Changes In Growth Velocity Research Articles

Female adolescent craniofacial growth spurts: real or fiction?

The purpose of the study is to determine whether the various aspects of the craniofacial complex exhibit female adolescent growth spurts. Multilevel polynomial models were used to estimate the growth curves of a mixed-longitudinal sample of 111 untreated females 10-15 years of age. To evaluate the horizontal and vertical movements of the individual landmarks relative to stable structures, the tracings were superimposed on the natural reference structures in the anterior cranial base. The horizontal and vertical growth changes of four landmarks and the changes of three traditional linear measurements were evaluated. Posterior nasal spine (PNS) moved posteriorly at a constant rate of approximately 0.12mm/year. Five measures showed changes in growth velocity (i.e. quadratic growth curves) but not adolescent growth spurts, including the anterior movements of anterior nasal spine (ANS) and pogonion (Pg), the inferior movements of gonion (Go), and the increases in ANS-PNS and condylion to pogonion (Co-Pg). Five measurements, including the inferior movements of ANS, PNS and Pg, the posterior movements of Go, and the increases of Go-Pg exhibited adolescent growth spurts. Peak growth velocities were attained between 11.4 and 12.8 years of age, approximately 0.7-1.4 years earlier in the maxilla than mandible. While the vertical aspects of craniofacial growth exhibit distinct female adolescent growth spurts, with peak rates occurring earlier in the maxilla than mandible, most horizontal aspects of craniofacial growth do not exhibit an adolescent spurt.

Modeling pollen tube growth: Feeling the pressure to deliver testifiable predictions

The frequency and amplitude of oscillatory pollen tube growth can be altered by changing the osmotic value of the surrounding medium. This has motivated the proposition that the periodic change in growth velocity is caused by changes in turgor pressure. Using mathematical modeling we recently demonstrated that the oscillatory pollen tube growth does not require turgor to change but that this behavior can be explained with a mechanism that relies on changes in the mechanical properties of the cell wall which in turn are caused by temporal variations in the secretion of cell wall precursors. The model also explains why turgor and growth rate are correlated for oscillatory growth with long growth cycles while they seem uncorrelated for oscillatory growth with short growth cycles. The predictions made by the model are testifiable by experimental data and therefore represent an important step towards understanding the dynamics of the growth behavior in walled cells.

Effects of Inhaled Mometasone Furoate on Growth Velocity and Adrenal Function: A Placebo-Controlled Trial in Children 4–9 Years Old with Mild Persistent Asthma

Objective. To assess the effects of long-term mometasone furoate delivered via a dry powder inhaler (MF-DPI) on growth velocity and hypothalamic–pituitary–adrenal axis function in children with asthma. Study design. Children aged 4–9 years with asthma (n = 187) were randomized to MF-DPI 100 μg (delivered dose; actuated dose is 110 μg) once daily in the morning (QD AM), 100 μg twice daily (BID), 200 μg QD AM, or placebo for 52 weeks followed by a 3-month follow-up period. The primary outcome was growth velocity calculated from stadiometric heights recorded at each visit. Secondary outcomes included serum and 12-h urinary cortisol, serum osteocalcin, and urinary N-telopeptide. Results. MF-DPI 100 μg QD AM treatment did not significantly affect growth velocity compared with placebo (–0.10 ± 0.31 cm/y, p = 0.76). When the effect of a total daily dose of 200 μg MF-DPI on growth velocity was examined, no significant effect was demonstrated for MF-DPI 100 μg BID compared with placebo (–0.64 ± 0.39 cm/y, p = 0.10), although the change in mean growth velocity with MF-DPI 200 μg QD AM reached statistical significance (–0.70 ± 0.29 cm/y, p = 0.02). The effects of all examined doses of MF-DPI on mean plasma cortisol levels were similar to cortisol changes seen in the placebo group, suggesting an absence of drug-related effects. No differences in 12-h urinary cortisol or other outcomes were observed between groups. Conclusions. One year of treatment with a total daily dose of 100 μg of MF-DPI in the morning resulted in no significant difference, whereas a total daily dose of 200 μg of MF-DPI was associated with some changes in growth velocity when compared with placebo. The differences in growth velocity, and the absence of drug-related cortisol effects, support the use of a total daily dose of 100 μg of MF-DPI in children aged 4–9 years with mild persistent asthma.

