Research progress on the relationship between Klotho and the growth of children and newborns / 中国综合临床

Klotho is a gene associated with aging, the transmembrane protein encoded by this gene is highly expressed in the kidney, and is also expressed in tissues such as the brain, parathyroid and pituitary glands. The extracellular domain of Klotho can also be cleaved and shed to form soluble Klotho, which acts as a circulating hormone and can be detected in blood, cerebrospinal fluid, and urine. More and more studies have shown that Klotho protein plays an important role in the complex regulation of growth hormone (GH)-insulin-like growth factor 1(IGF1) axis. The interaction between Klotho protein and GH-IGF1 axis is bidirectional, which regulates each other, and then regulates the normal linear growth of children. In addition, Klotho protein can also affect the growth and development of fetus and newborn through different ways, and its mechanism is not very clear.

Effect of prednisolone on linear growth in children with nephrotic syndrome / Efeito da prednisolona sobre o crescimento linear em crianças com síndromenefrótica

Abstract Objective This study aims at determining the relationship between prednisolone cumulative dose and linear growth in pre-pubertal children with idiopathic nephrotic syndrome. Method This cross-sectional study was conducted on all children with idiopathic nephrotic syndrome registered to the pediatric nephrology department at the main referral children's hospital in Southwestern Iran. Inclusion criteria included age (males <12 years; females <10 years), >6 months of use, and the minimum prednisolone cumulative dose of 152 mg/kg. The exclusion criteria were individuals who had entered puberty or had other diseases affecting linear growth. Based on the prednisolone cumulative dose of ≥550 mg/kg (four or more relapses), the children were divided into two groups. All data regarding age, height, and weight at disease onset and the last visit, bone age, and the parents' height were collected. Secondary variables including mid-parental target height and predicted adult height were also calculated. Height data were compared between the different rates of relapse. Results A total of 97 children (68% male) were enrolled. Their post-treatment mean height Z-score was less than that obtained before treatment (−0.584 vs. −0.158; p = 0.001). Subjects with higher prednisolone cumulative doses were found to have more reduction in height Z-score (p = 0.001). Post-treatment height prediction also showed less growth potential compared to pre-treatment target height (p = 0.006). Thirty-three children (34.4%) had four or more relapses, among whom more mean-height Z-score decreases were found compared to those with less-frequent relapses (−0.84 vs. −0.28; p = 0.04). Conclusion This study showed the negative effect of cumulative dosages of prednisolone on linear growth, which was greater in children with four or more relapses.

Resumo Objetivo Determinar a relação entre a dose cumulativa de prednisolona e o crescimento linear em crianças pré-púberes com síndrome nefrótica idiopática. Método Estudo transversal conduzido em todas as crianças com síndrome nefrótica idiopática registradas no departamento de nefrologia pediátrica no principal hospital infantil para encaminhamento no sudoeste do Irã. Os critérios de inclusão incluíram idade (meninos < 12 anos; meninas < 10 anos), > 6 meses e a dose cumulativa de prednisolona mínima de 152 mg/kg. Os critérios de exclusão foram indivíduos que entraram na puberdade ou tinham outras doenças que afetam o crescimento linear. Com base na dose cumulativa de prednisolona de ≥ 550 mg/kg (≥ 4 recidivas), as crianças foram divididas em dois grupos. Foram coletados todos os dados relacionados a idade, estatura e peso no início da doença e na última visita, idade óssea e estatura dos pais. Também foram calculadas as variáveis secundárias, inclusive estatura-alvo e estatura adulta prevista. Os dados de estatura foram comparados entre as diferentes taxas de recidivas. Resultados Foram inscritas 97 crianças (68% do sexo masculino). Seu escore z de estatura média pós-tratamento foi inferior ao obtido antes do tratamento (−0,584 em comparação com −0,158; p = 0,001). Os indivíduos com maiores doses cumulativas de prednisolona mostraram maior redução no escore z para estatura (p = 0,001). A estatura pós-tratamento também foi preditiva de menor potencial de crescimento em comparação com a estatura-alvo pré-tratamento (p = 0,006); 33 crianças (34,4%) apresentaram ≥ 4 recidivas, entre as quais foram encontradas mais reduções médias no escore z para estatura em comparação com as recidivas menos frequentes (−0,84 em comparação com −0,28; p = 0,04). Conclusão Este estudo mostrou o efeito negativo das doses cumulativas de prednisolona sobre o crescimento linear, que foi maior em crianças com ≥ 4 recidivas.

