379 research outputs found
A randomized controlled trial of three years growth hormone and gonadotropin-releasing hormone agonist treatment in children with idiopathic short stature and intrauterine growth retardation
We assessed the effectiveness and safety of 3 yr combined GH and GnRH
agonist (GnRHa) treatment in a randomized controlled study in children
with idiopathic short stature (ISS) or intrauterine growth retardation
(IUGR). Gonadal suppression, GH reserve, and adrenal development were
assessed by hormone measurements in both treated children and controls
during the study period. Thirty-six short children, 24 girls (16 ISS/8
IUGR) and 12 boys (8 ISS/4 IUGR), with a height SD score of -2 SD or less
in early puberty (girls, B2-3; boys, G2-3), were randomly assigned to
treatment (n = 18) with GH (genotropin 4 IU/m(2). day) and GnRHa
(triptorelin, 3.75 mg/28 days) or no treatment (n = 18). At the start of
the study mean (SD) age was 11.4 (0.56) or 12.2 (1.12) yr whereas bone age
was 10.7 (0.87) or 10.9 (0.63) yrs in girls and boys, respectively. During
3 yr of study height SD score for chronological age did not change in both
treated children and controls, whereas a decreased rate of bone maturation
after treatment was observed [mean (SD) 0.55 (0.21) 'yr'/yr vs. 1.15
(0.37) 'yr'/yr in controls, P < 0.001, girls and boys together]. Height SD
score for bone age and predicted adult height increased significantly
after 3 yr of treatment; compared with controls the predicted adult height
gain was 8.0 cm in girls and 10.4 cm in boys. Furthermore, the ratio
between sitting height/height SD score decreased significantly in treated
children, whereas body mass index was not influenced by treatment. Puberty
was effectively arrested in the treated children, as was confirmed by
physical examination and prepubertal testosterone and estradiol levels.
GH-dependent hormones including serum insulin-like growth factor I and II,
carboxy terminal propeptide of type I collagen, amino terminal propeptide
of type III collagen, alkaline phosphatase, and osteocalcin were not
different between treated children and controls during the study period.
Thus, a GH dose of 4 IU/m(2) seems adequate for stabilization of the GH
reserve and growth in these GnRHa-treated children. We conclude that 3 yr
treatment with GnRHa was effective in suppressing pubertal development and
skeletal maturation, whereas the addition of GH preserved growth velocity
during treatment. This resulted in a considerable gain in predicted adult
height, without demonstrable side effects. Final height results will
provide the definite answer on the effectiveness of this combined
treatment
System size dependence of cluster properties from two-particle angular correlations in Cu+Cu and Au+Au collisions at = 200 GeV
We present results on two-particle angular correlations in Cu+Cu and Au+Au
collisions at a center of mass energy per nucleon pair of 200 GeV over a broad
range of pseudorapidity () and azimuthal angle () as a function of
collision centrality. The PHOBOS detector at RHIC has a uniquely-large angular
coverage for inclusive charged particles, which allows for the study of
correlations on both long- and short-range scales. A complex two-dimensional
correlation structure in and emerges, which is
interpreted in the context of a cluster model. The effective cluster size and
decay width are extracted from the two-particle pseudorapidity correlation
functions. The effective cluster size found in semi-central Cu+Cu and Au+Au
collisions is comparable to that found in proton-proton collisions but a
non-trivial decrease of the size with increasing centrality is observed.
Moreover, a comparison between results from Cu+Cu and Au+Au collisions shows an
interesting scaling of the effective cluster size with the measured fraction of
total cross section (which is related to the ratio of the impact parameter to
the nuclear radius, ), suggesting a geometric origin. Further analysis
for pairs from restricted azimuthal regions shows that the effective cluster
size at drops more rapidly toward central
collisions than the size at . The effect of limited
acceptance on the cluster parameters is also addressed, and a correction
is applied to present cluster parameters for full coverage, leading to
much larger effective cluster sizes and widths than previously noted in the
literature. These results should provide insight into the hot and dense medium
created in heavy ion collisions.Comment: 9 pages, 8 figures, Published in Phys. Rev.
Nucleon-Gold Collisions at 200 AGeV Using Tagged d+Au Interactions in PHOBOS
Forward calorimetry in the PHOBOS detector has been used to study charged
hadron production in d+Au, p+Au and n+Au collisions at sqrt(s_nn) = 200 GeV.