Efficacy of treatment with gonadotropin-releasing hormone analogue alone or combined with recombinant human growth hormone in pubertal short children

：Objective To assess theefficacy of gonadotropin-releasing hormone analogue(GnRHa)with or without recombinanthuman growth hormone(rhGH)treatment in Chinese short pubertal children with non-growthhormone deficiency.Methods Of 42 short pubertal children(14 males,28 females)withoutgrowth hormone deftcieney,the average age was(11.6±0.8)year.30 children were treated withslow release GnRHa with initial dose (100μg·kg-1·d-1,28d)and maintenancedose(60-80μg·kg-1·d-1,28d)labdrgGH with initial dose(0.15IU·kg-1·d-1)and maintenancedose(0.10-0.15IU·kg-1·d-1)for at least 1year.16 ofthem were still ongoing till the end of the second year.12 children were treated withGnRHa alone by initial dose(100μg·kg-1·d-1,28d)and maintenance dose(60-80μg·kg-1·d-1,28d),and 7 of themremained on it for 2 years.Dynamic changes including annual growth velocity(GV),boneage(BA)/chronologic age(CA)ratio,Tanner stage,height SDS for CA (HtSDSCA),height SDS forBA(HtSDSBA),and predicted adult height (PAHSDS)were observed.Results By the end of thefirst year tretment with combination therapy,the followingparameters:GV,HtSDSCA,HtSDSBA,and PAHSDS all increased significantly(allP 0.05).Changes in GV,HtSDSBA,and PAHSDS betweenthese two groups were statistically significant(all P 0.05).HtSDSCA,HtSDSBA,PAHSDSincreased(all P>0.05).Changes in GV,HtSDSCA,HtSDSBA,and PAHSDS between these 2 groupswere statistically significant respectively(all P<0.05).Conclusion This combinedtreatment regimen significantly impreved the growth by increasing growth rate and delayingbone matumtion in pubertal chidren without growth hormone deficiency.Further study isneeded to verify beneficial effects on the final height gain. Key words: Idiopathicshort stature; Gonadotropin-releasing hormone analogue; Recombinant human growth hormone

The shifting trajectory of growth in femur length during gestation

Bone size is a determinant of bone strength and tracks in its percentile of origin during childhood and adolescence. We hypothesized that the ranking of an individual's femur length (FL) is established in early gestation and tracks thereafter. Fetal FL was measured serially using 2D ultrasound in 625 Norwegian fetuses. Tracking was assessed using Pearson correlation, a generalized estimating equation model, and by calculating the proportion of fetuses whose FL remained within the same quartile. Baseline FL Z-score (weeks 10 to 19) and later measurements correlated, but more weakly as gestation advanced: r = 0.59 (weeks 20 to 26); r = 0.45 (weeks 27 to 33); and r = 0.32 (weeks 34 to 39) (p < 0.001). Tracking within the same quartile throughout gestation occurred in 13% of fetuses. Of the 87% deviating, 21% returned to the quartile of origin, so 34% began and ended in the same quartile, 38% deviated by one quartile, and 28% deviated by two or more quartiles by the end of gestation. A standard deviation higher baseline FL Z-score, placental weight (150 g), maternal height (5 cm), and weight (10 kg), was associated with a 0.25, 0.15, 0.10, and 0.05 SD higher FL Z-score at the end of gestation, respectively (p ranging from <0.001 to 0.02). Tracking within the same percentile throughout the whole of gestation, as suggest by growth charts, is uncommon. Deviation from tracking is more common and is the result of changes in growth velocity within and between fetuses and is partly influenced by maternal, fetal, and placental factors.