A prospective study on the effects and prevalence of maternal, fetal and placental risk factors on low birth weight neonates

Background: Maternal, foetal and placental risk factors have a causative effect in the prematurity and failure to thrive in the early infantile period. Timely diagnosis helps in the anticipation of complications specific to risk factors and managing by impairing their harmful effects on the growth and development of the baby.Methods: The study was conducted prospectively in Department of Paediatrics, Rajah Muthiah Medical College and Hospital, Chidambaram from January 2018 to June 2018. 361 Low birth weight babies were included. Neonates (n=361) weighing less than 2.5 kilograms with parental informed consent are included, whereas those with severe congenital anomaly, systemic disease or infection were excluded from the study. Various known maternal, placental and foetal risk factors are observed during the course of the study. The gestational age of the neonates was estimated using modified Dubowitz scoring. Other factors like mode of delivery of the babies were also noted. Statistical analysis (descriptive statistics) was done by using Microsoft Word 2010.Results: Out of 1040 babies born from January to July 2018, 341 babies weight less than 2.5 kg. Out of which 162 (44.88%) babies were born preterm. Of the full term births 52% were low birth weights The risk factors of the neonates are not mutually exclusive. In the present study 28 maternal risk factors were studied. The prevalence of maternal, fetal and placental risk factors was 85.32%, 74.79% and 6.65% respectively.Conclusions: Period prevalence of low birth weight babies and prematurity is 34.71% and 15.58% respectively. Risk factors are not independent to each other with maternal and foetal risk factors have almost have an effect on nearly three fourths of low birth weight neonates.

Genetic regulation of linear growth

Linear growth occurs at the growth plate. Therefore, genetic defects that interfere with the normal function of the growth plate can cause linear growth disorders. Many genetic causes of growth disorders have already been identified in humans. However, recent genome-wide approaches have broadened our knowledge of the mechanisms of linear growth, not only providing novel monogenic causes of growth disorders but also revealing single nucleotide polymorphisms in genes that affect height in the general population. The genes identified as causative of linear growth disorders are heterogeneous, playing a role in various growth-regulating mechanisms including those involving the extracellular matrix, intracellular signaling, paracrine signaling, endocrine signaling, and epigenetic regulation. Understanding the underlying genetic defects in linear growth is important for clinicians and researchers in order to provide proper diagnoses, management, and genetic counseling, as well as to develop better treatment approaches for children with growth disorders.

Depression Levels Following Discharge Predict Quality of Life in Heart Disease Patients / Depressão após Alta Prediz Qualidade de Vida Prévia em Pacientes Cardíacos

Abstract Depression and stress have been related with poor Health Related Quality of Life (HRQoL) prognosis. However, it is not clear when these depressive symptoms should be measured. A sample of 177 Coronary Heart Disease patients were followed for 15 months aimed to compare the effect of depression and stress measure at time of hospitalization and three months later on the physical HRQoL trajectory. Linear growth models' results showed that depression and stress after discharge are negatively correlated with the physical HRQoL and depressive symptoms negatively affect the prognosis of these patients.

Resumo Depressão e estresse têm sido associados ao prognóstico da Qualidade de Vida Relacionada à Saúde (QVRS). Contudo, não há clareza sobre quando os sintomas de depressão devem ser mensurados. Uma amostra de 177 pacientes com cardiopatia isquêmica foi acompanhada por 15 meses, para comparar o efeito do estresse e a depressão durante a internação e, três meses depois, avaliou-se a trajetória do componente físico da QVRS. Os resultados da comparação de duas curvas de crescimento latente mostraram que a depressão e o estresse pós-alta estão negativamente correlacionados com o componente físico da QVRS, e que os sintomas depressivos afetam negativamente o prognóstico desses pacientes.

