Efficacy and safety results of long-term growth hormone treatment of idiopathic short stature

CONTEXT

Small clinical trials of GH treatment of idiopathic short stature (ISS) show variable efficacy.

OBJECTIVE

The study was an analysis of a large GH registry for efficacy and safety of GH treatment of ISS. There was also a comparison with a specific clinical trial.

DESIGN

Up to 7 yr of GH treatment of ISS was evaluated for efficacy and safety in the National Cooperative Growth Study (NCGS).

SETTING

The NCGS study was conducted at Genentech, Inc. and included 47,226 patients.

PATIENTS

The ISS group included maximum stimulated GH 10 ng/ml or more and/or a report of ISS by investigator (n = 8018; all included for safety). Cohort 1 (n = 2520) was similar to the clinical trial, cohort 2 (n = 283) included subjects younger than 5 yr of age, and cohort 3 (n = 940) was pubertal at GH start.

INTERVENTION

GH, approximately 0.30 mg/kg.wk, was given.

MAIN OUTCOME MEASURES

These included growth velocities and height sd (HtSDS).

RESULTS

Mean first-year growth velocities in cohorts 1, 2, and 3 increased 4.6, 3.9, and 4.4 cm/yr over pretreatment, respectively. Measures included: baseline mean HtSDS, -2.9, -3.2, and -2.8; mean HtSDS at 1 yr, -2.4, -2.3, and -2.3, respectively. Mean HtSDS after 7 yr in cohorts 1 (n = 303) and 2 (n = 85) and 5 yr in cohort 3 (n = 58) were: -1.2, -1.0, and -1.5, respectively. Cohort 3 shorter treatment time was due to advanced baseline age (mean 13.8 yr) and puberty. Mean HtSDS gain in cohort 1 was comparable with the clinical trial. No new safety signals specific to the NCGS ISS population were observed.

CONCLUSION

ISS patients in the GH registry demonstrate a significant increase in HtSDS with the safety profile similar to GH-deficient patients. RESULTS were similar to the clinical trial.

Are the perceptual biases found in chimeric face processing reflected in eye-movement patterns?

Studies of patients with focal brain lesions and neuroimaging indicate that face processing is predominantly based on right hemisphere function. Additionally, experiments using chimeric faces, where the left and the right-hand side of the face are different, have shown that observers tend to bias their responses toward the information on the left. Here, we monitored eye-movements during a gender identification task using blended face images for both whole and chimeric (half female, half male) faces [Neuropsychologia 35 (1997) 685]. As expected, we found a left perceptual bias: subjects based their gender decision significantly more frequently on the left side of the chimeric faces. Analysis of the first saccade showed a significantly greater number of left fixations independent of perceptual bias presumably reflecting the tendency to first inspect the side of the face better suited to face analysis (left side of face/right hemisphere). On top of this though, there was a relationship between response and fixation pattern. On trials where participants showed a left perceptual bias they produced significantly more left saccades and fixated for longer on the left. In contrast, for trials where participants showed a right perceptual bias there was no reliable difference between the number, or total fixation duration, on the left or the right. These results demonstrate that on a trial-by-trial basis subtle differences in the extent of left or right side scanning are related to the perceptual response of the participant, although an overall initial fixation bias to the left occurs irrespective of response bias.

The Assessment of Preterm Infants' Behavior (APIB): furthering the understanding and measurement of neurodevelopmental competence in preterm and full-term infants

The Assessment of Preterm Infants' Behavior (APIB) is a newborn neurobehavioral assessment appropriate for preterm, at risk, and full-term newborns, from birth to 1 month after expected due date. The APIB is based in ethological-evolutionary thought and focuses on the assessment of mutually interacting behavioral subsystems in simultaneous interaction with the environment. The subsystems of functioning assessed include the autonomic (respiration, digestion, color), motor (tone, movement, postures), state organization (range, robustness, transition patterns), attention (robustness, transitions), and self-regulation (effort, success) systems as well as the degree of facilitation required to support reorganization and subsystem balance. The environment is represented by a sequence of distal, proximal, tactile, and vestibular challenges, derived from the BNBAS. The APIB conceptualizes infant competence as the degree of differentiation of subsystem function and degree of modulation of subsystem balance at any stage in infant development. Infants are understood as actively seeking their next differentiation, while counting on good enough environments to assure progressing developmental competence. In the case of interference such as premature birth, the mismatch of expectation and actual experience causes misalignment, which may become developmentally costly. The assessment is a finely tuned dialogue between examiner and infant, which requires training, skill and self-knowledge. The APIB has well established inter-rater-reliability, concurrent and construct validity, and is clinically relevant for behavioral intervention and individually appropriate and supportive care.

