulação do hormônio liberador do hormônio luteinizante.

Efficacies of rhGH alone and rhGH combined with stanozolol therapies on growth velocity of girls with Turner syndrome / 实用医学杂志

Objective To compare the different efficacies of recombinant human growth hormone (rhGH) alone and rhGH combined with low-does stanozolol on growth velocity (GV) of girls with Turner syndrome (TS). Methods 51 girls with TS were divided into two groups: Group 1 (n = 23) were treated with rhGH alone and group 2 (n = 28) with rhGH combined with low-does stanozolol both for more than six months. The two groups were compared in terms of GV, height standard deviation score for chronologic age (HtSDSCA), HtSDS for bone age (HtSDSBA), HtSDS (ΔHtSDS) and the ratio of ΔBA/ΔCA. Results In the first year, the GV was (6.29 ± 1.44) and (8.13 ± 1.87) cm/a in Group 1 and Group 2, respectively. HtSDSCA changed from (-3.51 ± 0.99) to (-3.19 ± 1.09) and (-4.21 ± 1.19) to (-3.43 ± 1.06), and ΔBA/ΔCA was (0.60 ± 0.39) and (0.77 ± 0.56) in Group 1 and Group 2, respectively. The GV and ΔHtSDS in Group 2 were significantly better than Group 1 (P < 0.05). The GV was negatively correlated with the age. Conclusion Compared with the therapy with rhGH alone, the one with rhGH combined with low-dose stanazolol is more effective in improving GV without accelerating bone maturation among the girls with Turner syndrome.

A comparison study on the growth velocity of low birth weight and normal birth weight infants / 预防医学

Objective To compare the growth velocity of low birth weight premature (LBWP),mature low birth weight (MBLW)and normal birth weight(NBW)infants and to explore the intervention mode for low birth weight (LBW)infants. Methods 1 133 Infants were divided into LBWP group,MBLW group and NBW group.The growth velocity of weight, height and head -circle were compared.Results The growth velocity of LBW group was greater than that of NBW group (P <0.05).Head circumference of LBWP group was the same as NBW group when they were 1 year old.The growth velocity of LBWP group was greater than that of MBLW group(P <0.05 )and the growth velocity of LBWP group was significantly greater than that of MBLW group when they were 1 year old (P <0.01).Conclusion LBWP infants have greater growth velocity potential than MBLW and NBW infants.It's necessary to pay more attentions to the growth velocity of MLBW infants.

Milk and Protein Intake by Pregnant Women Affects Growth of Foetus.

The study assessed the effects of the daily intake of milk and protein by pregnant women on foetal growth and determined the growth pattern and velocity of growth. A total of 504 ultrasound observations from 156 respondents were collected following a cross-sectional design in the last trimester of pregnancy; majority of them were in the last month of pregnancy. De facto and purposive sampling was done, and direct interviews of affluent pregnant women were conducted. Kruskal-Wallis test shows that majority of the respondents had tendency to consume 155.65 to 465.17 mL of milk per day, resulting in better and higher foetal growth. Most respondents consumed about 50-70 g of protein per day, and the foetal growth measurements, such as abdomen-circumference, femur length, biparietal diameter, and head-circumference, on an average, were higher in the same group. Quadratic regression model exhibited that all the traits of growth pattern in Model 1 (low milk and protein intake) appeared to have more mode of decline, in contrast to Model 2 (more milk and protein intake), which shows better growth. In addition, velocity of growth pattern was obtained through the first derivative of quadratic regression of growth pattern. Moreover, 95% confidence interval calculated for regression line slope of Model 1 and Model 2 showed that the estimation point (2 B2) of Model 1 does not lay into 95% CI of Model 2; so, statistical significance assorted and also the same trend conversely hold for Model 2. The rate of growth was highly influenced by maternal milk and protein intake. These findings suggest that contribution of common nutrients or other nutritional factors present in milk and protein promote the growth of foetus.

