Maternal and fetal outcomes in multiparous women with Cystic Fibrosis

BACKGROUND

Quality of life and survival in Cystic Fibrosis (CF) have improved dramatically, making family planning a feasible option. Maternal and perinatal outcomes in women with CF (wwCF) are similar to those seen in the general population. However, the effect of undergoing multiple pregnancies is unknown.

METHODS

A multinational-multicenter retrospective cohort study. Data was obtained from 18 centers worldwide, anonymously, on wwCF 18-45 years old, including disease severity and outcome, as well as obstetric and newborn complications. Data were analyzed, within each individual patient to compare the outcomes of an initial pregnancy (1st or 2nd) with a multigravid pregnancy (≥3) as well as secondary analysis of grouped data to identify risk factors for disease progression or adverse neonatal outcomes. Three time periods were assessed - before, during, and after pregnancy.

RESULTS

The study population included 141 wwCF of whom 41 (29%) had ≥3 pregnancies, "multiparous". Data were collected on 246 pregnancies, between 1973 and 2020, 69 (28%) were multiparous. A greater decline in ppFEV1 was seen in multiparous women, primarily in pancreatic insufficient (PI) wwCF and those with two severe (class I-III) mutations. Multigravid pregnancies were shorter, especially in wwCF over 30 years old, who had high rates of prematurity and newborn complications. There was no effect on pulmonary exacerbations or disease-related complications.

CONCLUSIONS

Multiple pregnancies in wwCF are associated with accelerated respiratory deterioration and higher rates of preterm births. Therefore, strict follow-up by a multidisciplinary CF and obstetric team is needed in women who desire to carry multiple pregnancies.

Exercise training for adult lung transplant recipients

BACKGROUND

Pulmonary transplantation is the final treatment option for people with end-stage respiratory diseases. Evidence suggests that exercise training may contribute to speeding up physical recovery in adults undergoing lung transplantation, helping to minimize or resolve impairments due to physical inactivity in both the pre- and post-transplant stages. However, there is a lack of detailed guidelines on how exercise training should be carried out in this specific sub-population.

OBJECTIVES

To determine the benefits and safety of exercise training in adult patients who have undergone lung transplantation, measuring the maximal and functional exercise capacity; health-related quality of life; adverse events; patient readmission; pulmonary function; muscular strength; pathological bone fractures; return to normal activities and death.

SEARCH METHODS

We searched the Cochrane Kidney and Transplant Specialised Register up to 6 October 2020 using relevant search terms for this review. Studies in the CKTR are identified through CENTRAL, MEDLINE, and EMBASE searches, conference proceedings, the International Clinical Trials Register (ICTRP) Search Portal, and ClinicalTrials.gov.

SELECTION CRITERIA

Randomised controlled trials (RCTs) were included comparing exercise training with usual care or no exercise training, or with another exercise training program in terms of dosage, modality, program length, or use of supporting exercise devices. The study population comprised of participants older than 18 years who underwent lung transplantation independent of their underlying respiratory pathology.

DATA COLLECTION AND ANALYSIS

Two authors independently reviewed all records identified by the search strategy and selected studies that met the eligibility criteria for inclusion in this review. In the first instance, the disagreements were resolved by consensus, and if this was not possible the decision was taken by a third reviewer. The same reviewers independently extracted outcome data from included studies and assessed risk of bias. Confidence in the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.

MAIN RESULTS

Eight RCTs (438 participants) were included in this review. The median sample size was 60 participants with a range from 16 to 83 participants. The mean age of participants was 54.9 years and 51.9% of the participants were male. The median duration of the exercise training programs for the groups undergoing the intervention was 13 weeks, and the median duration of training in the active control groups was four weeks. Overall the risk of bias was considered to be high, mainly due to the inability to blind the study participants and the selective reporting of the results. Due to small number of studies included in this review, and the heterogeneity of the intervention and outcomes, we did not obtain a summary estimate of the results. Two studies comparing resistance exercise training with no exercise reported increases in muscle strength and bone mineral density (surrogate outcomes for pathological bone fractures) with exercise training (P > 0.05), but no differences in adverse events. Exercise capacity, health-related quality of life (HRQoL), pulmonary function, and death (any cause) were not reported. Three studies compared two different resistant training programs. Two studies comparing squats using a vibration platform (WBVT) compared to squats on the floor reported an improvement in 6-minute walk test (6MWT) (28.4 metres, 95% CI 3 to 53.7; P = 0.029; and 28.3 metres, 95% CI 10.0 to 46.6; P < 0.05) with the WBVT. Supervised upper limb exercise (SULP) program improved 6MWT at 6 months compared to no supervised upper limb exercise (NULP) (SULP group: 561.2 ± 83.6 metres; NULP group: 503.5 ± 115.2 metres; P = 0.01). There were no differences in HRQoL, adverse events, muscular strength, or death (any cause). Pulmonary function and pathological bone fractures were not reported. Two studies comparing multimodal exercise training with no exercise reported improvement in 6MWT at 3 months (P = 0.008) and at 12-months post-transplant (P = 0.002) and muscular strength (quadriceps force (P = 0.001); maximum leg press (P = 0.047)) with multimodal exercise, but no improvement in HRQoL, adverse events, pulmonary function, pathological bone fractures (lumbar T-score), or death (any cause). One study comparing the same multimodal exercise programs given over 7 and 14 weeks reported no differences in 6MWT, HRQoL, adverse events, pulmonary function, muscle strength, or death (any cause). Pathological bone fractures were not reported. According to GRADE criteria, we rated the certainty of the evidence as very low, mainly due to the high risk of bias and serious imprecision.