Prolonged T*2 values in newborn versus adult brain: Implications for fMRI studies of newborns

The neonatal brain possesses higher water content, lower macromolecular concentration, and reduced synaptic density than is found in the brain of a 1-year-old child. Changes in MRI characteristics of brain such as relaxation times accompany rapid changes in brain during early postnatal development. It was hypothesized that T(*)(2) values found in newborns would be significantly higher than those found in 9-month-old children and adults as measured at 1.5 T. Spoiled gradient echo measurements of T(*)(2) within the brains of newborns, 9-month-olds, and adults confirmed this hypothesis. The results have implications with regard to functional MRI studies in newborns since, in general, BOLD signal optimization is achieved when echo times TE are set equal to the T(*)(2) values of the tissue of interest. Since significantly longer T(*)(2) values are found in newborns, it is suggested that the TE values employed for fMRI studies of newborns should be increased to maximize BOLD signal intensity changes and improve the overall reliability of fMRI results in newborns.

The moon and its relationship to oral and maxillofacial emergencies

OBJECTIVE

To study the relationship between the full moon and oral and maxillofacial emergencies.

STUDY DESIGN

Retrospective analysis of 2416 referrals to the Department of Oral and Maxillofacial Surgery, St. Bartholomews and The Royal London Hospital, London, over a 16-month period (17 lunar months). Frequency distributions were used to assess emergency workload during the week of the full moon.

RESULTS

There was a rise in referrals in the latter part of the 7-day period surrounding the full moon. There was a persistent reduction in emergency workload in the 3-day period leading up to the full moon. The results approach but do not reach significance.

CONCLUSIONS

The effect of the moon on oral and maxillofacial referrals cannot be proven.

Good foragers can also be good at detecting predators

The degree to which foraging and vigilance are mutually exclusive is crucial to understanding the management of the predation and starvation risk trade-off in animals. We tested whether wild-caught captive chaffinches that feed at a higher rate do so at the expense of their speed in responding to a model sparrowhawk flying nearby, and whether consistently good foragers will therefore tend to respond more slowly on average. First, we confirmed that the time taken to respond to the approaching predator depended on the rate of scanning: as head-up rate increased so chaffinches responded more quickly. However, against predictions, as peck rate increased so head-up rate increased and mean length of head-up and head-down periods decreased. Head-up rate was probably dependent on peck rate because almost every time a seed was found, a bird raised its head to handle it. Therefore chaffinches with higher peck rates responded more quickly. Individual chaffinches showed consistent durations of both their head-down and head-up periods and, therefore, individuals that were good foragers were also good detectors of predators. In relation to the broad range of species that have a similar foraging mode to chaffinches, our results have two major implications for predation/starvation risk trade-offs: (i) feeding rate can determine vigilance scanning patterns; and (ii) the best foragers can also be the best at detecting predators. We discuss how our results can be explained in mechanistic terms relating to fundamental differences in how the probabilities of detecting food rather than a predator are affected by time. In addition, our results offer a plausible explanation for the widely observed effect that vigilance continues to decline with group size even when there is no further benefit to reducing vigilance.

Effects of lesioning noradrenergic neurones in the locus coeruleus on conditioned and unconditioned aversive behaviour in the rat

