212 research outputs found
Growth, head growth, and neurocognitive outcome in children born very preterm: methodological aspects and selected results
No full textIn light of the growing number of surviving children born very preterm, there is an increasing focus on their long-term outcomes in terms of growth, metabolic status, and neurocognitive development. Therefore, it is of importance to follow such children from birth onwards with the aim of identifying the causes of atypical development, developing preventative measures, and improving outcomes. Since such long-term follow-up needs to be conducted with the least possible burden, clinical investigations such as anthropometry and neurocognitive tests, if conducted rigorously, will continue to have a predominant role. The aim of this review is to discuss the complexity of longitudinal anthropometry in children born very preterm and to provide an overview of the main studies that have examined associations between growth, in particular head growth, and neurocognitive outcomes at around school age
Insulin-like Growth Factor I (IGF-I), IGF Binding Protein-3 (IGFBP-3) und Alkaline Phosphatase (AP) with organic growth hormone deficiency (GHD), intrauterine growth retardation and idiopathic short stature (ISS)
No full textVollständiger Titel: Insulin-like Growth Factor I (IGF-I), IGF Binding Protein-3 (IGFBP-3) und Alkalische Phosphatase (AP) bei organischem Wachstumshormonmangel (GHD), intrauteriner Wachstumsretardierung und idiopathischem Kleinwuchs (ISS), vor und während der Therapie mit Wachstumshormon (GH)
In dieser Studie wurde untersucht, inwieweit bei bestehendem Kleinwuchs die Substitution mit hGH die Serumkonzentration von IGF-I, IGFBP-3 und AP beeinflusst, ob die Änderungen der einzelnen Parameter mit dem Größenwachstum korrelieren und welchen diagnostischen Stellenwert diese Parameter dabei einnehmen. Insgesamt wurden 70 Patienten (45 Jungen, 25 Mädchen) im Alter von 2 bis 17 Jahren auf drei Gruppen verteilt: Gruppe 1: Patienten mit Kleinwuchs bei organischem GHD, behandelt mit hGH = ~ 0,45 IE/kg/Woche (n=20); Gruppe 2: Patienten mit Kleinwuchs bei intrauteriner Wachstumsretardierung (IUGR), Silver-Russell- oder Noonan-Syndrom, therapiert mit hGH = ~ 0,80 IE/kg/Woche (n=20) und Gruppe 3: ISS-Patienten und Patienten mit nicht klassifizierbarem Kleinwuchs, behandelt mit hGH = ~ 0,57 IE/kg/Woche (n=30). Wachstumshormon wurde in jedem Fall täglich subcutan appliziert, der Beobachtungszeitraum betrug ein Jahr (70 Pat.) bzw. drei Jahre (60 Pat.). Mittleres Alter zu Therapiebeginn: 8,7 Jahre. Die höchste mittlere Zunahme der Serumspiegel bezüglich der untersuchten Parameter erfolgte im ersten Therapiejahr, insbesondere während den ersten drei Therapiemonaten: IGF-I stieg in Gruppe 1 sehr signifikant (p= 0,003), in den Gruppen 2 u. 3 jeweils hoch signifikant (p<0,001) an, die Zunahme von IGFBP-3 war in den drei Gruppen jeweils hoch signifikant (p<0,001), diejenige von AP in den Gruppen 1 und 2 jeweils sehr signifikant (p=0,003 bzw. p=0,007), in Gruppe 3 hoch signifikant (p<0,001). In dem entsprechenden Zeitraum nahm auch die Körpergröße in allen drei Gruppen hoch signifikant (p<0,001) zu. Aus der folgenden Tabelle sind in jeder Gruppe neben den Ausgangsdaten der Untersuchungsgrößen die ein- und dreijährigen Zunahmen, ausgedrückt als mittlerer Standard Deviation Score (SDS), ersichtlich (∆SDS: Differenz des Mittelwert-SDS nach einem Jahr bzw. nach drei Jahren Therapie und zu Therapiebeginn). Signifikante Unterschiede im Hinblick auf den Anstieg der Parameter im direkten Gruppenvergleich ergaben sich lediglich im ersten Jahr jeweils zwischen den Gruppen 1 und 3 in Bezug auf IGFBP-3 (p=0,03) und AP (p=0,02).