AUTHORS' CONCLUSIONS

In adults undergoing lung transplantation the evidence about the effects of exercise training is very uncertain in terms of maximal and functional exercise capacity, HRQoL and safety, due to very imprecise estimates of effects and high risk of bias.

Bilateral bifid mandibular condyles diagnosed with three-dimensional reconstruction

Bifid mandibular condyles (BMCs) are rare anomalies. The overwhelming majority of prior reports described their predominantly unilateral occurrence diagnosed by panoramic radiography. We present an even rarer case of bilateral BMC initially identified by panoramic radiography and confirmed with colour-enhanced three-dimensional CT. These images substantiate the theory that the secondary condyles arise from the neck of the mandible (Lopez-Lopez et al. Bifid condyle: review of the literature of the last 10 years and report of two cases. Cianio 2010; 28: 136-140).

Diurnal variation in stature and sitting height in 12-14-year-old boys

1. Measurements of stature and sitting height were made at 0930 and 1400 h on 19 boys aged 12-14 years with the "stretching upward" technique. 11 different boys were similarly measured at 1000 and 1700 h. 2. The average decrease in stature from 0930 to 1400 h was 2.0 mm and from 1000 to 1700 h was 4.6 mm. The corresponding values for sitting height were 2.0 mm and 2.8 mm. 3. No strong evidence for individual differences in diurnal change was found. 4. The standard error of stature measurement, estimated from duplicate measurements taken five minutes apart by the same observer in the afternoon sessions, was +/- 1.8 mm.

Cell analysis with the new Leipzig high-energy ion nanoprobe

The high-energy ion nanoprobe LIPSION at the University of Leipzig has been in operation since 1998. The ultrastable, 3.5 MV SINLETRON accelerator supplies the H+ or He+ ion beam. A magnetic scanning system moves the focused beam across the sample. At present, a resolution of 41 +/- 4 nm in the low current mode and 300 nm at 5 pA can be achieved. The experimental chamber is equipped with electron-, energy dispersive X-ray-, and particle detectors. They can be used simultaneously to analyse the sample by means of PIXE (particle induced X-ray emission), RBS (Rutherford backscattering), and in the case of thin sections or monolayer samples STIM (scanning transmission ion microscopy). A goniometer allows the application of channeling measurements in single crystals in combination with these methods. In contrast to previous publication describing microbeam facility at LIPSION, the current biomedical research has concentrated on microscopy and tomography on chondrocytes in pig cartilages and fixed single endothelial cells (HUVEC). For the irradiation of single living cells, an external beam facility with irradiation platform, fast beamgate and mini-Petri dishes is under construction.

The growth and development of the Annals of Human Biology: a 25-year retrospective

The history of the founding in 1958 of the Society for the Study of Human Biology is outlined, and the circumstances in which the Annals of Human Biology began publication in 1974. The contents of the papers published 1974-1997 are reviewed; about 40% concern Population Biology, 40% Auxology and 20% Population Physiology. Some outstanding contributions in the first two of these fields are mentioned. Many consist of groups of papers from an ongoing study: 11 papers from the Otmoor villages study by Harrison and colleagues, and 11 concerning the growth of children in the Zurich Longitudinal Study, by Gasser and colleagues. Papers concerning the analysis of growth data and modelling of the growth curve, especially by Healy, are noted, and papers giving evidence of mini-spurts in growth and the saltation-stasis growth model are recalled. Wilson's papers on catch-up and growth regulation in twins are reviewed; also the contribution to growth-as-a-mirror of social conditions by workers at the Stockholm Institute of Education. The National Study of Health and Growth, led by Rona, contributed 13 papers over 14 years to the Annals, and there were outstanding one-off papers from the National Child Development Study, and the Cuban National Growth Study of 1972, and concerning the secular trend towards greater leg length in Japan, the upward social mobility of the taller of pairs of brothers, the growth of 18th century children in Vienna and Stuttgart and the measurements of 19th century slaves in the USA.

