Research advance in the influencing factors of pubertal timing / 中国儿童保健杂志

Adolescence is a critical period for sexual maturation and physical growth, and the time of the first appearance of events during puberty initiation is called puberty timing. Recent studies have shown that abnormal changes in the pubertal timing are mainly influenced by genetic, environmental, nutritional, ethnic, and early-life factors. This review focuses on the current research progress of factors influencing puberty onset phase and related disease, in order to provide theoretical basis for prevention of clinical related diseases.

The effect of anastrozole therapy on final height and sex hormone levels in pubertal boys receiving growth hormone therapy

ABSTRACT Objective: This research aimed to evaluate retrospectively the effect of anastrozole on height gain and sex hormone levels in pubertal boys receiving growth hormone (GH). Materials and methods: Pubertal boys who received both GH and anastrozole (GH+A) were one-to-one matched with boys who received only GH (GH-Only) for chronological and bone age, pubertal stage and height before the GH initiation, treatment duration and midparental height. Anthropometric measurements throughout treatment and adult heights were compared between the groups. Sex hormone levels were evaluated longitudinally in the GH+A group. Results: Forty-eight cases (24 in each group) were included. There was no statistical difference in adult height between the GH+A and GH-Only (p = 0.071). However, when the analysis was limited to those receiving anastrozole for at least 2 years, mean adult height was higher in the GH+A than in the GH-Only group (173.1 ± 6.2/169.8 ± 5.6 cm, p = 0.044). Despite similar growth rates between the two groups, bone age advancement was slower in the GH+A than in the GH-Only in a mean anastrozole treatment period of 1.59 years (1.37 ± 0.80/1.81 ± 0.98 years, p = 0.001). The greatest increase for FSH, LH, total and free testosterone and decrease for estradiol levels were observed in the third month after anastrozole was started, albeit remaining within the normal ranges according to the actual pubertal stages. Conclusions: Using anastrozole with GH for at least 2 years decelerates the bone age advancement resulting in adult height gain with no abnormality in sex hormone levels. These results suggest anastrozole can be used as an additional treatment to GH for further height gain in pubertal boys.

Advances in the RNA N6-methyladenine modification in regulating pubertal sexual development / 国际儿科学杂志

N6-methyladenine(m 6A)has been identified as the most abundant, common and conserved internal RNA modification.RNA m 6A can couple different levels of gene regulation and may play an important role in epigenetic regulation(such as RNA splicing, translation, stabilization, and ectopic). Studies have shown that RNA m 6A methylation is an important factor in pubertal sexual development.The abundance of RNA m 6A methylation changed with the progression of pubertal development.The abnormalities of RNA m 6A methylation can lead to dysfunction of hypothalamic gonadotropin-releasing hormone(GnRH)neuronal networks.Those genes affected by RNA m 6A methylation may be critical targets in regulating puberty initiation.The review summarizes the research progress between RNA m 6A methylation and pubertal sexual development to provide the evidence to discover new therapeutic targets and improve the prognosis of the disease.

Association between early-life factors and pubertal timing in girls / 中国当代儿科杂志

OBJECTIVES@#To study the association between early-life factors (including birth weight, method of birth, gestational age, and history of gestational metabolic disorders) and pubertal timing in girls.@*METHODS@#The stratified cluster sampling method was used to select the girls in grades 2-3 and 7-8 from three primary schools and three middle schools in Guangzhou, China from March to December, 2019, and breast development was examined for all girls. A questionnaire survey was performed to collect the information on early-life factors. The multivariate logistic regression model was used to evaluate the association of gestational metabolic disorders, birth weight, method of birth, and gestational age with pubertal timing in girls. The Bootstrap method was used to assess the mediation effect of body mass index (BMI) (Z score) between high birth weight (≥4 000 g) and pubertal timing.@*RESULTS@#A total of 1 665 girls were enrolled, among whom 280 (16.82%) were judged to have early pubertal timing. The multivariate logistic regression analysis showed that high birth weight was associated with the increased risk of early pubertal timing (OR=2.12, 95%CI: 1.19-3.66, P=0.008). Nevertheless, no significant association was observed between other early-life factors and pubertal timing (P>0.05). The OR for the mediation effect of BMI (Z score) between high birth weight and early pubertal timing was 1.25 (95%CI: 1.09-1.47), accounting for 29.33% of the total effect of high birth weight on early pubertal timing.@*CONCLUSIONS@#High birth weight is associated with the increased risk of early pubertal timing in girls, and overweight/obesity may play a partial mediating role in the association between high birth weight and early pubertal timing in girls.

