Osteometabolic profile and bone mass in the transition phase: ethnic differences in Brazilians treated with somatropin during childhood

OBJECTIVE

The main growth hormone action is to promote linear growth increasing protein synthesis stimulation and osteoblastic activity. Peak bone mass extends from adolescence to 30 years of age. Several factors may influence this acquisition and prevent fracture risk in adulthood, such as genetic potential, GH, ethnicity, and lifestyle factors. This study aims to compare bone mass and osteometabolic profile of white and Afro-descendant Brazilian adolescents in the transition phase, who were treated with human recombinant growth hormone in childhood.

METHODS

The authors selected 38 adolescents from the Transition Outpatient Clinic of the University of São Paulo. Lumbar spine and total body bone mineral density (BMD) and bone mineral content (BMC), serum calcium, 25-OH-vitamin D and bone markers were analyzed at the rhGH withdrawal.

RESULTS

The mean age was 16.8 ± 1.6 years. There were 21 Afro-descendant and 17 whites. Thirty-four percent of the sample presented vitamin D insufficiency, 66% inadequate calcium intake and 44.7% physical inactivity. The Afro-descendants showed a lower lumbar spine and total body Z scores than those of the whites (p = 0.04 and p = 0.03, respectively), as well as their mean body weight (p = 0.03). There were no differences in the remaining osteometabolic parameters.

CONCLUSION

As most adolescents had vitamin D insufficiency, low calcium intake, and physical inactivity, calcium, and cholecalciferol supplementation and lifestyle changes should be encouraged. The Brazilian Afro-descendant may be a vulnerable group for low bone mass, requiring special strategies to increase bone accrual and body weight. More studies are necessary to compare ethnic differences in this population.

Variability in Probiotic Formulations Revealed by Proteomics and Physico-chemistry Approach in Relation to the Gut Permeability

Variability in the efficacy, safety, and quality of probiotic formulations depends on many factors, including process conditions used by manufacturers. Developing reliable analytical tools is therefore essential to quickly monitor manufacturing differences in probiotic samples for their quality assessment. Here, multi-strain probiotics from two production sites and countries were investigated by proteomics and physico-chemistry approaches in relation to the protective effect on gut barrier. Proteomic analyses showed differences in protein abundances, identities, and origins of two series of VSL#3 samples from different sites. Even though both formulations were qualitatively similar in thermal and colloidal profiles, significant differences were quantitatively observed in terms of maximum decomposition temperature Tmax (p < 0.05) and phase transition temperature Tm (p < 0.01). Such variability in physical and biochemical features impacts on probiotic functionalities and translates into a differential modulation of gut permeability in mice. Physico-chemical scans provide coherent data with proteomics and represent a new tool for time and cost effective quality control of probiotic-based products.

Pre-exercise skin temperature evolution is not related with 100 m front crawl performance

During the transition between warm-up and competition there is a change in core, muscle and (eventually) skin temperature that may affect swimming performance. We have aimed to assess skin temperature evolution during transition phases of different durations before a typical front crawl effort and to investigate its relationship with performance. Following a standardized warm-up, nine adolescent male swimmers performed three maximal randomized 100 m maximum front crawl trials after 10, 20 and 45 min transition phases. Skin temperature, performance (time, stroke frequency, length and index, and propelling efficiency), heart rate, lactate and perceived effort were assessed. Data showed a skin temperature log increase over time (R² > 0.96, p < 0.01) without differences from the 15 min with the following instants. Performance and psychophysiological variables were similar between transition phases. However, skin temperature at the end of the transition periods, i.e., just before the 100 m trials, was lower in the 10 min than the 20 and 45 min transitions (32.0 ± 0.6 vs 33.0 ± 0.4 and 33.5 ± 0.5 °C, respectively). The main finding was that no relevant relationships were observed between pre-test skin temperature and performance times (|r| < 0.6, p > 0.05) for the studied transition phases. We have concluded that transitions longer than 10 min will not present thermal changes and that, within the physiologic limits studied, pre-exercise skin temperature does not influence swimming performance.

