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The suitable thickness for investigating three-dimensional granular column collapse has not yet been determined. In this study, granular columns with different column thicknesses and varying aspect ratios (ARs) (initial height/initial length) were examined by discrete element method simulations, after the numerical model was calibrated based on a previously reported study. The results showed that the normalized final height is significantly affected by the column thickness when AR ≥ 1. As W/d (column thickness/particle diameter) increases, the normalized run-out distance first increases gradually (W/d

Introduction Protocol for prescribing hormone replacement therapy in isolated growth hormone (GH) deficiency includes magnetic resonance imaging of the brain. There is controversy on the frequency of structural pituitary abnormalities and on the importance of abnormal MRI findings on prognosis and response to GH replacement. Methods A descriptive, retrospective study of children of both sexes aged 0–14 years, who had undergone brain MRI, diagnosed with isolated GH deficiency at a tertiary hospital in the past 14 years, aimed at reporting the frequency of abnormal MRI findings in isolated GH deficiency, and to establish whether differences exist in height diagnosis and evolution according to MRI findings. MRI findings were also compared with the findings reported in healthy children in order to establish incidence. Results 96 patients were studied, of whom 74/96 (77%) reached adult age. Abnormal MRI findings were seen in 11.5% of them (8/11 of pituitary origin). No brain or pituitary tumor was seen in any case. Patients with abnormal images had a mean age at treatment start of 8 years, a target height of −0.8SD, and a final height of 1.04SD, while patients with normal MRI findings had an age at treatment start of 10 years old, a target height of −1.44SD, and a final height of −1.75SD, with statistically significant differences. Conclusions Patients with abnormal MRI findings show a more favorable response to GH replacement therapy.

Background: Given the rarity of 11β-hydroxylase deficiency (11βOHD), there is a paucity of the data about the differences in clinical and biochemical characteristics of classic (C-11βOHD) and non-classic 11βOHD (NC-11βOHD).Objective: To characterize a multicenter pediatric cohort with 11βOHD. Method: The clinical and biochemical characteristics were retrieved. CYP11B1 gene sequencing was performed. Seventeen plasma steroids were quantified by liquid chromatography-mass spectrometry and compared to that of controls. Results: 102 patients (C-11βOHD; n=92, NC-11βOHD; n=10) from 76 families (46,XX; n=53) had biallelic CYP11B1 mutations (novel 9 out of 30). Five 46,XX patients (10%) were raised as males. Nineteen patients (19%) had initially been misdiagnosed with 21-hydroxylase deficiency. Female final height was 152 cm (-1.85SDS) and male 160.4 cm (-2.56SDS). None of the NC-11βOHD girls had ambiguous genitalia (C-11βOHD 100%) and none of the NC-11βOHD patients were hypertensive (C-11βOHD 50%). Compared to NC-11βOHD, C-11βOHD patients were diagnosed earlier (1.33 vs. 6.9 years, p 2.2

Droplet impact onto a substrate usually embedded the air film at the droplet/substrate interface. However, an in-depth understanding of the migration of air film and its influence on crystallization of supersonic droplet is still lacking. In this contribution, the high pressure of supersonic impingement effectively promoted the air solubility and broke up, resulting in the diameter of air bubble significantly reduced by one-sixteenth compared to the subsonic impingement. The thin air film was not insufficiently affected the heat diffusion and caused the formation of some amorphous films around nano-sized pores. The final height and width of columnar grains were approximately decreased by one-quarter and a half than that of flattened subsonic droplet. The intersection interface of splats atomically reconstructed and formed the partially epitaxial growth of [ 2 2 ‾ 0 ] direction of columnar grains, which essentially improved the cohesion property.

Human adult height has been increasing world-wide for a century and a half. The rate of increase depends on time and place of measurement. Final height appears to have reached a plateau in Northern European countries but it is still increasing in southern European countries as well as Japan. While mean birth length has not changed recently in industrialized countries, the secular trend finally observed in adult height mostly originates during the first 2 years of life. Secular trend in growth is a marker of public health and provides insights into the interaction between growth and environment. It has been shown to be affected by income, social status, infections and nutrition. While genetic factors cannot explain such rapid changes in average population height, epigenetic factors could be the link between growth and environment.