Effect of herbicide based formulations on structure and function of testis in rats

For instant weed management, widely used herbicide formulations (HFs) are Paraquat based formulation (PBF) or Glyphosate based formulation (GBF). Here, we investigated the effect of PBF Gramoxone® and GBF Roundup® on the structure and function of the testis of the male Wistar rats at the pubertal or post pubertal stage. Male rats were gavaged with Gramoxone® (5 mg/kg body wt.) or Roundup® (250 mg/kg body wt.). The treatment period of 25 days starts on a postnatal day (PND) 28 to 53 (from pre-pubertal to the pubertal stage) or 60 days from PND 28 to 88 (from prepubertal to the post pubertal stage). Age-matched control animals received distilled water. The structure of the testes was evaluated by observing changes in its histology and the function of the testes was assessed by estimating serum follicle-stimulating hormone (FSH), luteinizing hormone (LH) and testosterone levels. No significant effect was observed in the structure and function of the testes of the pubertal stage rats on exposure to both herbicide formulations. However, shrunken and distorted seminiferous tubules with oligozoospermia in testes, a non-significant decrease in FSH and LH, and a significant reduction in testosterone levels were noted in the post pubertal stage rats. The results indicated that changes in the testes of post pubertal groups are due to a longer duration of exposure to the Gramoxone® or Roundup® than in pubertal groups, and also the effect of these two formulations was more on the testis structure and function than on the pituitary-testis axis

Sexuality Education- Understanding adolescents’ perspective

Introduction: Adolescence is very dynamic phase in life and if child is not able to cope up with the changes then the effects on health are lifelong. Evidence supporting role of holistic/ comprehensive sexuality education empowering children in this coping process is present. But still the controversies exists in all countries about either acceptance, content or delivery of the sexuality education. To make curriculum more acceptable, engaging and effective, it is very important to take into consideration adolescent’s perspective. In present study, we tried to understand felt need of adolescents about sexuality education. Objective: To understand need for sexuality education. Methods: The methods used were question box, selfadministered questionnaire, and name the organs in blank human figure activity all in different set of students. Results: 48% questions were to seek scientific information but extent was up to enquiring about sex toys.12% about emotional changes, 11% about cultural norms,9% about romantic relationship and 6% to clear myths. The basic knowledge about human body, pubertal changes was poor, more so in girls. The attitude towards pubertal changes was mostly negative in girls, curious in boys. The inhibition in mentioning reproductive system organs was significant in both, indicating attitude. 98% were willing to have correct knowledge about the pubertal changes and effects on life. Conclusion: The comprehensive sexuality education is unmet need in India. Taking into consideration perspective of adolescents, it should contain scientific knowledge and other relevant topics.

Comparison of the clinical profile of prepubertal versus pubertal female child sexual abuse in a tertiary hospital

Objective@#This study aimed to compare the clinical profile of prepubertal and pubertal female child sexual abuse. @*Methods@#A cross-sectional analytical study involving 43 sexually abused children was done. Each patient was categorized as prepubertal or pubertal based on the Tanner stage. Medical history was gathered using a structured interview and physical examination done with proper documentation after obtaining consent. Blind review by child protection specialists was done on genital images. Descriptive statistics were utilized for all variables. @*Results@#This study showed 11.97% and 22.22% prevalence for prepubertal and pubertal child sexual abuse, respectively. Most prepubertal children disclosed digital vaginal penetration by the father and non-relative household members, while most pubertal children reported penile-vaginal penetration by the boyfriend. Fondling was common to both groups. The majority were repeated abuse and usually happened at the perpetrator’s house. Behavioral changes and genital symptoms were common in prepubertal children. Findings of hymenal trauma were found in 25% of prepubertal girls and half of the pubertal adolescents. The interobserver variability of these hymenal findings was fair. The prevalence of sexually transmitted infections (STIs) was low, none for the prepubertal children, and only 6% of the adolescent had STI, which was Hepatitis B. @*Conclusion@#The clinical profile of sexually abused prepubertal children differed from that of pubertal adolescents. There was a higher incidence of hymenal trauma and STIs in adolescents.

