Endocrine Sequelae in 157 Pediatric Survivors of Hematopoietic Stem Cell Transplantation (HSCT)

Successful rates of hematopoietic stem cell transplantation (HSCT) face paralleled escalation of late endocrine and metabolic effects. Objective: This work aimed to characterize these sequelae distinguishing between the underlying pathologies and treatments received. Methods: A retrospective descriptive study was conducted in 157 children post-HSCT (hematopoietic pathology [N = 106], solid tumors [N = 40], and rare entities [N = 11]) followed at a single endocrine department between 2009 and 2019. Regression analysis was used to ascertain association. Results: Of all patients, 58.7% presented with at least one endocrine abnormality. Endocrinopathies post HSCT were most frequently developed in lymphoblastic leukemia (60.5% of them), whereas myeloid leukemias had the fewest. A total of 64% of patients presented with primary hypogonadism, 52% short stature, and 20% obesity. Endocrinopathy was associated with older age at HSCT (9.78 years [6.25-12.25] vs 6.78 years [4.06-9.75]) (P <. 005), pubertal Tanner stage V (P <. 001), chronic graft-vs-host disease (GVHD) (P =. 022), and direct gonadal therapy (P =. 026). The incidence of endocrinopathies was higher in girls (15% more common; P <. 02) and in patients who received radiotherapy (18% higher), steroids (17.4% increase), allogenic HSCT (7% higher), thymoglobulin, or cyclophosphamide. Those on busulfan presented with a 27.5% higher rate of primary hypogonadism (P =. 003). Conclusion: More than half of children surviving HSCT will develop endocrinopathies. Strikingly, obesity has risen to the third most frequent endocrine disruption, mainly due to steroids, and partly adhering to the general population tendency. Lymphoblastic leukemia was the condition with a higher rate of endocrine abnormalities. Female sex, older age at HSCT, pubertal stage, allogenic transplant, radiotherapy, alkylating drugs, and GVHD pose risk factors for endocrine disturbance

Mapping of neurokinin-like immunoreactivity in the human brainstem

BACKGROUND: Using an indirect immunoperoxidase technique, we have studied the distribution of immunoreactive fibers and cell bodies containing neurokinin in the adult human brainstem with no prior history of neurological or psychiatric disease. RESULTS: Clusters of immunoreactive cell bodies and high densities of neurokinin-immunoreactive fibers were located in the periaqueductal gray, the dorsal motor nucleus of the vagus and in the reticular formation of the medulla, pons and mesencephalon. Moreover, immunoreactive cell bodies were found in the inferior colliculus, the raphe obscurus, the nucleus prepositus hypoglossi, and in the midline of the anterior medulla oblongata. In general, immunoreactive fibers containing neurokinin were observed throughout the whole brainstem. In addition to the nuclei mentioned above, the highest densities of such immunoreactive fibers were located in the spinal trigeminal nucleus, the lateral reticular nucleus, the nucleus of the solitary tract, the superior colliculus, the substantia nigra, the nucleus ambiguus, the gracile nucleus, the cuneate nucleus, the motor hypoglossal nucleus, the medial and superior vestibular nuclei, the nucleus prepositus hypoglossi and the interpeduncular nucleus. CONCLUSION: The widespread distribution of immunoreactive structures containing neurokinin in the human brainstem indicates that neurokinin might be involved in several physiological mechanisms, acting as a neurotransmitter and/or neuromodulator

Estudio observacional de calidad de vida en cirugía cardiaca

� Introducción y objetivo: Entre los objetivos de la cirugía cardiaca está mejorar la supervivencia y la calidad de vida de los pacientes (deteriorada por el proceso cardiológico). El objetivo de nuestro estudio, es valorar si la cirugía cardiaca mejora la calidad de vida y ayuda a recuperar el estado que el paciente presentaba un año antes de ser intervenido. � Material y método: Estudio prospectivo observacional sobre 140 pacientes, intervenidos de derivación coronaria (bypass) o cirugía valvular. Se utilizó el cuestionario EuroQOL, en entrevistas realizadas un año antes de la intervención, al ingreso, al mes y al año postcirugía. Se analizaron las categorías de salud y cada una de las cinco dimensiones que lo componen, de forma individualizada. Para el análisis estadístico se utilizó: test T-Student, U-Mann-Whitney, chi-cuadrado y test-Friedman. Se considera significativa p<0,05. � Resultados y conclusión: Un 69,3% eran varones (edad media de 65,56+/-10,01 y 70,09+/-8,81 en mujeres) y un 57,1% se sometieron a cirugía coronaria (con un 78,5% de varones). Todas las dimensiones estudiadas, estaban afectadas al ingreso. Al mes los pacientes recuperan la movilidad basal y perdieron en autonomía; manteniéndose porcentajes similares en las Actividades Cotidianas, Dolor/incomodidad y Ansiedad/depresión. Al año alcanzaron valores medios similares a los basales. Las mujeres tenían peor calidad de vida al ingreso y al mes, por mayores porcentajes de depresión postoperatoria y mayor afectación global al mes. Al año seguían manteniendo niveles de dolor peores a los varones y superiores a los basales. No se encuentran diferencias relevantes en calidad de vida por edad ni por tipo de cirugía

Supplementary material for the paper ‘Pappalysins and stanniocalcins and their relationship with the peripheral IGF axis in newborns and during development’

This dataset is supplementary material for the paper: "Pappalysins and stanniocalcins and their relationship with the peripheral IGF axis in newborns and during development". It countains 4 figures and 2 tablesBackground: Pappalysins (PAPP-A, PAPP-A2) modulate body growth by increasing IGF-I bioavailability through cleavage of IGFBPs and are inhibited by stanniocalcins (STC1, STC2). Normative data of these novel factors, as well as of free IGF-I and uncleaved fractions of IGFBPs are not well established. Objective: To determine serum concentrations of PAPP-A, PAPP-A2, STC1 and STC2, in relationship with other GH-IGF axis parameters during development. Patients and methods: Full-term newborns (150; gestational age: 39.30 ± 1.10 weeks), 40 preterm newborns (30.87 ± 3.35 weeks) and 1071 healthy individuals (1-30 years old) were included in the study and divided according to their Tanner stages (males and females): I:163 males, 154 females; II:100 males, 75 females; III:83 males, 96 females; IV: 77 males, 86 females; and V:109 males,128 females. Results: Serum concentrations of total and free IGF-I, IGF-II, total IGFBP-3 and ALS rose gradually during development peaking in Tanner stages III-IV. Concentrations of IGFBP-4 and IGFBP-5 were lower in prepubertal children. PAPP-A, PAPP-A2, STC1, STC2, IGFBP-2, total IGFBP-4 and total IGFBP-5 were elevated at birth and declined throughout childhood. In postnatal life, PAPP-A2 concentrations decreased progressively in concomitance with the free/total IGF-I ratio; however, stanniocalcin concentrations remained stable. PAPP-A2 concentrations positively correlated with the free/total IGF-I ratio (r=+0.28 p<0.001) and negatively with the intact/total IGFBP-3 ratio (r=-0.23, p<0.001). PAPP-A concentrations inversely correlated with intact/total IGFBP-4 ratio (r=-0.21, p<0.001), with PAPP-A concentrations being lower in females at all ages. Conclusion: This study provides reference values of pappalysins and stanniocalcins, which modulate IGF-I activity by changing the concentrations of uncleaved IGFBPs. </p