Poor linear growth is one of the main concerns in children with congenital adrenal hyperplasia (CAH). We aimed to analyze factors affecting growth trajectory in children with classical CAH.Clinical records of children followed from infancy up to the end of growth at two Italian tertiary referral hospitals were reviewed. Fifty-seven patients (31 males), treated with hydrocortisone and fludrocortisone only, were included. Clinical observations were divided into three groups: 0 to 2 years, 172 observations; from 2 years to puberty onset, 813 observations; after puberty onset, 527 observations. Height velocity, pubertal growth spurt, and final height were evaluated as outcomes.Final height standard deviation score (SDS) was lower than target height SDS (-0.74 ± 1.1 versus -0.31 ± 1.01; P.001). Target-adjusted final height SDS was -0.44 ± 1.8 in males and -0.13 ± 1.1 in females (P = .001). Total pubertal growth was 21.9 ± 7.3 cm in males and 19.2 ± 8.2 cm in females (P = .19). Hydrocortisone dose increased and height-velocity SDS decreased during puberty. At multivariable analysis, height-velocity SDS was adversely affected by hydrocortisone dose (P = .038) and directly related to adrenocorticotropic hormone (ACTH) levels (P = .023). Target-adjusted final-height SDS was adversely affected by hydrocortisone dose (P.001) and positively related to mineralocorticoid therapy (P = .001) and ACTH levels (P = .02). Total pubertal growth (cm) was positively related to ACTH levels (P = .01).Height outcome of CAH patients is now better than previously reported. During puberty, the lowest effective dose of hydrocortisone should be used to optimize pubertal growth spurt and final height.17-OHP = 17-alpha-hydroxyprogesterone ACTH = adrenocorticotropic hormone BMI = body mass index CAH = congenital adrenal hyperplasia GH = growth hormone HPA = hypothalamus-pituitary-adrenal PRA = plasma renin activity SDS = standard deviation score SV = simple virilizing SW = salt-wasting.

Fenugreek can be grown for medicinal purposes, as a spice or as an annual hay. Most fenugreek production is in India; none is grown in the USA. Practices suitable for growing fenugreek in the U.S. High Plains is unknown. The objectives were to identify the irrigation need, and planting and harvest dates in western Nebraska. Fenugreek was planted from early May to early June and harvested from late Aug to early Oct. Irrigation consisted of none, 15 and 30 cm. Height, flowering and fruiting, and seed and straw yields were measured. Later planting did not affect final height but delayed flowering and fruiting (late June to early Aug). Years differed due to weather variations. Seed and straw yields were greatest with later planting and with earlier harvest in 2013 and 2014. Irrigation affected yields primarily in 2013. The lowest yields were in 2015 when the agronomic parameters had the least effect probably due to the very wet spring conditions. For 2013 and 2014, maximum seed yields ranged from 1724 to 1886 kg ha −1 , and maximum straw yields ranged from 4352 to 4981 kg ha −1 when planted late, irrigated and harvested in late Aug or early Sep. Recommendations are that when May is very dry, plant near 1 June, irrigate and harvest in late Aug or early Sep, when May is slightly wet, plant in late May, do not irrigate and harvest early Sep, and when May is very wet, do not plant for seed and do not irrigate.

Background It is held that enzyme replacement therapy (ERT) accelerates the growth rate in children with Gaucher disease, but its effect on final height has not been established with certainty. This study presents final heights of Gaucher patients followed up for 15 years. Methods The study included 41 adults with non-neuronopathic Gaucher disease. The final height of the patients and age at puberty was compared to their mid-parental target height and to their siblings' heights. Results Mean final height standard deviation score (HSDS) in the patients was − 0.22, but none of the patients was abnormally short (HSDS of less than − 2.2). Mean age at menarche of the female patients (14.7 years) was significantly delayed compared to that of their mothers ( P = 0.0005), and mean age at first shaving in the boys was 16 years. Conclusion Our study showed that the mean final height of Gaucher patients fell below the mean of the 2000 CDC growth charts, but the patients were not of short stature (height less than the 3rd percentile). ERT treatment did not significantly impact the mean final HSDS. The onset of puberty, as indicated by the age at menarche, was delayed in girls with Gaucher disease.

Hippocampus reidi is one of the most popular seahorse species in the aquarium trade. The commercial breeding of this species is an alternative to reducing the fishing pressure on natural populations. Two experiments with newly born juveniles were conducted in this study to assess salinity tolerance (Lethal Time for 50% of the population-LT50), survival and growth during the first 10 days of life. A third experiment determined the isosmotic point of adults. The highest LT50 was observed at 10 psu, followed by 15, 20, 25, 30, and 35 psu, and the lowest LT50 was recorded at 5 psu. A negative relationship between salinity and final weight and between salinity and final height was observed through the regressions performed, such that a decrease in salinity (until the lowest level analysed; 10 psu) implied a higher growth in height and weight. The highest survival rates were observed between the salinities 10 and 25 psu. The isosmotic point of the species was determined at 11.68 psu (303.38 mOsm/kg), which is in agreement with the salinity where the best salinity results were observed in the first two experiments. Using an intermediate salinity to produce H. reidi on a commercial scale would be advantageous because of survival and growth improvement in addition to requiring a lower seawater uptake and less cost for purchase artificial salt.

