Giving the cells what they need when they need it: Biosensor-based feeding control

"Giving the cells exactly what they need, when they need it" is the core idea behind the proposed bioprocess control strategy: operating bioprocess based on the physiological behavior of the microbial population rather than exclusive monitoring of environmental parameters. We are envisioning to achieve this through the use of genetically encoded biosensors combined with online flow cytometry (FCM) to obtain a time-dependent "physiological fingerprint" of the population. We developed a biosensor based on the glnA promoter (glnAp) and applied it for monitoring the nitrogen-related nutritional state of Escherichia coli. The functionality of the biosensor was demonstrated through multiple cultivation runs performed at various scales-from microplate to 20 L bioreactor. We also developed a fully automated bioreactor-FCM interface for on-line monitoring of the microbial population. Finally, we validated the proposed strategy by performing a fed-batch experiment where the biosensor signal is used as the actuator for a nitrogen feeding feedback control. This new generation of process control, -based on the specific needs of the cells, -opens the possibility of improving process development on a short timescale and therewith, the robustness and performance of fermentation processes.

Protein composition of pulses and their protein isolates from different sources and in different isolation pH values using a reverse phase high performance liquid chromatography method

The objective of this study was to compare the composition of pulse proteins isolated from lentils and green and yellow peas at two isolation pH values (9 and 11) and determine the effect of this variability on protein functionality. Chromatogram peaks obtained from reverse-phase high performance liquid chromatography were identified by isolation of albumin-, vicilin- and legumin-rich fractions for the three pulses. Protein composition was obtained for each isolate and compared against that of the originating pulse flour. Lentil flour showed the highest level of vicilin with a vicilin/legumin ratio of ∼ 2.5, while this ratio was 1.3 and 1.2 for green and yellow pea flour, respectively. Albumin content of yellow pea flour was high (∼36.1 %), which reduced to ∼ 15-19 % in isolated proteins showing a loss in albumins during the isolation. Higher extraction pH increased pea protein yield but led to lower protein solubility with no changes in foaming properties and in-vitro digestibility.

26 Extending the Shelf-life of Beef Bone-in Short Rib Steaks Using Acerola Cherry Powder and Rosemary Extract

Improving the shelf-life of beef bone-in short rib steaks, which are commonly exported, will increase beef export demand and subsequently producer profits. The objective was to determine the effect of the topical application of acerola cherry powder and rosemary extract from various suppliers on beef bone-in short rib shelf-life. Beef bone-in short ribs (IMPS 123A) (n = 18) from USDA Choice carcasses were aged for 28 days post-fabrication at 0°C. Steaks 1.02 cm-thick were systematically assigned based on location to treatments including: untreated control (C), topically sprayed (~2ml) with an acerola cherry powder solution (0.05%) from one of three suppliers (C1, C2, C3), or topically sprayed (~2ml) with a rosemary extract solution (0.10%) from one of three suppliers (R1, R2, R3). Steaks were assigned to day 0 lipid oxidation or 4 days of retail display followed by day 4 lipid oxidation. Steaks were weighed on day 0 and 4 to determine fluid loss. Throughout retail display, objective and subjective color were measured twice daily on the lean and bone marrow portions of the steaks. Data were analyzed using the Mixed Model procedure of the Statistical Analysis System. Lipid oxidation (P = 0.323) did not differ between treatments. However, treatments differed in fluid loss (P = 0.024), where steaks treated with C1, C2, C3, R2, and R3 had less fluid lost than control steaks. Subjective color evaluation of lean color (P < 0.0001) and uniformity (P < 0.001) differed between treatments. Steaks treated with C1, C2, C3, and R3 were a brighter red than control steaks. Treatments differed when measuring bone marrow L* (P < 0.001), a* (P < 0.001), and b* (P = 0.004), where R3 treated marrow was the darkest, reddest, and yellowest. Natural antioxidants, specifically acerola cherry powder and rosemary extract, improved steak color and water holding capacity of beef bone-in short ribs aged for an extended period.

32 Assessment of Dry-Aged Beef from Commercial Aging Locations Across the United States

Dry-aging is a practice that involves storing meat at refrigerated temperatures without protective packaging. Despite the increase in dry-aged beef popularity, relatively little is known about commercial dry-aging parameters. Thus, the objectives of this study were to determine dry-aging parameters of commercial aging facilities and their influence on eating quality (acceptability, flavor, tenderness, and juiciness) of dry-aged beef from locations across the United States. Sixty-six Certified Angus Beef® brand bone-in beef strip loins (IMPS #175) were randomly assigned to ten commercial dry-aging facilities across the United States. An additional six strip loins were wet-aged for 45-days as a negative control. Strip loins were shipped overnight to aging locations where a 45-day dry aging period transpired before being returned for subsequent analysis, upon completion of aging. Objective color, pH, and water activity were measured post aging, at the time of processing. Strip loins were then fabricated, and steaks were vacuum packaged and frozen until further analysis. Intrinsic quality parameters objective color (L*, a*, b*), pH, and water activity were not different (P > 0.05) between strip loins aged 45 days by location. Cooler conditions including temperature, percent relative humidity, and air speed were different (P < 0.01) across aging locations. Pacific Northwest consumer panelists indicated a difference in overall acceptability (P < 0.01), tenderness (P = 0.01), and flavor (P < 0.01) based on aging location. Additionally, consumers detected (P < 0.01) unique dry-aging flavors for individual aging locations including cheesy and nutty attributes. Research indicates individual dry-aging facility conditions aid in producing unique dry-aged beef products according to U.S. consumers from the Pacific Northwest Region.

