抗早熟Ⅱ号对青春期大鼠长骨干骺端胰岛素样生长因子1及其受体基因表达的影响

目的观察抗早熟Ⅱ号对青春期大鼠长骨干骺端胰岛素样生长因子1(IGF1)及胰岛素样生长因子1受体(IGF1蛳R)基因表达的影响,探讨抗早熟Ⅱ号对长骨干骺端骨生长的作用机理。方法将青春期SD雌性大白鼠分为2组,对照组喂饲生理盐水1个月,实验组喂饲抗早熟Ⅱ号中药合剂1个月,采用实时荧光RT蛳PCR定量检测技术检测大鼠长骨干骺端IGF1mRNA及IGF1蛳RmRNA表达水平。结果实验组长骨干骺端IGF1基因表达水平较对照组显著下调(t=10.268,P<0.05);两组间IGF1蛳R基因表达水平差异无统计学意义(t=0.110,P=0.914)。结论抗早熟Ⅱ号通过使长骨干骺端软骨细胞IGF1的基因表达水平下调,从而抑制长骨生长,延缓骨骼成熟。     

Continuous exposure to dibromoacetic acid delays pubertal development and compromises sperm quality in the rat.

Previously our work on the haloacid by-products of drinking water disinfection focused on adult exposures. Herein we evaluate the consequence of continuous exposure to dibromoacetic acid (DBA) via drinking water through reproductive development into adulthood. An initial study in which offspring were exposed from gestation day (GD) 15 through adulthood revealed significant delays in preputial separation and vaginal opening, dose-related decreases in the fertility of cauda epididymal sperm, and dose-related diminutions in the sperm membrane protein SP22. Subsequent studies consisted of groups in which exposure ceased on postnatal day 21 (PND 21) versus adulthood. For each exposure, animals were evaluated after puberty (PND 56) as well as at adulthood (PND 120). Exposure to 4, 40, or 400 ppm DBA from GD 15 through PND 21 failed to result in any significant reproductive alterations. By contrast, continuous exposure until adulthood resulted in dose-related alterations consistent with those observed in the dose-finding study. Preputial separation and vaginal opening were delayed 4 and 3 days in males and females exposed to 400 ppm (76.3 mg/kg) DBA. This was associated with increased responsiveness of both the testis and ovary to hCG ex vivo; hCG-stimulated testosterone production by testicular parenchyma on PND 56 was increased at 4 ppm (0.6 mg/kg) DBA and higher. Finally, the quality of proximal cauda epididymal sperm was compromised by continuous exposure to DBA. The sperm membrane proteome was altered in a dose-related manner with SP22, and one of its charged variants, diminished at 40 ppm (3.6 mg/kg) DBA and higher. As more sensitive endpoints are evaluated, lower effect levels can be attributed to haloacid exposure. We are now extending our evaluations to epidemiology studies designed to evaluate sperm quality in men exposed to varying levels of disinfection by-products.     

Changes in steroid metabolism among girls with precocious puberty may not be associated with urinary levels of bisphenol A

Precocious puberty (PP) refers to the appearance of physical and hormonal signs of pubertal development at an abnormally early age. Urinary steroid signatures obtained from 42 patients with central PP and 40 patients with peripheral PP were assessed to compare metabolic changes. Levels of androgens such as testosterone, androstenedione, androstenediol, 16α-hydroxy-dehydroepiandrosterone, and 5α-androstenedione tended to be high in both PP groups, and the level of 17β-estradiol was higher in the central-PP group (P < 0.01) than in the peripheral-PP and 32 age-matched healthy girls. Altered steroid metabolism was also associated with urinary BPA levels, and levels of testosterone, 17β-estradiol, and pregnenolone were significantly increased among individuals with high BPA levels. In particular, a correlation was observed between estrogen metabolism and BPA levels irrespective of the type of PP. These findings suggest that in girls, BPA exposure causes metabolic changes in steroidogenesis, but not the early onset of PP.     

