La chirurgie de première intention a-t-elle encore une place dans le traitement de l’acromégalie ?

Transsphenoidal surgery is currently the first-line treatment of acromegaly. Remission is observed in 80-90% of microadenomas, 50-60% of noninvasive macroadenomas, and less than 20% of invasive macroadenomas. Predictive factors include age, maximal size of the adenoma, cavernous sinus invasion, initial hormone levels and neurosurgeon's experience. Complications are rare, with about 5% definitive diabetes insipidus, and 10% of new anterior pituitary hormone deficits. Somatostatin agonist pretreatment can be proposed, as it decreases tumor volume in about 25% of cases and might reduce the rate of immediate postsurgical complications; however, there is no obvious difference in surgical remission rate whether patients are pretreated or not. Debulking surgery can also be proposed in very large macroadenomas incompletely controlled by somatostatin agonists, or resistant to medical treatment, as it was shown to facilitate somatostatin agonist efficacy in more than 50% of cases.     

Plasma ghrelin and growth hormone regulation in response to metabolic state in hybrid striped bass: Effects of feeding, ghrelin and insulin-like growth factor-I on in vivo and in vitro GH secretion

The regulation of growth hormone (GH) secretion by ghrelin during variable metabolic states is poorly understood. We examined plasma GH and ghrelin in hybrid striped bass (HSB) undergoing seasonally-based feeding and temperature manipulations. Fasting for 21 days (d) at 24 °C resulted in catabolism and up-regulation of plasma GH and ghrelin relative to fed controls. Continued fasting during cold-banking (14 °C, 90d) resulted in a further 43-fold increase in ghrelin while GH remained elevated. A subsequent 19 day refeeding period at 24 °C elicited hyperphagic and compensatory growth responses, accompanied by declines in ghrelin and GH. We then tested the role of ghrelin in stimulating GH release in vivo and in vitro. Intraperitoneal injections of ghrelin resulted in dose-dependent increases in plasma GH after 6 hours (h). Ghrelin also increased GH release from HSB pituitaries during 6 h incubations. Lastly, we assessed how metabolic state, ghrelin and insulin-like growth factor-I (IGF-I) affect in vitro pituitary GH release. Spontaneous GH release was 5.2-fold higher from pituitaries of fasted compared with fed animals. Ghrelin was equally effective in stimulating GH release from pituitaries of fed and starved animals, while it was ineffective in enhancing GH release from pituitaries of starved (21d) then refed (4d) HSB. Incubation with IGF-I inhibited GH release regardless of metabolic state. These studies are the first to show that seasonally-based periods of feed deprivation and low temperature yield sustained increases in GH secretion that are likely mediated, at least partially, through elevated ghrelin, reduced IGF-I negative feedback and fasting-induced spontaneous GH release.     

HIV感染母亲分娩婴幼儿的体格生长发育状况研究

目的了解艾滋病病毒（HIV）感染母亲分娩的婴幼儿的体格生长发育状况。方法对我国4个艾滋病高发省的7个县／区,HIV感染母亲分娩的活产婴幼儿,分别在出生时、3、6、9、12、15、18月龄进行随访调查及生长发育监测,分析18月龄存活婴幼儿的体格生长发育指标。结果2005—2008年,共调查18月龄存活婴幼儿154名,其中HIV感染婴幼儿22名,非感染婴幼儿132名。结果：（1）HIV感染婴幼儿在6—18月龄的身长、体重明显低于非HIV感染婴幼儿（P〈O．05）,年龄别头围的差别无统计学意义。（2）与世界卫生组织（WHO）儿童生长标准比较,非HIV感染婴幼儿中,男、女童6月龄前的年龄别体重与该标准无差别,6月龄后的年龄别体重高于该标准（P〈O．05）;年龄别体重z值（wAz）和身长别体重z值（WHz）在-0．1～1之间;男、女童12月龄内的年龄别身长与该标准的差别无统计学意义,15—18月龄身长低于该标准（P〈0．05）,年龄别身长z值（HAz）和年龄别头围Z值在-0．1～-1之间。（3）HIV感染男、女童各月龄的体重、头围与WHO标准的差别无统计学意义,15—18月龄身长低于该标准;随访期间wAZ在O．2～-0．6之间,3月龄内wAZ下降较快,之后处于低水平状态;HAZ在0．1～-1．7之间,呈下降趋势,在6—12月龄接近-1,15—18月龄低于-1。结论HIV感染母亲分娩的非HIV感染婴幼儿的体格生长不足,身长、头围发育较差,而HIV感染婴幼儿更为严重。     