Je niedriger die Serumspiegel von IGF-I und IGFBP-3 zu Therapiebeginn waren, desto schneller und stärker vollzog sich deren Annäherung unter WH-Therapie an altersentsprechende Normwerte mit konsekutivem Aufholwachstum. Dieses Verhalten lässt sich nicht auf die alkalische Phosphatase übertragen. Die Ergebnisse dieser Studie belegen die Rolle von IGF-I, IGFBP-3 und AP im Patientenserum als unverzichtbare Indikatoren im Rahmen der Diagnostik und Therapie des Kleinwuchses.Full Title: Insulin-like Growth Factor I (IGF-I), IGF Binding Protein-3 (IGFBP-3) und Alkaline Phosphatase (AP) with organic growth hormone deficiency (GHD), intrauterine growth retardation and idiopathic short stature (ISS), before and during the therapy with growth hormone (GH)
In this study it was examined, to what extent with existing short stature the substitution with hGH affects the serum concentration of IGF-I, IGFBP-3 and AP, whether the changes of the individual parameters correlate with the size growth and which diagnostic value these parameters take thereby. Altogether 70 patients (45 boys, 25 girls) at the age of 2 to 17 years were distributed on three groups: group 1: patients with short stature with organic GHD, treated with hGH = ~ 0,45 IU/kg/week (n=20); group 2: patients with short stature with intrauterine growth retardation (IUGR), Silver-Russell- or Noonan-syndrome, treated with hGH = ~ 0,80 IU/kg/week (n=20) and group 3: patients with ISS and patients with non-classifi- able short stature, treated with hGH = ~ 0,57 IU/kg/week (n=30). Growth hormone was administered in each case daily subcutaneously, the period of observation amounted to one year (70 patients) and three years (60 patients), respectively. Mean age at start of therapy: 8,7 years. The highest mean increase of the serum levels with regard to the examined parameters occurred in the first year of therapy, in particular during the first three months of therapy: IGF-I rose very significantly (p=0,003) in group 1, in the groups 2 and 3 highly significant (p<0,001) in each case, the increase of IGFBP-3 in the three groups was highly significant (p<0,001) in each case, that of AP in the groups 1 and 2 very signi- ficantly (p=0,003 and p=0,007, respectively) in each case, in group 3 highly significant (p<0,001). In the corresponding period, the height also increased in all three groups highly significantly (p<0,001). From the following table, besides the original data of the investigation sizes, the one and three-year increases in each group, expressed as the mean standard deviation score (SDS), are evident (∆SDS: difference of the average value-SDS after one year and after three years of therapy, respectively and at start of therapy). Significant differences with regard to the rise of the parameters in the direct comparison of the groups only arose in the first year in each case between the groups 1 and 3 concerning IGFBP-3 (p=0,03) and AP (p=0,02).
At start of therapy, the lower the serum levels of IGF-I and IGFBP-3 were, the faster and more strongly carried out themselves their approximation to age- appropriate standard values under GH therapy with consecutive catch-up growth. This behavior can not be assigned onto the alkaline phosphatase. The results of this study cover the role of IGF-I, IGFBP-3 and AP in the patient serum as indispensable indicators within the diagnostics and therapy of short stature
Insulin-like Growth Factor I (IGF-I), IGFBP-3 and Alkaline Phosphatase (AP) in children with idiopathic Growth Hormone Deficiency (iGHD) and Neurosecretoric Dysfunction (NSD) before and during therapy with human Growth Hormone (GH)
No full textEs wurden 116 überwiegend präpubertäre Kinder über einen Zeitraum von einem bzw. vier Jahren untersucht, die an der Universitäts-Kinderklinik Tübingen wegen idiopathischem Wachstumshormonmangel (iGHD) oder wegen Neurosekretorischer Dysfunktion (NSD) mit ca. 0,6 IU rekombinantem Wachstumshormon pro kg Körpergewicht und Woche behandelt wurden. Die Diagnose iGHD wurde gestellt bei einer mittleren nächtlichen Spontansekretion von 10ng/ml GH. Es wurden folgende Parameter untersucht: Körpergröße/ -gewicht, Body-Mass-Index, Knochenalter, Insulin-like Growth Factor I (IGF-I), IGFBP-3 und Alkalische Phosphatase (AP). Die Körpergröße war bei beiden Diagnosen zu Therapiebeginn deutlich erniedrigt (iGHD: MW=-3,7+/-1,3SD; NSD: MW=-3,0+/-0,7SD). Die iGHD-Patienten zeigten zu Therapiebeginn signifikant niedrigere Werte für die Körpergröße, die IGF-I- und die IGFBP-3-Serumkonzentration (p10ng/ml). The following parameters were measured: height, weight, body-mass-index, bone age, insulin-like growth factor I (IGF-I), insulin-like growth factor binding protein 3 (IGFBP-3) and alkaline phosphatase (AP). In both groups height before GH-therapy was below the reference-data (mean[iGHD]=-3,7+/-1,3SD; mean[NSD]=-3,0+/-0,7SD). Furthermore the children with the diagnosis iGHD had significant lower hight, IGF-I- and IGFBP-3-serum-levels before therapy (p<0,001). In both groups (iGHD and NSD) a significant rise of hight, weight, IGF-I, IGFBP-3 and AP was found during the first year of therapy (p<0,001 except AP[NSD]: p=0,02). It could be seen that the iGHD-patients grew faster than the NSD-patients (1 year: p=0,04; 4 years: p=0,03). In the iGHD-group a significant correlation between the rapid catch-up growth during the first year on GH and small values of hight (p=0,007), IGF-I (p<0,001) and IGFBP-3 (p=0,002) before therapy onset were found