Rapid implementation of a support intervention for bereavement at the beginning of the COVID-19 pandemic

Introduction

There have been over 900,000 deaths from COVID-19, with more than 3 million people bereaved. These deaths are associated with factors leading to poor bereavement outcomes, and distress in frontline-staff

Objectives

to (i)present the rapid implementation of an intervention for bereavement support; (ii)characterize first calls and follow-up.

Methods

We recruited a multidisciplinary team and prepared a structure called “SIB” (Support and Intervention for Bereavement) in a matter of days. There were three steps for the support (Screening, First-line intervention, Second-line intervention (short follow-up). We collected data screening risk factors for complicated grief (CG).

Results

Between March 24th-May 14th (lockdown, March 16th-May 13th), the hotline received nineteen calls for an intervention. The hospital contacts were various, including mortuary. Fifteen relatives were followed, among them thirteen bereaved for ten deaths (on 52 deaths=19.23%). Dead persons were young (m=59.68 years-old, SD=15.25). All contacts reported several risk factors for a CG (no “goodbye” (100%), no funeral rituals (82.35%)). Six relatives were addressed for short follow-up.

Conclusions

The actual pandemic is at high risk for complicated grief and may until 2021. We hope that all hospitals would implement basic bereavement outreach programs to prepare families for the death and to support them afterwards, as well as provide basic support to frontline staff.

Disclosure

No significant relationships.

Do Published Cooking Temperatures Correspond with Consumer and Chef Perceptions of Steak Degrees of Doneness?

The objective of this study was to assess consumer and chef perceptions and knowledge of beef degrees of doneness (DOD) as well as to measure the changes in cooked color over time related to DOD. Steaks from strip loins (M. longissimus lumborum) from each of 5 quality treatments were used for this study. Steaks were cooked to an endpoint temperature of either very-rare (54°C), rare (60°C), medium-rare (63°C), medium (71°C), well-done (77°C), or very well-done (82°C). L*, a*, and b* were evaluated at 0, 1, 2, 3, 6, 9, and 12 min post-cutting and digital pictures were taken immediately on an internal surface of the steak. Digital surveys for the evaluation of the images of the cooked steaks were created for consumers and chefs. There were time × DOD interactions (P < 0.05) for L*, a*, and b* values. For very-rare, rare, medium-rare, and medium, a* values increased (P < 0.05) over time. For L*, well-done and very well-done steaks became darker (P < 0.05) and very-rare, rare, and medium-rare steaks became lighter (P < 0.05) over time. Surveys indicated consumers determine DOD when cooking beef in their home primarily by using color, whereas chefs primarily use touch to determine DOD. There were no quality grade effects (P > 0.05) for DOD responses for steak pictures evaluated by consumers or chefs. Consumers identified the DOD of cooked steaks as the DOD that corresponds to published end-point temperatures 27 to 35% of the time. Chefs typically identified the DOD as 1 DOD higher than which the steaks were cooked for steaks cooked to medium or less and 1 DOD lower for steaks cooked to well-done and higher. This indicates differences exist in the perceptions of DOD between culinary professionals and consumers, and may contribute to decreased consumer satisfaction when ordering steaks in a restaurant.

Optimization of growth hormone dosing in children born small for gestational age: an open-label, randomized study of children during the fourth year of therapy

BACKGROUND

Optimal dosage for growth hormone (GH) therapy in short, prepubertal children born small for gestational age (SGA) is controversial.

METHODS

SGA OPTIMIS (NCT00249821) is a multicenter, open-label, parallel-group, pilot study of short children born SGA who had received recombinant human GH (r-hGH) (57 μg/kg/day) for 3 years. Children were randomized 1:1 to receive either 57 or 35 μg/kg/day r-hGH during year 4. The primary endpoint was height gain during year 4.

RESULTS

22 children were randomized (57 μg/kg/day, n = 10; 35 μg/kg/day, n = 12) and 21 completed the fourth year of therapy; 22 were included in efficacy analyses. During year 4, mean [standard deviation (SD)] height velocity was 6.4 (1.4) and 4.4 (1.2) cm/year (p = 0.001) and height velocity SD score (SDS) was 0.3 (0.3) and -0.1 (0.2) (p = 0.002) in the 57 and 35 μg/kg/day groups, respectively. The 57 μg/kg/day group continued with catch-up growth, had a significantly higher mean weight gain (p = 0.015) and significantly higher insulin-like growth factor-I levels at 12 months (p = 0.038). Five treatment-emergent adverse events were reported; none was serious or caused study withdrawal.

CONCLUSIONS

Children who continued receiving 57 μg/kg/day r-hGH in year 4 had significantly greater height gain than those receiving 35 μg/kg/day r-hGH.

Evolution of IGF-1 in children born small for gestational age and with growth retardation, treated by growth hormone adapted to IGF-1 levels after 1 year

AIM

This study was designed to estimate the percentage of growth hormone (GH)-treated children born small for gestational age (SGA), with serum IGF-1 >2 SDS before and after GH dose adaptation.

METHODS

SGA boys aged 4-9 and girls aged 4-7 with a height <-2 SDS and an annual growth rate below the mean received a subcutaneous GH dose of 57 μg/kg/day for 2 years. The GH dose was to be decreased by 30% in children with serum IGF-1 >2 SDS at 12 months and on the previous sample. The GH dose could be reduced a second time to 35 μg/kg·day. IGF-1 and IGFBP-3 dosages were centralized.

