1
|
Reversal of Growth Arrest With the Combined Administration of Oxandrolone and Propranolol in Severely Burned Children. Ann Surg 2017; 264:421-8. [PMID: 27433905 DOI: 10.1097/sla.0000000000001844] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND The hypercatabolic response in severely burned pediatric patients is associated with increased production of catecholamines and corticosteroids, decreased formation of testosterone, and reduced strength alongside growth arrest for up to 2 years after injury. We have previously shown that, in the pediatric burned population, the administration of the testosterone analog oxandrolone improves lean body mass accretion and bone mineral content and that the administration of the β1-, β2-adrenoceptor antagonist propranolol decreases cardiac work and resting energy expenditure while increasing peripheral lean mass. Here, we determined whether the combined administration of oxandrolone and propranolol has added benefit. METHODS In this prospective, randomized study of 612 burned children [52% ± 1% of total body surface area burned, ages 0.5-14 years (boys); ages 0.5-12 years (girls)], we compared controls to the individual administration of these drugs, and the combined administration of oxandrolone and propranolol at the same doses, for 1 year after burn. Data were recorded at discharge, 6 months, and 1 and 2 years after injury. RESULTS Combined use of oxandrolone and propranolol shortened the period of growth arrest by 84 days (P = 0.0125 vs control) and increased growth rate by 1.7 cm/yr (P = 0.0024 vs control). CONCLUSIONS Combined administration of oxandrolone and propranolol attenuates burn-induced growth arrest in pediatric burn patients. The present study is registered at clinicaltrials.gov: NCT00675714 and NCT00239668.
Collapse
|
2
|
Grahnemo L, Jochems C, Andersson A, Engdahl C, Ohlsson C, Islander U, Carlsten H. Possible role of lymphocytes in glucocorticoid-induced increase in trabecular bone mineral density. J Endocrinol 2015; 224:97-108. [PMID: 25359897 PMCID: PMC4254076 DOI: 10.1530/joe-14-0508] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Treatment with anti-inflammatory glucocorticoids is associated with osteoporosis. Many of the treated patients are postmenopausal women, who even without treatment have an increased risk of osteoporosis. Lymphocytes have been shown to play a role in postmenopausal and arthritis-induced osteoporosis, and they are targeted by glucocorticoids. The aim of this study was to investigate the mechanisms behind effects of glucocorticoids on bone during health and menopause, focusing on lymphocytes. Female C57BL/6 or SCID mice were therefore sham-operated or ovariectomized and 2 weeks later treatment with dexamethasone (dex), the nonsteroidal anti-inflammatory drug carprofen, or vehicle was started and continued for 2.5 weeks. At the termination of experiments, femurs were phenotyped using peripheral quantitative computed tomography and high-resolution micro-computed tomography, and markers of bone turnover were analyzed in serum. T and B lymphocyte populations in bone marrow and spleen were analyzed by flow cytometry. Dex-treated C57BL/6 mice had increased trabecular bone mineral density, but lower cortical content and thickness compared with vehicle-treated mice. The dex-treated mice also had lower levels of bone turnover markers and markedly decreased numbers of spleen T and B lymphocytes. In contrast, these effects could not be repeated when mice were treated with the nonsteroidal anti-inflammatory drug carprofen. In addition, dex did not increase trabecular bone in ovariectomized SCID mice lacking functional T and B lymphocytes. In contrast to most literature, the results from this study indicate that treatment with dex increased trabecular bone density, which may indicate that this effect is associated with corticosteroid-induced alterations of the lymphocyte populations.