1. The brain noradrenergic system may have a role in anxiety disorder. This study has examined the effect of bilateral 6-hydroxydopamine lesions of the noradrenergic neurones in the locus coeruleus (LC) of male Lister hooded rats on behaviour produced by unconditioned and conditioned aversive stimuli. 2. The 6-hydroxydopamine (4 microg) lesions markedly reduced the noradrenaline content of the locus coeruleus hypothalamus, frontal cortex and the periaqueductal grey area without altering the levels of either dopamine or 5-hydroxytryptamine measured 14 days after administration. 3. Exposure to ultrasound (20 kHz at 98 dB for 60 sec), an unconditioned aversive stimulus, induced a defence response in the rats characterised by an increase in activity (running and jumping) followed by a period of inactivity (freezing). 4. Lesioning of the LC significantly attenuated the duration of freezing but was without effect on the active phase of the response. A similar reduction in freezing behaviour was seen with LC lesions when rats were exposed (3 hours after the acquisition) to the contextual cue of the conditioned emotion response paradigm. 5. These findings confirm that the locus coeruleus is involved in the regulation of fear-related behaviour in the rat both in an unconditioned and a conditioned model. Furthermore the results indicate that noradrenaline modifies defence behaviour rather than being the principle activating mechanism.

Long-Term use of rivastigmine in patients with dementia with Lewy bodies: an open-label trial

Patients with dementia with Lewy bodies (DLB) have progressive deficits in cognition, parkinsonism, and neuropsychiatric symptoms. Cholinesterase inhibitors have been used to ameliorate cognitive decline and neuropsychiatric symptoms in short-term trials. In this study, patients with DLB were treated with rivastigmine up to 96 weeks. Improvement from baseline was seen in cognitive function as measured by the Mini-Mental State Examination (MMSE), and neuropsychiatric symptoms as measured by the Neuropsychiatric Inventory (NPI) over the first 24 weeks of treatment. By 96 weeks, neither the MMSE scores nor the NPI scores were significantly worse than at baseline.

Striving for the best of both worlds: Samoan parenting in New Zealand

This qualitative, exploratory study based on the principles of the Strauss and Corbin grounded theory method, considered the parenting patterns of fourteen parents bringing up their children in New Zealand. This paper presents findings, which suggest that being a Samoan parent in New Zealand is influenced by cultural pride that is shaped by a context described as the rat-race and intervening conditions which encompass the nineties trend. Samoan parents manage their parental roles by making a conscious effort. As a result, they experience a parenting style that involves striving for the best of both worlds.

Antibody response to Burkholderia cepacia in patients with cystic fibrosis colonized with Burkholderia cepacia and Pseudomonas aeruginosa

INTRODUCTION

This study was designed to determine the relationship between formation of serum antibodies to lipopolysaccharide (LPS) core antigen of Burkholderia cepacia and pulmonary colonization with B. cepacia and Pseudomonas aeruginosa in patients with cystic fibrosis (CF), and to define if an enhanced host humoral immune response to B. cepacia was related to a poor clinical outcome.

METHODS

Serum IgG to B. cepacia LPS core antigen was measured in adult cystic fibrosis patients colonized with B. cepacia and P. aeruginosa, and serial titres were measured in 13 B. cepacia and 41 P. aeruginosa colonized patients followed prospectively over 18 months.

RESULTS

The median B. cepacia antibody titre was significantly greater in the patients colonized with B. cepacia compared to those colonized with P. aeruginosa, a group which grew B. cepacia intermittently from their sputum. and nine healthy controls. The median antibody titre at recruitment into the study was significantly greater in patients who later went into exacerbations compared with those who remained clinically stable. but there was no difference between B. cepacia antibody titres in patients who died and those who survived the study duration.

DISCUSSION

The degree of overlap of serum IgG levels to B. cepacia LPS core antigen in cystic fibrosis patients colonized with B. cepacia and P. aeruginosa does not allow this antibody to be used in a clinical context to define infection status. The magnitude of the humoral response to B. cepacia may influence occurrence of pulmonary exacerbations, but a more exuberant humoral immune response to B. cepacia core LPS is not the mechanism by which pulmonary deterioration occurs.

Mismatch negativity in the visual modality

In the auditory system, the automatic detection of stimulus change provides a mechanism for switching attention to biologically significant events. It gives rise to the mismatch negativity (MMN) event related potential. It is unclear whether a similar mechanism exists in vision. To investigate this issue, evoked potentials were recorded to target stimuli in the centre of the visual field, and to frequent standard and infrequent deviant stimuli presented outside the focus of attention, in the peripheral field. Deviants evoked a more negative potential than standards 250-400 ms after the stimulus. The negativity, distributed over supplementary visual areas of occipital and posterior temporal cortex, was associated with the rarity of the deviants and not the physical features which distinguished them from standards. This negativity shares a number of characteristics with auditory MMN.