长效促性腺激素释放激素类似物对特发性中枢性性早熟的疗效观察

目的探讨分析长效促性腺激素释放激素类似物对特发性中枢性性早熟的临床疗效。方法选取2012年5月-2013年5月在我院接受治疗的30例特发性中枢性性早熟患儿，所有患儿均符合特发性中枢性性早熟的诊断标准，使用GnRH—a的缓释制剂曲普瑞林即达菲林对30例患儿进行治疗，给药剂量为根据患儿体重给药：对于体重大于等于20kg的患儿给药剂量为每个月3．5mg，对于体重小于20kg的患儿给药每个月1．8mg，治疗疗程为6～12个月。治疗期间每月定期观察记录患儿的身高、体重、第二性征等项目变化，同时记录患儿出现的任何药物副作用。结果治疗后患儿身高的增长速率明显减缓、骨龄指数增长速度同样减缓（p〈0．05），差异具有统计学意义；女惠儿乳房发育得到明显控制，治疗6个月后乳房发育积分明显低于治疗前，两者差异显著（P〈0．05），同时，女患儿阴毛发育积分、子宫发育积分、以及卵巢发育积分均较治疗前有明显降低（p〈0．05），差异具有统计学意义；男患儿通过治疗，睾丸均停止发育，阴毛积分也较治疗前得到了明显降低，数据对比差异显著（P〈0．05），差异具有统计学意义；治疗后患儿激素峰值水平和治疗前峰值水平相比均明显下降，P〈0．05，而IGF—1（胰岛素样生长因子）和E2则没有明显变化。结论使用GnRH—a药物治疗儿童真性性早熟可以快速达到较好的临床抑制效果，长期使用可能改善患儿预期身高。     

促性腺激素释放激素类似物激发试验尿检法对儿童促性腺激素释放激素类似物疗效的判断价值

目的 探讨促性腺激素释放激素类似物(GnRHa)激发试验时免疫化学发光分析法(ICMA)检测的无创性尿促性腺激素(UGn)可否用于儿童GnRHa的疗效判断.方法 患儿23例(男4例,女19例).中枢性性早熟17例(均为女童),予GnRHa治疗.青春期预测终身高矮小6例(男4例,女2例),予GnRHa联合生长激素治疗.在治疗前和治疗3个月均行GnRHa激发试验,留激发试验0～3.5 h尿,其中18例留取了激发试验前1d同一时段的日间自发性尿,应用ICMA检测促黄体生成素(LH)和卵泡刺激素(FSH).结果 1.治疗前后GnRHa激发试验时UGn显著性检验:治疗前后的尿促黄体生成素(ULH)水平分别为(1.27±1.63) IU和(0.07±0.06) IU,尿卵泡刺激素(UFSH)水平分别为(6.38±3.85)IU和(0.54±0.30) IU.2.GnRHa激发试验时血清Gn峰值和UGn对GnRHa疗效评估:当血清LH峰值(PLH)和FSH峰值(PFSH)分别≤2.30IU·L-1和2.39 IU·L-时,其判断疗效的灵敏度分别为95.45％和100％,特异度均为100％；当ULH水平和UFSH水平分别≤0.083 IU和1.089 IU时,其灵敏度分别为90.91％和100％,特异度均为100％.3.GnRHa激发试验时血清Gn和UGn分别与其激发试验前的比值对GnRHa疗效评估:当血清PLH/日间自发性血清LH、血清PFSH/日间自发性血清FSH分别≤5.40和2.16时,其灵敏度和特异度均为100％；当其激发试验时ULH水平/日间自发性ULH水平、激发试验时UFSH水平/日间自发性UFSH水平分别≤6.076和2.480时,其灵敏度和特异度也均达100％.结论 GnRHa激发试验时ICMA检测的无创性3.5 h UGn水平、激发试验时3.5 h UGn水平/日间自发性UGn水平指标可能对儿童GnRHa疗效具有判断价值,其中UFSH水平及其与日间自发性UFSH水平比值指标价值可能更大.     

个案管理模式应用于特发性中枢性性早熟患儿及其主要照护者的效果分析

目的探讨个案管理模式应用于特发性中枢性性早熟(ICPP)患儿及其主要照护者的效果,为特发性中枢性性早熟患儿及其主要照护者提供更加专业的、有效的临床护理及延伸服务,从而进一步提高满意度,降低特发性中枢性性早熟患儿主要照护者焦虑的发生。方法选取我院2014年3-9月确诊的96例ICPP患儿及其主要照护者为研究对象,将96例ICPP患儿及其主要照护者随机分为观察组和对照组,研究过程中,对照组4例患儿失访退出。最终完成研究的患儿为对照组44例,观察组48例。观察组接受个案管理,对照组接受常规护理,分别于确诊当日和接受治疗1年后,比较患儿主要照护者的焦虑发生率、患儿治疗依从性及患儿主要照护者满意度。结果两组患儿主要照护者焦虑程度、满意度前后对比以及患儿治疗依从性差异有统计学意义(P0.05)。结论应用个案管理模式能够减少患儿主要照护者的焦虑发生、提高患儿治疗依从性,从而提高患儿及主要照护者的生活质量,还可提高患儿主要照护者的满意度,改善护患关系。     

Rupture du Moi-corps à l’adolescence

From the essential notion, clinical and theoretical “breakdown”, the authors present in this text the observation of a teenager aged fourteen. This young girl “triggers” at the beginning of her pubertal metamorphosis, at the age of twelve, paralysis of the lower limbs. The psychotherapeutic technical work undertaken reveals a massive, intrapsychic and intersubjective tension in the maternal and more largely family environment.