The forward proton calorimeter detectors are described and a procedure for
determining collision centrality with these detectors is detailed. The
deposition of energy by deuteron spectator nucleons in the forward calorimeters
is used to identify p+Au and n+Au collisions in the data. A weighted
combination of the yield of p+Au and n+Au is constructed to build a reference
for Au+Au collisions that better matches the isospin composition of the gold
nucleus. The p_T and centrality dependence of the yield of this improved
reference system is found to match that of d+Au. The shape of the charged
particle transverse momentum distribution is observed to extrapolate smoothly
from pbar+p to central d+Au as a function of the charged particle
pseudorapidity density. The asymmetry of positively- and negatively-charged
hadron production in p+Au is compared to that of n+Au. No significant asymmetry
is observed at mid-rapidity. These studies augment recent results from
experiments at the LHC and RHIC facilities to give a more complete description
of particle production in p+A and d+A collisions, essential for the
understanding the medium produced in high energy nucleus-nucleus collisions.Comment: 17 pages, 18 figure
Referral patterns of children with poor growth in primary health care
Background. To promote early diagnosis and treatment of short stature, consensus meetings were held in the mid nineteen nineties in the Netherlands and the UK. This resulted in guidelines for referral. In this study we evaluate the referral pattern of short stature in primary health care using these guidelines, comparing it with cut-off values mentioned by the WHO. Methods. Three sets of referral rules were tested on the
Perioperative strategy in colonic surgery; LAparoscopy and/or FAst track multimodal management versus standard care (LAFA trial)
BACKGROUND: Recent developments in large bowel surgery are the introduction of laparoscopic surgery and the implementation of multimodal fast track recovery programs. Both focus on a faster recovery and shorter hospital stay. The randomized controlled multicenter LAFA-trial (LAparoscopy and/or FAst track multimodal management versus standard care) was conceived to determine whether laparoscopic surgery, fast track perioperative care or a combination of both is to be preferred over open surgery with standard care in patients having segmental colectomy for malignant disease. METHODS/DESIGN: The LAFA-trial is a double blinded, multicenter trial with a 2 × 2 balanced factorial design. Patients eligible for segmental colectomy for malignant colorectal disease i.e. right and left colectomy and anterior resection will be randomized to either open or laparoscopic colectomy, and to either standard care or the fast track program. This factorial design produces four treatment groups; open colectomy with standard care (a), open colectomy with fast track program (b), laparoscopic colectomy with standard care (c), and laparoscopic surgery with fast track program (d). Primary outcome parameter is postoperative hospital length of stay including readmission within 30 days. Secondary outcome parameters are quality of life two and four weeks after surgery, overall hospital costs, morbidity, patient satisfaction and readmission rate. Based on a mean postoperative hospital stay of 9 +/- 2.5 days a group size of 400 patients (100 each arm) can reliably detect a minimum difference of 1 day between the four arms (alfa = 0.95, beta = 0.8). With 100 patients in each arm a difference of 10% in subscales of the Short Form 36 (SF-36) questionnaire and social functioning can be detected. DISCUSSION: The LAFA-trial is a randomized controlled multicenter trial that will provide evidence on the merits of fast track perioperative care and laparoscopic colorectal surgery in patients having segmental colectomy for malignant disease
Catch-up growth up to ten years of age in children born very preterm or with very low birth weight
BACKGROUND: Improved survival due to advances in neonatal care has brought issues such as postnatal growth and development more to the focus of our attention. Most studies report stunting in children born very preterm and/or small for gestational age. In this article we study the growth pattern of these children and aim to identify factors associated with postnatal catch-up growth. METHODS: 1338 children born with a gestational age <32 weeks and/or a birth weight of <1500 grams were followed during a Dutch nationwide prospective study (POPS). Subgroups were classified as appropriate for gestational age and <32 weeks (AGA) or small for gestational age (<32 wks SGA and ≥32 wks SGA). Data were collected at different intervals from birth until 10 years for the 962 survivors and compared to reference values. The correlation between several factors and growth was analysed. RESULTS: At 10 years the AGA children had attained normal height, whereas the SGA group demonstrated stunting, even after correction for target height (AGA: 0.0 SDS; SGA <32 wks: -0.29SDS and ≥32 wks: -0.13SDS). Catch-up growth was especially seen in the SGA children with a fast initial weight gain. BMI was approximately 1 SD below the population reference mean. CONCLUSION: At 10 years of age, children born very preterm AGA show no stunting. However, many children born SGA, especially the very preterm, show persistent stunting. Early weight gain seems an important prognostic factor in predicting childhood growth
Laparoscopic ileocolic resection versus infliximab treatment of distal ileitis in Crohn's disease: a randomized multicenter trial (LIR!C-trial)
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69534.pdf (publisher's version ) (Open Access)BACKGROUND: With the availability of infliximab, nowadays recurrent Crohn's disease, defined as disease refractory to immunomodulatory agents that has been treated with steroids, is generally treated with infliximab. Infliximab is an effective but expensive treatment and once started it is unclear when therapy can be discontinued. Surgical resection has been the golden standard in recurrent Crohn's disease. Laparoscopic ileocolic resection proved to be safe and is characterized by a quick symptom reduction.The objective of this study is to compare infliximab treatment with laparoscopic ileocolic resection in patients with recurrent Crohn's disease of the distal ileum with respect to quality of life and costs. METHODS/DESIGN: The study is designed as a multicenter randomized clinical trial including patients with Crohn's disease located in the terminal ileum that require infliximab treatment following recent consensus statements on inflammatory bowel disease treatment: moderate to severe disease activity in patients that fail to respond to steroid therapy or immunomodulatory therapy. Patients will be randomized to receive either infliximab or undergo a laparoscopic ileocolic resection. Primary outcomes are quality of life and costs. Secondary outcomes are hospital stay, early and late morbidity, sick leave and surgical recurrence. In order to detect an effect size of 0.5 on the Inflammatory Bowel Disease Questionnaire at a 5% two sided significance level with a power of 80%, a sample size of 65 patients per treatment group can be calculated. An economic evaluation will be performed by assessing the marginal direct medical, non-medical and time costs and the costs per Quality Adjusted Life Year (QALY) will be calculated. For both treatment strategies a cost-utility ratio will be calculated. Patients will be included from December 2007. DISCUSSION: The LIR!C-trial is a randomized multicenter trial that will provide evidence whether infliximab treatment or surgery is the best treatment for recurrent distal ileitis in Crohn's disease. TRIAL REGISTRATION: Nederlands Trial Register NTR1150
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