Growth velocity monitoring of the efficacy of different therapeutic protocols in a group of thalassaemic children

Since intensive chelating therapy for thalassaemic children was introduced, growth rates appear to have diminished. To investigate what factors were responsible we compared velocities of growth in length over a period of 1 year between groups distinguished by different strategies of treatment. Forty-two thalassaemic patients, 30 males aged 4-12 years, and 12 females, 4-10 years old, were assigned from their current treatment into subgroups based upon blood ferritin levels, daily dose of desferrioxamine and urinary zinc levels. CONCLUSION The results confirm that a reduction in desferrioxamine results in greater growth. If blood ferritin is low, the change effect may be greater. Secondly, any zinc deficiency should be treated. The changes in treatment convert a growth velocity of -2 to -3 SDS to a velocity of about -1 SDS.

Somatostatin analog treatment slows growth and the tempo of reproductive maturation in female rhesus monkeys

The present study tested the hypothesis that a reduction in serum GH during adolescence would result in slower growth and delayed puberty. Skeletal growth and maturation as well as indices of reproductive development were studied in juvenile female rhesus monkeys receiving a constant sc infusion of a somatostatin analog, Sandostatin, at a dose of approximately 4.50 micrograms/kg BW.day (Ssa; n = 6) and in untreated females (Con; n = 6) from 18 months of age through the luteal phase of the second ovulation. Although age at menarche was similar in Con and Ssa females, first ovulation was delayed significantly in Ssa females, such that the interval between menarche and first ovulation was significantly longer in Ssa females. Serum concentrations of GH, insulin-like growth factor-I (IGF-I), and IGF-binding protein-3 were reduced in Ssa females, particularly after menarche. Although changes in body weight were similar between Ssa and Con females, growth in height was significantly greater in Con females. Furthermore, peak growth velocity in height occurred at a significantly later age in SSa females, but at a similar degree of skeletal maturity. Serum insulin and glucose levels in response to iv glucose were similar in the two groups; however, fasting levels of serum glucose decreased significantly in both groups with advancing age, but the decrease was greater in Con. During the luteal phase of the first 2 ovulatory cycles, there were diminished serum progesterone in 16.7% (2 of 12) of the Con and 41.7% (5 of 12) of the Ssa females. Serum estradiol was significantly lower throughout the first 2 ovulatory cycles in Ssa females, whereas serum LH and IGF-I were similar to those in Con females. Multiple regression analyses revealed that age at menarche was best predicted from the amount of growth in height before menarche, whereas those females who had higher serum IGF-binding protein-3 levels before menarche had an earlier growth spurt, and those who grew faster had a shorter interval between menarche and first ovulation. These data indicate that treatment with a long-acting somatostatin analog, which produces a relative deficiency in the GH axis, slows growth and delays the tempo of puberty. The data suggest that this delay may be due to a reduction in gonadal sensitivity to LH.

Automatic bone age measurement using computerized image analysis

In 1992 we described a computer-assisted method for assigning Tanner-Whitehouse RUS skeletal maturity scores to hand-wrist radiographs. An operator positions each epiphysis in turn beneath a video camera, views the image on the computer screen and corrects the position of the radiograph by matching to templates of the TW stages displayed on the screen. The process is then automatic; the computer, not the operator, rates the bone. The image is digitized and then represented by a large number of mathematical coefficients. These coefficients are then compared to those generated by each stage of the TW standards, and the closest match is sought. Since the comparison is quantitative the system produces continuous stage scores instead of the old discrete ones such as B, C, D, etc. Thus in longitudinal data a much smoother progression of skeletal maturity scores with age is achieved. The reliability of the computer-assisted skeletal age score (CASAS) is considerably greater than that of the usual manual method. Differences between duplicate readings of a bone by a single observer average about 0.25 stage, and reach 1.0 stage or more only in about 3% of instances, compared with 15-20% characteristic of manual ratings.

Reliability and validity of computer-assisted estimates of Tanner-Whitehouse skeletal maturity (CASAS): comparison with the manual method

Three observers rated 57 X-rays from normal healthy children in Project HeartBeat! twice each by CASAS, the computer-assisted version of the TW2 RUS bone age method. Differences between duplicates of individual bone ratings which reached or exceeded 1.0 unit (or 1 stage) were 5% within observer and 8% between observers for CASAS, and 17 and 33%, respectively, for the unassisted MANUAL method. In children followed longitudinally, CASAS scores increased much more steadily than MANUAL scores, largely because the bones were rated, in the former system, on a continuous rather than a discrete-integer scale. We conclude that CASAS is a more reliable and probably a more valid estimator of skeletal maturity than the MANUAL version of the TW2 RUS method.