The impact of asthma and its treatment on growth: an evidence-based review / O impacto da asma e seu tratamento no crescimento: revisão baseada em evidências

Abstract Objectives: To assess the impact of asthma and its treatment (inhaled corticosteroids and other control medications) on growth. Data sources: The authors searched PubMed (up to August 24, 2018) and screened the reference lists of retrieved articles. Systematic reviews and meta-analysis were selected. If there was no such article, the authors selected either randomized clinical trials or observational studies. Data synthesis: A total of 37 articles were included in this review. The findings from 21 studies suggest that asthma per se, especially more severe and/or uncontrolled cases, can transitorily impair child's growth. Two Cochrane reviews of randomized clinical trials showed a small mean reduction in linear growth (-0.91 cm/year for beclomethasone, -0.59 cm/year for budesonide, and -0.39 cm/year for fluticasone) in the first year of treatment with inhaled corticosteroids in prepubertal children with persistent asthma. The effects were likely to be molecule- and dose-dependent. A recent review showed that most of "real-life" observational studies had not found significant effects of inhaled corticosteroids on growth in asthmatic children. Fifteen studies showed that the maintenance systemic corticosteroids could cause a dose-dependent growth suppression in children with severe asthma, but other controllers (cromones, montelukast, salmeterol, and theophylline) had no significant adverse effects no growth. Conclusions: Severe and/or uncontrolled asthma can transitorily impair child's growth. Regular use of inhaled corticosteroids may cause a small reduction in linear growth in children with asthma, but the well-established benefits of inhaled corticosteroids in controlling asthma outweigh the potential adverse effects on growth. Use of the minimally effective dose of inhaled corticosteroids and regular monitoring of child's height during inhaled corticosteroids therapy are recommended.

Resumo Objetivos: Avaliar o impacto da asma e seu tratamento (corticosteroides inalados e outros medicamentos de controle) no crescimento. Fontes de dados: Uma busca foi feita no PubMed (até 24 de agosto de 2018) e foram triadas as listas de referência dos artigos recuperados. Revisões sistemáticas e metanálises foram selecionadas. Se não houvesse tal artigo, ensaios clínicos randomizados ou estudos observacionais eram selecionados. Síntese dos dados: Trinta e sete artigos foram incluídos nesta revisão. Os achados de 21 estudos sugerem que a asma por si só, especialmente os casos mais graves e/ou descontrolados, podem prejudicar o crescimento da criança. Duas revisões Cochrane de ensaios clínicos randomizados mostraram uma pequena redução média no crescimento linear (−0,91 cm/ano para beclometasona, −0,59 cm/ano para budesonida e −0,39 cm/ano para fluticasona) no primeiro ano de tratamento com corticosteroides inalados em crianças pré-púberes com asma persistente. Os efeitos pareciam ter efeito dose- e molécula-dependente. Uma revisão recente mostrou que a maioria dos estudos observacionais da "vida real" não encontrou efeitos significativos dos corticosteroides inalados no crescimento de crianças asmáticas. Quinze estudos mostraram que a manutenção de corticosteroides sistêmicos poderia causar uma supressão do crescimento dose-dependente em crianças com asma grave, mas outros controladores (cromonas, montelucaste, salmeterol e teofilina) não tiveram efeitos adversos significativos no crescimento. Conclusões: A asma grave e/ou descontrolada pode prejudicar o crescimento da criança. O uso regular de corticosteroides inalados pode causar uma pequena redução no crescimento linear em crianças com asma, mas os benefícios bem estabelecidos dos corticosteroides inalados no controle da asma superam os potenciais efeitos adversos no crescimento. Recomenda-se o uso de doses minimamente eficazes de corticosteroides inalados e o monitoramento regular da altura da criança durante a terapia com corticosteroides inalados.