Pérdida de peso corporal y velocidad de crecimiento postnatal en recién nacidos menores de 1,500 gramos durante su estancia en un hospital de tercer nivel de atención / Body weight and postnatal growth velocity in premature ≤ 1,500 g during their hospital stay in a teartiary level of care

Introducción: La pérdida de peso en los primeros cinco a siete días de vida y el crecimiento en los prematuros depende de muchos factores. Existe una asociación inversa entre la edad gestacional y la pérdida de peso corporal en la primera semana de vida: a menor edad gestacional y menor peso al nacimiento es más difícil lograr una velocidad de crecimiento adecuada. Los objetivos de este estudio fueron determinar la pérdida de peso corporal en recién nacidos ≤ 1,500 g, calcular la velocidad de crecimiento absoluta (g/día) y relativa (g/kg/día), y correlacionar la pérdida ponderal porcentual con la edad gestacional. Material y métodos: Estudio observacional, longitudinal y retrospectivo de recién nacidos ≤ de 1,500 g. Las variables de estudio fueron edad gestacional, peso, talla y perímetro cefálico al nacer, con seguimiento de peso diario, talla y perímetro cefálico semanal. Se calculó la pérdida ponderal máxima, la velocidad de crecimiento y se correlacionó la pérdida ponderal máxima con la edad gestacional. Resultados: Se analizaron 101 casos, con edad gestacional promedio de 30.2 ± 2.3, peso al nacer de 1,190.7 g ± 204.5, 42 neonatos (41.6%) fueron con peso bajo para la edad gestacional y 59 (58.4%) con peso adecuado para la edad gestacional. El porcentaje máximo de pérdida de peso fue de 8.6 ± 4.5%, la recuperación del peso se presentó en el día 10.9 ± 5.2; la velocidad de crecimiento fue de 19.3 ± 5.4 g/día y 16.9 ± 5.4 g/kg/día; a menor edad gestacional hay mayor pérdida ponderal máxima con una correlación negativa baja y significativa (r = -0.422, p < 0.0001). Conclusiones: La velocidad de crecimiento absoluta (g/d) y relativa (g/kg/d) son útiles en la valoración nutricia diaria de todo recién nacido prematuro, permite detectar patrones de crecimiento subóptimos y realizar de manera oportuna intervenciones nutricionales para mejorar la velocidad de crecimiento. La pérdida ponderal en recién nacidos prematuros tiene una asociación significativa negativa, inversa con la edad gestacional.

Introduction: Weight loss in the first five to seven days of life and growth in preterm infants depends on many factors. In the first week of life, there is an inverse association between gestational age and loss of body weight; with very low birth weight and low gestational age is more difficult to achieve adequate growth velocity. The objectives were to determine the loss of body weight in infants less than 1,500 g calculate, the absolute growth velocity (g/day) and relative (g/kg/day), and correlate the percentage weight loss and gestational age. Methods: Observational, longitudinal and retrospective study of preterm neonates ≤ 1,500 g. The variables analyzed were at birth: weight, gestational age, length, and cephalic circumference, then monitoring the weight per day, and length and cephalic circumference, per week. It was calculated maximum weight loss and growth velocity. For maximum weight loss and gestational age, Pearson correlation was used. Results: Cases of 101 infants, with birth weight 1,190.7 ± 204.5 g and gestational age of 30.2 ± 2.3 were analyzed, 42 neonates (41.6%) had low birth weight for gestational age and 59 (58.4%) adequate weight for gestational age; the maximum average of weight loss was 8.6% ± 4.5; loss was presented in day 4.2 ± 1.7 and weight regain was presented on day 10.9 ± 5.2. Growth velocity was 19.3 ± 5.4 g/day and 16.9 ± 5.4 g/kg/day, an inverse negative correlation was observed between weight loss and gestational age (r = -0.422, p < 0.0001). Conclusions: The absolute growth velocity (g/day) and relative (g/kg/day) are useful in assess the nutritional condition in premature infants, and gives the opportunity to clinicians detect suboptimal growth velocity patterns and make adequate interventions. An inverse negative correlation was observed between weight loss and gestational age.

Research progress of enteral nutrition and growth velocity in very low birth weight infants / 中国小儿急救医学

This article reviewed the digestive system characteristics,enteral nutrition style,milk choice,the starting time of enteral nutrition,the velocity of milk volume increased and the ideal growth velocity of very low birth weight infants.The aim was to investigate the effect of the different starting time of enteral nutrition on their digestive function and the growth velocity,in order to find the suitable starting time of enteral nutrition,providing the basis for clinical enteral nutrition program of very low birth weight infant.