Synopsis Healthy girls with early puberty are sometimes given gonadotropin-releasing hormone agonists (GnRHas) to delay their pubertal development until they reach an average age of onset. Feminist research has called this treatment into question, arguing that age at puberty should be seen in terms of diversity rather than normality and abnormality. In support of this feminist position, it is argued that treatment has been justified by an ideology that medicalises healthy girls to make them “normal.” This core objective has been linked to increasing final height, reducing psychosocial difficulties, delaying sexual activity and reducing the risk of abuse. All of these auxiliary treatment objectives have been justified by being fitted to evidence rather than tested against it, and all are problematic. Side effects of GnRHas, including reduced IQ, have not been properly addressed, the alternative of providing girls with support has been little considered, and the rights of the girls are not recognised.

In children with growth disorders, mean final height is associated to poor adherence to Growth Hormone therapy. The primary goal of this study is to identify patients who do not adhere to GH therapy and determine the influence of adherence in response to the treatment. The role of serum IGF-I and influence of socio-economic factors on the therapeutic adherence will also be evaluated.158 children under treatment with rhGH were included in the study. Age, gender, etiology, Tanner stage, duration of treatment, growth rate, IGF-I serum values, daily dose, and annual rhGH dose data were collected. Adherence to therapy was defined as moderate-to-poor when the patient had taken less than 92% of the prescribed medication. A subgroup of 106 patients completed a questionnaire to assess social and environmental effects.Moderate-to-poor adherence to rhGH treatment was determined in 33.5% of study patients. A decrease in adherence was associated to treatment duration (p=0.001). A significant correlation was determined between adherence and height velocity (p=0.002) and IGF-I (p0.0001) levels. Adherence rates were associated to the mother's educational level (p=0.007).Poor adherence to GH therapy was observed in one-third of study patients, resulting in suboptimal growth. IGF-I levels can be helpful to identify patients with poor adherence to GH medication. Physicians should pay special attention to certain characteristics of the patient and their environment, and encourage desirable therapeutic compliance.

Aphrons are surfactant stabilized microbubbles with thick soapy shells. Stability is a key feature of microbubbles. Colloidal gas aphrons (CGAs), with an average diameter of 50 μm, offer particular advantages where the stability of microbubbles is of interest. Various factors that affect on CGA stability such as surfactant type, concentration, and processing parameters have been extensively studied. However, there is no simple and accurate stability index for characterizing the stability of microbubbles dispersion. In this study, the stability of CGAs dispersion has been examined based on the drainage curve by four stability indexes. The surfactant of choice was nonyl phenol ethoxylate (NPE), a nonionic surfactant. The results show that the one-tenth of drained liquid life ( T 0.1 ), the time elapsed when the drained liquid from CGA dispersion reaches ten percent of its final height is the best indicator among the other stability indexes for characterizing the CGAs dispersion.

Objective To describe in practical terms the clinical management in adult life of patients with Turner syndrome. Material & methods Systematic review of the literature and practical issues. An evaluation of clinical trials, meta-analysis, case reports and reviews assessing the management of different conditions related to Turner syndrome was done using the following data sources: Medline, PubMed (from 1966 to July 2014) and the Cochrane Controlled Clinical Trials Register, Embase (up to July 2014). Results Extracted information is summarized here on karyotype, screening of malformations, malformations debuting in adult life, final height, treatments with growth hormone, cardiovascular risk, endocrino-metabolic and liver abnormalities, sensorineural disorders and osteoporosis and its treatment. Conclusions This review provides recommendations for the management of adult patients with Turner syndrome and insight into the associated medical complaints. A link between karyotypes and clinical features suggests a novel hypothesis to explain the different phenotypes and clinical abnormalities of these patients.

Growth impairment in children with asthma, as a consequence of inhaled corticosteroids (ICS), is a major issue. Adverse systemic effects of ICS have been reviewed extensively, but no clinically relevant effects are reported if they are used in an appropriate dose as advocated in most guidelines. Growth studies can be divided into knemometry studies, intermediate term studies, and long term studies up to final adult height. These different studies provide different information. Knemometry demonstrates a dose dependent systemic effect, while all intermediate term studies demonstrate growth reduction of approximately one cm after one year of treatment. Most reassuring is that this delay seems to be temporary. The one study with a follow-up to final height shows no differences between the ICS and non-ICS treated children. The studies suggest that the use of ICS with respect to growth is safe if these drugs are used in a low to medium dose.

