Height benefit of GnRH agonists after age 8 in a Portuguese cohort of central precocious puberty

OBJECTIVE

Idiopathic central precocious puberty (iCPP) is common in paediatric endocrinology. Gonadotropin-releasing hormone agonists (GnRHa) are safe, but the effect on final height and the ideal timing for treatment remains controversial. This study aims to assess the effectiveness of GnRHa on growth outcomes in girls with iCPP treated before and after the age of 8 years old.

DESIGN AND PATIENTS

This retrospective longitudinal study evaluated data from Portuguese girls with iCPP who completed treatment between 2010 and 2021.

MEASUREMENTS

Auxological and clinical characteristics were compared according to age at treatment onset.

RESULTS

A cohort of 134 girls with iCPP, was divided into early treatment (ET) (<8 years, n = 48) and later treatment (LT) groups (≥8 years, n = 86). In both groups, most children presented with Tanner II and III. Tanner IV was more frequent in LT group (p = .003). At the end of treatment, predicted adult height increased in both groups (ET p = .032; LT p = .04) and bone age significantly slowed down in all participants (p = .008, p = .034). The height gain was greater in the ET group, but without significant differences (p = .065).

CONCLUSIONS

Treatment with GnRHa improved final height in all girls with iCPP, even when initiated after 8 years. To achieve better outcomes, treatment should be provided promptly after diagnosis.

Do GnRH Agonists Really Increase Body Weight Gain? Evaluation of a Multicentric Portuguese Cohort of Patients With Central Precocious Puberty

INTRODUCTION

There are several concerns associated with gonadotropin-releasing hormone agonist (GnRHa) treatment for central precocious puberty (CPP), such as obesity and changes in body mass index (BMI). We aimed to investigate whether any anthropometric differences exist and if they persist over time.

METHODS

We conducted an observational study of Portuguese children (both sexes) diagnosed with CPP between January 2000 and December 2017, using a digital platform, in order to analyze the influence of GnRHa treatment on BMI-SD score (BMI-SDS).

RESULTS

Of the 241 patients diagnosed with CPP, we assessed 92 patients (8% boys) in this study. At baseline, 39% of the patients were overweight. BMI-SDS increased with treatment for girls but then diminished 1 year after stopping GnRHa therapy (p = 0.018). BMI-SDS variation at the end of treatment was negatively correlated with BMI-SDS at baseline (p < 0.001). Boys grew taller and faster during treatment than did girls (p < 0.001), and therefore, their BMI-SDS trajectory might be different.

CONCLUSIONS

This study showed an increase of body weight gain during GnRHa treatment only in girls, which reversed just 1 year after stopping treatment. The overall gain in BMI-SDS with treatment is associated with baseline BMI-SDS.

Image quality of compressive single-pixel imaging using different Hadamard orderings

Single-pixel imaging is an imaging technique that has recently attracted a lot of attention from several areas. This paper presents a study on the influence of the Hadamard basis ordering on the image reconstruction quality, using simulation and experimental methods. During this work, five different orderings, Natural, Walsh, Cake-cutting, High Frequency and Random orders, along with two different reconstruction algorithms, TVAL3 and NESTA, were tested. Also, three different noise levels and compression ratios from 0.1 to 1 were evaluated. A single-pixel camera was developed using a digital micromirror device for the experimental phase. For a compression ratio of 0.1, the Cake-cutting order achieved the best reconstruction quality, while the best contrast was achieved by Walsh order. For compression ratios of 0.5, the Walsh and Cake-cutting orders achieved similar results. Both Walsh and Cake-cutting orders reconstructed the images with good quality using compression ratios from 0.3. Finally, the TVAL3 algorithm showed better image reconstruction quality, in comparison with NESTA, when considering compression ratios from 0.1 to 0.5.

Chondrosarcoma of the hyoid bone: Case report and review of the literature

INTRODUCTION

Chondrosarcomas are cartilaginous tumors that range from low-grade tumors with low metastatic potential to high-grade aggressive tumors with premature and high metastatic rate. Low-grade types have few karyotype abnormalities and are near-diploid, while high-grade chondrosarcomas originate from complex karyotypes and are aneuploid. The most common karyotype aberrations found include 12q13-15 and 9p21 rearrangements. Here, it is presented a case of chondrosarcoma of the hyoid bone with its image, surgical procedure and pathological correlation as well as a review of the literature.