Effect of Letrozole on the Reproductive Function and Linear Growth in the Early and Mid Puberty Boys / 中山大学学报(医学科学版)

[Objective] To investigate the effect of letrozole on the reproductive function and linear growth in the early and mid pubertal boys.[Methods] 43 early and middle pubertal boy with seriously damaged predict adult height,treated with letrozole 1.5 mg/m2/d Po ((＞)2.5mg/d) were enrolled as treatment group.48 cases of healthy pubertal boys were enrolled as control.Growth parameters,sex hormone profiles,IGF-1,AMH and Inhibin B (INHB) were elevated at the beginning and after letrozole treatment.[Results] At baseline,no significant differences appeared in age,bone age,observation time,height for chronological age,height for bone age,midparental target height,BMI,or testis volume between two groups.After intervention,treatment group of bone age delayed,predict adult height increased,testicular volume increased and BMI increased compared with the control group (P=0.001,0.018,0.002,and 0.027,respectively).The serum FSH,△FSH,LH,△LH,LH/FSH,T,and △T in the treatment groups were much higher (all P＜0.001),while the serum E2 and △ E2 levels were obviously lower than the control group (P=0.043 and P=0.033,respectively).17 cases of control group and 13 cases of treatment group had serum AMH,INHB level tested before and after letrozole treatment.Serum AMH level in the control group appeared with a decreasing trend with the progress of puberty,while the treatment group showed the opposite tendency.And the △ AMH was significant difference between control group and treatment group (P＜0.001).The serum INHB in the two groups increased in varying degrees after the intervention,the INHB level in control group increased more than the treatment group,but the difference was not statistically significant (P=0.517).[Conclusion] Letrozole treatment can elevated levels of serum T with E2 reduce,bone age delay,predict adult height improved,and can obviously promote the secondary sex characters development in adolescent boys.And the longer letrozole treatment time,the more obvious growth effect.As to the reproductive function,letrozole may have inhibitory effect on testis maturity and cannot deny testis sertoli cells function affected with letrozole exposure.

Maternal depression and child development: Evidence from São Paulo's Western Region Cohort Study

Summary Introduction: While a growing body of evidence has investigated the relationship between maternal mental health and child development, evidence on children’s early life outcomes remains mixed. We analyze the empirical relationship between maternal depression and children’s development at age one using data from the São Paulo Western Region Cohort project. Method: Seven hundred and ninety-eight (798) mother-child dyads living in the Butantã-Jaguaré’ region of São Paulo were assessed through a home visit between January and March 2015. Maternal mental health was assessed using the Edinburgh Postnatal Depression Scale (EPDS). Mothers were classified as “possibly depressed” if their EPDS score was between 10 and 13 and as “likely depressed” if their EPDS score was > 13. The child outcomes analyzed were height, weight, and overall development as assessed by the Ages and Stages Questionnaire (ASQ). Height and weight were age-normalized using WHO growth standards. Stunting was defined as height-for-age z-score (HAZ) < -2. Obesity was defined as body mass index z-score (BMIZ) > 2. Adjusted and unadjusted linear regression models were used to assess the associations between Edinburgh scores and child outcomes. Results: No association was found between maternal depression variables and children’s height, weight, stunting, and obesity. Positive associations were found between possible depression and ASQ (delta = 0.33; 95CI 0.11-0.54; p-value<0.01); no associations were found between likely depression and any of the outcomes analyzed. Conclusion: The results from this study suggest that symptoms of maternal depression are not associated with delays in child development in the study setting analyzed. Further research will be needed to understand this lack of association: while it is possible that caregivers’ mental health did not affect caregiving behavior, it is possible that the effect of maternal depression can vary according to timing, persistence, and intensity. It is also possible that the EPDS instrument may fail to identify mothers with clinical depression, or that children with depressed mothers get increased support from other family members or public early childhood focused programs.

Growth Pattern of Exclusively Breastfed Babies in Urban Affluent of Bangladesh

Objective: To find out the growth in the exclusively breastfed babies of the affluent mothers and to compare the figures with those of the children in the industrialized countries. Methods and materials: Fifty-three babies were selected in 1 year time period for this cross-sectional study under 6-month of age with prefixed criteria, such as exclusively breastfed and not fed with any formula feeding. Recommended schedule of immunization (EPI) was followed to weigh and measure for supine length. Data were analyzed in PC through SPSS and some calculations were done in calculator too. Place and time of work: Data were collected from August 2011 to June 2012 in the Pediatrics Department of Bangladesh Medical College Hospital and the Researcher’s Chamber at Dhanmondi, Dhaka. Results: The data of developed countries showed that in first 3-month of age, children grow in weight 30 gm/day and in length 3.5 cm/month, followed by weight gain of 20 gm/day and linear growth 2 cm/ month in next 3-6 months. Our babies could be compared to those figures, with 33.54 gm/day in the weight gain and 4.17 cm/month in linear growth in the first 3 months. The average weight gain during the next 3 months (3-6 months of age) was 22.3 gm/d and linear growth for this period was 2.12 cm/month. Conclusion: Babies of our country in well-off families can grow optimally in comparison to the growth of the babies in the industrialized countries, or even can exceed, if they are exclusively breastfed and brought up ensuring immunization and follow up in educated mothers.