Referencias internacional y nacional, su uso en el estudio del crecimiento y la maduración física / International and national references, their use in the study of growth and physical maturation

Los factores genéticos y ambientales interactúan durante todo el crecimiento. La talla final adulta, el ritmo o tempo de crecimiento y maduración, así como la maduración sexual, esquelética y dental, tienen una transmisibilidad entre 41 y 71%. El estirón puberal ocurre un año antes en africanos que en europeos y los asiáticos son intermedios. Esta heterogeneidad puberal dificulta el uso de una referencia internacional en esta etapa, aunque su valor al permitir la comparabilidad entre poblaciones es indiscutible, así como el hecho que no todos los países pueden desarrollar sus propias referencias. En la Región Latinoamericana, Argentina, Cuba y Venezuela desarrollaron referencias hace muchos años y recientemente, Colombia, Ecuador y Perú. En Venezuela, se realizó el Estudio Nacional de Crecimiento y Desarrollo Humano (ENCDH) y el Estudio Longitudinal de Caracas (ELAMC) para establecer patrones de referencia, relevantes debido a la maduración más temprana y a las diferencias significativas en crecimiento y maduración con los anglosajones. Así mismo se elaboró el Atlas de Maduración Ósea del Venezolano y se han construido Curvas para uso Clínico integrando ambos estudios. Debido a la disparidad en el uso de referencias- internacionales y nacionalesse está planificando un estudio multicéntrico, denominado PRONNA, de la línea de investigación sobre Crecimiento y Desarrollo en Niños y Adolescentes (CDNNA) del Grupo Transición Alimentaria y Nutricional (grupo TAN) para la escogencia definitiva de las referencias a ser usadas(au)

Genetic and environmental factors interact during growth. Final height, tempo of growth, sexual, skeletal and dental maturation have between 41 and 71% heritability. The puberal spurt occurs one year earlier in Africans than in European descendants, Asiatic are intermediate. This pubertal heterogeneity difficult the use of an international reference during this period, although its importance in the comparability of prevalences is unique, as well as the fact that many countries are unable to develop their own references. In the Latin American Region, Argentina, Cuba and Venezuela have long--standing references, Colombia, Ecuador and Perú only recently. In Venezuela, due to the earlier maturation and differences from puberty onwards with anglosaxons, the National Growth and Development Study and the Caracas Longitudinal Study were developed in order to obtain growth charts. Both studies integrated for Clinical Use dual use charts: an Atlas for Bone Maturity Asessment is also available. Due to the multiple use of references (national as well as international) a multicenter national study-PRONNA- is being planned in order to decide which reference is most adequate. This is part of the Growth and Development Research line of study of TAN Group (Food and Nutritional Transition Group)(AU)

Regulatory mechanisms of microRNAs involved in pubertal development / 国际儿科学杂志

The regulatory mechanisms of pubertal development are complex and affected by many factors.MicroRNAs, which major participants in epigenetics, are short single-stranded RNAs composed of 21-25 nucleotides.They can regulate the expression or translation of multiple target genes, playing an important role in complex biological phenomena.During pubertal development, microRNAs can regulate the expression of related genes on the hypothalamic-pituitary-gonadal axis(HPGA). Recently, studies have found that the lack or overexpression of some specific microRNAs can cause abnormal pubertal development(premature or delayed)and lead to reproductive disorders, providing a new direction for the diagnosis and treatment of puberty diseases.Here we mainly review the regulatory mechanisms that microRNAs participate in pubertal development.