CASE PRESENTATION

A sixty-three year old man presented with a large cervical mass located at submental level. The CT scan revealed a voluminous and well-limited mass of 5 x 4 x 3 cm located in the suprahyoid region. The operative finding revealed a grade 2 chondrosarcoma originating from the hyoid bone.

DISCUSSION

Chondrosarcoma of the. hyoid bone is a rare pathology, thus making it difficult to diagnose. Fine needle biopsies have high diagnostic accuracy, although correct grading is only obtained 46% of the time. CT scan is the golden standard to characterize tumor extension and origin. Surgical excision is the treatment of choice for chondrosarcoma.

Schizophrenia-risk variant rs6994992 in the neuregulin-1 gene on brain developmental trajectories in typically developing children

The neuregulin-1 (NRG1) gene is one of the best-validated risk genes for schizophrenia, and psychotic and bipolar disorders. The rs6994992 variant in the NRG1 promoter (SNP8NRG243177) is associated with altered frontal and temporal brain macrostructures and/or altered white matter density and integrity in schizophrenic adults, as well as healthy adults and neonates. However, the ages when these changes begin and whether neuroimaging phenotypes are associated with cognitive performance are not fully understood. Therefore, we investigated the association of the rs6994992 variant on developmental trajectories of brain macro- and microstructures, and their relationship with cognitive performance. A total of 972 healthy children aged 3-20 years had the genotype available for the NRG1-rs6994992 variant, and were evaluated with magnetic resonance imaging (MRI) and neuropsychological tests. Age-by-NRG1-rs6994992 interactions and genotype effects were assessed using a general additive model regression methodology, covaried for scanner type, socioeconomic status, sex and genetic ancestry factors. Compared with the C-carriers, children with the TT-risk-alleles had subtle microscopic and macroscopic changes in brain development that emerge or reverse during adolescence, a period when many psychiatric disorders are manifested. TT-children at late adolescence showed a lower age-dependent forniceal volume and lower fractional anisotropy; however, both measures were associated with better episodic memory performance. To our knowledge, we provide the first multimodal imaging evidence that genetic variation in NRG1 is associated with age-related changes on brain development during typical childhood and adolescence, and delineated the altered patterns of development in multiple brain regions in children with the T-risk allele(s).

Septo-optic dysplasia: fitting the pieces together

A 7-year-old boy was admitted for a general tonic-clonic seizure with severe hypoglycaemia (1.39 mmol/l). His medical history was remarkable for a congenital left eye strabismus, unilateral cryptorchidism and three previous episodes of hypoglycaemic seizures with inconclusive metabolical and neurological investigations. Physical examination revealed a hoarse tone voice, dry skin, cold extremities and height in the third percentile (target height between 50th and 85th percentile). Left wrist radiography revealed a bone age of 4.5 years ±6 months Laboratory studies confirmed growth hormone deficiency and central hypothyroidism. The brain MRI showed an ectopic neurohypophysis. Neuroophthalmology investigation revealed left optic nerve hypoplasia and septo-optic dysplasia was then diagnosed. Thyroid and recombinant growth hormone replacement were started showing clinical improvement. A detailed clinical history and a careful physical examination in children presenting with multiple clinical signs of hypopituitarism may lead to a timely diagnosis, avoiding clinical morbidity associated to untreated hormonal abnormalities.

Berardinelli-Seip syndrome: highlight of treatment challenge

Berardinelli-Seip congenital lipodystrophy (BSCL) syndrome is a rare autosomal-recessive disease characterised by lipoatrophy and associated with deregulations of glycidic and lipid metabolism. We report three BSCL cases with its typical clinical picture and complications. Clinically, they all show marked atrophy of adipose tissue, acromegaly, acanthosis nigricans and tall stature. Two cases present attention deficit hyperactivity and developmental learning disorders; another patient has hypertrophic myocardiopathy and polycystic ovary syndrome. In all the cases AGPAT2 was the identified mutation. All the cases present hypertriglyceridemia. One case has developed hyperinsulinism controlled with metformin and another case already has type 2 diabetes with a difficult clinical control. There is no curative treatment and the current treatment options are based only on symptomatic control of the complications. Recently, published studies showed that leptin-replacement therapy appears a promising tool in the metabolic correction of BSCL complications, highlighting the importance of further investigations in BSCL treatment.