Curvas de crecimiento infantil para detectar precozmente la talla baja en el menor de 2 años / Infant growth curves for early detection of short stature in children under 2 years of age

Pregunta de investigación: ¿Permitirán las curvas de crecimiento infantil (T/E) identificar el retardo en el crecimiento lineal en forma previa a la talla baja (<-2 DE) y la edad promedio de alteración del crecimiento en niños de 6 a 24 meses de edad que demandan atención en establecimientos de salud? Objetivo: Optimizar el uso de los datos del Carnet de Salud Infantil para identificar alteraciones en el crecimiento lineal previa a la talla baja (< -2DE) y los tiempos promedio de inicio de la declinación de curva de crecimiento normal hasta llegar por debajo de -2DE, relacionando esta tendencia con la curva de crecimiento ponderal. Material y métodos: Estudio descriptivo, longitudinal y retrospectivo, que incluyo a 71 niños menores de 2 años. Se analizaron datos del Carnet de Salud Infantil e indicadores antropométricos a partir de ellos. El punto de corte de Talla/Edad fue menor a la -2DE para clasificar talla baja. Resultados: La talla baja en uno o varios de los controles fue de 38.08 por ciento, y desde el primer control 48.1 por ciento. Los que presentaron talla baja como inicio en controles posteriores al primero (51.8 por ciento) mostraban una T/E por debajo a la -1 DE al primer control en el 64.2 por ciento; en este último grupo, el tiempo de descenso desde la T/E <-1 DE hasta <-2DE fue en promedio de 3.9 meses. En el 74 por ciento que iniciaban con talla baja no se observo la presencia concomitante de P/E <-2DE. Existe una asociación estadísticamente significativa entre T/E <-1 DE al primer control y talla baja (chi² 14.07; p=0.0001). Conclusiones: El uso adecuado de las curvas de crecimiento lineal infantil permite identificar de forma previa retardo en el crecimiento, con una T/E <-1 DE en el primer control. La talla baja en nuestro medio se caracteriza por presentarse en edad temprana y acompañarse de retardo en el crecimiento ponderal (P/E) solamente en los casos con inicio de esta en el primer control.

Research question: Do curves of children growth (height/age) let us to identify growth delayed in advance to short stature (<-2DS) and average age of abnormal growth on 6 to 24 years old children who are attended in health centers? Background: Chronic malnutrition is one of the nutritional problems with high magnitude in Latin-America and high prevalence in Bolivia. Objetive: To improve the use of children's health cards data to let it identify abnormal growth in advance to short stature (<-2DS) and overage time of declination beginning from a normal growth lineal curve to across the -2DS relating this tendency whit the weight growth curve. Material and method: A descriptive and prospective longitudinal study, including 71 children less than 2 year's old age. The children's health card data were analyzed generating anthropometric indicators of them. Sort stature was classified as a height/age under -2DS. Results: The frequency of short stature in one or several controls was 38,08 percent taking place since the first control in 48,15 percent. Children who has short stature as beginning after the first control (51,85 percent) showed a height/age under -1DS in the first control in 64,29 percent. The Children who have begun short stature without weight/age <-2DE were 74,04 percent. There is a hard association between height/age under -1DS at the first control and short stature (chi2 14,07; p=0,0001). Conclusions: The children 's growth curves used rightly let us identify growth delayed previously with a height/age under-1DS in the first control or 3,92 previous mouths to the diagnostic of short stature. In our environment, the short stature is characterized because of to take place in early age and is accompanied with weight growth delayed (weight/age) just in cases with beginning in the first control.

