Age-specific Normative Values Research Articles

Normative Values for Serum Neurofilament Light Chain in US Adults.

Neurofilament light chain (NfL) levels serve as a marker of neuroaxonal injury and can be measured in both cerebrospinal fluid and serum. Although serum NfL (sNfL) levels have been shown to increase with the progression of various neurological conditions, normative values for healthy individuals have not yet been established. This study was undertaken to determine age-specific normative values for sNfL and evaluate the associations between sNfL and sociodemographic characteristics. A retrospective analysis was conducted using population-based data collected by the National Health and Nutrition Examination Survey between 2013 and 2014. The sera of 2071 adult participants were collected. General linear models were used to examine the associations between sNfL levels and sample characteristics. The data analysis revealed a significant positive association between age and sNfL levels (p<0.001). Sex was also associated with sNfL levels (p=0.04) after controlling for age. The mean sNfL levels for males and females were 17.99 pg/mL (95% confidence interval [CI]=15.43-20.17) and 15.78 pg/mL (95% CI=13.00-18.55) respectively, after controlling for age. These results suggest that sNfL levels increase with age and are affected by sex. The findings of this study provide a useful baseline for comparing sNfL levels in clinical practice and future research.

Normative-referenced values for health-related fitness among Czech youth: Physical fitness data from the study IPEN Adolescent Czech Republic.

The aim of this study was to developed sex- and age-specific normative-referenced percentile values for health-related fitness among 12 to 18 years old Czech youth. This study included cross-sectional data from 1,173 participants (50.7% boys) collected between 2013 and 2016. Participants were recruited from 32 elementary or secondary schools across eight cities located in the Czech Republic. Health-related fitness was objectively measured using both anthropometric (height, body mass, and sum of skinfolds) and performance (20-m shuttle run for cardiorespiratory endurance, modified push-ups for muscular strength/endurance, and V sit-and-reach for flexibility) tests. Sex- and age-specific normative values were calculated using the Lambda Mu Sigma method. Sex- and age-related differences in means were expressed as standardized effect sizes. Normative percentiles were tabulated and displayed as smoothed curves. Among boys, measures of health-related fitness generally increased with age, except for an age-related decline in the sum of skinfolds and a plateau in V sit-and-reach. Among girls, most measures of health-related fitness increased from age 12 to 16 years before stabilizing, except for the sum of skinfolds, which remained stable from age 12 to 18 years. The sex-related differences were large with boys having higher cardiorespiratory endurance and muscular strength/endurance than girls. Girls compared to boys had higher flexibility. This study presents the most up-to-date sex- and age-specific normative-referenced percentile values for health-related fitness among Czech youth. Normative values may be useful for fitness and public health screening and surveillance, for example, by helping to identify youth with low fitness who might benefit from a fitness-enhancing intervention.

Association of cardiorespiratory fitness level with vascular function and subclinical atherosclerosis in the elderly.

Physical exercise is crucial for healthy aging and plays a decisive role in the prevention of atherosclerotic cardiovascular disease (ASCVD). A higher level of cardiorespiratory fitness (CRF) in the elderly is associated with lower cardiovascular and all-cause mortality. This study investigated the association of CRF level with vascular function and cardiovascular risk factors in the elderly. We examined 79 apparently healthy and physically active subjects aged > 55years (64 ± 4years). Cardiovascular functional parameters assessed included brachial and central blood pressure (BP), pulse wave velocity (PWV), augmentation index (Aix), and ankle-brachial index. Sonography of the common carotid artery was performed. CRF level was determined by a cardiopulmonary exercise test, and everyday activity was quantified with an accelerometer. All participants had a higher CRF level than the reported age-specific normative values. Twenty-nine subjects had subclinical atherosclerosis of the common carotid artery. Compared with participants without atherosclerosis, they were older (p = 0.007), displayed higher brachial systolic BP (p = 0.006), and higher central systolic BP (p = 0.014). Lower brachial (p = 0.036) and central (p = 0.003) systolic BP, lower PWV (p = 0.004), lower Aix (p < 0.001), lower body fat percentage (< 0.001), and lower LDL cholesterol (p = 0.005) were associated with a higher CRF level. In this cohort of healthy and physically active individuals, subjects with subclinical atherosclerosis displayed higher systolic brachial and central BP. A higher CRF level was associated with enhanced vascular function, consistent with an influence of CRF on both BP and vascular function in the elderly.

Sex- and age-specific normative values of lower extremity muscle power in Italian community-dwellers.