A computerized image analysis system for estimating Tanner-Whitehouse 2 bone age

A method for assigning Tanner-Whitehouse 2 skeletal maturity scores (or bone ages) to hand-wrist X-rays by an image analysis computer system is described. An operator positions the relevant area of the X-ray on a light box beneath a video camera. Correct positioning is assured by computer templates of each bone stage. Thereafter the process is automatic; the computer, not the operator, rates the bones. The system produces continuous stage scores, not discrete ones such as B, C or D. Data are given which show that the computer-assisted skeletal age score is more repeatable than the usual manual (or unassisted) rating. The absolute difference between duplicates averaged 0.25 stages; differences of as much as 1.0 stage occurred in only 3% of duplicates compared with 15% obtained in manual ratings.

Constant low-dose oestradiol replacement accelerates skeletal maturation and growth in ovariectomized adolescent rhesus monkeys

The effects of oestradiol (OE2) on adolescent growth in female rhesus monkeys were evaluated by testing the hypothesis that, upon removal of the ovary, the increase in growth normally seen at the time of puberty would be abolished and that treatment with OE2 would restore it. Juvenile monkeys (n = 12) were ovariectomized and were given either an OE2-bearing silicone elastomer capsule implanted subcutaneously to simulate mid-pubertal concentrations ('treated =', n = 8) or no steroid treatment ('control =', n = 4). Females were studied from 18 to 42 months of age which, in intact females, typically encompasses the prepubertal period to the occurrence of first ovulation. Over the whole period, growth in body weight, crown-rump (CR) length and tibia length for control females were less than the 95% confidence limits of females treated with OE2. However, significant spurts of growth in both CR and tibia length occurred in the control as well as treated animals, although the peak velocities were somewhat lower for non-OE2-treated animals. Peak growth velocities occurred at an earlier chronological age in treated females, although at the same degree of skeletal maturity as found in control females. Skeletal maturity was significantly advanced in treated females from 27 months onward. Serum concentrations of nocturnal GH increased significantly with advancing age in both groups, with greater increases observed in treated females. Serum concentrations of IGF-I were higher in treated females until some 30 months of age, at which point concentrations increased in a similar fashion in both groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Neonatal treatment of male monkeys with a gonadotropin-releasing hormone agonist alters differentiation of central nervous system centers that regulate sexual and skeletal development

Male rhesus monkeys treated continuously with a GnRH agonist for the first 4 months of postnatal life exhibited a delay in the onset of puberty and an attenuated peripubertal rise in testosterone (T) secretion. The objectives of the current study were to determine whether these effects on sexual development were permanent and whether the hypothalamic-pituitary-testicular axis was functioning normally in these animals as adults. Neonatal GnRH agonist treatment delays but does not permanently block sexual maturation in male monkeys. Treated animals that did not show a pubertal rise in serum T during the breeding season of their 4th year exhibited a seasonal but subnormal elevation of serum T during the subsequent breeding season. Growth of the skeleton was diminished as evidenced by shorter adult crown-rump, tibia, and femur length and reduced bone mineral density of the humerus and lumbar spine. The magnitude of the serum LH and T response to iv pulses of GnRH [50 ng/kg body weight (BW)] and naloxone (1 mg/kg BW) did not differ between control and treated animals during the nonbreeding or breeding season at 6 yr of age. Conversely, treated animals showed a subnormal serum LH and T response to N-methyl-D,L-aspartic acid (5 mg/kg BW iv) during the nonbreeding season. These data suggest that adult monkeys treated neonatally with a GnRH agonist exhibit subnormal sensitivity of the central nervous system to one or more excitatory amino acids (e.g. aspartate or glutamate). Thus, abolishing neonatal activation of the pituitary-testicular axis with a GnRH agonist may permanently alter differentiation of central nervous system centers that are either involved in GnRH secretion or govern this process.