RESULTS

Among the 49 (21 boys) children included in the study, 8 (16.3%) had an IGF-1 >2 SDS consecutively at 9 and 12 months (95% CI 7.3, 29.7). The GH dose was decreased in 6/8 children. However, IGF-1 levels were elevated at several nonconsecutive determinations in 45% (95% CI 28.4, 56.6) of the patients.

CONCLUSION

A high IGF-1 level is observed in 45% of the GH SGA-treated children with a relatively high dose of GH. A 30% reduction in the GH dose causes a decrease in IGF-1 below 2 SDS in most children.

[Pilot study and preliminary validation of the French version of a quality-of-life questionnaire specific for subjects with growth hormone deficiency]

This study forms part of a research project seeking to develop a standardized questionnaire by which clinicians can assess the impact of growth hormone (GH) deficiency and its treatment on the "perceived health" or health-related quality of life of adults. The specific aim of this study was to translate and adapt for French patients the AGHDA (Adult Growth Hormone Deficiency Assessment) a standardized health-related quality of life measure for use with GH-deficient adults, initially developed in the United Kingdom, and to collect data which could be used to assess the main psychometric characteristics of its French version the ISPA-HC (Indicateur de Santé Perceptuelle Adulte-Hormone de Croissance). The main properties analyzed are: 1/ The scale's acceptability, as determined by means of face-to-face interviews with a small number of subjects, then by an ad hoc questionnaire administered during a test-retest study; 2/ The scale's reliability, as determined by a test-retest study (with a 15-days interval between tests); 3/ The scale's concurrent validity, as expressed by comparison with scores obtained by means of a generic quality of life scale, the ISPN (the French version of the Nottingham Health Profile). The results of this first trial with the ISPA-HC are conforming to what one can expect from a good instrument. The ISPA-HC has been shown to have very good levels of reliability and internal consistency. Its scores show a close correlation with those of the ISPN (the French version of the Nottingham Health Profile). This instrument can be used to measure variations in the perceived health of subjects with growth hormone deficiency. Its responsiveness to change is to be examined in subsequent studies.

Three-year data from a comparative study with recombinant human growth hormone in the treatment of short stature in young children with intrauterine growth retardation

Growth acceleration and bone maturation were studied for 3 y in 69 children with severe short stature and a history of intrauterine growth retardation (IUGR), to determine the effect of treatment with recombinant human growth hormone (r-hGH). The patients were enrolled in an open, multicentre trial and were randomly allocated to either the treated group (Group 1) or the control group (Group 2). The children in Group 1 were treated daily with 0.2 IU/kg/body weight (0.067 mg/kg) s.c., during 3 y and the children in Group 2 started the study with a 1-y observation period followed by a 3-y treatment period. At birth, their mean weight standard deviation score (SDS) was -2.5 and their mean length SDS -3.5. At baseline, the patients were prepubertal, non-GH deficient, with no known dysmorphic features. Mean age was 4.5 y, bone age was 3.3 y, height SDS was -3.4, height velocity (HV) SDS was -1.6, and body mass index SDS was -1.4. After 1 y of treatment, linear HV in Group 1 increased in comparison with the pre-treatment period (from 5.7 +/- 2.0 to 10.1 +/- 1.7 cm/y; p < 0.001) and with the first year of observation in Group 2 (p < 0.001). Increased HV was sustained during the second and third year of treatment and was significantly higher than at baseline. A similar growth pattern was seen during the 3 y of GH treatment in Group 2. Mean height SDS for chronological age increased by 2.0 +/- 0.7 in the two groups after 3 y of treatment. HV after 1 y of treatment was negatively correlated with growth velocity at baseline. Bone age remained retarded but increased with a mean of almost 4 y after 3 y of treatment in both groups. Even at a dose that is three times the replacement dose treatment with r-hGH was well tolerated. From these results, we conclude that r-hGH treatment over 3 y can induce sustained catch-up growth in young children with severe short stature and a history of IUGR. Long-term studies are needed to assess ultimate effects on final height.

Growth hormone therapy with three dosage regimens in children with idiopathic short stature. European Study Group Participating Investigators

OBJECTIVE

In children with idiopathic short stature (ISS) we studied the growth-promoting effect at 4 years of recombinant human growth hormone (rhGH) therapy in three dose regimens and evaluated whether increasing the dosage after the first year could prevent a decline in height velocity (HV).

DESIGN

Included were 223 patients who were treated with subcutaneous administrations of rhGH 6 days per week. They were randomized to three groups: 3 IU/m2 body surface/day, 4.5 IU/m2/day, and 3 IU/m2/day during the first year and 4.5 IU/m2/day thereafter, corresponding with dosages of 0.2 and 0.3 mg/kg body weight/week, respectively. Growth was compared with a standard of 229 untreated children with ISS [ISS standard].

RESULTS

During the first year of treatment HV almost doubled and was higher with 4.5 IU/m2 than with 3 IU/m2. In the second year HV no longer differed among the groups, but increasing the dosage slowed the rate of the fall of HV. During 4 years of therapy the height SD score for age increased by a mean (SD) of 2.5 (1.0) [ISS standards], or 1.2 (0.7) (British standards), bone age increased by 4.8 (1.3) years, and predicted adult height SD score increased by 1.5 (0.7). After 4 years the results of the group with 4.5 IU/m2 were slightly better than those of the other groups. When dropouts were included in the analysis (assuming a stable height SD score after discontinuation of rhGH therapy), height gain was still significant.

CONCLUSIONS

During 4 years of rhGH therapy, growth and final height prognosis improved, slightly more with 4.5 IU/m2 than with 3 IU/m2 or 3 to 4.5 IU/m2. However, bone age advanced on average 4.8 years during this period; therefore, any effect on final height will probably be modest.