Deficiência de micronutrientes e crescimento linear: revisão sistemática de estudos observacionais / Micronutrient deficiencies and linear growth: a systematic review of observational studies

O objetivo do artigo é avaliar a associação das deficiências de ferro, vitamina A e zinco com o déficit de crescimento linear. Revisão sistemática nas bases de dados eletrônicas PubMed, LILACS e SciELO. Foram selecionados artigos publicados entre janeiro de 1995 e março de 2010, considerando os descritores: (growth OR nutritional status) AND (child, preschool OR infant) AND (zinc AND iron AND vitamin A) OR (zinc AND iron) OR (zinc AND vitamin A) OR (iron AND vitamin A). Foram revisados 14 estudos de delineamento observacional. Dos estudos tipo coorte (dois), um indicou associação estatística entre o estado nutricional de ferro e o déficit de estatura; o outro apontou associação estatística entre as concentrações de ferritina sérica e o ganho de estatura. Dez estudos transversais investigaram a associação estatística entre as deficiências de micronutrientes e o déficit de estatura, resultando três deles na associação para o ferro, dois para a vitamina A e nenhum para o zinco. O esclarecimento sobre a associação entre o déficit de estatura e as deficiências de ferro, vitamina A e zinco dificulta-se por fatores de caráter biológico e relacionados à magnitude das deficiências, o que sugere a importância da padronização metodológica dos estudos.

This article seeks to evaluate the association of iron, vitamin A and zinc deficiencies with linear growth retardation. A systematic review of electronic databases in PubMed, LILACS and SciELO was conducted. Scientific papers published between January 1995 and March 2010 were selected, inserting the key words: (growth OR nutritional status) AND (child, preschool OR infant) AND (zinc AND iron AND vitamin A) OR (zinc AND iron) OR (zinc AND vitamin A) OR (iron AND vitamin A). Fourteen observational design studies were reviewed. In the cohort studies (two), one indicated a statistical association between iron levels and stunting; and the other revealed a statistical association between serum ferritin concentrations and an increase in height. Ten cross-sectional studies investigated the statistical association between micronutrient deficiencies and stunting, three of which resulted in an association with iron, two with vitamin A and none with zinc. Elucidation of the association between stunting and iron, vitamin A and zinc deficiencies involves difficulties of a biological nature and also related to the magnitude of these deficiencies, indicating the importance of a methodological standardization of the studies.

Retardo estatural em menores de cinco anos: um estudo "baseline" / Linear growth retardation in children under five years of age: a baseline study

OBJETIVO: Descrever a prevalência e analisar fatores associados ao retardo estatural em menores de cinco anos. MÉTODOS: Estudo "baseline", que analisou 2.040 crianças, verificando possíveis associações entre o retardo estatural (índice altura/idade < 2 escores Z) e variáveis hierarquizadas em seis blocos: socioeconômicas, do domicílio, do saneamento, maternas, biológicas e de acesso aos serviços de saúde. A análise multivariada foi realizada por regressão de Poisson, com opção de erro padrão robusto, obtendo-se as razões de prevalência ajustadas, com IC 95 por cento e respectivos valores de significância. RESULTADOS: Entre as variáveis não dicotômicas, houve associação positiva com o tipo de teto e o número de moradores por cômodo e associação negativa com renda, escolaridade da mãe e peso ao nascer. A análise ajustada indicou ainda como variáveis significantes: abastecimento de água, visita do agente comunitário de saúde, local do parto, internação por diarreia e internação por pneumonia. CONCLUSÃO: Os fatores identificados como de risco para o retardo estatural configuram a multicausalidade do problema, implicando na necessidade de intervenções multisetoriais e multiníveis para o seu controle.

The scope of this study was to describe the prevalence of, and analyze factors associated with, linear growth retardation in children. The baseline study analyzed 2040 children under the age of five, establishing a possible association between growth delay (height/age index < 2 scores Z) and variables in six hierarchical blocks: socio-economic, residence, sanitary, maternal, biological and healthcare access. Multivariate analysis was performed using Poisson regression with the robust standard error option, obtaining adjusted prevalence ratios with a CI of 95 percent and the respective significant probability values. Among non-binary variables, there was a positive association with roof type and number of inhabitants per room and a negative association with income per capita, mother's schooling and birth weight. The adjusted analysis also indicated water supply, visit from the community health agent, birth delivery location, internment for diarrhea, or for pneumonia and birth weight as significant variables. Several risk factors were identified for linear growth retardation pointing to the multi-causal aspects of the problem and highlighting the need for control measures by the various hierarchical government agents.