Objectives Growth failure is a permanent sequelae in juvenile idiopathic arthritis (JIA). The aim of the study was to compare pubertal growth in control and growth hormone (GH) treated JIA subjects. Design 64 children with JIA at a mean age of 10.38 ± 2.80 years were enrolled and followed until final height (measured in standard deviation (SD) scores). 39 children (20 m) received GH therapy and 24 (9 m) served as controls. GH dose was 0.33 mg/kg/week. Linear regression analysis was performed to identify factors influencing total pubertal growth. Results Mean total pubertal growth was 21.1 ± 1.3 cm (mean ± SD) in GH treated JIA patients and 13.8 ± 1.5 cm in controls. Final height was significantly higher with GH treatment (− 1.67 ± 1.20 SD) compared to controls (− 3.20 ± 1.84 SD). Linear regression model identified age at onset of puberty (s = − 4.2,CI: − 5.9, − 2.6 in controls and s = − 2.3,CI: − 3.6, − 1.1 in GH treated) as the main factor for total pubertal growth. Final height SDS was determined by the difference to target height at onset of puberty (s = − 0.59;CI: − 0.80, − 0.37 in controls and s = − 0.30,CI: − 0.52, − 0.08 in GH treated), age at onset of puberty (s = 0.47;CI:0.02,0.93 in controls and 0.23;CI: − 0.00,0.46 in GH treated) and height gain during puberty (s = 0.13;CI:0.05,0.21 in controls and s = 0.11;CI:0.07,0.16 in GH treated). Conclusion Total pubertal growth in JIA patients treated with GH was increased by a factor of 1.5 greater in comparison to controls leading to a significantly better final height. To maximize final height GH treatment should be initiated early to reduce the height deficit at onset of puberty.

Approximately 10% of small for gestational age (SGA) children maintain a small body size throughout childhood and often into adult life with a decreased pubertal spurt. Growth hormone (GH) therapy increases short-term growth in a dose-dependent manner and adult height had now been well documented. Shorter children might benefit from a higher dose at start (50μg/kg/day). The response to GH treatment was similar for both preterm and term short SGA groups and the effect of GH treatment on adult height showed a wide variation in growth response. As a whole, mean adult height is higher than -2 SDS in 60% of patients and 70% reached an adult height in their target height with better results with higher doses and combined GnRH analog therapy in those who were short at onset of puberty.

It has been shown that changes in IGF-I and IGFBP levels in children with classical congenital adrenal hyperplasia due to 21-hydroxylase deficiency (CAH) are correlated with different states of metabolic control. Our approach was to analyze the serum levels of IGF-I, IGFBP-3, their molar ratio IGF-I:IGFBP-3 (MR), and ALS in a cohort of CAH children and adolescents, and their associations with different clinical and biochemical parameters.56 patients, aged between 5.6 and 19.0 years were studied cross-sectionally. All patients had genetically proven CAH and received standard steroid substitution therapy. We measured serum levels of IGF-I, IGFBP-3, and ALS by commercial ELISA and calculated MR and assigned population-based SD scores (SDS).(median, quartiles) Overall IGF-I was not significantly altered (0.05 SDS, -1.21, 0.92), whereas IGFBP-3 was significantly elevated (1.50 SDS; 0.58, 1.95, p0.0001) compared to the reference population. Consecutively, MR was decreased (-0.64 SDS; -1.38, 0.32; p=0.0017). ALS was clearly decreased (-1.95 SDS; -3.075, -1.00; p0.0001). ALS, IGF-I, MR, and IGFBP-3 SDS were lower in pubertal than in prepubertal patients (p0.05). ALS SDS were lower in girls (p=0.0038). Correlation analyses (r(s), p) revealed correlations between MR/ALS and chronological age (-0.583,0.0001/-0.428, 0.0010), MR/ALS and Tanner stages (-0.500,0.0001/-0.334, 0.0118), MR/ALS and bone age (0.407, 0.0075/0.426, 0.0049), and between MR and ALS (0.405, 0.0020), respectively. For MR and ALS, we found no significant correlations for BMI, HOMA-IR, hydrocortisone and fludrocortisone dosage, or parameters of metabolic control.Our data provide evidence that the components of the trimeric IGF-I-IGFBP-3-ALS complex are altered in CAH children with possible implications on pubertal growth and final height.

Photosynthetic characteristics, chlorophyll index and leaf area were examined in selected leaves of cucumber ( Cucumis sativus L. cv. Euphorbia). In the first experiment, plants of cucumber were grown horizontally at a lighting period of 20 h day −1 . Photosynthetic measurements in horizontally growing cucumbers showed that there was no decline in photosynthetic capacity when cucumber leaves are developing under good light conditions. In a second experiment, plants were grown in a traditional high-wire cultivation system under 20 h day −1 lighting period until they reached final height and then exposed to different lighting periods (20 and 24 h day −1 ) for 3 weeks. In stands of cucumber plants photosynthetic measurements showed that the lower leaves have a significant reduction in photosynthetic capacity due to reduced light conditions. Three weeks exposure to 24 h day −1 lighting period reduced leaf area by 20%. Plant grown under continuous light had also lower chlorophyll index compared to plants grown under 20 h day −1 lighting period.