Once daily subcutaneous growth hormone-releasing hormone therapy accelerates growth in growth hormone-deficient children during the first year of therapy. Geref International Study Group

The efficacy and safety of 1 yr of GH-releasing hormone [GHRH-(1-29)] therapy in GH-deficient children were determined. One hundred and ten previously untreated prepubertal GH-deficient children were treated for up to 1 yr in a multicenter, open label study with 30 micrograms/kg GHRH-(1-29)/day, sc, given at bedtime. Eighty-six of the 110 patients were eligible for efficacy analysis. The main outcome measures, monitored every 3-6 months, were linear growth enhancement (height velocity), bone age progression, and safety measures including clinical chemistry. The mean height velocity for the group increased from 4.1 +/- 0.9 cm/yr at baseline to 8.0 +/- 1.5 and 7.2 +/- 1.3 cm/yr after 6 and 12 months of therapy, respectively. At 6 months, 74% of the children were considered to have a good response to GHRH. The ratio of the change in bone age to height age was not significantly different from unity at 12 months (1.04 +/- 0.58; P = 0.63). No adverse changes in general biochemical or hormonal analyses were noted. No change in fasting glucose concentration or excessive generation of insulin-like growth factor I occurred, and overall GHRH was well tolerated. We conclude that GHRH administered as a once daily dose of 30 micrograms/kg GHRH.(1-29), s.c., was effective in increasing height velocity in GH-deficient children.

Treatment of central precocious puberty with depot leuprorelin. French Leuprorelin Trial Group

We evaluated the pituitary and gonadal suppression in 40 girls and nine boys treated with depot leuprorelin (3.75 mg sc if body weight > or = 20 kg, 1.87 mg if body weight < 20 kg) every 28 days for central precocious puberty. Gonadal suppression was obtained in most of the children with this dose: 3 months after initiation of the treatment, 85% of children had a peak plasma luteinizing hormone response to gonadotropin-releasing hormone < 3 IU/l and the gonadal axis remained suppressed throughout the duration of the study (up to 24 months). Four patients required higher doses of leuprorelin to achieve suppression. In two girls, a cutaneous reaction to the drug was associated with incomplete suppression and the treatment had to be interrupted. Plasma leuprorelin levels tended to increase from day 3 to day 28 after injection. Residual leuprorelin levels measured 28 days after injection were stable during the first year of the study. We conclude that an initial dose of depot leuprorelin of 3.75 mg sc every 28 days is efficient in most children with central precocious puberty.

[Treatment of growth hormone deficiencies with growth hormone releasing hormone. Current status and perspectives]

Results of clinical trials performed with human hypothalamic growth hormone releasing factor (GRF) are conflicting, but rather disappointing for most of them. Pulsatile administration of GRF has been found to increase growth hormone secretion as well as growth velocity, but is not convenient for practical use. All other routes and rhythms of administration lead only to sub-optimal results, and generally does not seem to procure an appropriate GRF bio-availability. Improvements are possible, particularly the development of agonists and new galenic forms with sustained release. Therapeutic approach with hexapeptides, or hexapeptides analogs, looks promising, but could be more complementary than competitive.

Final height in Turner syndrome patients treated with growth hormone

The first treatment trials on patients presenting with Turner syndrome were successful in accelerating growth velocity. It is therefore essential to know the final height of the patients who were treated in order to ascertain whether or not growth hormone treatment increases final height. We are reporting on a group of 117 patients with Turner syndrome whose growth hormone treatment was initiated in 1986. The mean growth hormone dose was 0.74 IU/kg/week for an average period of 4 years. At the start of treatment, the patients' chronological age was 129/12 years, height -3.8 +/- 1.0 standard deviation scores (SDS) and bone age 10.5 +/- 2.1 years. Mean final height was 147.7 +/- 5.6 cm, i.e. a gain of 1.5 SDS. We noted no significant difference due to the type of chromosomal abnormality, nor to oxandrolone or estrogen-associated treatment. A significant correlation was found between final height, mean parental height, the duration of the treatment, height SDS at the start of treatment and growth hormone peak during pharmacological stimulation tests. However, there was no correlation between growth hormone dosage, chronological age and bone age at the start of treatment. These results show that the growth hormone treatment improves the final heights of patients with Turner syndrome.

Effects of growth hormone therapy in prepubertal children with short stature secondary to intrauterine growth retardation

A total of 130 short children were included in a French multicentre study and randomized between a control group (group A) and two groups treated with daily subcutaneous injections of GH at doses of 0.7 IU/kg/week (group B) and 1.4 IU/kg/week (group C) for 2 years. Height velocity was significantly increased (p < 0.0005) in groups B and C, with a greater increase in group C than in group B (p < 0.001). The benefit after 2 years compared with controls was 4.3 cm in group B and 5.9 cm in group C. The rate of bone maturation was not affected by GH therapy. These results led to the conclusion that 2 years of treatment with GH improves final height prognosis in children with short stature secondary to IUGR, and that this effect is dose dependent. The effect on final height has still to be demonstrated.

Adult height in children with prepubertal short stature secondary to intrauterine growth retardation

In a retrospective study of 47 children seen before puberty for growth retardation secondary to intrauterine growth retardation (IUGR), 23 boys had a final height of 161.9 +/- 8.0 cm and 24 girls a final height of 147.6 +/- 7.2 cm, values that were significantly lower than the target heights of these patients (p < 0.001). This reduction in adult height indicates the possible usefulness of growth hormone therapy in children with IUGR.