Anatomy and lignification status of the Lophanthera lactescens Ducke plant grown in vitro

This aim of this study was to evaluate the lignification in young stems of the Lophanthera lactescens Ducke plant grown in vitro L. lactescens (Malpighiaceae), a species endemic in the Brazilian Amazon that possesses both medicinal properties and could be used in the forest product industry. Plants grown in vitro condition in MS medium were analyzed using Infrared (IR) microspectroscopy in a diffuse reflectance mode, fluorescence microscopy. Moreover, histochemical tests such as the Wiesner and Maüle test were run to monitor the process of lignification in cell walls. The spectra of IR microscopy recorded using cross section tissue are representative of guaiacyl/syringyl lignin, based on the 1336 and 1246 cm-1 signal. Individuals presenting stem sprains, resulting from the marked development, produced gelatinous fibers with a clear cellulose layer. Initially, fluorescence microscopy demonstrated lignin deposition in the cell corner region having progressive deposition in the secondary wall of tracheary elements of the stem.

[Turner syndrome. From child to adult... A multidisciplinary approach]

Turner syndrome is one of the most frequent chromosome disorders in clinical practice. It is characterized by a multisystemic involvement, responsible for a high morbidity and an increased mortality at all ages. Therefore it is essential that there is a continuous and integrated approach in reference centers to improve the quality of life and prevent early mortality. There has been a growing interest in the scientific community to achieve these goals, with the publication of clinical guidelines. This article intends to review these guidelines, with particular emphasis on a multidisciplinary care of these patients from the age of diagnosis and throughout their adult life.

Novel mutations of the BSCL2 and AGPAT2 genes in 10 families with Berardinelli-Seip congenital generalized lipodystrophy syndrome

CONTEXT

Congenital generalized lipodystrophy, or Berardinelli-Seip syndrome, is a rare autosomal recessive disease caused by mutations in either the BSCL2 or AGPAT2 genes. This syndrome is characterized by an almost complete loss of adipose tissue usually diagnosed at birth or early infancy resulting in apparent muscle hypertrophy. Common clinical features are acanthosis nigricans, hepatomegaly with or without splenomegaly and high stature. Acromegaloid features, cardiomyopathy and mental retardation can also be present.

DESIGN

We investigated 11 kindreds from different geographical areas of Brazil (northeast and southeast). All coding regions as well as flanking intronic regions of both genes were examined. Polymerase chain reaction (PCR) amplifications were performed using primers described previously and PCR products were sequenced directly.

RESULTS

Four AGPAT2 and two BSCL2 families harboured the same set of mutations. BSCL2 gene mutations were found in the homozygous form in four kindreds (c.412C>T c.464T>C, c.518-519insA, IVS5-2A>G), and in two kindreds compound mutations were found (c.1363C>T, c.424A>G). In the other four families, one mutation of the AGPAT2 gene was found (IVS3-1G>C and c.299G>A).

CONCLUSIONS

We have demonstrated four novel mutations of the BSCL2 and AGPAT2 genes responsible for Berardinelli-Seip syndrome and Brunzell syndrome (AGPAT2-related syndrome).

Efeito dos fixadores formalina e Bouin na preservação de biópsias do endométrio de éguas após inclusão em resina plástica

Biópsias do endométrio de 16 éguas sexualmente maduras, em estro e diestro, foram processadas para microscopia de luz utilizando-se fixação em formalina ou Bouin e inclusão em resina plástica à base de glicol metacrilato. Análises morfológicas de 46 biópsias demonstraram que o epitélio de revestimento do endométrio, o epitélio glandular, as fibras do tecido conjuntivo e os diferentes tipos celulares presentes na lâmina própria, tais como fibroblastos, plasmócitos, mastócitos e macrófagos, apresentaram-se melhor preservados quando os fragmentos de tecidos foram fixados em formalina. O epitélio de revestimento mostrou grau mais acentuado de retração tecidual nas biópsias fixadas em Bouin, independente da fase do ciclo estral. A fixação em formalina aliada à inclusão em resina plástica resultou em melhor resolução das células ao microscópio de luz, permitindo um estudo citológico mais acurado do endométrio eqüino.