Muscle power is associated with health-related parameters. Simple equations were validated to estimate lower extremity muscle power measures based on the time to complete the five-repetition sit-to-stand test. The present study was conducted to provide lower extremity muscle power estimates and produce centile values in a large and relatively unselected population across a wide age spectrum. Data were from the Longevity Check-up 7+ (Lookup 7+) project, an ongoing initiative conducted in unconventional settings (e.g., exhibitions, shopping centres and health promotion campaigns) across Italy to foster adoption of healthy lifestyles. Absolute, relative, allometric and specific muscle power measures of the lower extremities were estimated using validated formulas. Cross-sectional centile and normative values for muscle power measures from 18 to 81+years were produced for the two sexes. Smoothed normative curves for men and women were constructed using the lambda-mu-sigma method. From 1 June 2015 to 31 October 2021, 13 515 participants were enrolled of whom 12864 were eligible for the present study. Mean age was 55.9years (standard deviation: 14.8years; range: 18-98years), and 7217 (56.%) were women. Absolute, relative, allometric and specific muscle power declined significantly with age. Specific patterns of decline were observed according to sex and muscle power parameter. Absolute muscle power peaked at 41-50 and 31-40years in men and women, respectively. Afterwards, a decline rate of approximately 12% per decade was observed, regardless of sex. Relative muscle power showed the largest reduction with age, such that it was 40.6% and 46.4% smaller in men and women older than 80, respectively, compared with those aged 18-30years. Age-related changes in allometric and specific muscle power measures were similar between men and women. Data from the Lookup 7+ project indicate that lower extremity muscle power estimated using simple equations is significantly associated with age. Sex-specific patterns of decline in absolute and relative muscle power were observed with age. Allometric and specific muscle power declined at a similar rate in men and women.

Age-dependent normal values for the ‘Infant Gastroesophageal Reflux Questionnaire Revised’

The Infant Gastroesophageal Reflux Questionnaire Revised (I-GERQ-R) is used to score and evaluate gastroesophageal reflux (GER) related symptoms such as regurgitation, irritability and crying. A cut-off of ≥ 16 has been suggested to discriminate between GER and GER-disease. However, age-specific normal values were not assessed. Aim of this study was to determine age-specific normal values in healthy infants. Cross-sectional survey in healthy infants aged 0–24 months during their regular check-ups at well-baby clinics and through an online questionnaire using the I-GERQ-R. Infants with a history of (suspected) GER-disease were excluded. Spearman’s correlation coefficient was calculated to explore age-related trends. A total of 979 healthy infants (47% male, median age 6 [0–24] months) were included. Median I-GERQ-R score, regardless of age, was 6 (range: 0–27). I-GERQ-R scores significantly decreased with age (rs = -0.569, p < 0.001). Of all infants, 49 (5%) had a score of ≥ 16 which previously has been considered ‘suggestive of GER-disease’. Scores of ≥ 16 were most frequently seen in newborns aged 0–4 months (16% in 0–1 months to 4% in 3–4 months) and disappeared after the age of 16 months. High scores in the first months of life were caused by a high prevalence of regurgitation, colic-associated symptoms and hiccup frequency. Conclusion: Age-dependent normal values for the I-GERQ-R show that reflux symptoms decrease in the first 24 months of life in healthy infants. Scores of ≥ 16 should not necessarily be considered abnormal in young infants. Validation as a diagnostic tool for GER-disease using age-appropriate normal values is needed.What is Known:• The Infant Gastro Esophageal Reflux Questionnaire Revised (I-GERQ-R) was developed to objectively score and evaluate GER-related symptoms in infants.• Previously a cut off of ≥ 16 has been suggested to differentiate between gastro esophageal reflux (GER) and GER-disease.What is New:• We present age-specific normal values of the I-GERQ-R in healthy infants.• I-GERQ-R scores clearly decrease with age and up to 16% of young healthy infants have a score that is above the previously suggested cut-off score of 16 for GER-disease.

4Dimensional XStrain Echocardiography: M-mode and Tissue Doppler Estimation of Age and Gender Specific Normative Values of Aortic Stiffness in Healthy Adults during Covid-19 Pandemic.

The elastic properties of the aorta are modified in numerous cardiovascular and non-cardiovascular diseases. Multiple studies have evaluated aortic stiffness in myriads of disease state, albeit only few Indian studies have estimated the normal values of aortic stiffness in healthy population. To the best of our knowledge, till date no research has been undertaken to determine the age and gender specific value ranges of aortic stiffness parameters in healthy subjects. Hence, in the present study we endeavoured to estimate these values in our distinctive study groups of healthy adults. This was a prospective observational study in which 58 healthy adults were enrolled during the turbulent corona pandemic. Study group was of the age group 18-60 years of either sex and was arbitrarily divided into six groups. Exhaustive M-mode and Tissue doppler Imaging was performed by 4Dimensional XStrain echocardiography system for extensive evaluation of multiple M-mode and Tissue Doppler imaging derived parameters of Aortic stiffness and superior wall velocities of ascending aorta. AOS, AOD, Aortic strain, and elasticity modulus were greater in males. On the contrary Aortic superior wall velocities (SAO, EAO, and AAO) were higher in females. Increasing age led to a decline in majority of stiffness parameters derived by M-mode echocardiography. Correspondingly EAO determined by TDI of superior wall of aorta, showed a deterioration with advancing age. The authors report a normal range of M-mode and TDI derived values of Aortic stiffness of ascending aorta, in healthy Indian adults. Difference in magnitude of aortic elasticity indices has been demonstrated in men and women, as well as in different subsets of the study group.