The growth of boys in the Stuttgart Carlschule, 1771-93

Height measurements taken in a mixed longitudinal manner on 1084 German-born boys aged 7 to 21+ at the Carlschule Academy in Stuttgart during the period 1771-93 have been examined. The boys can be divided into upper (aristocrat), middle and lower (artisan, servant) classes, nearly all housed and fed in this boarding school. Preece-Baines curves have been fitted to a subsample of 155 boys whose measurements cover at least the period 12-16 years at a density of two or three per year. In addition, the whole data, totalling 11,040 observations, have been examined as if purely cross-sectional; and the height-at-entry measurement for each of 670 students has been examined. The results of the longitudinal subsample and the cross-sectional analyses agree reasonably well. Social class differences existed both in tempo of growth as signified by age at peak height velocity, and in adult height. The longitudinal analysis gives adult differences of about 2 cm between upper and middle classes and a further 2 cm between middle and lower, even amongst these boys all resident in the same, very privileged, school. Tempo differences between upper and middle class were minor, amounting to only 0.3 year, but lower-class boys had their maximum growth increment about a year later than the others. Amongst middle classes a secular trend of about 2 cm averaged over all ages was found between those born before 1770 and those born later. This mainly represents a trend in tempo rather than in adult height. The heights of these boys are compared with those of contemporary Austrian upper and lower classes, English upper and lower classes, American Army cadets, and American slaves. The increase in German middle-class heights during the 18th century indicates that this group was improving its nutritional status and well-being, at a time when the heights of the remainder of the population were constant or declining. This is evidence in favour of the view that at the beginning of economic development the distribution of income tends to become more skewed.

Growth as a measure of the nutritional and hygienic status of a population

The history of the use of children's growth as a measure of the nutrition and hygiene of a population since the early 19th century is outlined. Secular trends towards greater height and earlier maturity are reported; the increase in adult height in British men born between 1900 and 1946 averaged about 1.25 cm/decade and in those born between 1946 and 1960 0.6 cm/decade, according to the data of Kuh et al. [Int J Epidemiol 1991;20:1001-1009]. Social class differences in height persist in the UK, amounting to almost 2 cm between the well off and the unskilled. The average height of subgroups of most populations serves well as a proxy for their health status and relates to their mortality rate.

Long-term effects of recombinant human growth hormone treatment on skeletal maturation and growth in female rhesus monkeys with normal pituitary function

Female rhesus monkeys (n = 5), having normal pituitary function, were treated for 50 months with recombinant human growth hormone (rhGH; 250 micrograms/kg) 3 days/week (Monday, Wednesday and Friday) and rates of growth were compared with a group of age-matched untreated females (n = 6). Treatment was initiated at 20 months of age, approximately 10 months before the expected age of menarche. Long-term treatment with rhGH accelerated bone maturation and increased the velocity of increase in crown-rump length, tibia length and body weight. The period of acceleration occurred coincident with the occurrence of spontaneous puberty. Body measurements remained larger in the treated females until growth ceased. Long-term rhGH treatment increased final adult crown-rump length by some 3%, with a slight increase in tibia length and body weight, without having any untoward effects on reproductive capacity or health. One treated animal exhibited higher estimates of antibodies to rhGH throughout the study period, and this female also had a smaller increment in crown-rump length than the other treated females. These data suggest that long-term treatment of normal-pituitary females with rhGH augments crown-rump growth without any untoward effects of health.

Effects of growth hormone on neonatal growth in nursing rhesus monkeys

The effects of recombinant human GH treatment of either nursing mothers or their infants on neonatal growth in rhesus monkeys was determined. Growth rates of infants treated daily from birth with GH (INFGH; n = 9; 100 micrograms/kg, sc) were compared to those of infants given saline (INFc; n = 10), infants whose mothers received saline from the second trimester of pregnancy through 7 weeks postpartum (CON; n = 9), infants of mothers who received GH during pregnancy only from the second trimester to parturition (PRG; n = 8), infants of mothers who received GH during lactation only from parturition through 7 weeks postpartum (LAC; n = 9), and infants of mothers who received GH during the second trimester of pregnancy through 7 weeks postpartum (PRG/LAC; n = 8). Mothers receiving GH were given 250 micrograms/kg, sc, Monday, Wednesday, and Friday. Infants were allowed to nurse ad libitum. Although infant birth weights were similar among the six groups, body weights at 7 weeks of age were significantly greater in PRG/LAC infants (0.77 +/- 0.03 kg) compared to those in CON (0.66 +/- 0.02 kg), INFc (0.62 +/- 0.03 kg), LAC (0.62 +/- 0.04 kg), and INFGH infants (0.62 +/- 0.01 kg), with infants of PRG mothers intermediate (0.71 +/- 0.02 kg) between them. By 35 weeks of age, after infants had been weaned by their mothers, body weights were similar among all groups. Serum concentrations of insulin-like growth factor-I (IGF-I) rose significantly in all infants during the study period. Although IGF-I levels did not vary significantly among the treatment groups, average concentrations of IGF-I were significantly related to weight gains. Analyses of milk composition revealed that total protein, lactose, and IGF-I levels were similar among groups, whereas the percentage of fat in the milk was significantly higher in PRG/LAC mothers. Milk protein content was significantly related to weight gain. These data suggest that neonatal body weight gain can be accelerated in nursing infants whose mothers have received GH from at least the second trimester of pregnancy through the lactational interval. Since infants of mothers receiving GH during lactation only were not different from controls, the effect of GH in this treatment paradigm may be mammogenic rather than galactopoietic per se.