Impact of the Exon 3-Deleted Growth Hormone (GH) Receptor Polymorphism on Baseline Height and the Growth Response to Recombinant Human GH Therapy in GH-Deficient (GHD) and Non-GHD Children with Short Stature: A Systematic Review and Meta-Analysis

The exon-3 deleted GH receptor (GHR(d3)) polymorphism is associated with an increased growth response to recombinant human GH (rhGH) therapy in some, but not all, studies in GH-deficient (GHD) and non-GHD children with short stature. The aim of the study was to assess the effects of GHR(d3) on baseline height and the first year's growth response to rhGH treatment in prepubertal GHD and non-GHD children with short stature. We conducted a systematic review and meta-analysis. Fifteen studies reporting the effect of GHR(d3) on growth parameters were included. Principal outcomes were baseline height sd score (SDS) and the weighted average of change in growth velocity (Delta cm/yr) and height gain (Delta height SDS) after 1 yr of rhGH. In GHD, not in non-GHD, baseline height SDS was 0.159 sd higher [95% confidence interval (CI), 0.020, 0.298] in GHR(d3) compared with GHR(wt-wt). In GHR(d3), rhGH therapy resulted in a higher increase in growth velocity (0.521 cm/yr; 95% CI, 0.196, 1.015) and height gain (0.075 sd; 95% CI, 0.007, 0.143) compared with GHR(wt-wt). Meta-regression demonstrated a larger difference between GHR(d3) and GHR(wt-wt) in studies using lower rhGH doses and carried out at a higher age, independently of the cause of short stature. This meta-analysis in prepubertal children with short stature indicates that GHR(d3) is associated with increased baseline height in GHD, but not in non-GHD. Furthermore, GHR(d3) stimulates growth velocity by an additional effect of approximately 0.5 cm during the first year of rhGH treatment, and this effect is more pronounced at lower doses of rhGH and higher age.

The effect of periosteal resection on tibial growth velocity measured by microtransducer technology in lambs.

Disruption of the periosteum, whether traumatic or elective, has long been known to accelerate growth in the developing skeleton. However, the extent, timing, and mechanism of the resultant increase in growth velocity (if any) remain undefined. The primary research questions were: Does periosteal resection result in a change (increase) in growth velocity of a long bone at the growth plate? When does the effect start after the resection and for how long? Finally, which of several cellular mechanisms is most likely responsible for the change in growth velocity? Five lambs underwent proximal tibial growth plate periosteal resection with subsequent measurement of growth velocity by implantable microtransducers or fluorochrome labeling. This former technique provided real-time growth velocity data with a resolution of about 10 microm (width of a proliferative zone chondrocyte). These measurements were accurate at up to 4 weeks postoperative, as verified by fluorochrome labeling, and radiographic measurement. Two lambs were continued on the study for an additional 3 weeks. Histomorphometric and stereological assessments of chondrocytic kinetic parameters were performed on control and experimental tibiae after euthanasia. Periosteal resection increased growth velocity in every lamb, at every time point, and in a consistent and sustained manner. Histomorphometric correlation to this phenomenon indicated that the cellular basis of this acceleration was most likely the result of hypertrophic chondrocyte axial elongation rather than changes in chondrocyte proliferation, magnitude of hypertrophic chondrocytic swelling, or increased matrix production. Periosteal resection creates immediate and sustained acceleration of growth resulting from axial elongation of the hypertrophic chondrocyte. Although the increase in growth velocity was consistent, the absolute magnitude of the acceleration suggests that periosteal resection be considered as an adjunct to other primary procedures. Periosteal resection may serve as a useful clinical adjunct to provide a modest growth stimulus in cases of hemihypertrophy or angular limb deformity or to counteract the growth inhibition seen when performing distraction osteogenesis.