Hydrocoele of the vaginal cavity of stallions

The aim of the present study was to analyse the effect of hydrocoele of the vaginal cavity of stallions on semen characteristics, libido and fertility, and to contribute to the understanding of the aetiopathology of this condition in stallions. Hydrocoele did not substantially affect either the libido or semen characteristics of affected stallions compared with a control group, and had no effect on fertility. However, the protein content of hydrocoelic fluid was significantly higher than that of peritoneal fluid and was lower than the protein content of blood serum. Electrophoretic profiles of proteins were similar in peritoneal and hydrocoelic fluid. The results of the present study indicate that hot weather, sometimes in association with restricted exercise, age and communication between the vaginal and peritoneal cavities may be predisposing factors for hydrocoele.

Langerhans cell histiocytosis: retrospective evaluation of 123 patients at a single institution

The aim of this study was to retrospectively evaluate clinical characteristics at diagnosis and outcome of patients with Langerhans cell histiocytosis (LCH). From October 1987 to March 1996, 133 patients with confirmed LCH were admitted to Hospital JP Garrahan in Buenos Aires (123 evaluable). Median age was 5 years (range 15 days to 18 years). Initial organ involvement included bone 114 patients, ear 34, skin 30, liver 18, lung 14, lymph nodes 14, spleen 12, diabetes insipidus 9, and bone marrow 2. Nineteen patients had organ dysfunction, pulmonary 14, hematological 14, and hepatic 12. Two groups were defined: Group A included patients with single system disease (uni- or multifocal) and group B multisystem (with or without organ dysfunction). In group A (n = 82), 24 patients were treated with chemotherapy (prednisone and vinblastine), 21 with surgery, 15 received radiotherapy, and 22 were only observed. Patients of group B (n = 41) were treated with chemotherapy consisting of prednisone and vinblastine, DALHX 83, or LCH1-based chemotherapy. At a median follow-up of 3 years (range 1 month-8 5/12 years) 93% of patients of group A and 39% of group B survive free of reactivation. In group B, 22% had a reactivation and 39% died of progressive disease. Sequelae were detected in 35 patients (28%), which included diabetes insipidus in 17, hearing loss in 13, bony sequelae in 11, sclerosing cholangitis in 6, and lung fibrosis with bullae in 6. Two patients had a subsequent malignant disease. A total of 17 (14%) patients died and 16 of them belonged to the group B: 13 died of progressive disease, 2 due to sclerosing cholangitis (with sepsis in one case and encephalitis in the other one), 1 with progressive disease and associated myelofibrosis, and 1 patient of group A with active disease and brain stem tumor. Patients who had organ dysfunction had a reactivation free survival of 32%. All these patients survived with sequelae. Logistic regression analysis showed that organ dysfunction and hematological involvement had significant predictive values in relation to death. Patients of group A had an excellent survival rate, whereas in those of group B a high mortality was found, especially in the subgroup of patients with organ dysfunction. Lahey's criteria should be revised. Sequelae were also more common in this group.

Collaborative practice: a nursing perspective of the psychiatric interdisciplinary treatment team

The article describes the evolution of collaborative practice across the continuum of care of nurse members of two psychiatric interdisciplinary treatment teams in an inpatient mental health care unit and a psychiatric partial hospital program. The benefits and difficulties of the process are examined in the context of Bowen's family systems theory and a patient case study. There is evidence that patients on these two units have benefited from the improved communication and coordinated care arising from collaborative practice. The sharing of expertise, insights, and knowledge has led to individual professional and personal growth for members of the treatment teams.

[Clinical experience with totally implantable venous access systems in pediatric hematology and oncology]

Forty-three children with malignant diseases who received 48 totally implanted venous accesses (TIVA) were retrospectively analyzed. More than half the patients had acute leukemia. Mean age was 6 years 10 months. Mean duration of use of the TIVA was 473 +/- 50 days (range 28 to 1,285 da; median 424 days). Removal of the TIVA was required because of an adverse event in 33% of cases. Main reasons for removal included infection (22.9%), thrombosis (6.25%), and catheter dysfunction (4.16%). Catheter-related infections were most often due to staphylococci (90%), especially S. epidermidis (63%). Infection rate was 0.48 per 1,000 patient-days. Flushing with a vancomycin-heparin solution can be expected to decrease this rate. Selection of the implantation site is discussed. In children under 6 years of age, the cephalic vein and external jugular vein are often frail or absent and are therefore less appropriate than the internal jugular vein or subclavian vein.