A Rare Case of Idiopathic Intracranial Hypertension in Prepubertal Age

@#A 2-year-old girl who was under genetic follow up for developmental delay and dysmorphism was accidentally found to have bilateral optic disc swelling during screening examination. She showed response to optokinetic drum examination and the anterior segment examination was unremarkable. Optic disc swellings were seen in both eyes. Lumbar puncture shows high opening pressure of 50 cm H2O with unremarkable CSF analysis. MRI of brain was done and showed features in keeping with mild cerebral atrophy, with no evidence of hydrocephalus or space occupying lesion. She was diagnosed with idiopathic intracranial hypertension and oral acetazolamide 125mg bd was commenced. However, papilloedema persist despite medical therapy. Ventriculoperitonel shunt was inserted to reduce the csf pressure. This case report highlights the importance of considering idiopathic intracranial hypertension as a cause of optic disc swelling in pre-pubertal children because delay in diagnosis and treatment may permanently affect visual function especially in children.

The association between sleep duration, bedtimes, and early pubertal timing among Chinese adolescents: a cross-sectional study

BACKGROUND AND OBJECTIVE@#Early pubertal timing is associated with sleep among Western adolescents, but little is known about this association in Chinese adolescents, especially with regard to the association between bedtimes and early pubertal timing. This paper aimed to identify the association between sleep duration, bedtimes, and early pubertal timing in Chinese adolescents.@*METHODS@#An anonymous cross-sectional survey was conducted among primary and junior middle students (grades 3 to 9) from QiJiang District, ChongQing, China. Participants were recruited by applying stratified cluster sampling. Pubertal timing, sleep duration, and bedtimes were assessed using the Pubertal Development Scale and a self-designed sleep questionnaire. We utilized multivariable logistic linear regression (MLLR) to test the association between sleep duration, bedtimes, and pubertal timing.@*RESULTS@#A total of 5461 adolescents were evaluated, with mean age and BMI values of 11.41 ± 2.05 and 18.03 ± 3.03, respectively, of whom 1257 (23.02%) were in early pubertal timing. In MLLR controlling for age, BMI, family economic status, and other covariates, sufficient sleep (b = - 0.214, P = 0.032, OR = 0.808, 95% CI 0.664-0.982) was negatively related to early pubertal timing, and later bedtime (b = 0.195, P < 0.001, OR = 1.215, 95% CI 1.104-1.338) was positively associated with early pubertal timing.@*CONCLUSION@#Students with early pubertal timing had less sleep duration and later bedtimes, which may be the result of increased stress caused by physical and psychological changes. Therefore, more attention should be paid to pubertal health education for adolescents during puberty. Further longitudinal studies are needed to confirm the causality between sleep and early pubertal timing in Chinese adolescents.

Comparative Study of Carrying Angle between Dominant and Non Dominanat Limb in Kashmiri Population

Introduction: Carrying angle (CA) is the angle subtendedby median axis of the arm with fully extended and supinatedforearm. There is scarcity of evidence in the literature regardingdifferences between the CA in both sexes depending uponthe ossification of arm and forearm bones and comparison ofCA between dominant and non dominant limb. Study aimedat comparison of data obtained by measuring CA by manualmethod between dominant and non dominant limb in agegroup 18 – 30 years.Material and Methods: CA was measured in 200 individualsof both sexes by clinical method with a manual goniometer.Results: Present study shows the significant gender differenceand significant difference between dominant and non dominantlimb.Conclusion: Unnecessary x ray exposure to children, youngadults and pregnant women can be avoided, by measuring CAby clinical methods.

Skeletal Age Assessment of SMI and MP3 Stages to Predict the Pubertal Growth Spurt / 대한소아치과학회지

This study aimed to assess the skeletal age of skeletal maturational indicator (SMI) and middle phalanx of the middle finger (MP3) stages and to predict the SMI and MP3 stages corresponding to pubertal growth spurt in boys and girls respectively.The skeletal age was assessed from hand-wrist radiographs of 363 children (182 boys, 181 girls) aged 7 to 16 years by radiologists using the Korean standard bone age chart. Also, SMI and MP3 stages were evaluated from the radiographs. From these records, the mean skeletal age of SMI and MP3 stages was calculated.The stages including pubertal growth spurt were SMI 4 – 5, MP3 FG – G stages in boys and SMI 3 – 4, MP3 F – FG stages in girls.