Growth hormone deficiency and replacement in children

Growth hormone deficiency (GHD) is a rare but treatable cause of short stature. The diagnosis requires a careful evaluation of clinical history, physical examination and appropriate interpretation of longitudinal growth, with specific features for each period of life. Other clinical findings, in addition to growth failure, may be present and can be related to the etiology and to associated hormone deficiencies. Despite more than 50 years since the first reports of provocative tests of growth hormone (GH) secretion for the diagnosis of GHD, the interpretation of the results remains a matter of debate. When GHD is confirmed, GH treatment is recommended. Treatment is effective and safe, but requires daily injections during many years, which can affect adherence. At the end of longitudinal growth, during the transition phase, it might be necessary to re-evaluate GH secretion. This review summarizes and updates the recent information related to GHD in children, as well the recommendations for treatment.

Effectiveness of two thermal activated orthodontic archwire sequences based on transition temperature range during alignment: A randomized non-controlled comparative study

INTRODUCTION

It has been suggested that heat-activated NiTi archwires (HANT) speed up crowding alleviation. HANT wires are available with different austenite finish temperatures.

OBJECTIVE

The aim of the present study was to compare the effectiveness of two alignment sequences using thermally activated archwires with different austenite activation temperatures for the correction of mandibular anterior crowding.

MATERIAL AND METHODS

The following NiTi archwire sequence was used for both groups: 0.012 in (conventional NiTi), 0.018 in (heat-activated NiTi archwires), 0.016×0.022 in (heat-activated NiTi archwires) and 0.019×0.025 in (conventional NiTi). The conventional NiTi used for both groups belongs to the same commercial brand. Two different austenite activation temperatures (35°C and 37°C) were used for the heat-activated archwires. The primary outcome was the degree of crowding correction measured on study models. The secondary outcome was crowding survival time over a six-month period. This RTC included fifty-four patients that were randomly allocated to the two different archwire sequences. A Mann-Whitney test was used to compare the groups regarding crowding alleviation. A survival curve was created using the Kaplan-Meier method to illustrate the reduction of crowding over time. A Mantel-Cox log-rank test was used to compare survival times (until correction of crowding).

RESULTS

No differences in crowding alleviation were identified between both groups (log-rank test; P=0.77).

CONCLUSIONS

The two alignment sequences with different thermal activated archwires at 35°C and 37°C achieved similar clinical results during the correction of mandibular anterior crowding.

An especial transition phase of hospitals: the adaptation of hospital operations to the development of COVID-19 and policy adjustments

The ongoing pandemic coronavirus disease 19 (COVID-19) remains a significant issue for global health, economics, and society. In order to balance epidemic control and economic recovery, many countries have successively announced the gradual relaxation of some lockdown restrictions. Hospitals and medical staff constitute the backbone in this war against COVID-19. In response to this serious situation, many hospitals went into emergency and impaired healthcare access to patients with conditions other than COVID-19. Therefore, gradually promoting hospital operations and functions back to the new normal is important, especially when this outbreak has been effectively controlled. In this study, we introduce existing and potential problems that could seriously affect people’s health. Additionally, we propose that an especial transition phase between the emergency and regular modes of hospitals can be well adapted to the current situation.

Evaluation of hemodynamics in healthy term neonates using ultrasonic cardiac output monitor

BACKGROUND

Transition from intrauterine to extrauterine life is a critical phase during which several changes occur in cardiovascular system. In clinical practice, it is important to have a method that allows an easy, rapid and precise evaluation of hemodynamic status of a newborn for clinical management. We here propose a rapid, broadly applicable method to monitor cardiovascular function using ultrasonic cardiac output monitoring (USCOM).

METHODS

We here present data obtained from a cohort of healthy term newborns (n = 43) born by programmed cesarean section at Fondazione MBBM, Ospedale San Gerardo. Measurements were performed during the first hour of life, then at 6 + 2, at 12-24, and 48 h of life. We performed a screening echocardiography to identify a patent duct at 24 h and, if patent, it was repeated at 48 h of life.