Crescimento em asmáticos pré-púberes em uso de corticosteróide inalatório / Linear growth in pre-pubertal asthmatics and inhaled corticosteroid use

Introdução: O objetivo deste estudo retrospectivo foi identificar a relação entre o uso de corticosteróide inalatório e o crescimento linear de asmáticos pré-púberes. Métodos: Análise retrospectiva de uma amostra selecionada por conveniência, constituída por pacientes pré-púberes ( dez anos de idade) com diagnóstico de asma e tratados com corticosteróide inalatório. As medidas da estatura foram avaliadas pelo escore de desvio-padrão da estatura (H505) em três ocasiões diferentes. Para análise estatística utilizaram-se os testes de ANOVA. Resultados: A média de idade dos 22 pacientes (14 do sexo masculino) foi de 7,7 anos na primeira consulta. A maior parte dos pacientes apresentava asma leve (dez casos) e mode-rada (dez) e apenas dois pacientes tinham asma de intensidade grave. O tempo médio decorrido entre as três ocasiões em que os pacientes foram avaliados foi de doze meses. Dezessete pacientes (77,2%) utilizavam corticosteróide inalatório em doses baixas (até 500 mcg/dia de beclometasona ou doses equivalentes de outros corticosteróides inalatórios). A mediana do escore H5D5 obtido na primeira, segunda e terceira consultas foi respectivamente de 0,35; 0,25 e 0,20 respectivamente (p =0, 284). Conclusões: Neste grupo de asmáticos pré-púberes a média de H505 mostrou que, independente da dose de corticosteróide inalatório utilizada, os pacientes mantiveram seu canal de crescimento.

Introduction: The aim of this study was to verify the rE tion between pre-pubertal asthmatics linear growth and use of inhaled corticosteroids. Methods: Pre-pubertal asthmatic patients (~ 10 years c under inhaled corticosteroids were included. The height mea re was determined by height standard deviation score (H5[ in three d ifferent occasions. Data were analysed by ANC tests. Results: The mean age of the 22 subjects (14 males) inc ded was 7,7 years at first visito The majority of the patie had mild asthma (10 cases) and moderate (10), and only ~ them had severe asthma. The mean time between the th occasions when the subjects were analyzed was 12 mont 5eventeen subjects (77,2%) were under low doses of inha corticosteroid (~500 mcg/day beclomethasone or equival dose of different inhaled steroid). The median H505 at fi second and third visits was respectively 0,35; 0,25 and O (p=0,284). Conclusions: ln this group of asthmatics the H5D5 rru showed that, regardless the inhaled corticosteroid dose, th was no influence on linear growth.

Analysis of Linear Growth in Children after Living-related Liver Transplantation / 대한소아소화기영양학회지

PURPOSE: The aim of this study is to evaluate the effective role of living-related liver transplantation (LRLT) on posttransplant linear growth in children. METHODS: Thirty six children were enrolled who received LRLT at Asan Medical Center from December, 1994 to February, 1999 and showed more than one-year postoperative survival. Mean height standard deviation score (zH) was analyzed according to medical records including heights during pretransplant and posttransplant follow-up periods. RESULTS: zH of total children showed significant linear growth after LRLT from -1.58 to 0.33 at 24 posttransplant month (p<0.05). zH in children under 6 years of age, to exclude the effect of adolescent linear growth spurt, showed increment in height (p<0.05). Linear growth of children with liver cirrhosis improved and that with fulminant hepatitis was matained same. While stunted children (mean zH=-2.30) achieved good catch-up growth after transplantation, children with normal growth remained same. Children with significant hepatic dysfunction after LRLT such as chronic rejection or posttransplant lymphoproliferative disorder showed retarded posttrasplant linear growth. There was no statistical difference according to the type of immunosuppressants. CONCLUSION: LRLT resulted in adequate or catch-up linear growth in children with acute, chronic and metabolic liver disease. Successful LRLT suggested to be a promising option not only in long term survival but also in normal linear growth.