Effects of growth hormone on the tempo of sexual maturation in female rhesus monkeys

The signal that initiates and maintains the developmental change in LHRH and, consequently, LH secretion in primates, thus regulating the tempo of puberty, is not known. Given the close association between reproductive development and bone maturation, we examined the hypothesis that GH was involved in developmental increases in LH release, specifically by augmenting the decrease in estradiol (E2) negative feedback inhibition of LH that characterizes late puberty in primates. Recombinant human GH (rhGH; 250 micrograms/kg) was given (sc) three times weekly to immature female rhesus monkeys to determine if developmental increases in basal serum LH would occur at an earlier age, and if menarche and first ovulation also would be advanced. The study groups included intact females receiving rhGH (INT + GH; n = 5), intact control animals (INT; n = 6), ovariectomized females receiving E2 plus rhGH (E2OVX + GH; n = 5), and E2-treated ovariectomized control monkeys (E2OVX; n = 4). The females were studied from 20 months of age until their serum LH levels increased (E2OVX groups) or until the occurrence of first ovulation (intact groups). After 12 months of rhGH treatment, the crown-rump lengths were significantly increased, regardless of ovarian status, an effect maintained in the intact females through 21 months of treatment. The mean age at the time of the initial rise in serum LH was advanced by rhGH treatment in intact females (29.6 +/- 0.4 vs. 31.3 +/- 0.3 months), but not E2OVX females. Subsequent maturational elevations in LH secretion were similar in the E2OVS + GH and E2OVX animals even after an incremental increase in E2. Ages at menarche were similar in the INT + GH and INT groups, whereas first ovulation was significantly advanced in three of five INT + GH females (31.5 +/- 0.7 months) compared to that in INT females (43.5 +/- 0.3 months). The remaining INT + GH females ovulated at an age (42.4 +/- 0.4 months) similar to that of INT females. Those females that ovulated by 32 months had higher skeletal maturity scores than the later ovulating INT females, with the other INT + GH females being intermediate. Furthermore, rhGH resulted in a significant increase in serum E2 levels within 12 h of injection, which remained elevated through 24 h. This effect of rhGH on ovarian E2 secretion did not occur until females had shown elevations in basal serum LH.(ABSTRACT TRUNCATED AT 400 WORDS)

Effects of a natural versus artificial environment on the tempo of maturation in female rhesus monkeys

To identify factors that regulate the tempo of growth and puberty, the present study examined how the environment influenced the timing of menarche and first ovulation in rhesus monkeys and how these events were related to differential rates of growth. Spring-born females were raised from 12 months of age under natural outdoor conditions (OH; n = 6) or indoors (IH; n = 9) under a controlled photoperiod (12h of light, 12h of darkness) and temperature (20-23 C). Ages at the initial increases in serum bioactive LH levels (27.7 +/- 0.7 vs. 31.4 +/- 1.0 months), menarche (26.0 +/- 0.7 vs. 32.5 +/- 0.9 months), and first ovulation (33.9 +/- 1.4 vs. 43.5 +/- 0.3 months) were significantly advanced in IH compared to OH females. First ovulation for the OH females occurred exclusively in October and November of the fourth year, whereas the distribution of first ovulation of IH females was biomodal, with seven of nine occurring in November or December at 31.8 +/- 0.5 months, and two of nine ovulating in September or October at 41.2 +/- 0.5 months. Serum levels of PRL varied seasonally in OH females throughout development, with peaks in July and nadirs in October. A similar rhythm was observed for IH females during the first 12 months of indoor housing, after which point the period decreased from 11.9 +/- 0.5 to 9.3 +/- 0.6 months. Overall increments in body weight did not differ between groups. An acceleration of growth in both crown-rump and tibial lengths occurred just before menarche in both groups, and this occurred at about 26 months for IH and about 32 months for OH females. Skeletal maturity was significantly advanced at 27 months in IH females and at every chronological age thereafter. Serum concentrations of somatomedin-C and GH paralleled group differences in bone maturation. Both hormones were significantly elevated by 16-18 months of age in IH animals compared to OH females and remained so until 34-36 months of age. Although a distinct seasonal rhythm in both GH and somatomedin-C was evident in OH animals, no such pattern was observed in IH females. These data suggest that exposure to an outdoor environment moderates the tempo of both sexual and skeletal maturation. The acceleration in reproductive development in animals exposed to a constant environment was associated with an acceleration in bone maturation, suggesting that common factors may be responsible for the initiation of both events.

[Body height in children with growth hormone deficiency: results following 5-l5 years of treatment]

The final results of long-term continuous treatment with human GH in patients with growth hormone deficiency (GHD) are described. Untreated patients with isolated idiopathic GHD average about -6 SD height at maturity; our patients averaged about -2 SD. The statistics appear to show that what is important is starting treatment before the child has fallen much below the normal centiles for height and this usually means before age two or three in idiopathic cases. Ascertainment through an effective system of primary care is more important than an elaboration treatment schedules.