Efficacy and safety of granisetron in the prevention of chemotherapy-induced emesis in paediatric patients

In an open ascending-dose study, granisetron, a specific 5-HT3 receptor antagonist, was administered to 24 paediatric patients (17 male, 7 female, mean age 6.2, range 3-15 years) who were receiving moderately or highly emetogenic chemotherapy for malignant disease. Single doses of 10, 20 and 40 micrograms/kg were administered by intravenous infusion 1 h before chemotherapy. Each dose level was studied in a group of 8 patients. With the 40 micrograms/kg dose, 5 of 8 patients experienced no nausea or vomiting in the 24 h after granisetron treatment. With 20 micrograms/kg, a similar response was seen, but with 10 micrograms/kg only 2 of 8 patients experienced complete antiemetic protection despite additional prophylactic chlorpromazine in this group. Granisetron was very well tolerated, and there were no clinically important changes in pulse rate, blood pressure or Holter electrocardiogram. It is concluded that granisetron was very well tolerated by paediatric patients. In addition, there was clear evidence of a major antiemetic effect for at least 24 h after a single intravenous dose of 20 or 40 micrograms/kg.

[Hepatic undifferentiated (or embryonal) sarcoma. Diagnostic and therapeutic problems apropos of botryoid rhabdomyosarcoma]

Primary undifferentiated sarcomas (also called embryonal sarcomas or malignant mesenchymomas) are an exceptional form of cancer of the liver, occurring preferentially in children or adolescents. They can exhibit poor differentiation, embryonal rhabdomyosarcoma being the most frequent. To date, therapeutic success has been reported only rarely. The authors describe the case of a 16 year old boy with primary hepatic sarcoma showing a rhabdomyoblastic differentiation, who is in complete remission two years after total surgical resection and polychemotherapy.

Assessment of depression and cognitive impairment after hip fracture

Fifty patients, over 60 years of age, were evaluated for mental status change at the time of hip fracture. Specifically, demographic and historical data were gathered and patients were given an assessment battery to evaluate depression and cognitive impairment during hospitalization for femoral fracture. Prevalence of depression was 28%, and cognitive impairment was present in 40% of the patients evaluated. Pre-fracture activities of daily living were estimated. These data provide the first systematically accumulated baseline data for patients in the immediate post-hip fracture period. Patients will be reassessed at three-month intervals to quantify mental status change and to evaluate its effects on morbidity, mortality, and rehabilitative success.

Glucose metabolism in Pycnoporus cinnabarinus

It was demonstrated by the measurement of enzyme activities and by radiorespirometric assays that the basidiomycete Pycnoporus cinnabarinus metabolizes glucose through the glycolytic pathway and the pentose phosphate cycle.

Carbon source dependent differences in the composition of the cell walls of the basidiomycete Picnoporus cinnabarinus

A wild-type monokaryotic strain of Picnoporus cinnabarinus grown on glucose produced shorter and thicker hyphae than cultures grown on acetate. Colonies from glucose media were smaller and more compact than acetate-grown colonies. Chemical and enzymatic analysis of the isolated cell wall of both morphological types showed that the amount of amino sugars and the ratio glucosamine:galactosamine were higher in the acetate-grown cells. This may be the cause of morphological differences observed.

Regulation of fructose uptake by glucose in Escherichia coli

A mutant, DAI, has been isolated from the Escherichia coli K12, strain K2. 1t, as a colony resistant to 2-deoxyglucose (DG) when growing on fructose but still sensitive to DG when growing on other sugars. The mutation in DAI specifically affects the catabolite inhibition of fructose utilization by glucose and glucose-6-phosphate; the affected gene (designated cif) is located at min 41 on the E. coli linkage map and is highly co-transducible with the genes that specify the uptake of fructose (ptsF) and enzymic conversion of fructose-1-phosphate to fructose-1,6-bisphosphate (fpk).