Intermittent parathyroid hormone treatment can promote linear growth in the ovariectomized growing rat

To compare the effect of intermittent parathyroid hormone (PTH) treatment with that of estrogen treatment on epiphyseal growth in ovariectomized rats, 46 Sprague-Dawley female rats aged 9-10 weeks (about 200-220 g) were either ovariectomized or sham operated. From 6 weeks after ovariectomy (ovx), rats were daily injected with subcutaneous human recombinant PTH (1-84)-dosed 30 micrograms/kg (the low dose PTH-treated group) or 300 micrograms/kg (the high dose PTH-treated group), 17 beta-estradiol (the 17 beta-estradiol-treated group, 30 micrograms/kg) or vehicle (the ovx-alone group), 5 times a week for 4 weeks. The decalcified sections of the distal femoral epiphyseal plate were analyzed on light microscopy after H&E stain, and the lengths of the zones of proliferation, maturing and hypertrophic chondrocytes were measured. The length of the growth plate, the zone of proliferation and the zone of hypertrophic chondrocyte in the ovx-alone group were significantly shorter than those of the sham-operated group. The treatment of 17 beta-estradiol speeded up the differentiation of cells from proliferating chondrocytes to maturing and hypertrophic chondrocytes even though the length of the growth plate was comparable to that of the sham-operated group. Both low and high dose PTH treatments increased the length of the growth plate, and those lengths were comparable to that of the sham-operated group. The fractions of proliferating, maturing and hypertrophic zone in the low dose PTH-treated group were also comparable to those of the sham-operated group. However, high dose PTH treatment slowed down the differentiation of cells from proliferating chondrocytes to maturing and hypertrophic chondrocytes to a greater extent, and therefore the fraction of proliferating chondrocytes of the high dose PTH-treated group was larger than that of the low dose PTH-treated group (73.8 +/- 1.8 Vs 63.3 +/- 1.3%, p < 0.005). From these results, we showed that intermittent PTH treatment could promote linear growth in the ovariectomized growing rat. We propose that PTH may be an alternative drug candidate for promoting linear growth of long bones without the risk for early closure of the growth plate.

Effects of Growth Hormone Treatment on Alterations of Growth and Bone Metabolism in Rats Induced by Dexamethasone Administration

PURPOSE: The aim of this study was to investigate the alterations of growth and bone metabolism in SDR induced by dexa administration and to evaluate the effects of GH treatment in dexamethasone(dexa) induced growth and bone metabolism in SDR. METHODS: Forty-five female Sprague-Dawley rats(weight 150-170gm) were divided in 3 groups: Group 1(n=15) received normal saline as control, Group 2(n=15) received dexa(1mg/kg/day), Group 3(n=15) received dexa and rhGH(LG Chem, 1IU/kg/day) simultaneously. Group 2 and 3 were injected rhGH daily, 6 days per week. Each group was divided in three subgroups(n=5) and sacrificed at 4, 6, 8 weeks, respectively. RESULTS: In Group 2, the length of tibia and femur and tibia epiphyseal plate thickness decreased significantly at 4, 6, 8 weeks compared to Group 1, respectively. In Group 2, serum IGF-I and PICP level also decreased at 6, 8 weeks and serum ICTP level increased at 4, 6 weeks compared to Group 1 significantly. In Group 3, the length of tibia and femur increased at 4, 6, 8 weeks compared to Group 2 but there was no statistical significance. In Group 3, tibia epiphyseal plate thickness increased significantly at 6, 8 weeks compared to Group 1. In Group 3, serum IGF-I and PICP level increased significantly at 4, 6, 8 weeks respectively compared to Group 2. But serum ICTP level showed no changes between two groups. Serum PTH level increased in Group 2 compared to Group 1, and decreased in Group 3 compared to Group 2 but no statistical significance was noted, respectively. CONCLUSION: Our data suggest that dexa inhibits longitudinal bone growth and interferes with bone metabolism, both inhibiting bone formation and stimulating bone resorption in SDR. Simultaneous GH administration may abolish alterations of growth and bone metabolism induced by dexa in SDR.