In the management of ISS auxological, biochemical, psychosocial and ethical elements have to be considered. In boys with constitutional delay of growth and puberty androgens are effective in increasing height and sexual characteristics, but adult height is unchanged. GH therapy is efficacious in increasing height velocity and adult height, but the inter-individual variation is considerable. The effect on psychosocial status is uncertain. Factors affecting final height gain include GH dose, height deficit in comparison to midparental height, age and first year height velocity. In case of a low predicted adult height at the onset of puberty, addition of a GnRH analogue can be considered. Although GH therapy appears safe, long-term monitoring is recommended.

With modern growth hormone (GH) replacement algorithms, children with a diagnosis of growth hormone deficiency achieve at the end of pediatric GH treatment an adult height that is on the average in the normal range. Recent experience with GH replacement in young adults with childhood-onset growth hormone deficiency, however, has shown that these patients present with variable degrees of somatic immaturity. As childhood GH treatment is discontinued when final height is attained, attention moves to the phase of somatic development that follows the end of longitudinal growth, called ''transition'', which had been excluded previously from consideration for either pediatric or adult GH replacement. This article reviews the changes taking place during this phase of development and their relevance for the attainment of adult body maturation. The critical role of GH in this process is described.

Summary Objective There is uncertainty as to whether asthma has an effect on final height. We investigated using subjective and objective assessments whether untreated asthma is associated with final height, leg length and sitting height to leg length ratio in an area of Chile in which almost no one received asthma treatment. Methods We collected data on 1232 males and females aged 22–28 years in a semi-rural area of Chile. Information on asthma was collected using the European Community Respiratory Health Survey (ECRHS) questionnaire. We assessed sensitisation to eight allergens and bronchial hyper-responsiveness (BHR) to methacholine as a dichotomous variable and as a log slope. Information on possible confounders in terms of smoking, birth weight, number of siblings and socio-economic factors such as household possessions, car ownership and education was available. Results Regardless of the asthma assessment used, there was no association between asthma symptoms, diagnosis of asthma, atopy, BHR as log slope, binary or categorical and height, leg length or the ratio of sitting height to leg length. The latter was used as a potentially more appropriate measure to assess a detriment of growth. Conclusion Asthma as assessed in community studies is unrelated to final height or body proportions.

Few data exist on the diagnostic criteria, and on the effects of puberty induction, in boys with constitutional delay in growth and puberty (CDGP). We, therefore aimed at developing puberty nomograms based on Danish boys with normal pubertal development. Furthermore, we evaluated the different diagnostic criteria and the effect of oral testosterone undecanoate (TU) in boys with CDGP. Participants One hundred and sixty-four (36%) boys evaluated for CDGP were excluded due to missing data, reclassification, or associated comorbidities, yielding 287 (64%) eligible for analysis. Results Seventy-eight (27%) of the 287 boys had delayed pubertal onset according to the classical criteria, whereas 173 (60%) of the 287 boys had impaired pubertal progression according to the puberty nomogram. Ninety-six (56%) of these 173 boys were treated with oral TU for 0.8 years (0.5;1.3) [median (25th; 75th percentiles)], which resulted in beneficial effects on pubertal progression. Height increased from -1.9 SD (–2.5;–1.2) to –1.5 SD (–2.1;0.7) ( p p = 0.001) following one year of oral TU treatment. Conclusions The puberty nomogram evaluates both delayed pubertal onset as well as delayed pubertal progression and allows separation of normal versus abnormal pubertal development. Oral TU treatment was followed by pubertal induction and progression and short-term growth without compromising final height.

The main aim of sex steroid replacement during induction of puberty is to obtain a balance between healthy psychological and somatic development and optimal final height and peak bone mass (PBM). At present, the age at which it is considered appropriate to begin inducing puberty is younger than it was in the past. This trend aims for optimisation of prepubertal and pubertal growth through earlier onset of growth hormone (GH) therapy and administration of higher doses during puberty as necessary. Adequate initiation of puberty should ensure not only optimal final height and psychological balance, but also normal body proportions, appropriate bone formation and preservation of fertility for children with GH and gonadotropin deficiencies.

During the past decade, the safety and efficacy of long-term treatment with recombinant human growth hormone (rhGH) in children with chronic renal failure before and after renal transplantation has been established. This article reviews the increasing evidence that rhGH treatment also results in a significant improvement of adult height in patients with childhood-onset chronic renal failure. The eventual height benefit of extended rhGH treatment appears to be 1.0 to 1.5 standard deviations on average. Whereas prepubertal rhGH treatment has a beneficial effect on final height, the efficacy of rhGH during puberty is less evident. The cumulative duration of rhGH treatment was found to be the most important positive, and the duration of dialysis treatment periods a negative predictor of rhGH efficacy, stressing the importance of prolonged rhGH treatment starting early in the course of chronic renal failure.