Cortisol suppression as a surrogate marker for inhaled corticosteroid-induced growth retardation in children

Exposure of inhaled corticosteroids (ICSs) in pediatrics results in adrenal suppression and growth inhibition. The objective of this study was to assess the relationship of ICS mediated growth retardation with cortisol suppression in asthmatic children. A meta-analysis approach was performed with 33 published articles. Growth velocity (GV) data were obtained from the literature for evaluation of growth. Cumulative cortisol suppression within 24 h (CCS%) was calculated at steady state with a validated algorithm. Consolidated GV and CCS% data were employed for model development. A linear mixed effects model was developed to adequately describe the relationship between GV and CCS%. No impact of tested covariates was observed. Population estimate of the rate of change in GV was −0.06 cm/year/CCS% (12.7%, coefficient of variation) for both stadiometry and knemometry methods. However, GV from stadiometry is expected to be approximately three fold higher than that from knemometry when cortisol suppression was not presented. The final model was evaluated with posterior predictive check and pattern check approaches. The results from this study elucidate CCS% as an excellent predictor of ICS mediated growth retardation in asthmatic children.

Slow Prenatal Growth and Accelerated Postnatal Growth

It is well established that birth weight has a significant and inverse relationship with systolic blood pressure.1 Rapid weight gain in early infancy after slow fetal growth promotes higher blood pressure and increased cardiovascular risk in later life.2,3 Accelerated weight gain during childhood also enhances the risk of elevated blood pressure associated with low birth weight.4 However, the exact contribution of weight gain during “distinct” periods of early life on later blood pressure and whether accelerated postnatal growth independent of birth weight is critical to a later increase in blood pressure remain unclear. In the current issue of Hypertension , Ben-Shlomo et al5 used multiple measures of growth from birth to 5 years with an approach that modeled changes in growth velocity rather than anthropometry in relation to adult blood pressure. Use of this approach to model growth trajectories allowed them to investigate the inherent complexities of discrete periods of early growth on later blood pressure. In this study they demonstrated that rapid increases in postnatal weight in the first 6 months of life were critical to elevated adult systolic and diastolic blood pressure. …

Ciclesonide Noninferiority to Placebo on Growth Velocity: In Reply

In concordance with US Food and Drug Administration guidance,1 our study's main objective was to assess the effect of the inhaled corticosteroid ciclesonide on growth in children with asthma.2We agree that “the method of noninferiority trials is of delicate use and leads commonly to a false claim of noninferiority.” Naturally, a conclusion of noninferiority in a safety trial is valid only if patients complied with study medication use. Compliance was assessed in our study by 2 methods, one direct (diary cards, canister-weight changes) and one indirect (efficacy). The overall mean diary compliance was 97.4%. Highly concordant data were obtained by using canister-weight changes (94.9%). Thus, the possibility that parents of children enrolled in this trial overreported study-medication usage is highly unlikely.However, efficacy (forced expiratory volume in 1 second [FEV1]) was not observed. Although a positive signal would have provided additional support that patient adherence was good, the study was not designed to assess efficacy. On the basis of Food and Drug Administration guidance, patients with very mild asthma were recruited to minimize any confounding growth effect resulting from poor disease control or oral corticosteroid use. Thus, considering the high baseline FEV1 levels, an improvement in lung function would be difficult to detect.We also agree that both intention-to-treat (ITT) and per-protocol (PP) analyses are needed. These analyses were performed for nearly all parameters and demonstrated high concordance. For treatment withdrawals, the PP and ITT populations showed comparable rates (7.1% and 8.3%, respectively). Respective growth-velocity changes were also similar (mean ± SE: 5.76 ± 0.088 and 5.75 ± 0.080 cm/year for placebo, 5.69 ± 0.085 and 5.73 ± 0.080 cm/year for ciclesonide 40 μg/day, and 5.60 ± 0.090 and 5.60 ± 0.084 cm/year for ciclesonide 160 μg/day). In addition, with regard to concomitant treatments, >50% of the patients in each treatment group received montelukast in both populations. Thus, although it may have been helpful to include both the ITT and PP analyses in the article, only the primary PP analyses were displayed because of high concordance, a space limitation, and avoidance of confusion to readers.On the basis of the high concordance of the measures of compliance and the fact that the ITT and PP analyses were similar on the major end point, as well as possible confounding variables (eg, concomitant medications), we concluded that the relevant clinical outcome from this study, namely the linear regression estimate of the growth velocity of ciclesonide versus placebo over the year-long treatment period, was reported and demonstrated that ciclesonide at the 2 doses tested demonstrated no detectable effects on childhood growth velocity.