Important tools for use by pediatric endocrinologists in the assessment of short stature
No full textAssessment and management of children with growth failure has improved greatly over recent years. However, there remains a strong potential for further improvements by using novel digital techniques. A panel of experts discussed developments in digitalization of a number of important tools used by pediatric endocrinologists at the third 360 degrees European Meeting on Growth and Endocrine Disorders, funded by Merck KGaA, Germany, and this review is based on those discussions. It was reported that electronic monitoring and new algorithms have been devised that are providing more sensitive referral for short stature. In addition, computer programs have improved ways in which diagnoses are coded for use by various groups including healthcare providers and government health systems. Innovative cranial imaging techniques have been devised that are considered safer than using gadolinium contrast agents and are also more sensitive and accurate. Deep-learning neural networks are changing the way that bone age and bone health are assessed, which are more objective than standard methodologies. Models for prediction of growth response to growth hormone (GH) treatment are being improved by applying novel artificial intelligence methods that can identify non-linear and linear factors that relate to response, providing more accurate predictions. Determination and interpretation of insulin-like growth factor-1 (IGF-1) levels are becoming more standardized and consistent, for evaluation across different patient groups, and computer-learning models indicate that baseline IGF-1 standard deviation score is among the most important indicators of GH therapy response. While physicians involved in child growth and treatment of disorders resulting in growth failure need to be aware of, and keep abreast of, these latest developments, treatment decisions and management should continue to be based on clinical decisions. New digital technologies and advancements in the field should be aimed at improving clinical decisions, making greater standardization of assessment and facilitating patient-centered approaches.Developmen
Growth and development are similar in VLBW children born appropriate and small for gestational age: an interim report on 97 preschool children
No full textAim: To investigate growth and development in a cohort of children born with very low birth weight (VLBW) treated at a single tertiary neonatal unit. Methods: We studied 97 children born between January 1995 and July 1997 with BW <1,500 g. At follow-up (mean age 3.7 years) anthropometric data and data on neurological status, motor, speech and language development were collected. Small for gestational age (SGA) was defined as weight and/or length at birth <10th percentile; shortness at follow-up was defined as height <10th percentile. Results: Comparison was made between the appropriate for gestational age (AGA) (n = 46) and SGA (n = 51) groups. At follow-up, 23 AGA and 35 SGA children were short, had a smaller head circumference (-1.9 vs -0.8 SDS), were lighter at birth (BW -1.3 vs -0.7 SDS), and had a higher rate of broncho-pulmonary dysplasia (BPD) (28 vs 12); no differences in neonatal characteristics or neurological status were evident. A higher frequency of motor delay occurred in the 'short' group. Short children also had a smaller head circumference (HC) (-1.6 vs -0.7). Short SGA children had a higher frequency of BPD, smaller HC (-2.1 vs -1.0), and a slightly higher proportion of suspicious neurological findings, motor delay, and speech and language delay (n.s.). Conclusions: Preterm VLBW infants, whether AGA or SGA at birth, face the risk of being short at preschool age. Height outcome is probably influenced by postnatal factors. Our data also suggest that short stature is associated with developmental difficulties in this population.<br/
Height Gain in Ullrich-Turner Syndrome after Early and Late Growth Hormone Treatment Start: Results from a Large Retrospective German Study and Potential Basis for an Individualized Treatment Approach
No full textBackground:
Ullrich-Turner syndrome (UTS) girls often present with short stature in adolescence to the endocrinologist when the efficacy of growth hormone (GH) to improve growth remains unknown and parameters to estimate individual GH responsiveness have yet to be determined.
Objective:
Retrospective evaluation of adult height (AH) and predicted adult height at GH start (descriptive model of Ranke, Model PredAH) in early and late GH-treated German UTS patients.
Subjects/Methods:
313 patients treated with GH, early [chronological age (CA) at GH start <12 years, n = 259] or late (CA at GH start ≥12 years, n = 54) who reached AH were selected from KIGS (Pfizer International Growth Database).