中国艾滋病致孤儿童生长发育与营养水平及心理健康研究

目的调研中国艾滋病致孤儿童生长发育、营养水平与心理健康状况,为政策制定提供依据。方法按性别、年龄1：1匹配,调查96对艾滋病致孤儿童与非孤儿的身心健康水平,并进行差异比较。结果孤儿组BMIz评分与肩胛下皮褶厚度显著低于非孤儿（P〈0．01）,消瘦明显。孤儿组自尊量表（SES）总分更低,而抑郁问卷（BDI）总分更高（P〈0．05）。男性孤儿身心健康弱势明显,女性组间未见显著性差异。结论中国艾滋病致孤儿童的身心健康脆弱性显著,需探索可持续性更强的孤儿抚养策略,并进行以心理支持为核心的综合健康干预,而且对男性孤儿应给予更多关注。     

Improvement of reduced serum cartilage oligomeric matrix protein levels in systemic juvenile idiopathic arthritis patients treated with the anti-interleukin-6 receptor monoclonal antibody tocilizumab

In this study, we determined serum cartilage oligomeric matrix protein (COMP) levels in systemic juvenile idiopathic arthritis (sJIA) patients during both the active and the remission phases to investigate how the growth cartilage turnover changed under tocilizumab treatment. Specimens were collected from 201 healthy children under 16 years of age with no growth impairment, and paired sera were collected from 11 sJIA patients treated with tocilizumab. Disease activity was assessed from white blood cell count, erythrocyte sedimentation rate, C-reactive protein, and ferritin, and the COMP concentration was determined by sandwich enzyme-linked immunosorbent assay. Serum COMP concentrations were found independent of age, and the mean value in healthy children was 17.74 ± 5.6 U/L. The mean serum COMP in sJIA patients during the active phase was 10.75 ± 3.9 U/L, lower than that of healthy children. The mean serum COMP in the remission phase (14.89 ± 3.9 U/L) was significantly higher than that in the active period (P < 0.05). These results suggested that in sJIA patients, a reduced serum COMP concentration is a useful marker of active disease and growth impairment, and that the growth cartilage turnover suppressed during the active phase is improved in the remission phase under tocilizumab treatment.     

Childhood BMI trajectories and the risk of developing young adult-onset diabetes

Aims/hypothesis  The aim of this study was to examine the effects of childhood BMI growth dynamics on the risk of developing young adult-onset type 1 and type 2 diabetes. Methods  Finnish national healthcare registers were used to identify individuals with diabetes diagnosed between 1992 and 1996 at 15–39 years of age. Non-diabetic control participants were chosen from the National Population Registry. Anthropometric measurements were obtained from the original child welfare clinic records. Only the case–control pairs with sufficient growth data recorded were included in the analyses (218/1,388 for type 1 diabetes [16%] and 64/1,121 for type 2 diabetes [6%]). Two developmental stages in BMI growth (the points of infancy maximum BMI and the BMI rebound) were examined, and conditional logistic regression was applied to the variables of interest. Results  The risk for type 1 diabetes increased 1.19-fold per 1 kg/m² rise in the infancy maximum BMI (p = 0.02). In addition, there was a 1.77-fold increase in the risk for type 2 diabetes per 1 kg/m² rise in the level of BMI at the BMI rebound (p = 0.04). Higher values of BMI at these points corresponded to a larger BMI gain from birth to that developmental stage. Age at the infancy maximum BMI or age at the BMI rebound did not affect the risk for either type of diabetes. Conclusions/interpretation  The BMI gain in infancy among individuals who subsequently developed young adult-onset type 1 diabetes was faster than that of those who remained healthy. The excess BMI gain in individuals who developed young adult-onset type 2 diabetes could already be seen during early childhood.     

Pituitary-hormone secretion by thyrotropinomas

Hormone secretion by somatotropinomas, corticotropinomas and prolactinomas exhibits increased pulse frequency, basal and pulsatile secretion, accompanied by greater disorderliness. Increased concentrations of growth hormone (GH) or prolactin (PRL) are observed in about 30% of thyrotropinomas leading to acromegaly or disturbed sexual functions beyond thyrotropin (TSH)-induced hyperthyroidism. Regulation of non-TSH pituitary hormones in this context is not well understood. We there therefore evaluated TSH, GH and PRL secretion in 6 patients with up-to-date analytical and mathematical tools by 24-h blood sampling at 10-min intervals in a clinical research laboratory. The profiles were analyzed with a new deconvolution method, approximate entropy, cross-approximate entropy, cross-correlation and cosinor regression. TSH burst frequency and basal and pulsatile secretion were increased in patients compared with controls. TSH secretion patterns in patients were more irregular, but the diurnal rhythm was preserved at a higher mean with a 2.5 h phase delay. Although only one patient had clinical acromegaly, GH secretion and IGF-I levels were increased in two other patients and all three had a significant cross-correlation between the GH and TSH. PRL secretion was increased in one patient, but all patients had a significant cross-correlation with TSH and showed decreased PRL regularity. Cross-ApEn synchrony between TSH and GH did not differ between patients and controls, but TSH and PRL synchrony was reduced in patients. We conclude that TSH secretion by thyrotropinomas shares many characteristics of other pituitary hormone-secreting adenomas. In addition, abnormalities in GH and PRL secretion exist ranging from decreased (joint) regularity to overt hypersecretion, although not always clinically obvious, suggesting tumoral transformation of thyrotrope lineage cells.     