A novel CHD7 mutation in an adolescent presenting with growth and pubertal delay

Mutations in the CHD7 gene, encoding for the chromodomain helicase DNA-binding protein 7, are found in approximately 60% of individuals with CHARGE syndrome (coloboma, heart defects, choanal atresia, retarded growth and development, genital hypoplasia, ear abnormalities and/or hearing loss). Herein, we present a clinical case of a 14-year-old male presenting for evaluation of poor growth and pubertal delay highlighting the diagnostic challenges of CHARGE syndrome. The patient was born full term and underwent surgery at 5 days of life for bilateral choanal atresia. Developmental milestones were normally achieved. At age 14 his height and weight were

Fertility-sparing surgery for a prepubertal female with malignant ovarian germ cell tumor

@#<p style="text-align: justify;">Malignant ovarian germ cell tumors are rare ovarian malignancies accounting for 3 to 5% of all ovarian malignancies. They are mostly seen in adolescents and young women and are usually unilateral making fertility preservation imperative. Raised alpha-feto protein level is the hallmark of this tumor. Presented is a case of a premenarcheal 13 year old female diagnosed with yolk sac tumor and who underwent fertility-sparing surgery and adjuvant platinum-based chemotherapy post-operatively, with good outcome. In young patients, conservative surgery with adjuvant chemotherapy has made the preservation of fertility possible, even in patients with advanced disease. The increase in cure rates has shifted the focus of recent studies to the long term menstrual, reproductive, and gynecologic outcomes in these patients. </p>

THE PUBERTY PROFILE OF FEMALE ADOLESCENTS IN CHERAS, MALAYSIA

@#Objectives: The objectives of our study were to determine the mean age of onset of thelarche and menarche, to determine the ages of each stage of puberty and to investigate if there are any ethnic differences in these ages amongst female adolescents in Kuala Lumpur, Malaysia. Methods: This was a cross-sectional study involving three secondary schools in Cheras, Kuala Lumpur. A total of 730 students were recruited via stratified random sampling. Self-administered survey forms on menstruation and puberty were used. Results: Out of 730 recruited respondents, 385 (52.74%) completed the survey and informed consents were obtained from their parents/legal guardians. Our respondents’ ages ranged between 13 to 17 years old with the median (IQR) age of 14.00(2.00) years. With regards to ethnicity, 329 (85.50%) were Malay, 46 (11.90%) were Chinese, 9 (2.30%) were Indian and 1(0.30%) was a Bajau. The mean age for breast development (thelarche) and menarche were 11.72 ±1.10 and 11.97±1.11 years respectively. The majority, 363 (94.30%), out of 385 respondents had attained menarche. There appeared to be a later onset of puberty amongst Malays comparatively. Conclusion: The mean ages of pubertal onset and menarche amongst female adolescents in the Cheras area are similar to those reported worldwide.

Propuestas para el estudio del pensar del analista de pacientes púberes / Proposals for the study of the thinking process of the psychoanalyst of pubertal patients

El trabajo aborda el pensar del terapeuta desde un punto de vista de Freud quien define pensamiento como desplazamiento de energía en camino a la acción. Describimos los instrumentos clásicos para el estudio del pensar del analista en sesión y aportamos algunos instrumentos novedosos que detectan el hacer y el decir del terapeuta y su contribución a la alianza terapéutica y el cambio clínico del paciente púber. Establecemos algunas relaciones entre los instrumentos clásicos y los nuevos que presentamos en este trabajo. (AU)

The work deals with the thinking process of the analyst of pubertal patients from the Freudian point of view, which defines thought as the displacement of energy on its way to action. We describe the classical instruments for the study of the thinking process of the analyst in session and provide some novel instruments that detect the therapist's doing and saying and his contribution to the therapeutic alliance and the clinical change of the pubertal patient. We establish some relationships between the classical instruments and the new ones that we present in this work. (AU)