Study of final height in Turner's syndrome: ethnic and genetic influences

In understanding Turner's syndrome, spontaneous adult height is a prerequisite for an accurate assessment of the therapeutic efficiency of growth hormone treatment. The heights described in the literature reveal significant differences (136-147 cm). Our collaborative study pooled results from 16 pediatric endocrinology centers and obtained a large number of spontaneous adult heights (n = 216). The selective criteria were: chronological age (CA) > 18 years, bone age (BA) > 16 years, typical karyotype, no treatment with growth hormone or anabolic steroids. Mean CA was 23.3 +/- 5.6 years. Chromosomal anomalies were: monosomy X 56%; mosaicism 37.2%; structural aberration 10.6%. Mean final height in the whole group was 141.5 (129-160) cm. There was no significant difference in height between the three groups: monosomy X (n = 121: 141.1 +/- 6.4 cm); mosaicism (n = 72: 141.5 +/- 7.5 cm); X anomaly (n = 23: 141.4 +/- 5.0 cm). Mean parental height was 170.4 +/- 7.1 cm (father) and 160.1 +/- 6.2 cm (mother). Parental height and patients' heights correlated significantly, but more so with fathers' heights (r = 0.50) than with mothers' (r = 0.42). The correlation was still apparent with the target height (r = 0.55). The results of different series in the literature show the existence of significant variations as mean final heights are between 136 and 147 cm. These differences can be explained by the variations in normal female heights in each country. We have found in these different countries a very strong correlation (r = 0.91) between normal height and final height in Turner's syndrome.(ABSTRACT TRUNCATED AT 250 WORDS)

[Growth hormone administered to non-growth hormone deficient, small girls: echographic aspect of the gonads and uterus]

The effect of growth hormone (GH) treatment on prepubertal gonads is controversial especially with regard to the risk of precocious puberty. Ultrasound assessment of ovarian volume, follicle size, and uterine growth was performed in 20 premenarcheal girls (8.0 +/- 2.6 years) receiving growth hormone (GH) for short stature (-2.8 +/- 0.4 SD) not related to growth hormone deficiency or Turner syndrome. Mean GH dosage was 1.0 +/- 0.4 IU/kg/week and mean duration of treatment at evaluation was 16.3 +/- 8.9 months. All patients underwent real time ultrasonography of the pelvic organs and ten subjects also had color Doppler studies of the ovarian and uterine arteries. Ultrasound findings were similar to those reported in normal prepubertal girls. Mean uterine length (29.1 +/- 7.5 mm) and volume (1.23 +/- 0.86 ml) were correlated with age but not with dosage or duration of GH treatment. Ovarian volumes was within the normal age-specific range in all patients except a 7.9 year old girl with substantially enlarged ovaries (4.7 ml) but no evidence or precocious puberty. Ovarian follicles were found in five girls; they measured less than 9 mm in diameter in every case except one (13 mm follicle in an 11-year-old). Blood flow in the ovarian arteries was seen on 5 of the 10 color Doppler studies and was not correlated with dosage or duration of GH treatment. Administration of GH to non-GH-deficient girls did not substantially affect the internal genital organs. It remains uncertain whether the single case of ovarian enlargement seen was related to GH treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Discontinuation of growth hormone therapy in growth-hormone-deficient patients: assessment of body fat mass using bioelectrical impedance

The changes in body composition evaluated by the mean of bioelectrical impedance analysis (BIA) have been observed in a group of 16 male adolescents at the time of discontinuation of growth hormone (GH) therapy as well as at 6 and 12 weeks later. After reevaluation of their endocrine function, 6 patients (3 craniopharyngioma, 1 irradiation, 1 malformative, 1 idiopathic) had a profound persistent GH deficiency (maximum peak of GH under provocative tests < 5 ng/ml and low IGF-1 levels), while 10 patients had a normal somatotropic function. Both groups were comparable as far as age, weight and body mass index are concerned. Fat weight is significantly higher in the GH-deficient patients (9.9 +/- 2.6 kg) than in boys with a normal somatotropic function (6.0 +/- 1.1 kg) at the time of the discontinuation of GH therapy (p < 0.01). 3 months later, the increase in fat weight is significant only in the group of patients with severe GH deficiency (+4.1 +/- 2.2 kg; p < 0.05), the difference between the 2 groups (14.0 +/- 3.5 and 7.3 +/- 1.0 kg) becoming highly significant (p < 0.001). Lean body mass is lower in the GH-deficient patients and decreases slightly after GH discontinuation, while no significant variation is observed in the group of non GH-deficient boys. Although BIA assessment of body composition may be discussed when applied to GH-deficient subjects, these results show that such patients should be reevaluated after the discontinuation of GH therapy, including examination of the possible metabolic consequences of GH deficiency.

Nocturnal profile of growth hormone secretion during sleep induced by zolpidem: a double-blind study in young adults and children

Overnight blood sampling for repeated growth hormone (GH) assays, regarded as the most physiological assessment of GH status, may induce some disturbances in patients' sleep and then in the evaluation of GH secretion. We studied the influence of a hypnotic drug, zolpidem (10 mg), on nocturnal GH profiles (GH peak, time to first and maximum GH peak, area under the curve, mean integrated concentration) over two nights at a 7-day interval, in a double-blind cross-over design in a group of 12 young adult volunteers (27.9 +/- 4.3 years), and in a group of 12 children (10.8 +/- 2.3 years) with short stature, in a parallel double-blind study. Mean GH profiles showed no difference between zolpidem-treated subjects and placebo-treated controls, either in adults or in children. Although in these experimental conditions, sleep onset latency was significantly reduced with zolpidem in the adult volunteers, the mean time to first GH peak remained unchanged. Furthermore, GH profile did not relate with sleep duration, sleep onset latency or number of awakenings. A hypnotic drug, such as zolpidem, given at bedtime, is therefore devoided of effect on nocturnal GH profile and may be used in young children for overnight blood sampling when needed.