Dendrite spacing and microstructure evolution dependent on specimen history

Growth velocity in unidirectional solidification of succinonitrile–2 wt.% salol was systematically varied in a stepwise sequence. A gradual change in growth velocity showed definitive history-dependent dendrite spacing, while in the case of a large variation in growth velocity, the history effect did not exist. The present work shows that not only primary dendrite spacing but also microstructure evolution is history-dependent.

Catch-up growth follows an abnormal pattern in experimental renal insufficiency and growth hormone treatment normalizes it

The primary goal of this study was to determine if the ability to undergo catch-up growth following a transient injury is preserved in an experimental model of moderate chronic renal failure (CRF) and the effect of growth hormone (GH) administration on such phenomenon. Young rats were subtotally nephrectomized (days 0 and 4) (Nx). From days 11 to 13, food intake was restricted in subgroups of Nx and control (C) rats (NxR and CR). After refeeding, subgroups of NxR and CR rats received GH from days 14 to 20 (NxRGH and CRGH). Rats were killed on days 14 (C, CR, Nx, NxR), 17 and 21 (C, CR, CRGH, Nx, NxR, NxRGH), and 36 (C, CR, Nx, NxR). Longitudinal growth rate was measured by osseous front advance in the proximal tibiae. With refeeding, growth rate of CR, NxR, and NXrGH rats became significantly greater than that of C, indicating catch-up growth. This occurred later and with lower growth rate in NxR than in CR rats, whereas the characteristics of catch-up growth in CR and NxRGH animals were similar. Changes in growth rate were associated with modifications in the morphology and proliferative activity of growth cartilage. We conclude that catch-up growth occurs in renal insufficiency but follows a different pattern from that observed with normal renal function. GH treatment normalizes the pattern of catch-up growth in CRF. Changes in growth velocity are associated to modifications in the structure and dynamics of growth cartilage.

Relationship between systemic corticosteroid exposureand growth velocity: development and validation of a pharmacokinetic/pharmacodynamic model

Background: Use of high-dose oral corticosteroids (CSs) can reduce growth velocity (GV) in children, whereas use of low-dose topical CSs has either no effect or transient effects on short-term growth and no effect on final adult height Despite the large body of literature on this topic, some fundamental questions remain concerning the relationship between CS exposure and growth effects. Objectives: The aims of this study were to determine the relationship between CS exposure and GV in children receiving CS therapy for asthma or rhinitis, and to examine whether there is likely to be a link between GV and cortisol suppression. Methods: Data from 32 published studies of the effect on growth of inhaled, intranasal, and oral CSs, includingdelivery by dry powder inhaler, metered-dose inhaler, and aqueous nasal spray, were consolidated by expressing CS exposure in cortisol equivalents using a physiologically based pharmacokinetic/pharmacodynamic approach. The relationship between change in GV and CS exposure in cortisol equivalents was described using a nonlinear sigmoid maximum-effect (E max) model with the following parameters: E max = −5.9 cm/y; steady-state unbound AUC for 50% reduction in GV, in cortisol equivalents = 20,000 ng-h/L; Hill constant= 1.2; and change in GV at zero systemic exposure = 0.06 cm/y. Validation was achieved by comparing the model's predictions with data from 5 studies that were not included in the model development The model was also used to predict the potential of various CS regimens to reduce GV Results: Exploratory data analysis established that change in GV was highly correlated with exposure in cortisol equivalents ( P < 0.001). CSs with high systemic bioavailability by the intranasal route were predicted to have short-term growth effects exceeding the clinical equivalence limit for change in GV (±0.8 cm/y), whereas those with lower bioavailability were predicted to produce systemic exposures below the threshold for significant effects on GV The findings were similar for inhaled CSs and for regimens combining delivery by the intranasal and inhaled routes. In descending order, the model predicted the following ranking of the potential of the various intranasal, inhaled, and oral regimens to reduce GV, expressed as fractions or multiples of the pediatric dose (in μg/d): oral prednisolone 5000 μg/d, 0.14; inhaled beclomethasone dipropionate metered-dose inhaler 400 μg/d, 0.54; inhaled budesonide dry powder inhaler 400 μg/d, 0.66; intranasal triamcinolone acetonide aqueous nasal spray 220 μg/d, 0.74; inhaled triamcinolone acetonide metered-dose inhaler 400 μg/d, 0.75; intranasal beclomethasone dipropionate aqueous nasal spray 336 pg/d, 0.89; inhaled mometasone furoate dry powder inhaler 200 μg/d, 2.4; intranasal budesonide aqueous nasal spray 128 μg/d, 2.5; inhaled fluticasone propionate dry powder inhaler 200 μg/d, 2.6; intranasal mometasone furoate aqueous nasal spray 100 μg/d, 120; and intranasal fluticasone propionate aqueous nasal spray 100 pg/d, 150. Values >1 are predictive of no significant effect on GV The model predicted that a 10% to 15% reduction in plasma cortisol concentration should be detectable at the lower equivalence limit for growth reduction (−0.8 cm/y). The validation procedure showed that the model was capable of predicting the results of the 5 comparative growth studies not included in model development with a correlation coefficient of 0.98. Conclusions: Growth effects appear to be nonlinearly related to CS exposure; therefore, no-effect exposure should be possible for CSs with low systemic exposure. Growth inhibition appears unlikely to occur in the absence of detectable reductions in cortisol concentrations.