Issues and advances in adolescent growth and development

The differences between individuals in tempo of growth, leading to early or late appearance of puberty, are of great importance at adolescence. Late developers, and particularly those who are genetically small as well as late, often suffer acutely and may keep scars of their suffering for years afterward. These individuals need sympathetic support and counseling, which can only be forthcoming from someone who understands thoroughly the auxology of adolescence and is able to tell the adolescent precisely and correctly what will happen in the next six months, one year, and two years. Educating the counselors, and educating the children before they enter adolescence, is a task of importance and immediacy. The physiologic mechanism of tempo is entirely unknown at present, and the major job of research is to remove this ignorance. Close collaboration is needed with pediatric endocrinologists and endocrinologists working with nonhuman primates. A prime need here is for the building of further auxologic and endocrinologic tools and the development of testable models of growth regulation.

Clinical growth standards for Irish children

A cross-sectional study, measuring height and weight, was performed on a representative sample of 3,509 Irish children aged from 5 to 19 years inclusive. Comparison with other countries showed a significantly later pubertal growth spurt than either the U.K. or the U.S. However, the final adult height and weight are similar to other countries as in the weight-for-height of children aged 5 to 9 years. The urban children are taller than the rural and the higher socio-economic groups are taller than the lower at all ages, but all achieved the same final adult height. Longitudinal tempo-conditional growth standards were constructed based on the Irish cross-sectional and menarche data together with all the available information from longitudinal studies. These charts are similar to those of the U.K., but the use of colours allows more information to be put on the charts, thus making them more suitable for clinical use.

Normal growth and techniques of growth assessment

The shape of the human growth curve is described and illustrated. Growth studies may be longitudinal, cross-sectional, mixed longitudinal or linked-longitudinal; each has advantages and disadvantages, and each requires appropriate statistical methods for handling the data. Standards for height and height velocity for use in a clinical setting wherein follow-up over several years is presumed are described and illustrated. Such standards have to take into account tempo of growth at ages over nine years. Cross-sectionally derived standards do not do this and are not suitable for clinical use. The techniques of measurement of height, sitting height and skinfolds are described and illustrated. Growth and development during puberty is described; there are changes in body composition as well as in body size and shape. Standards for pubertal stages of breasts, pubic hair and genitalia are given and emphasis is laid on the great variation in both the timing and the duration of these pubertal changes. Measurement of developmental age is discussed. The Greulich-Pyle and Tanner-Whitehouse methods for skeletal age are described. These methods can be used for predicting adult height which is useful both in diagnosis and in following the effects of treatment. In diagnosis the predicted adult height is compared to the range of expected heights in the children of the particular pair of parents concerned (the so-called 'target' range of heights) to see if smallness is simply due to delay. Change in Tanner-Whitehouse predicted height occurs on successful treatment of, for example, growth hormone deficient short stature, and is thus a guide to the success of treatment. Standards are also given for height of children from age two to nine inclusive, with allowance for height of their parents.

London Archive of Longitudinal Growth Data

An Archive of longitudinal growth data, accessible to research workers under the usual safeguards, has been set up in the Department of Growth and Development. The present S.I.R. database contains seven British and one Indian study. The Archive is open to receive other contributions if researchers wish.

Clinical longitudinal standards for height and height velocity for North American children

Longitudinally-based height and height velocity charts for North American children are presented. Centiles are given for early, middle, and late maturers. The shape of the curves is taken from a review of longitudinal studies, and the prepubertal and adult centiles for height attained are taken from National Center for Health Statistics data. The charts are suitable for following an individual child's progress during observation or treatment throughout the growth period, including puberty.

Prediction of adult height from height and bone age in childhood. A new system of equations (TW Mark II) based on a sample including very tall and very short children

A new series of equations is presented for predicting the adult height of a child given present height and bone age. These equations (TW height prediction, Mark II) which replace the ones given in 1975 (TW height prediction, Mark I) are based on larger numbers of normal children, and more importantly on a sample that includes, for the first time, numbers of very tall, very short, and very growth-delayed children. In addition, equations are given for use when the increment of height or bone age, or both, over the previous year is known. These variates improve the prediction at most ages over 8 years in girls and 11 years in boys. The previously given parental allowance has been dropped. Typically 95% of the predictions lie within +/- 8 cm of the real value for boys aged 10 years, falling to +/- 6 cm for boys aged 15 years, or +/- 4 cm if their previous height increment is known. For premenarcheal girls the predictions lie within about +/- 6 cm at age 8 years; a figure which diminishes little till 13 years unless height and bone age increments are known, when it reaches +/- 4 cm at 13 years. For postmenarcheal girls the predictions are substantially more accurate.