Expanding access and choice for health care consumers through tax reform

A refundable tax credit for the uninsured would complement the existing job-based health insurance system while letting people keep their job-based coverage if they wish. Among the wide variety of design options for a tax credit, policy and political analysis does not reveal an obvious choice, but a tax credit based on a percentage of spending may have a slight advantage. Congress should give states maximum flexibility to use existing funding sources to supplement the value of a federal tax credit and encourage the use of techniques to create stable insurance pools.

BMPs as mediators of roof plate repulsion of commissural neurons

During spinal cord development, commissural (C) neurons, located near the dorsal midline, send axons ventrally and across the floor plate (FP). The trajectory of these axons toward the FP is guided in part by netrins. The mechanisms that guide the early phase of C axon extension, however, have not been resolved. We show that the roof plate (RP) expresses a diffusible activity that repels C axons and orients their growth within the dorsal spinal cord. Bone morphogenetic proteins (BMPs) appear to act as RP-derived chemorepellents that guide the early trajectory of the axons of C neurons in the developing spinal cord: BMP7 mimics the RP repellent activity for C axons in vitro, can act directly to collapse C growth cones, and appears to serve an essential function in RP repulsion of C axons.

Effect of a 915-MHz simulated mobile phone signal on cognitive function in man

PURPOSE

To examine whether a simulated mobile telephone transmission at 915 MHz has an effect on cognitive function in man.

MATERIALS AND METHODS

Thirty-six subjects in two groups were each given two training sessions and then three test sessions in a randomized three-way cross-over design. About 1 W mean power at 915 MHz from a quarter-wave antenna mounted on a physical copy of an analogue phone, as a sine wave, or modulated at 217 Hz with 12.5% duty cycle, or no power, was applied to the left squamous temple region of the subjects while they undertook a series of cognitive function tests lasting approximately 25-30 min. The second group was investigated for sleep, consumption of alcohol and beverages, and any other substances that might affect performance.

RESULTS

In both groups, the only test affected was the choice reaction time and this showed as an increase in speed (a decrease in reaction time). There were no changes in word, number or picture recall, or in spatial memory. While an effect of visit-order was evident suggesting a learning effect of repeat tests, the design of the study allowed for this. Additionally, there was no systematic error introduced as a result of consumption of substances or sleep time.

CONCLUSIONS

There was evidence of an increase in responsiveness, strongly in the analogue and less in the digital simulation, in choice reaction time. This could be associated with an effect on the angular gyrus that acts as an interface between the visual and speech centres and which lies directly under and on the same side as the antenna. Such an effect could be consistent with mild localized heating, or possibly a non-thermal response, which is nevertheless power-dependent.

Impact of microbiology practice on cumulative prevalence of respiratory tract bacteria in patients with cystic fibrosis

Investigators participating in the Epidemiologic Study of Cystic Fibrosis project began to collect microbiological, pulmonary, and nutritional data on cystic fibrosis (CF) patients at 180 North American sites in 1994. Part of this study was a survey undertaken in August 1995 to determine microbiology laboratory practices with regard to pulmonary specimens from CF patients. The survey included a section on test ordering, completed by a site clinician, and a section on test performance and reporting, completed by each site's clinical microbiology laboratory staff. Seventy-nine percent of the surveys were returned. There was intersite consistency of microbiology laboratory practices in most cases. The majority of sites follow most of the CF Foundation consensus conference recommendations. There were differences in the frequency at which specimens for culture were obtained, in the use of selective media for Staphylococcus aureus and Haemophilus influenzae, and in the use of a prolonged incubation for Burkholderia cepacia. These variations in practice contribute to prevalence differences among sites and may result in differences in clinical care.

Body perceptions of bulimic and nonbulimic groups

A brief survey measuring satisfaction with the body, concern for physical appearance, and motivations for selection of clothing was administered to 30 women in a university-sponsored support group for bulimic students and 30 women randomly selected from a college campus. No mean differences were found between the groups on concern for physical appearance when in a social setting, but mean differences were significant on satisfaction with weight, satisfaction with body image, and concern for physical appearance when alone.