三峡工程对库区重庆段钉螺生长条件影响研究

目的了解三峡工程建成以后,库区气候、植被、淹没等条件变化对钉螺孳生的可能影响。方法利用ArcGIS软件的空间分析功能,结合气象资料及重点研究区1:1万和库区重庆段1:5万数字高程模型(DEM)就阶段性淹没区的气候条件、淹没时间、淹没区植被情况以及阶段性淹没可能对钉螺生长的影响进行综合分析。结果三峡库区淹没时间、气温、降水、日照时间、植被种类及覆盖度均适合钉螺,但其冬季蓄水、夏季放水的特点对钉螺的生长不利。结论三峡库区形成的"冬水夏陆"的洲滩环境不适于钉螺孳生,如能从源头上控制钉螺的外来输入问题,库区可避免成为钉螺孽生区。     

Epidermal growth factor tyrosine kinase receptors and the neuroendocrine control of mammalian puberty

In recent years evidence has begun to accumulate indicating that the central control of mammalian puberty requires not only changes in transsynaptic communication, but also the participation of glial cells. Neurons and astrocytes control the pubertal process by regulating the secretory activity of those neurons that produce luteinizing hormone-releasing hormone (LHRH), the neuropeptide that governs sexual development. LHRH, in turn, directs sexual development by stimulating the secretion of pituitary gonadotropins. Astrocytes affect LHRH neuronal function via cell–cell signaling mechanisms involving several growth factors acting via receptors endowed with tyrosine kinase activity. We have identified two members of the epidermal growth factor/transforming growth factor alpha (EGF/TGF) family and their respective receptors as key players in the glial–neuronal interactive process that regulates LHRH secretion. Our results indicate that TGF and its distant congener neuregulin (NRG) are produced in hypothalamic astrocytes and stimulate LHRH release indirectly via activation of their respective receptors, located—surprisingly—not on LHRH neurons, but on astrocytes. Activation of EGF receptors by TGF, and/or the erbB2/erbB4 receptor complex by NRG, leads to glial release of prostaglandin (PG) E₂, which then acts directly on LHRH neurons to stimulate LHRH release. That a central blockade of TGF or NRG action delays puberty, and focal overexpression of TGF advances it, leads to the conclusion that both TGF and NRG are physiological components of the central mechanism controlling the initiation of female puberty.     

艾灸预处理对大鼠应激性胃黏膜损伤增殖修复相关因子的影响

目的:观察艾灸预处理对应激性胃黏膜损伤大鼠血清和胃黏膜表皮生长因子(EGF)、转化生长因子-α(TGF-α)、胃黏膜三叶因子家族-1(TFF1)、增殖细胞核抗原(PCNA)的影响,探讨艾灸预处理促进胃黏膜损伤增殖修复的作用机制.方法:将48只健康SD大鼠随机分为4组,即空白组、模型组、艾灸穴位组、艾灸非穴组.束缚冷应激法制作大鼠应激性胃黏膜损伤模型.造模之前,艾灸组选取足三里、中脘、脾俞和胃俞等穴位行艾灸预处理8d,艾灸非穴组选取非穴对照点进行预处理.以Guth法计算胃黏膜损伤指数,光镜下观察大鼠胃黏膜组织学改变,放射免疫法测定血清EGF与TGF-α的含量,酶免法检测胃黏膜组织中EGF、TGF-α、TFF1和PCNA的含量.结果:与模型组和艾灸非穴组比较,艾灸足三里、中脘等穴位可使应激性胃黏膜损伤大鼠胃黏膜损伤指数明显下降(14.667±5.710vs27.250±7.448,24.750±7.300,P<0.01),血清EGF、TGF-α含量升高(2.167±0.756vs1.147±0.983,1.358±0.962,P<0.05;11.170±1.315vs4.585±0.720vs5.118±0.659,P<0.01),胃黏膜EGF、TGF-α和PCNA含量升高(343.560±27.644vs269.610±45.119,279.590±58.890,P<0.05;147.470±17.784vs115.530±24.319,116.620±14.908,P<0.01;191.910±37.262vs154.580±18.910,152.450±20.333,P<0.05);与模型组比较,艾灸穴位组胃黏膜TFF1含量明显升高(4.573±0.121vs3.654±0.507,P<0.05).结论:艾灸足三里、中脘等穴位预处理可减轻束缚水浸应激所造成大鼠胃黏膜损伤、促进胃黏膜损伤组织增殖修复,可能是通过上调胃黏膜损伤增殖修复相关因子(EGF、TGF-α、TFF1和PCNA)而达到其促胃黏膜损伤修复的作用.