Incidence of morphometric vertebral fractures in adult patients with growth hormone deficiency.

Cross-sectional studies showed an elevated prevalence of clinical and morphometric vertebral fractures (VFs) in adult patients with growth hormone deficiency (GHD). However, no data are available on incidence and determinants of radiological VFs in this clinical setting. In this prospective study, we investigated the incidence and risk factors of radiological VFs in adults with GHD. Forty patients with GHD (28 males, 12 females; median age 44 years, range 19-82) were studied for incident VFs using quantitative morphometric approach on spine X-ray at baseline and after 6 years of follow-up. GHD patients were also studied for bone mineral density (BMD) measured by DXA at lumbar spine. After 6 years of follow-up, 12 patients (30 %) experienced incident VFs. Patients with incident VFs had more frequently untreated GHD and prevalent VFs at baseline, as compared to patients who did not experience incident VFs. Untreated GHD patients were significantly older as compared to treated GHD (50 years, range 19-82 vs. 36 years, range 19-75; p = 0.003), but the correlation between high risk of VFs and untreated GHD remained significant even after adjustment for the age of patients (odds ratio 6.8, CI 95 % 1.1-41.8; p = 0.037). In GHD patients experiencing incident VFs, lumbar spine BMD decreased significantly whereas it did not change in patients not developing VFs. This is the first prospective study confirming the hypothesis suggested by cross-sectional studies that untreated GHD may cause high risk of VFs in adult patients and that recombinant human GH treatment may effectively decrease such a risk.

Ocular alignment and refraction in preterm children at 1 and 6 years old.

PURPOSE: To investigate cycloplegic refraction and ocular alignment in a population of preterm children at 1 and 6 years old. PATIENTS AND METHODS: We included 261 preterm infants with a birth weight ≤1,500 g and a gestational age ≤32 weeks; there were 217 preterm infants (group 1), 28 preterm infants with mild retinopathy of prematurity (ROP) (group 2), and 16 preterm infants affected by severe ROP (group 3). Each patient underwent retinoscopy, ocular alignment assessment, and fundus examination at 1 and 6 years old. RESULTS: The prevalence of refractive errors and ocular alignment abnormalities at 1 year old in groups 2 and 3 compared to group 1 were, respectively (P<0.05): myopia 18% and 40.6% versus 6.9%; hyperopia 28.6% and 22% versus 39.2%; astigmatism 53.4% and 37.4% versus 53.9%; and strabismus 12.5% and 38% versus 5.3%. At 6 years old, they were, respectively (P<0.05): myopia 10.8% and 28.4% versus 7.4%; hyperopia 48.3% and 40.5% versus 62%; astigmatism 40.9% and 31.1% versus 30.6%; and strabismus 25% and 56.25% versus 11.5%. CONCLUSION: At 6 years old, we observed increased rates of both hyperopia and strabismus in all groups compared to 1-year-old children. In preterm children with mild and severe ROP, we recorded increased rates of myopia and strabismus versus preterm children without ROP, and the risk of developing these disorders increased significantly with ROP severity. Astigmatism at 1 year old is not predictive of further development during growth. Patients born prematurely should be informed of the possible risks of ocular alterations due to refractive and ocular component changes.

Bone marrow cell transplantation improves cardiac, autonomic, and functional indexes in acute anterior myocardial infarction patients (Cardiac Study).

AIMS: Bone marrow (BM) stem cells improve cardiac function and outcome after acute ST-segment elevation myocardial infarction (MI). In this randomized controlled trial, the effects of intracoronary transfer of autologous BM cells on left ventricular ejection fraction (LVEF) and volumes (2D-echo and resting SPECT), stroke volume [impedance cardiography (ICG)], autonomic control [heart rate variability (HRV)], baroreflex sensitivity (BRS), and exercise tolerance (cardiopulmonary exercise test) were assessed in post-MI patients. Exercise stress SPECT was also performed. METHODS AND RESULTS: After percutaneous coronary intervention (PCI), 38 patients with residual LV dysfunction were randomized to either the BM group (optimized treatment plus intracoronary transfer of autologous BM cells 4 + or - 1 days after PCI, n = 19) or control (C) group (optimized treatment only, n = 19). After 12 months, mean LVEF (%) increased 13.1 + or - 1.9 in the BM patients vs. 5.3 + or - 2.0 in C, with an increase in stroke volume (mL, 14.5 + or - 4.0 in BM vs. 1.8 + or - 3.7 in C) associated with improved HRV [SD (ms) 62.4 + or - 8.3 in BM vs. 19.0 + or - 7.5 in C), higher BRS (ms/mmHg, 8.0 + or - 1.8 in BM vs. -1.9 + or - 1.7 in C), and peak VO(2) (mL/kg min(-1), 3.5 + or - 1.0 in BM vs. -0.4 + or - 0.5 in C). Stress SPECT showed improvements in perfusion, regional and global LV function scores (P < 0.05 BM vs. C groups for all comparisons). Cell transfer did not increase the risk of adverse clinical, in-stent restenosis, or proarrhythmic events. CONCLUSION: The beneficial effect of autologous BM cells in post-MI patients with depressed LV function may be mediated by restoration of autonomic control, and improved exercise tolerance.