Results:
AH (152.5 ± 5.9 vs. 151.1 ± 5.4 cm, p = n.s.) after GH treatment for 7.5 ± 2.12 years (GH start early) and for 5.2 ± 1.2 years (GH start late) were similar (p = n.s.) as Model PredAH (155.7 ± 4.8 vs. 154.7 ± 4.8 cm; p = n.s.) but higher (p < 0.001) than projected adult height (Ranke, ProjAH; 148.2 ± 5.5 vs. 145.2 ± 6.7 cm; p = 0.001). Total height gain over ProjAH was 4.3 ± 4.6 cm (GH start early) and 5.8 ± 4.7 cm (GH start late, p = 0.021), respectively.
Conclusions:
GH may improve AH in UTS patients even when started late. The individual growth response could be estimated by the descriptive Model PredAH independent of age at treatment start
A literary and rhetorical examination of the depiction of Luther's monastic period in Peter Manns's Martin Luther
No full textMuch historical writing before the nineteenth century was produced with little historiographical consciousness and sought to 'tell the story'. The nineteenth century, however, saw a shift in historical writing mainly as a result of the work of Ranke; his legacy has been far reaching and many historians continue to write in the post-Rankean tradition, aiming essentially to depict the past wie es eigentlich gewesen. As suggested by several theorists, notably Hayden White, post-structuralism questions whether this is possible or indeed desirable and argues that there is a correlation between the historian's view and narrative emplotment. In light of this, post-structuralist critics argue that historical writing may be subjected to the same analysis as figurative writing. Nevertheless, while theories have been produced regarding the emplotment of historical writing and its correlation to the author's ideological view, few, if any, studies have combined historiography with detailed nanatological analysis. Luther's monastic years are problematical as the subject of historical writing, as while they seemingly played a significant role in Luther's development, documentary evidence on the period is scant. The historian must compensate for this lack of documentary fact and create a narrative which tallies with this deterministic emplotment. As such, Luther's monastic period represents an ideal candidate for such rhetorical analysis. Regarded as an influential and groundbreaking biography, Manns's Martin Luther represents an important step in historical writing on Luther's life, showing a significant development in the Catholic understanding of the reformer. By analysing the treatment of key episodes in exemplar texts, narrative traditions can be identified and through comparison with Manns, an ecumenical shift emerges on a conceptual and a rhetorical level in how a polemical figure from the past can be understood and represented
Anti-Müllerian hormone levels in girls and adolescents with Turner syndrome are related to karyotype, pubertal development and growth hormone treatment
No full textIn girls and adolescents with Turner syndrome (TS), is there a correlation between serum AMH levels and karyotype, spontaneous puberty and other biochemical markers of ovarian function, or growth hormone (GH) therapy? SUMMARY ANSWER: Serum anti-Müllerian hormone (AMH) correlates with karyotype, pubertal development, LH, FSH and are measurable in a higher percentage of TS patients under GH therapy. WHAT IS KNOWN ALREADY: Most girls with TS suffer from incomplete sexual development, premature ovarian failure and infertility due to abnormal ovarian folliculogenesis. Serum AMH levels reflect the ovarian reserve in females, even in childhood. STUDY DESIGN, SIZE, DURATION: Cross-sectional study investigating 270 karyotype proven TS patients aged 0-20 years between 2009 and 2010. PARTICIPANTS/MATERIALS, SETTINGS, METHODS: Studies were conducted at three University Children's hospitals in Europe. Main outcome measures were clinical data concerning pubertal development as well as laboratory data including karyotype, serum AMH, LH, FSH, estradiol (E2), inhibin B and IGF. RESULTS AND THE ROLE OF CHANCE: Serum AMH was detectable in 21.9% of all TS girls and correlated strongly with karyotypes. A measurable serum AMH was found in 77% of TS girls with karyotype 45,X/46,XX, in 25% with 'other' karyotypes and in only 10% of 45,X TS girls. A strong relationship was also observed for measurable serum AMH and signs of spontaneous puberty such as breast development [adjusted odds ratio (OR) 19.3; 95% CI 2.1-175.6; P = 0.009] and menarche (crude OR 47.6; 95% CI 4.8-472.9; P = 0.001). Serum AMH correlated negatively with FSH and LH, but did not correlate with E2 and inhibin B. GH therapy increased the odds of having measurable AMH in TS (adjusted OR 4.1; 95% CI 1.9-8.8; P < 0.001). LIMITATIONS, REASONS FOR CAUTION: The cross-sectional design of the study does not allow longitudinal interpretation of the data; for that further studies are needed. High percentage of non-measurable AMH levels in the cohort of TS require categorized analysis. WIDER IMPLICATIONS OF THE FINDINGS: Serum AMH levels are a useful marker of the follicle pool and thus ovarian function in pediatric patients with TS. These findings are in line with the published literature. The finding that GH therapy may affect AMH levels is novel, but must be confirmed by future longitudinal studies
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