Increase in length of leg relative to trunk in Japanese children and adults from 1957 to 1977: comparison with British and with Japanese Americans

The secular trends in height, sitting height and leg length in Japanese children have been studied by fitting Preece-Baines Model I curves to the annual mean values from ages five to 17 of school data collected in 1957, 1967 and 1977. The method provides estimates of final adult value, and of age of maximum annual increment. Between 1957 and 1977 the maximal increments in height, sitting height and leg length all became earlier, by about a year in boys and a little less in girls. Japanese now mature about a year earlier than North Europeans. Adult height increased by 4.3 cm in boys and 2.7 cm in girls between 1957 and 1977, the increment being less in the second decade than in the first. Sitting height showed practically no increase whatever; almost the whole secular trend was due to change in leg length. Japanese now have trunk/leg proportions much more similar to those of North Europeans than was the case 20 years ago, but their adult height remains about one standard deviation lower.

A longitudinal analysis of the growth of limb segments in adolescence

The growth of upper and lower-limb segments of 96 adolescent boys and girls from the Royal Hospital School Longitudinal Study was analysed. Preece-Baines Model 1 curves were fitted to the longitudinal data to obtain, for each measurement, age at peak velocity and the magnitude of this velocity. Mean-constant peak velocities were between 1-0 and 2-5 cm/yr in all segments. They were in all cases greater than the values obtained from fitting the P-B curve to the cross-sectional means at successive ages. Boys had greater peak velocities than girls in all measurements (sex ratio 1-1 to 1-4). On average distal segments preceded more proximal segments in the ages at which peak velocity occurred. Considerable individual differences, however, occurred in the order for the upper limb segments. These differences seemed to be related to the individual's tempo of growth; late developers had a significantly different order to early developers.

Degree of resemblance of the pattern of growth among sibs in families of West Bengal (India)

The Preece-Baines Model 1 curve has been fitted to longitudinal data on growth in height of 105 boys and girls in 70 Bengal families: 60 of these were sibs distributed in 25 families. For a number of growth characteristics, such as age at peak height velocity, the proportion of the total population variance that was due to variation between, as opposed to within, families was estimated by Smith's (1980) method. The proportions for age at take-off of the adolescent spurt, of age at PHV, and of PHV itself were 22%, 26% and 33% (where adult height gives a value of about 40%). The sample is small and these estimates have high standard errors and need confirmation.

Radiographically determined widths of bone muscle and fat in the upper arm and calf from age 3-18 years

In the Harpenden Growth Study arm and calf radiographs were taken on 280 boys and 225 girls twice a year over varying periods. Widths of bone, muscle and fat halfway down the arm and at maximum calf diameter were measured, with widths of bone cortex and medulla where possible. Mean distance and velocity curves are given for chronological age 3-18 years together with curves based on time from peak-height velocity (PHV) and time from peak muscle velocity over the pubertal period. Muscle widths have their peak velocity more nearly coincident with the sitting height peak than with PHV; in the average child the whole muscle spurt lasts two years from start to finish. Calf muscle is much more pronounced in girls in comparison with boys than is arm muscle; this is true at all ages, with sex differences at maturity amounting to 10% for calf and 20% for arm. Humerus cortex has a marked spurt in both sexes, with the peak contemporaneous with the muscle peak. Both humerus and tibia medulla widths have a spurt in boys, but none in girls, where the means do not change from age 11 onwards. The average girl actually loses fat in the arm for a year at puberty, a result which contrasts with the velocity curve derived from mass cross-sectional data. Correlations between widths of bone in arm and calf average 0.5 during the pre-adolescent years and 0.4 at maturity; those between muscle widths in arm and calf 0.4 in pre-adolescence and 0.4 again at maturity. Between-tissue correlations are very low at all ages.

Gonadotrophin response to LH-RH in boys with delayed growth and adolescence

Plasma luteinising hormone (LH) and follicle-stimulating hormone (FSH) concentrations were measured before and after intravenous luteinising hormone-releasing hormone (LH-RH) in 33 boys with growth delay. Eighteen were prepubertal and 15 pubertal. Basal LH and FSH levels were low in both groups with mean increments after LH-RH of 3.2 +/- 0.8 U/l (mean +/- SEM) and 2.6 +/- 0.4 U/l respectively in the prepubertal and 7.4 +/- 0.7 U/l and 2.0 +/- 0.3 U/l in the pubertal boys. The LH increment showed a positive correlation with increasing bone age (r = 0.71, P less than 0.001); FSH did not. The LH-RH response thus appeared normal in relation to the stage of maturity.