Growth response to growth-hormone administration during the decelerating phase of the pubertal growth spurt in short normal children

In order to investigate the value of growth hormone (GH) treatment during late puberty, we studied the effect of human GH (hGH) administration (0.85 +/- 0.30 IU/kg/week; range: 0.44-1.28) on height velocity (HV) after the peak of the pubertal growth spurt in a group of 10 (4 girls and 6 boys) short normal children (GH peak after pharmacological stimulation: 15.5 +/- 2.3 ng/ml) with growth retardation (height: 2.6 +/- 0.3 SD) and puberty Tanner stage 4. A group of 10 untreated children, observed prior to the study, served as controls. The children were regularly measured during their pubertal growth spurt, and HV (cm/year) was calculated every 6 months. The pretreatment evaluation consisted of 2 consecutive 6-month periods characterized by a decrease in HV of at least 25%. In the group of selected children, hGH administration was then initiated and growth variables were evaluated after 6 and 12 months of therapy. Skeletal maturation was evaluated at the beginning as well as after 6 months and 12 months of hGH therapy. In the controls, HV (mean +/- SD) had decreased from 8.8 +/- 1.8 to 4.9 +/- 1.4 cm/year during the pretreatment period (in girls from 7.9 +/- 1.4 to 4.1 +/- 0.6 cm/year and in boys from 9.6 +/- 1.6 to 5.8 +/- 1.2 cm/year). During the following semester, HV was 3.3 +/- 0.8 cm/year (girls: 3.4 +/- 1.0 and boys: 3.2 +/- 0.2 cm/year).(ABSTRACT TRUNCATED AT 250 WORDS)

A placebo-controlled trial of intranasal growth hormone-releasing hormone [GHRH(1-44)-NH2] administration in normal young adults

Growth hormone-releasing hormone, GHRH(1-44), was administered intranasally to 16 healthy young adult male volunteers in a placebo-controlled study using a dose of 1,000 micrograms dissolved in two different solvent vehicles: water alone and water with the surface tension-lowering agent Tween 80 (0.12%). The growth hormone (GH)-releasing effects of intranasal GHRH as well as that of the vehicle were established and compared to the effects of 80 micrograms intravenous GHRH. Plasma GH response was assessed by frequent blood sampling over an 180-min period, using both peak response and area under the curve (AUC). The results show that the GH-release effects of intranasal GHRH are comparable whichever vehicle is used, and are similar, with the dose of 1,000 micrograms, to the response obtained following the administration of 80 micrograms intravenous GHRH. Peak GH responses to GHRH (means +/- SEM) were 25.6 +/- 4.2 ng/ml (1,000 micrograms GHRH with water), 32.9 +/- 9.1 ng/ml (1,000 micrograms with water plus Tween 80) and 36.3 +/- 7.8 ng/ml (80 micrograms i.v. administration) (not significant). There was no significant GH response to placebo. Mean peak GH responses occurred after approximately 30 min in all three active treatments (29.2 +/- 2.7, 33.9 +/- 3.2 and 30.9 +/- 3.9 min, respectively). The AUC values (ng.min.ml-1) were not statistically different: 1,914.4 +/- 386.7 (water), 2,176.2 +/- 599.9 (water plus Tween 80) and 2,419.2 +/- 506.9 (i.v.) (not significant). Intranasal GHRH administration was well tolerated in all subjects. Occasional local reactions consisted of a prickly sensation in the nostrils or sneezing irrespective of the vehicle used.(ABSTRACT TRUNCATED AT 250 WORDS)

Plasma prolactin, sex steroids and gastrin in human volunteers treated for 2 weeks with therapeutic doses of cimetidine or the new histamine H2-receptor antagonist ramixotidine (CM 57755A)

Three groups of eight healthy male volunteers received placebo for 2 days, then daily morning doses either of cimetidine 800 mg, ramixotidine 750 mg (CM 57755A), or placebo, for 14 days, and then were all returned to placebo for one more day. Plasma levels of prolactin, testosterone and 17 beta-estradiol were measured on Days 2, 3, 16 and 17 in blood samples taken 30 and 15 min before and 0, 60, 120, 180, 240 and 300 min after treatment. Gastrin was assayed in blood collected on the same days 180 min after treatment. Mean pre- and post-treatment areas under the time-concentration curves of the first three hormones were not significantly different in the three groups on any test day, or within the same group throughout the four test days. Mean plasma gastrin levels ranged between 27 and 42 pg/ml, respectively, in the placebo and cimetidine treated groups on test day 3, and intermediate values were found in the group receiving CM 57755A. There was no statistically significant difference in gastrin level between the groups on any test day or within the same group throughout the four test days. No subjective side-effects attributable to the treatments were reported, and there were no abnormalities in blood pressure, heart rate or standard laboratory tests.