Shifts in percentiles of growth during early childhood: analysis of longitudinal data from the California Child Health and Development Study.

To document growth-velocity changes across major percentiles during the preschool years. Analyses of longitudinal data using height-for-age, weight-for-age, weight-for-height, and body mass index (BMI)-for-age percentiles were performed to examine crossing of major percentiles of the Centers for Disease Control and Prevention 2000 growth charts. The 5th, 10th, 25th, 50th, 75th, 90th, and 95th percentiles were defined as the major percentiles. Data from the California Child Health and Development Study were used. A total of 10,844 children up to 60 months of age, with 44,296 height and weight measurements, were included in our final analysis. For height-for-age, 32% of children between birth and 6 months of age, 13% to 15% of children between 6 and 24 months of age, and 2% to 10% of children between 24 and 60 months of age crossed 2 major percentiles. For weight-for-age, 39% of children between birth and 6 months of age, 6% to 15% of children between 6 and 24 months of age, and 1% to 5% of children between 24 and 60 months of age crossed 2 major percentiles. In contrast, for weight-for-height, 62% of children between birth and 6 months of age, 20% to 27% of children between 6 and 24 months of age, and 6% to 15% of children between 24 to 60 months of age crossed 2 major percentiles. Similar to the pattern observed for weight-for-height, 8% to 15% of children between 24 and 60 months of age crossed 2 major BMI-for-age percentiles. During the preschool years, weight-for-height had the highest percentages of children who crossed 2 major percentiles, and weight-for-age had the lowest percentages of children who crossed 2 major percentiles among these 3 indices. Shifts in growth rates were very common for children from birth to 6 months of age, somewhat less common for children 6 to 24 months of age, and least common for children 24 to 60 months of age. Shifts in weight-for-height occurred more frequently than did other growth changes. Pediatricians must consider the prevalence of growth rate shifts during infancy and early childhood before they counsel parents regarding growth or refer children for additional evaluations of growth.

Phase selection in undercooled binary peritectic alloy melts

The change of the primary solidification mode in undercooled peritectic Fe–Mo, Co–Si and Al–Co melts has been revealed by in situ observation of recalescence events during electromagnetic levitation. Levitated drops of controlled undercooling up to 380 K were quenched onto chill substrates and subjected to phase and microstructure analysis. Beyond a critical undercooling, the equilibrium solidification can be replaced by the direct growth of the peritectic phase. This was ascertained from sudden changes in growth velocity at a critical undercooling and the ultimate recalescence temperature. Metastable phases were detected in Co75Si25 and Al74.4Co25.6 as-quenched samples. The direct growth of the peritectic phase from the undercooled melt considerably improves the sample homogeneity.