Fundamento Analizar los efectos del tratamiento con analogos de la LHRH en ninas con inicio puberal a los 8 anos. Pacientes y metodo Estudio clinico no aleatorizado con dos grupos paralelos en 32 ninas con pubertad avanzada (16 control y 16 tratadas con triptorelina a 3,75 mg/mes, durante un ano).Estudio antropometrico: talla, peso, perimetro braquial y cuatro pliegues subcutaneos; estadios puberales, talla diana, edad de la menarquia y talla final. Se calculo la duracion puberal (anos desde el inicio puberal hasta el momento de adquisicion de la talla final) y el crecimiento puberal en talla (ganancia en centimetros desde el inicio puberal a la talla final). Resultados a) El tratamiento con analogos de la LHRH retrasa la menarquia (11,5 [1,46] frente a 10,37 [0,67] anos; p = 0,03), produce una retrogradacion de los caracteres sexuales secundarios, disminuye transitoriamente la velocidad de crecimiento en talla y la progresion de la maduracion osea. Pero son similares la duracion puberal (5,1 [1,1] frente a 5,2 [0,6] anos; p = NS) y el crecimiento puberal en talla (28,0 [4,2] frente a 30,6 [2,6] cm; p = NS) cuando se comparan el grupo control y el grupo tratado. b) La talla final es similar en ambos grupos (160,5 [5,1] frente a 161,2 [5,7] cm; p = NS). c) Ni con el tratamiento ni en edades posteriores se produce entre ambos grupos una diferencia significativa en la masa grasa corporal. Conclusiones El tratamiento con analogos de la LHRH en la pubertad avanzada modifica su desarrollo, sin modificar su duracion ni el crecimiento puberal en talla, lo que explica que no consiga ninguna mejora de la talla final.

Long-term effects of growth hormone (GH) treatment were studied in 59 GH deficient (GHD) children, whose treatment was started before the age of 1 year, during the period 1978-1992, under the supervision of the France-Hypophyse Association. Mean duration of treatment was 8 +/- 3.6 years. At the last evaluation, 20 patients (34%) had a height above normal mean for age, and 50 (85%) had a height above the second lower standard deviation (SD) for age. Final height prediction performed in 29 patients was greater than target size (-0.35 +/- 1.4 SD vs -0.56 +/- 0.79 SD). These results show that early treatment of GHD infants allows normal statural growth in the majority of the cases; in addition, they underline the importance of early diagnosis of GH deficiency.

Summary At present in the UK, growth hormone is licensed for the treatment of short stature caused by impaired growth hormone secretion, Turner's syndrome, renal failure and for hormone replacement in adults known to be growth hormone-deficient. It is clear that there are significant benefits of treatment on the final heights of children with growth hormone deficiency. In contrast, the benefits of therapy on the final height of children with Turner's syndrome may not be as great as were originally anticipated. The optimum method of increasing final height in both Turner's syndrome and renal failure is yet to be established and, if such children are treated long-term, the value of continued growth hormone in individual cases requires constant realistic re-evaluation. Although growth hormone has been shown to accelerate the short-term growth of children with a variety of other causes of short stature, the widespread and idiosyncratic use of growth hormone cannot be justified in these other groups until the benefits of therapy on final height have been demonstrated by carefully conducted research studies involving comparisons with suitably randomized, untreated control groups.

Summary Background Short-term studies have demonstrated acceleration of growth rate following administration of biosynthetic human growth hormone (r-hGH) to short normal children. We describe the effect of such treatment on final height. Methods This was an open study of consecutive referrals to a growth disorder clinic from which 16 short children (height standard deviation score [SDS] −2·17 [range −1·8 to −3·3]; height velocity SDS −0·44 [0·33]; peak serum GH response to stimulation 27·9 mU/L [9·2] were treated with r-hGH, and 7 short children who declined treatment (height SDS −2·34 [0·61]; height velocity SDS −0·36 [0·28]; peak serum GH response 28·2 mU/L [6·8]) acted as an observation group. Subcutaneous r-hGH dose ranged between 12·2 and 21·0 U/m 2 per week (0·02–0·04 mg/kg per day) for the first 2 years of treatment and 20 U/m 2 per week thereafter. 3 untreated children were lost to long-term follow-up. Findings r-hGH significantly increased the difference in final height compared with pretreatment predicted height (+0·42 SDS [0·79], p=0·03) but this change was not significantly greater than that of the observation group (+0·16 SDS [0·20]). Treatment had no effect on the timing of puberty. Boys progressed slightly faster through puberty, associated with an acceleration in bone-age maturation. No untoward effects on glucose metabolism were observed. Long-term therapy did not alter body-fat distribution or blood pressure. Interpretation Long-term therapy in this group of children appears safe but the small increment in final height, approximately 2·8 cm in boys and 2·5 cm in girls, does not justify the widespread use of r-hGH for short normal children.