[Osteocalcin in children of short stature and its nocturnal variations]

Serum osteocalcin (Gla-P) was measured in 65 children with normal stature for age and in 116 children with growth retardation, excluding endocrine disorders, in matched groups according to age: 1-6 years (n = 33); 7-10 years (n = 49); 11-14 years (n = 72); 15-18 years (n = 27). Thirty of these patients were retested at 2 weeks interval. In addition, Gla-P and growth hormone (hGH) were assayed in blood samples obtained every 20 minutes during sleep in 12 children with growth retardation. In younger children, Gla-P levels were significantly lower in patients with growth retardation, when compared with normal children. In contrast, this difference was no longer significant in children above 11, with either normal or delayed puberty. However, important intra-individual variations of Gla-P levels were observed on blood samples obtained at 2 weeks interval. A nocturnal periodicity in Gla-P was found; Gla-P rose slightly during sleep in the patients studied, maximum concentration being reached between 4 and 6 AM. No correlation between integrated concentrations of hGH and Gla-P was found. Gla-P determination may be of interest in the evaluation of young children with short stature. Standardized conditions of blood sampling for Gla-P use in children remain to be determined.

[Biosynthetic growth hormone and the opinions of pediatricians. The form of the problem after a regional survey]

An enquiry was undertaken with 35 pediatricians in the area of Bordeaux, concerning the attitudes induced by the future availability of a synthetic growth hormone obtained by genetic engineering and which might allow for treatment of a greater number of children presenting with important growth retardation. Biosynthetic growth hormone is perceived as a innovative technologic advance. However, the pediatricians questioned showed prudence as to the risks of excesses as to indications.

[Treatment of precocious puberty with LH-RH agonists. Multicenter study using D-Trp-6-LH-RH in a programmed-release form]

LH-RH analogs, substituted in position 6 by D-tryptophane, D-serine(tBu), D-leucine or D-alanine induce a strong stimulation of the gonadotrophs, followed by a desensitization of the LH-RH receptors, which leads to a blockade of the gonadotropin secretion and to a hypogonadism. A delayed release preparation of D-Trp-6-LH-RH (Decapeptyl in microcapsules), designed to release the peptide for 28 days after intramuscular injection, was given to 69 girls and 18 boys with precocious puberty. In both, plasma levels of gonadotropins and gonadal steroids were suppressed within 3 weeks, whilst pituitary responses to LH-RH were almost abolished within 7 weeks. A significant improvement of secondary sex characteristics, as well as gonadal size, was obvious within 6 months. Growth velocity was markedly lowered and, more, in most of children, bone maturation was blocked. This study shows that Decapeptyl in microcapsules is more rapidly and more constantly efficient than LH-RH agonists given discontinuously by subcutaneous or intranasal route.

[Utero-ovarian echography during normal development and in sexual precocity]

Utero-ovarian ultrasonography provides biometric data concerning internal female sexual organs. The length of the uterus provides the best indication of estrogen impregnation. This low-cost, non-invasive examination is suitable for an initial investigation of whether the uterus is stimulated at the normal age or prematurely. The method can be used to monitor the advance of puberty as well as the effects of therapy, surgery, slowing by LH-RH analogs, puncture under ultrasound of a secreting follicular cyst. Follicular cysts of this type are now found to be very common, thanks to the possibilities offered by ultrasonography.

Long term treatment of male and female precocious puberty by periodic administration of a long-acting preparation of D-Trp6-luteinizing hormone-releasing hormone microcapsules

The efficacy and safety of a delayed release formulation of the LHRH agonist D-Trp6-LHRH (LHRH-A; im microcapsules) were tested in 16 girls, 0.9-8.8 yr old, and 10 boys, 2.0-10.5 yr old, with precocious puberty. All children had advanced bone age, breast or testis enlargement, and a pubertal LH response to LHRH. Precocious puberty was idiopathic in 19 subjects and secondary to a brain tumor or other central nervous system abnormality in 7. Nine girls and 6 boys had been previously treated unsuccessfully with medroxyprogesterone and/or cyproterone acetate. The microcapsules were made of 2% LHRH-A dispersed in a biocompatible biodegradable polymeric matrix of DL-lactide-coglycolide. Sixty micrograms of LHRH-A/kg BW were given im on days 1 and 21 and thereafter every 4 weeks for 10-27 months. Plasma LHRH-A levels were measured in 13 children by means of a specific RIA. On days 3, 7, 14, and 21, mean concentrations (+/- SEM) were 295 +/- 44, 218 +/- 31, 215 +/- 45, and 224 +/- 39 pg/ml, respectively. In girls, breast enlargement disappeared, and mean uterus size decreased from 44.4 +/- 2.5 to 38.1 +/- 3.1 mm (mean +/- SEM; P less than 0.02) within 6 months. Mean ovary length decreased from 23.0 +/- 1.5 to 16.2 +/- 1.5 mm (P less than 0.01). In boys, mean testis volume decreased from 8.1 +/- 1.2 to 6.7 +/- 1.2 ml (P less than 0.02) within 6 months. In both sexes, growth velocity decreased significantly, and bone maturation was generally reduced. Plasma levels of estradiol or testosterone and FSH levels decreased significantly within 3 weeks. The LH response to LHRH was reduced to normal prepubertal values after 7 weeks. No secondary clinical or biochemical escape occurred. In 1 boy, all biological features of puberty recurred within 1 month after omission of the fifth injection. No side-effects occurred, except for transient vaginal bleeding in girls after the first or second injection. No antibodies to LHRH-A were detected in the patients' sera. This study demonstrates the ability of a delayed release formulation of LHRH-A to achieve stable levels of the drug in plasma for at least 21 days after a single im injection and to suppress pituitary and gonadal secretion and pituitary response to LHRH for as long as 2 yr after therapy. This treatment appears to be more efficient in treating both clinical and biochemical abnormalities than does treatment with inhibitory steroids. Additionally, the method of administration is more practical and ensures better patient compliance.