Factors to Predict Positive Results of Gonadotropin Releasing Hormone Stimulation Test in Girls with Suspected Precocious Puberty

Sometimes, the clinical findings and the results of the gonadotropin-releasing hormone (GnRH) stimulation test are inconsistent in girls with early breast development and bone age advancement. We aimed to investigate the factors predicting positive results of the GnRH stimulation test in girls with suspected central precocious puberty (CPP). We reviewed the records of 574 girls who developed breast budding before the age of 8 yr and underwent the GnRH stimulation test under the age of 9 yr. Positive results of the GnRH stimulated peak luteinizing hormone (LH) level were defined as 5 IU/L and over. Girls with the initial positive results (n = 375) showed accelerated growth, advanced bone age and higher serum basal LH, follicle-stimulating hormone, and estradiol levels, compared to those with the initial negative results (n = 199). Girls with the follow-up positive results (n = 64) showed accelerated growth and advanced bone age, compared to those with the follow-up negative results. In the binary logistic regression, the growth velocity ratio was the most significant predictive factor of positive results. We suggest that the rapid growth velocity is the most useful predictive factor for positive results in the GnRH stimulation test in girls with suspected precocious puberty.

Combined treatment with recombinant human growth hormone and stanazolol improves growth and final adult height in girls with Turner's syndrome / 中华内分泌代谢杂志

Forty girls with Turner's syndrome (TS),aged (12.6 ± 1.9) years,were treated with daily subcutaneous injection of recombinant human growth hormone (rhGH,1.0 ～ 1.1 IU · kg-1 · w-1) and oral stanozolol (0.02 ～ 0.04 mg · kg-1 · d-1) for 1 ～ 5 years.Growth velocity (GV),height standard deviation score (SDS) by reference of healthy Chinese girls (HtSDSNor) and height SDS by reference of untreated Chinese TS girls (HtSDSTs)were evaluated regularly.Of the forty girls studied,thirteen had discontinued the treatment after a mean duration of (2.9 ± 1.2)years when GV was less than 2 cm/year or when patients were satisfied with the achieved height.Final adult height (FAH) or near-final height,which was defined as the most recent available height after discontinuation of treatment,and the height gained in the thirteen girls were evaluated.Estrogen therapy was started at the age of(16.0 ± 1.1) years.HtSDSNor increased from-4.2 ± 1.0 to-3.4 ± 1.0 in the first year,and-2.8 ± 1.0,-2.4 ± 0.8,-2.5 ± 0.5,-2.3 ±0.3 respectively in the 2nd,3rd,4th,and 5th year.The change in HtSDSTs was similar to HtSDSNor.It was increased from 0.1 ± 0.9 to 1.0 ± 0.9 in the first year,and to 1.5 ± 0.8,1.9 ± 0.6,1.7 ± 0.4,1.7 ± 0.2 in the subsequent 4 years.The predicted adult height (PAH) in 13 girls was (142.8 ± 4.2) cm before treatment.FAH was (151.7 ± 4.1) cm,which was significantly higher than PAH (P＜0.01),and the mean height gain was (8.9 ± 2.8) cm (5.1 ～ 12 cm).FAHSDSNor was increased to-1.6 ± 0.8 from-3.8 ± 0.8.For girls with TS around 9 years of age,combined therapy with rhGH and low dosage of stanazolol may significantly increase growth velocity and improve final adult height.