Eighteen healthy, short children with normal growth during most of their childhood were evaluated after a sustained fall in weight and reduced linear growth. Growth was followed after nutritional counseling until final height. This report demonstrates the need for an appropriate-for-age weight gain in growing children as a relatively minor but prolonged caloric restriction, leading to a sustained fall in weight centiles, will affect growth velocities long term and may lead to reduced final heights.

Objectives: To study final height after long-term growth hormone (GH) treatment in girls with Turner syndrome (TS). Patients: One hundred fifty three patients with TS, participating in five European trials, were included. They started GH treatment in 1987-1989 at an age of 10 years or older. Mean age at start of treatment ranged between 11.7 and 14.6 years among countries and mean bone age between 9.4 and 11.8 years. Fourteen girls were lost to follow-up, leaving 139 for analysis. Most girls have now attained final height (FH), defined as a linear growth velocity (GV) of 4 mm/yr or less, measured over at least 6 months (group 1, n=56), or near-FH, defined as a GV of 5 to 9 mm/yr (group 2, n=22). Sixty-one girls were still growing 10 mm/yr or more. Methods and main results: At the last measurement, mean (SD) height was 150.7 (4.9) cm in group 1 and 148.5 (5.1) cm in group 2. The differences between FH and projected final height based on extrapolation of the initial height-standard deviation score on Turner syndrome reference values, were 2.9 (3.8) and 3.0 (3.3) cm, respectively. The mean gain over the Bayley-Pinneau prediction of FH was 3.3 (3.9) cm in both groups. No significant differences between countries were found. The range of gains over projected height (-4.7 to 12.1 cm) was large, and 25% of gains were 5 cm or more. Gain over initial projection was strongly related to initial growth delay and to growth response during the first 2 years of treatment. A logistic regression model is presented that predicts gain of more than 5 cm with a positive predictive value of 62% and a negative predictive value of 84%. Conclusions: Long-term GH treatment in girls with TS, starting treatment at a relatively advanced age (>10 years) resulted in a modest mean gain in FH of 3 cm, with wide interindividual variation. (J PEDIATR 1995;127:729-35)

Seventy-eight patients who had constitutional delay of growth and puberty were included in a retrospective study to determine whether, at the time of first evaluation, any predictive features could suggest final height outcome. Mean chronologic age was 14.3 years (range, 12 to 18 years), and all were either prepubertal or in an early stage of pubertal maturation (4 ml testicular volume). Initial mean (±SD) height standard deviation score was −:2.74 (±0.71); 85% had a relatively short spine compared with subischial leg length. Mean (±SD) growth rate was 4.8 (±1.6) cm/year, and epiphyseal maturation was delayed by 2.4 (±1) years. Sixteen boys were treated with a sustained-action preparation of testosterone (50 mg monthly for 3 to 4 months), six with oxandrolone (1.25 mg daily for a mean of 4 months), and one with both drugs in sequence. At final height attainment, 58% of the boys failed to achieve their full genetic potential; among the remaining 42%, only 0.7% attained a final height above corrected mid-parental height. The relative disproportion between the segments had no significant change at final height attainment. Regression analysis showed that final height impairment (the difference between mid-parental height and final height) was negatively influenced by standing height and growth velocity when initially evaluated and positively by the degree of segmental body proportion; that is, patients who were taller, were growing at a faster rate, and who had a major degree of segmental body disproportion with a short spine and long leg length attained a final height closer to their mid-parental height, irrespective of the degree of delayed epiphyseal maturation. Neither testosterone nor oxandrolone administered during early puberty modified final height attainment or segmental proportion. We conclude that a late onset in the timing of puberty seems to be deleterious to spinal growth and consequently to final height attainment. An alternative diagnosis should be sought among patients with features of constitutional delay of growth and puberty who do not have a significant degree of body disproportion. In these patients, as well as in those who are extremely short, who have a poor growth rate, or who have an unfavorable genetic potential, an alternative therapeutic approach may be required. ( J PEDIATR 1995;126:545-50)