[Plasma thyroglobulin in treated hypothyroidism in children]

In order to appreciate the value of the dosage of thyroglobulin (Tg) in the reappraisal of the classification of hypothyroidism after the onset of substitutive treatment and the supervision of patients treated with L-thyroxin (LT), plasma Tg and FT4 levels were studied in 42 samples from 21 hypothyroid children (ages ranging from 18 months to 16 years) under LT treatment. These patients were divided into 2 groups according to the results of scanning: group I: a thyroid (n = 8) and group II: ectopic or hypoplastic thyroid gland (n = 13). A control group consisted of 60 apparently healthy children of the same ages. Tg was undetectable in 11 samples of 6 children but significant levels (6.8 to 17 ng/ml) were found in 5 samples of 2 children. In group II, Tg could be measured in 20 of 26 samples, the mean level (+/- SEM) not being different from that in the control group (14.32 +/- 2.25 and 18.12 +/- 1.28 ng/ml, respectively). However, in this group, Tg levels seemed to be lower (9.75 +/- 3.94 ng/ml) in samples from patients with LT excess than in euthyroid or hypothyroid patients whose values of Tg were 15.8 +/- 3.36 ng/ml and 16 +/- 3.91 ng/ml, respectively.

[Knotting of Swan-Ganz catheter. How to unknot without surgery?]

While it is introduced, a Swan-Ganz catheter may occasionally become knotted at its tip. To unknot and remove it, a non-surgical technique based on the injection of warm (37 degrees C) saline under pressure is suggested. Knotting can be prevented by inflating the balloon at the tip of the catheter with 1.5 ml of air when it enters the vena cava.

[21-Hydroxylase deficiency. Clinical expression of heterozygote carriers in a family]

The observation of a neonate who presented with congenital adrenal hyperplasia due to 21-hydroxylase deficiency and of her aunt who presented with primary amenorrhea and hirsutism led to the genetic study of this family. The ACTH stimulation test and HLA typing proved that the young woman was heterozygous for the C-21 block and that the niece presented with the homozygous condition. This case confirms that, in rare cases, the clinical expression of C-21 block may appear in heterozygous carriers.

Betaxolol and propranolol in glucagon stimulation of growth hormone

Both betaxolol and propranolol, beta blockers with different pharmacological properties, increase the reliability of somatotropic testing with glucagon. The combination of glucagon and betaxolol, however, is much better tolerated than that of glucagon and propranolol. The use of a beta 1 cardioselective adrenoceptor block for growth hormone testing is recommended.

[Pelvic echographic data during normal and pathological development in girls]

From a population of 60 normal females divided in 4 groups of 15 according to age and puberty, standards of uterine length and ovarian volume as measured by ultrasonography were established. The length of the uterus increases moderately with age (mean: 26.4 mm under 2 years of age; 29.5 mm from 2 to 8 years; 36.5 mm from 8 to 12 years) and significantly with puberty (mean: 60 mm), as does the volume of the ovaries (mean: 0.98 cm3 from 8 to 12 years; 3.4 cm3 after puberty). These standards, confirming former data, allow a better understanding of ultrasonographic findings during pathologic growth in young females, such as precocious puberty, delayed puberty, hypopituitarism, or hyperandrogenism. Thus, this investigation may assume an important part in the diagnosis of disorders of puberty, as it is innocuous and may be repeated as often as necessary during the growth of young patients. As it is non invasive and inexpensive, it could be the first investigation in some of these indications.

Insulin-specific binding to erythrocytes in 6 girls with acanthosis nigricans

6 girls, aged 4-16 years, with acanthosis nigricans and hirsutism were studied. Fasting and postglucose hyperinsulinism was present in the 5 older girls. In the youngest, a transitory diabetes with hyperinsulinism was induced by a cortisone therapy for hepatitis. Insulin resistance, suggested by the failure to significantly decrease blood glucose after insulin injection (0.1 U/kg), was demonstrated in three steps: (1) Patient plasma failed to bind 125I-insulin after a 5-day incubation followed by precipitation by antihuman globulin serum. (2) Specific 125I-insulin binding to rat liver membranes was identical in the presence of patient plasma and control plasma. (3) Specific 125I-insulin binding to the erythrocytes of the 6 patients (3.5-7.0%) was significantly lower (p less than 0.01) than in controls (4.5-19.5%). Moreover, the significant correlation present in controls between total binding and reticulocyte counts (r = 0.824, p less than 0.001) was absent in the patients. These data demonstrate further that, in the juvenile type of acanthosis nigricans, insulin resistance which may precede hyperinsulinism is not related to anti-insulin antibodies nor to antireceptor antibodies, but results from a primary defect of insulin receptors.

[Echography in gonadal dysgenesis and ovarian dystrophy (author's transl)]

Pelvic ultrasound examination was performed in 28 patients presenting with disorder in the onset of puberty (13 suggesting gonadal dysgenesis and 15, ovarian hyperandrogenism). Results of this investigation were compared with those of coelioscopy, in order to establish the respective value of each technique in the diagnosis of disorders of puberty in girls. In patients with gonadal dysgenesis, echography may show 'residual gonads but coelioscopy remains necessary when results of radiologic investigation are negative, when clinical or hormonal data suggest that ovarian function is present. Ultrasound examination showed one or two enlarged ovaries in all but one patients in whom coelioscopy had shown this abnormality. Pelvic echography is now the first test to be performed in girls with disorders of puberty as it often permits to avoid coelioscopy.