Collapse
Affiliation(s)
- Louise Grahnemo
- Departments of Rheumatology and Inflammation ResearchInternal Medicine and Clinical NutritionCentre for Bone and Arthritis Research, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Box 480, Gothenburg 405 30, SwedenLaboratory of Tumor Immunology and BiologyCenter for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Caroline Jochems
- Departments of Rheumatology and Inflammation ResearchInternal Medicine and Clinical NutritionCentre for Bone and Arthritis Research, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Box 480, Gothenburg 405 30, SwedenLaboratory of Tumor Immunology and BiologyCenter for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA Departments of Rheumatology and Inflammation ResearchInternal Medicine and Clinical NutritionCentre for Bone and Arthritis Research, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Box 480, Gothenburg 405 30, SwedenLaboratory of Tumor Immunology and BiologyCenter for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Annica Andersson
- Departments of Rheumatology and Inflammation ResearchInternal Medicine and Clinical NutritionCentre for Bone and Arthritis Research, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Box 480, Gothenburg 405 30, SwedenLaboratory of Tumor Immunology and BiologyCenter for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Cecilia Engdahl
- Departments of Rheumatology and Inflammation ResearchInternal Medicine and Clinical NutritionCentre for Bone and Arthritis Research, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Box 480, Gothenburg 405 30, SwedenLaboratory of Tumor Immunology and BiologyCenter for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA Departments of Rheumatology and Inflammation ResearchInternal Medicine and Clinical NutritionCentre for Bone and Arthritis Research, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Box 480, Gothenburg 405 30, SwedenLaboratory of Tumor Immunology and BiologyCenter for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Claes Ohlsson
- Departments of Rheumatology and Inflammation ResearchInternal Medicine and Clinical NutritionCentre for Bone and Arthritis Research, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Box 480, Gothenburg 405 30, SwedenLaboratory of Tumor Immunology and BiologyCenter for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Ulrika Islander
- Departments of Rheumatology and Inflammation ResearchInternal Medicine and Clinical NutritionCentre for Bone and Arthritis Research, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Box 480, Gothenburg 405 30, SwedenLaboratory of Tumor Immunology and BiologyCenter for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Hans Carlsten
- Departments of Rheumatology and Inflammation ResearchInternal Medicine and Clinical NutritionCentre for Bone and Arthritis Research, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Box 480, Gothenburg 405 30, SwedenLaboratory of Tumor Immunology and BiologyCenter for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| |
Collapse
|
3
|
Hodge DR, Lietz CA. Using spiritually modified cognitive-behavioral therapy in substance dependence treatment: therapists' and clients' perceptions of the presumed benefits and limitations. HEALTH & SOCIAL WORK 2014; 39:200-10. [PMID: 25369720 DOI: 10.1093/hsw/hlu022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Cognitive-behavioral therapy (CBT) that has been modified to incorporate clients' spiritual beliefs and practices has been used to treat a variety of problems. This study examines the utility of this modality with the treatment of alcohol dependence and other forms of substance abuse. Toward this end, six focus groups (three therapist groups and three client groups) were conducted to identify the presumed benefits and limitations of using spiritually modified CBT in substance dependence treatment. In terms of benefits, spiritually modified CBT was perceived to enhance outcomes through operationalizing horizontal and vertical sources of social support, divine coping resources, and spiritual motivation. Potential challenges include the risk of therapists inadvertently imposing their own beliefs during the modification process and the possibility of offending clients when conflicts in belief systems emerge, particularly in group setting. The article concludes by providing suggestions for incorporating spiritually modified CBT into treatment and develops a number of illustrative examples of spiritually modified CBT self-statements.
Collapse
|
4
|
Sederquist B, Fernandez-Vojvodich P, Zaman F, Sävendahl L. Recent research on the growth plate: Impact of inflammatory cytokines on longitudinal bone growth. J Mol Endocrinol 2014; 53:T35-44. [PMID: 24711646 DOI: 10.1530/jme-14-0006] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Children with inflammatory diseases usually display abnormal growth patterns as well as delayed puberty. This is a result of several factors related to the disease itself, such as malnutrition, hypercortisolism, and elevated levels of pro-inflammatory cytokines. These factors in combination with glucocorticoid treatment contribute to growth retardation during chronic inflammation by systemically affecting the major regulator of growth, the GH/IGF1 axis. However, recent studies have also shown evidence of a direct effect of these factors at the growth plate level. In conditions of chronic inflammation, pro-inflammatory cytokines are upregulated and released into the circulation. The most abundant of these, tumor necrosis factor α, interleukin 1β (IL1β), and IL6, are all known to directly act on growth plate cartilage to induce apoptosis and thereby suppress bone growth. Both clinical and experimental studies have shown that growth retardation can partly be rescued when these cytokines are blocked. Therefore, therapy modulating the local actions of these cytokines may be effective for preventing growth failure in patients with chronic inflammatory disorders. In this review, we report the current knowledge of inflammatory cytokines and their role in regulating bone growth.
Collapse
Affiliation(s)
- Bettina Sederquist
- Pediatric Endocrinology Unit Q2:08Department of Women's and Children's Health, Karolinska University Hospital, SE-171 76 Stockholm, SwedenDevelopmental and Stem Cell BiologyThe Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Paola Fernandez-Vojvodich
- Pediatric Endocrinology Unit Q2:08Department of Women's and Children's Health, Karolinska University Hospital, SE-171 76 Stockholm, SwedenDevelopmental and Stem Cell BiologyThe Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Farasat Zaman
- Pediatric Endocrinology Unit Q2:08Department of Women's and Children's Health, Karolinska University Hospital, SE-171 76 Stockholm, SwedenDevelopmental and Stem Cell BiologyThe Hospital for Sick Children, University of Toronto, Toronto, Ontario, CanadaPediatric Endocrinology Unit Q2:08Department of Women's and Children's Health, Karolinska University Hospital, SE-171 76 Stockholm, SwedenDevelopmental and Stem Cell BiologyThe Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Lars Sävendahl
- Pediatric Endocrinology Unit Q2:08Department of Women's and Children's Health, Karolinska University Hospital, SE-171 76 Stockholm, SwedenDevelopmental and Stem Cell BiologyThe Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|