Recommended once-daily dose of budesonide aqueous nasal spray (Rhinocort Aqua®) does not suppress growth velocity in pediatric patients with perennial allergic rhinitis

Rationale Recent guidelines suggest that intranasal corticosteroids should be used as first-line treatment for controlling persistent symptoms of allergic rhinitis (AR), but long-term continual use of corticosteroids can raise growth concerns in a pediatric population. Effects of the recommended once-daily dose of budesonide aqueous nasal spray (BANS; Rhinocort Aqua ®) on growth velocity were examined in pediatric patients with perennial AR. Methods In this 1-year, multicenter, double-blind, placebo-controlled study, 229 pediatric patients (aged 4 to 8 years) with perennial AR were treated with once-daily BANS (64 μg) or placebo. Change in growth velocity and in the percentage of patients whose percentile for height decreased from the 6-month baseline to end of treatment were examined using stadiometry. Results Mean growth velocity (± SE) during the treatment period was 5.91 ± 0.11 cm/year for the BANS group and 6.19 ± 0.16 cm/year for the placebo group. The difference in growth velocity between groups was not significantly different during the 1-year treatment period (0.27 ± 0.18 cm/year; 95% CI, −0.07 to 0.62). The percentage of patients whose percentile for height decreased during the study was also not significantly different between groups (58.5% BANS, 54.1% placebo; p=.64). The incidence and types of adverse events were similar between treatment groups. Five placebo patients and zero BANS patients reported serious adverse events during the treatment period. Conclusion Administration of budesonide aqueous nasal spray 64 μg once daily for 1 year does not suppress growth velocity and is well tolerated in pediatric patients aged 4 to 8 years with perennial AR.

A longitudinal evaluation of the NCEP-Peds guidelines for elevated total and LDL cholesterol in adolescent girls and boys

The National Cholesterol Education Program-Peds (NCEP-Peds) guidelines established single sets of cutoffs for evaluating borderline and elevated total (TC) and low density lipoprotein (LDL-C) cholesterol in children up to age 19 years, corresponding roughly to the 75th and 95th percentiles, respectively, of these distributions in the Lipid Research Clinics Prevalence Study (1972–1976). These cutoffs do not take into account the effects of puberty on these lipids. The purpose of this review is to describe adolescent changes and to demonstrate the effects of these changes on the prevalence of elevated TC and LDL-C. Thus, we present data on changes in growth velocity, obesity, fat patterning and pubertal maturation and apply the NCEP-Peds cutoffs to biracial adolescent cohorts by single year of age to show the variability in the percentage of children identified for follow-up. The net effect of these adolescent changes is a fall in the percentage of children identified for follow up of almost 50% from age 10 to mid-adolescence, followed by a rise in the percentages. Using multivariable analyses, we show that increasing obesity (body mass index, kg/m 2) increases the prevalence of dyslipidemias and advancing puberty decreases it. Thus, how a child is diagnosed may be a function of age and pubertal status at the time of the tests. These results suggest a need to modify the NCEP-Peds classification cutoffs to account for pubertal status.

Growing concerns about inhaled steroids?*1The facts about their effect on children's height