Biomass production and plant quality vary between plant species and morphological components of a plant. The purpose of this two-part experiment was (1) to study the influence of energycane [ Saccharum sp. (L.) ‘US 72-1153’] harvest treatments (6) on dry biomass yield and (2) monitor changes in quantity and quality of plant components with increased plant height. Treatments for Part 1 determined the influence of plant height when harvested at 1.2, 2.5, and 3.7 m, mature stage in October (4.9 m, in flower), mature stage in December (4.9 m, in flower), and additional treatment harvested in October, which received half the total N (168 kg ha −1 ) on dry biomass yield from 1986 to 1989. Part 2 treatments were to monitor changes in quantity and quality (crude protein and in vitro organic matter digestion) of plant components (green leaf, dead leaf, and stem) at 0.6 m plant height increments to a final height of 4.3 m during 1986 and 1987. Treatments from both parts of the study received 25 kg P ha −1 and 93 kg K ha −1 in one application and 336 kg N ha −1 yr −1 in single or split applications applied prior to growth of each harvest. Plants repeatedly harvested at the 1.2 m height (Part 1) and mature stage produced a 4-year average yield of 10 and 48 Mg ha −1 yr −1 dry biomass, respectively and decreased in dry biomass yield 89% (1.2 m harvest) and 53% (mature harvest) between years 1 and 4. The stem (1986 and 1987) and dead leaf (1986) plant components increased quadratically as plant height increased, and green leaf decreased from 70% (0.6 m) to 17% (4.3 m height). The crude protein concentration decreased 51% (green leaf) and 81% (stem) and in-vitro organic matter digestion decreased 54, 32, and 34% for dead leaf, green leaf, and stem, respectively as plant height increased from 0.6 to 4.3 m. These data indicate that harvest management is an important factor for energycane biomass yield, ratoon-crop success and plant quality if biomass is used as a methane source.

We describe the capillary rise along a vertical thin fibre. We first recall what the final height of the meniscus is, and give some predictions about the dynamics of the rise. Then we present an experiment, in a situation of complete wetting: a fibre is brought into contact with a reservoir of silicone oil, and the dynamic contact angle is measured, from 90° (just at the contact) to 0° (the equilibrium position). Most of the rising time is spent in a long regime of relaxation towards equilibrium, where θ(t) varies as 1/√t. A characteristic time τ is also measured, and studied as a function of the liquid viscosity.

We analyzed growth and final heights in 127 patients (68 female patients) treated for childhood acute lymphoblastic leukemia. Central nervous system prophylaxis included either no cranial radiation therapy (CRT) (n = 38), irradiation with 1800 centigrays (cGy) (n = 36), or irradiation with 2400 cGy (n = 53). None of the patients received spinal irradiation. Mean (+/- SEM) age at diagnosis was 6.4 +/- 0.25 years, mean height standard deviation score (SDS) at diagnosis was 0.28 +/- 0.12, and mean age at final height was 18.26 +/- 0.19 years. The change in height SDS between diagnosis and achievement of final height was significant for all treatment groups: -0.49 +/- 0.14, no CRT; -0.65 +/- 0.15, 1800 cGy; and -1.38 +/- 0.16, 2400 cGy. Irradiated patients had a greater loss in height SDS compared with the nonirradiated patients (p < 0.01), and those treated with 2400 cGy CRT had a greater decrease in final height SDS than the patients treated with 1800 cGy (p < 0.01). Both younger age and female sex were significantly associated with a greater decrease in height SDS in the patients treated with CRT; girls < or = 4 years of age at diagnosis had a mean loss in height SDS that was more than twice that observed for others treated with the same dose of CRT. Thus, although modern regimens for acute lymphoblastic leukemia (no CRT or 1800 cGy CRT) appear overall to have only a modest impact on final height, patients, especially girls, treated with 1800 cGy CRT at a young age remain at risk for clinically significant growth failure.

Constitutional delay of growth and adolescence (CDGA) is characterized by simultaneous retardation of growth, skeletal maturation and sexual development. Primarily longitudinal growth is impaired. The late occurrence of puberty is a secondary phenomenon brought about by the retarded physical development. Plasma levels of sex hormones and gonadotrophin correlate with bone age, not with chronological age. The provocation tests for growth hormone (GH) show normal results. In contrast, the spontaneous secretion of GH, measured half-hourly through the night or over 24 hours, is markedly reduced. Plasma somatomedin C is diminished. According to these data, CDGA is not a genuine GH deficiency but represents a cybernetic disorder coinciding with a false threshold for GH. As shown by large series of investigations, the final height of the patients lies on average 1.85 SD below the mean of healthy adults, with large individual variations. The decision as to whether treatment by growth promoting hormones should be performed should be made with regard to the individual height prognosis. With GH in physiological doses growth velocity can be considerably increased. Bigger doses of the hormone appear to be necessary in order to enhance final height. Treatment by anabolics and testosterone increases height velocity only, not adult height.

Climatological differences accompanying changing land use from traditional pastoral farming to fruit orchards were measured over a 6-year period. During this time evergreen shelter belts, which subdivide orchards into 0.5-ha blocks, grew from establishment to an average final height of nearly 10 m. The main result was a progressive reduction in the relative wind run at 6 m which was linearly related to shelter height with a slope of −6% m−1. In this humid coastal region, shelter did not appear to influence minimum air temperatures. On the other hand, significant increases in 09.00 h soil and maximum screen air temperatures amounting to around 1°C for 10-m-high shelter were measured. These modest temperature increases were also linearly related to shelter height.