Comparison of Growth from First to Sixth Grade Based on the Obesity Index of Sixth Grade Students at an Elementary School in Seoul

This study was conducted to identify differences in growth based on the obesity index in sixth grade. Heights and weights of 141 students from first to sixth grades were collected from school records. Other information was gathered by survey, and the weight length index (WLI) was calculated. Subjects were classified into three groups: underweight (n = 57, UG), normal (n = 53, NG), and obese (n = 31, OG) using the WLI. Differences in weight, height, and growth velocity were compared among the three groups from the first to sixth grades. With regard to growth, the past physical status of the three groups was maintained. More than 50% of the OG was in the overweight range when they were in the third to fifth grades. Approximately 60% of NG was in the normal weight range between the first and fifth grades. More than 70% of UG was in the underweight range when they were in the first to fifth grades (p < 0.001). Growth velocity was faster in OG than that in NG and UG (p < 0.001). The annual growth rate of children was the highest when they moved from the third to the fourth grade (p < 0.001). The results indicate that general balanced diet education should be implemented in lower grades, because physical growth formed in lower grades tended to be maintained in senior grades. It would be better to educate students about diet to prevent obesity before the fifth grade when a major change in body structure has occurred.

The Comparison of Clinical Factors according to Growth Velocity during Gonadotropin-Releasing Hormone Agonist Treatment in Central Precocious Puberty Girls

BACKGROUND: The aim of this study was to investigate the favorable factors for gonadotropin-releasing hormone (GnRH) agonist treatment with regard to the growth velocity and the predicted adult height (PAH) in central precocious puberty (CPP) girls. METHODS: We reviewed the clinical and auxological parameters in 46 CPP girls who were treated with GnRH agonist at the pediatric endocrinology clinic of Korea University Hospital from January 2001 to August 2007. We divided the two groups according to the growth velocity of 5 cm/yr and we assessed the related factors associated with growth velocity. We also assessed the changes in PAH for two years. RESULTS: The pretreatment chronological age and bone age were significantly younger in the high growth velocity group (> 5 cm/yr) compared to that of the low growth velocity group (7.8 +/- 0.9 year vs. 8.4 +/- 0.5 year, 9.4 +/- 1.2 year vs. 10.1 +/- 0.9 year, respectively) (P 5 cm/yr)(P < 0.05). Growth velocity during treatment had negative correlation with the pretreatment chronological age and positive correlation with the PAH after one and two years of treatment (r = -0.45, P < 0.05 and r = 0.51, P < 0.01). PAH had positive correlation with the treatment duration (r = 0.31, P < 0.05). CONCLUSION: In our study, the growth velocity during GnRH agonist treatment was negatively related to age at the initiation of treatment. Therefore, earlier treatment is important to improve the outcomes and to maintain appropriate growth velocity in CPP girls.

Parâmetros cinéticos de linhagens de levedura isoladas de alambiques mineiros / Kinetic parameters of yeasts strains isolated from cachaça distilleries in Minas Gerais/Brazil

Foram isoladas leveduras prevalescentes de dois alambiques, em Betim e Rio Manso/MG, por meio de plaqueamento (WLN) e caracterizadas segundo a macromorfologia de colônias, após 8 dias de incubação a 32ºC. A amostra de Rio Manso apresentou 4 linhagens dominantes, com concentrações entre 2,0 x 10(7) e 4,0 x 10(5) UFC/mL. No alambique de Betim foram isoladas três linhagens dominantes, com contagens entre 1,3 x 10(8) e 2,0 x 10(4) UFC/mL. Foram determinados a velocidade específica máxima de crescimento (µmax) e o fator de conversão de substrato em biomassa (Yx/s) para dois isolados. Os valores de μmax foram 0,24 e 0,4 h-1, sendo que a linhagem RM01 apresentou maior valor. Para Yx/s, os resultados obtidos pelas linhagens RM01 e CV01 foram 0,179 e 0,185 g.g-1, respectivamente. Verificou-se uma semelhança nos resultados entre as linhagens RM01 e CV01. Concluiu-se que, do ponto de vista de μmax e de Yx/s, a melhor linhagem para produção de cachaça é a RM01.

Predominant yeasts of two cachaça distilleries were isolated in the cities of Betim and Rio Manso, in the State of Minas Gerais and characterized using WLN agar, according to colony morphology, after 8 days of imcubation at 32ºC. The sample from Rio Manso presented 4 dominant yeasts with concentrations between 2.0 x 10(7) and 4.0 x 10(5) CFU/mL. At Betim distillery, three dominant yeasts were isolated with cell density between 1.3 x 10(8) and 2.0 x 10(4) CFU/mL. The values of the maximum specific velocity for growth (µmax) and the conversion factor for substrate into cells (Yx/s) were determined for two isolates. The μmax values were 0.24 and 0.4 h-1, being RM01 strain the one with the highest value. Regarding to Yx/s, the results obtained by strains RM01 and CV01 were 0.179 and 0.185 g.g-1, respectively. Resemblances of results were observed between strains RM01 and CV01. It was concluded that, as far as μmax and Yx/s are concerned, the best strain to produce cachaça is RM01.