RESULTS

We show that physiologically, during the first 48 h of life, blood pressure and systemic vascular resistance gradually increase, while there is a concomitant reduction in stroke volume, cardiac output, and cardiac index. The presence of patent ductus arteriosus significantly reduces cardiac output (p = 0.006) and stroke volume (p = 0.023). Furthermore, newborns born at 37 weeks of gestational age display significantly lower cardiac output (p < 0.001), cardiac index (p = 0.045) and stroke volume (p < 0.001) compared to newborns born at 38 and ≥ 39 weeks. Finally, birth-weight (whether adequate, small or large for gestational age) significantly affects blood pressure (p = 0.0349), stroke volume (p < 0.0001), cardiac output (p < 0.0001) and cardiac index (p = 0.0004). In particular, LGA infants display a transient increase in cardiac index, cardiac output and stroke volume up to 24 h of life; showing a different behavior from AGA and SGA infants.

CONCLUSIONS

Compared to previous studies, we expanded measurements to longer time-points and we analyzed the impact of commonly used clinical variables on hemodynamics during transition phase thus making our data clinically applicable in daily routine. We calculate reference values for each population, which can be of clinical relevance for quick bedside evaluation in neonatal intensive care unit.

Calorie intake is associated with weight gain during transition phase of nutrition in female extremely low birth weight infants

We sought to determine whether there are sex-based differences in the requirements for calories or protein for optimal growth during the transition phase (TP) when an extremely low birth weight (ELBW) infant, defined as a preterm infant with a birth weight of < 1000 g, is progressing from parenteral to enteral feeds. A retrospective review of ELBW infants born from 2014 to 2016 was performed at a tertiary NICU. Infants with necrotizing enterocolitis, short bowel syndrome, or chromosomal anomalies were excluded. TP was defined as the period when the infant's enteral feeds were increased from 30 up to 120 ml/kg/day while weaning parenteral nutrition (PN). Effects of sex and protein-calorie intake on the change in growth parameters from the beginning to the end of TP were analyzed. Pre-TP growth percentiles and calorie and protein intake were similar in both sexes. There was a significant (r = 0.22, p = 0.026) correlation of total calorie intake with a change in weight percentiles (wt.pc) for the whole group, but on sex-specific analysis, this correlation was more robust and significant only in girls (r = 0.28, p = 0.015). Protein intake did not correlate with the changes in wt.pc in either sex. Despite a similar intake of calories and protein during the TP, we found a significant decrease in wt.pc only in girls. More extensive studies are needed to understand the sex-based differences in caloric needs and metabolic rate in ELBW infants.

Progressive visual function impairment as the predominant symptom of the transition phase to secondary progressive multiple sclerosis: A case report

BACKGROUND

No reliable indicators of the transition to the progressive course in multiple sclerosis (MS) have been identified so far. The main clinical feature of the progressive phase of MS is usually impairment of walking. Magnetic resonance imaging and optical coherence tomography have emerged recently as promising tools to assess increasing neurodegeneration and axonal loss in disease progression in MS.

METHODS

CASE REPORT

RESULTS

We report a case of progressive visual impairment as the dominant symptom in the transition to secondary progressive MS.

CONCLUSIONS

Impairment of vision, together with walking and cognition, should be considered to better define the transition from relapsing/remitting to secondary-progressive MS.

How to quantify the transition phase during golf swing performance: Torsional load affects low back complaints during the transition phase

The transition phase of a golf swing is considered to be a decisive instant required for a powerful swing. However, at the same time, the low back torsional loads during this phase can have a considerable effect on golf-related low back pain (LBP). Previous efforts to quantify the transition phase were hampered by problems with accuracy due to methodological limitations. In this study, vector-coding technique (VCT) method was proposed as a comprehensive methodology to quantify the precise transition phase and examine low back torsional load. Towards this end, transition phases were assessed using three different methods (VCT, lead hand speed and X-factor stretch) and compared; then, low back torsional load during the transition phase was examined. As a result, the importance of accurate transition phase quantification has been documented. The largest torsional loads were observed in healthy professional golfers (10.23 ± 1.69 N · kg^-1), followed by professional golfers with a history of LBP (7.93 ± 1.79 N · kg^-1), healthy amateur golfers (1.79 ± 1.05 N · kg^-1) and amateur golfers with a history of LBP (0.99 ± 0.87 N · kg^-1), which order was equal to that of the transition phase magnitudes of each group. These results indicate the relationship between the transition phase and LBP history and the dependency of the torsional load magnitude on the transition phase.