Influencing factors of early puberty / 国际儿科学杂志

Nearly half a century,an increasing number of studies have found that the puberty of human being is at early trends.Puberty is the process of physical changes involving reproductive system maturation and the acquisition of fertility,by the combination effects of nervous system,endocrine system and the environment.Pubertal timing is a relative concept and the process of pubertal development can be shown as early,timely or relatively late as compared with a reference group.This article mainly focuses on related influencing factors of pubertal timing including genetic factor,childhood obesity,growth pattern (intrauterine growth retardation,catchup growth,adiposity rebound),psychosocial stress (poor family emotional environment,father absence,international adoption),environmental endocrine disrupting chemicals with their mechanism and significance.The exploration of relevant risk factors of early puberty can provide scientific evidence for formulating relevant policies and targeted prevention.

Erythrocyte zinc and serum copper in male and female adolescents according to puberty stage at different growth phases

BACKGROUND: Considering that modification in body composition and growth velocity leads to alterations in zinc and copper nutritional status, the purpose of the study was to assess erythrocyte zinc and serum copper in adolescents of both genders, according to the stage of sexual maturity at different growth phases. METHODS: Two hundred and eighty-six adolescents were assessed, 157 were female, with body mass index Z-scorebetween−2 and +2. Clinical biochemical measurements were assessed using atomic absorption spectrophotometry. Student's t, Kruskal-Wallis, and Bonferroni tests were used. RESULTS Median serum copper was superior, and zinc was inferior to respective reference values in all groups. Serum copper presented significant reduction in the final stages of pubertal development in males; in turn, erythrocyte zinc values increased linearly with the evolution of puberty stages in both genders. Comparison between genders in each stage of growth showed significant difference in peak acceleration and in deceleration for erythrocyte zinc and serum copper, with both being higher in females. CONCLUSIONS: Serum copper is inversely influenced by modifications that occur with the evolution of puberty in males, whereas erythrocyte zinc is directly influenced in both genders, although always with deficient deposition. At peak acceleration and deceleration of growth, there is greater mobilization of erythrocyte zinc and serum copper in males, when compared with females, which does not occur at the onset of the acceleration of growth.

Intervenciones terapéuticas en disforia de género de niños y adolescentes / Therapeutic Interventions in gender dysphoria in children and adolescents

El concepto de Identidad de Género (IG) hace referencia a la convicción personal e internalizada de pertenencia a un determinado género y no a otro. Esta experiencia, temprana en el devenir del ser humano, establece los cimientos del desarrollo psicosexual. El distrés psicológico personal que produce el sentimiento de incongruencia entre la identidad de género y el sexo biológico asignado es conocido como Disforia de Género (DG). Los niños y adolescentes con DG constituyen un grupo de riesgo para sufrir problemas de salud mental, tanto por sus sentimientos disfóricos, como por el estigma y aislamiento social y familiar del que pueden ser objeto. Los psiquiatras infanto juveniles deben estar capacitados para evaluar y diagnosticar a aquellos pacientes que presentan estas dificultades, así como ser capaces de ofrecer tratamientos y soporte que les permita reestablecer la salud mental. El presente artículo es una revisión actualizada de los conceptos relacionados con la DG y su abordaje terapéutico, desde un enfoque multidisciplinario.

Gender identity refers to the internal and personal belief that a person belongs to one gender and not the other. This early developmental experience establishes the foundation for psychosexual development. The psychological distress that is produced by the incongruence between gender identity and biological sex is known as Gender Dysphoria (GD). Children and adolescents with GD constitute a risk group for mental health problems, both due to their dysphoria and the social stigma and isolation they may suffer. Child and adolescent psychiatrists need to know how to assess and diagnose patients with these symptoms, and be able to offer treatment and support to help reestablish their mental health. This is an updated review of the concepts related to GD and their treatment, from a multiprofesional perspective.