Turner syndrome: searching for better outcomes

OBJECTIVES: To assess the results of growth hormone on the growth of girls with Turner Syndrome and identify relevant parameters to improve outcomes. METHODS: Growth velocity and final height were studied in a historical cohort of 41 girls, regularly followed up for hormone distribution at three referral centers. The influence of oxandrolone and of estrogens on the final height was analyzed. The girls (initial chronological age=8.9±3.4years; initial bone age=7.0±3.1years) used 0.19 mg/kg/week of growth hormone for 4.0 ± 2.0 years. RESULTS: In the first year, growth velocity increased by 71.5 percent in 41 girls and 103.4 percent in those who reached final height (11 girls). The whole group had a gain in the height SDS of 0.8 ± 0.7 (p<0.01) and for those who reached a final height of 1.0 ± 0.8 (p<0.01). Final height (143.6 ±6.3 cm) was 3.9 ± 5.3 cm higher than the predicted height, and the height gain occurred before estrogen therapy. Oxandrolone had no significant influence on height gain. The significant variables contributing to the final height were the duration of growth hormone used and its use prior to starting estrogens, the initial height SDS, and the growth velocity during the first year of treatment. CONCLUSIONS: We concluded that the use of growth hormone significantly increased the final height, which remained lower than the target. Results point to a need for starting growth hormone use as early as possible and to maximize treatment before estrogen replacement. It has been observed that even moderate doses of growth hormone may significantly increase early growth velocity.

Profile of serum growth-promoting activity and growth veIocity of developing rats.

Serum growth-promoting activity (GPA) in rats was determined by measuring the degree of stimulation of thymidine incorporation into lymphocyts treated with low dose of phytohemagglutinin (PHA). GPA in rat serum was found to be low at birth (193% of that stimulation with PHA alone), increased slightly (224%) at 5 days of age and then increased rapidly to peak at 10 days of age (450%). Thereafter, GPA decreased gradually, reaching an adult level (which was similar to that of the newborn) at 60 days of age. A significant correlation was found between the level of GPA and normalized growth rate (% body weight increase/day) in rats.

GROWTH HORMONE-RELEASING HORMONE 1-44 STIMULATES GROWTH VELOCITY IN HYPOTHALAMIC GROWTH HORMONE-DEMCIENT PATIENTS / 中华内分泌代谢杂志

10?g/L and 5 patients with serum GH peak between 5 - 10?g/L in 5-day GHRH stimulation test were about the same. There was negative correlation between chronological age and growth velocity after treatment with GHRH 1 -44 for 6 months (r = 0.7078, P

THE INFLUENCE OF YOGHURT SUPPLEMENTATION ON THE GROWTH RATE OF PRESCHOOL CHILDREN IN BEIJING SUBURB / 营养学报

Objective: To observe the effect of yoghurt supplementation on the growth rate of preschool children in Beijing suburb. Methods: 402 healthy children (217 males, 185 females), aged 3-5 years old, were selected as subjects with height and/or weight less than WHO standard from 7 kindergartens in Beijing suburb. The children were divided randomly into control group (CG 201) and yoghurt supplemented group (YG 201). Children in YG were supplemented with yoghurt (125g) for 5d per week for 9 mo, and children in CG not supplemented. Height, weight and upper-arm circumference were measured every month. Blood biochemical parameters (Hb,TP) were detected every 3 mo. Results: Calcium, zinc and VB2 were consumed more in YG than CG. Hb in YG was also higher than CG . The height incease and weight gain of YG was significantly higher than CG during 3, 6 and 9mo. Conclusion: Yoghurt supplementation for 9 months can increase calcium, zinc and VB2 intake, and improve preschool childrens nutritional status, therefore increase their height increase and weight gain.