In a controlled prospective study we have measured growth and pulmonary function in children with asthma during long-term treatment with inhaled budesonide and compared these findings with those obtained from children not treated with corticosteroids. Two hundred and sixteen children were followed at 6 monthly intervals for 1–2 years without inhaled budesonide and then for 3–6 years on inhaled budesonide. Sixty-two children treated with theophylline, β2-agonists and sodiumcromoglycate but not with inhaled steroids were also followed for 3–7 years (controls).During the period of budesonide therapy the mean daily dose decreased from 710 to 430 μg (P<0·01) and no signs of tachyphylaxis to the treatment were seen. Budesonide treatment was associated with a significant reduction in the number of annual hospital admissions due to acute severe asthma (from 0·03 to 0·004 per child, P<0·001). In patients not treated with budesonide an annual decrease in % predicted FEV1 of 1–3% was seen. In contrast FEV1 improved significantly with time during budesonide treatment, both compared with the run-in period and with the control group (P<0·01). Furthermore, there was a significant (P=0·01) relationship between the duration of asthma at the start of budesonide and the annual increase in FEV1 during budesonide therapy. After 3 years of treatment with budesonide, children who started this therapy later than 5 years after the onset of asthma had significantly lower FEV1 (96%) than the children who received budesonide within the first 2 years after the onset of asthma (101%) (P<0·05). No statistically significant changes in growth velocity (run-in=5·6 cm year−1, controls=5·6 cm year−1, budesonide=5·5 cm year−1) or weight gain (run-in=3·5 kg year−1, controls=3·6 kg year−1, budesonide=3·6 kg year−1) were seen during budesonide treatment.We conclude that inhaled budesonide in doses up to 400 μg per day does not stunt growth in children with asthma and that early intervention with this treatment may prevent the development of irreversible airway obstruction and reduce the risk of under-treatment. Finally, continuous long-term treatment is not associated with the development of tachyphylaxis.

Observations of acetone pool boiling behavior under pulsed laser heating

AbstractThe variations of temperature on the surface of a specimen and acetone pool boiling behavior under pulsed laser heating are observed transiently. The effects of laser parameters and tiny metal grains on the temperature of the specimen's surface for acetone pool boiling are studied. It is seen that the pulse duration is the main factor that affects the temperature curve and vapor bubble behavior. When the pulse duration increases, the growth time of large vapor bubbles and their departure diameters decrease, but the growth velocity changes little. The growth velocity of large vapor bubbles is different from that under normal conditions. The period of isothermal growth was not observed, and the growth velocity rises quickly long after the laser pulse. The process of pool boiling turns vehement when the specimen surface is overlain with tiny metal grains. There are a great number of tiny vapor bubbles continuously generated long after the laser pulse, and the tiny vapor bubble's departure diameter is much less than the value calculated by the classical Fritz formula. © 2001 Scripta Technica, Heat Trans Asian Res, 30(4): 259–266, 2001

New reference for the age at childhood onset of growth and secular trend in the timing of puberty in Swedish

The objectives of the present work were to present a new reference for the age at childhood onset of growth and to investigate the secular trend in the timing of puberty in a community‐based normal population in Sweden. A total of 2432 children with longitudinal length/height data from birth to adulthood were used to determine the two measures by visual inspection of the measured attained length/height and the change in growth velocity displayed on a computer‐generated infancy‐childhood‐puberty (ICP) based growth chart. The series represents a sample of normal full‐term children born around 1974 in Göteborg, Sweden. We found about 10% of children were delayed (&gt;12 mo of age) in the childhood onset of growth based on the previous reported normal range, i.e. 14% in boys and 8% in girls. Distribution of the age at childhood onset of growth was skewed. The medians were 10 and 9 mo for boys and girls, respectively. After natural logarithmic transformation, the mean and standard deviation (SD) were 2.29 (anti‐log 9.9 mo) and 0.226 for boys, 2.23 (anti‐log 9.3 mo) and 0.220 for girls, respectively. The 95% normal ranges were 6.3‐15.4 and 6.0‐14.3 for boys and girls, respectively. The distribution of the timing of PHV was close to the normal distribution. The mean values were 13.5 y for boys and 11.6 y for girls with 1 y SD for both sexes.Conclusion: A downward secular trend in the onset of puberty was clearly shown in the population. The age at childhood onset of growth did not correlate with the timing of puberty (r=−0.01 and 0.05, p &gt; 0.7 and 0.1 in boys and girls, respectively). Normal ranges of the age at childhood onset of growth are in need of revise, as this study indicates. The new reference presented here could be a reliable indicator in further studies.