Normative values of cardiorespiratory fitness in Croatian children and adolescents.

Although defining normative values of cardiorespiratory fitness have been the topic of many Western societies, little evidence has been provided for less developed countries like Croatia. Since cardiorespiratory fitness rapidly declines in Croatian children and adolescents, the newly established normative values would help health-related professionals and physical education teachers to detect 'talented' groups and direct them towards sport and 'risky' groups for planning special interventions. Therefore, the main purpose of the study was to determine normative reference values of cardiorespiratory fitness. A total of 1,612 children and adolescents aged 7-14 years (mean±SD; age 9.7±2.4 years; stature 151.0±17.6 cm; body mass 45.1±19.1 kg; 52.5% girls) participated in this cross-sectional study. Cardiorespiratory fitness was assessed by the Maximal multistage 20-m shuttle run test and the performance was expressed as the number of stages. Maximal oxygen uptake (VO2max) was estimated by equations. Smoothed percentile curves were calculated. Boys outperformed girls in the maximal number of levels achieved after the 20-m shuttle run test and in the VO2max values at each age category. In boys, a gradually higher level of performance between ages 11 and 14 was observed, while in girls the values started to rise after the age of 8. Our study provides one of the first sex- and age-specific normative values for cardiorespiratory fitness assessed by the 20-m shuttle run test in Croatian children and adolescents.

Quantitative anatomy of the growing supraspinatus muscle in the human fetus.

The supraspinatus muscle, one of the four rotator cuff muscles, initiates abduction of the arm, simultaneously stretching the articular capsule at the glenohumeral joint, and also contributes to exorotation of the arm. In the present study we aimed to evaluate the age-specific normative values for morphometric parameters of the supraspinatus muscle in human fetuses at varying ages and to elaborate their growth models. Using anatomical dissection, digital image analysis (NIS Elements AR 3.0) and statistics (Student's t-test, regression analysis), the length, width, circumference and projection surface area of the supraspinatus muscle were measured in 34 human fetuses of both sexes (16 males, 18 females) aged 18-30 weeks of gestation. Neither sex nor laterality differences were found in numerical data of the supraspinatus muscle. In the supraspinatus muscle its length and projection surface area increased logarithmically, while its width and circumference grew proportionately to gestational age. The following growth models of the supraspinatus muscle were established: y = -71.382 + 30.972 × ln(Age) ± 0.565 for length, y = -2.988 + 0.386 × Age ± 0.168 for greatest width (perpendicular to superior angle of scapula), y = -1.899 + 0.240 × Age ± 0.078 for width perpendicular to the scapular notch, y = -19.7016 + 3.381 × Age ± 2.036 for circumference, and y = -721.769 + 266.141 × ln(Age) ± 6.170 for projection surface area. The supraspinatus muscle reveals neither sex nor laterality differences in its size. The supraspinatus muscle grows logarithmically with reference to its length and projection surface area, and proportionately with respect to its width and circumference.

Normative values and integrated score of functional fitness among Chinese community-dwelling older adults in Suzhou.

Objectives: This study was performed to establish the normative values and integrated score of the functional fitness on the basis of the senior fitness test (SFT) among Chinese community-dwelling older adults in Suzhou. Methods: In this cross-sectional descriptive study, 1,122 community-dwelling older adults aged 60years old and above were recruited at Suzhou, China, by using a multistage stratified sampling method and accepted the SFT measurements. Sex- and age-specific normative values of each index of the SFT were established by using the percentile method. The SFT integrated score was established using factor analysis according to the data of 70% of the participants (construction group) and verified using the error rate from the data of the remaining 30% of the participants (verification group). Results: Normative-referenced percentile values at the 5th, 10th, 25th, 35th, 50th, 65th, 75th, 90th, and 95th percentiles for each index of SFT were established for the men and women among the different age groups. Five indices of the SFT, namely, 2-min step test, 30-s arm curl, 30-s chair stand, chair sit-and-reach, and 8-ft up-and-go (TUGT), gradually declined with age in both sexes (p < .05). The SFT integrated score was calculated as follows: F = 3.8 × 2-min step test + 3.8 × 30-s arm curl + 3.8 × 30-s chair stand + 2.2 × back starch + 2.6 × chair sit-and-reach + 4 × TUGT - .04 × BMI. The formula was verified using the error rate. The error rates of the verification group compared with the construction group in each grade score of SFT were lower than 5%. Conclusion: Based on the data from the community-dwelling older adults in Suzhou, China, the functional fitness normative values for each index of the SFT and the integrated score of SFT were established. The SFT integrated score formula was verified to be reasonable and effective.

Sex- and age-specific normal values for automated quantitative pixel-wise myocardial perfusion cardiovascular magnetic resonance.

Recently developed in-line automated cardiovascular magnetic resonance (CMR) myocardial perfusion mapping has been shown to be reproducible and comparable with positron emission tomography (PET), and can be easily integrated into clinical workflows. Bringing quantitative myocardial perfusion CMR into routine clinical care requires knowledge of sex- and age-specific normal values in order to define thresholds for disease detection. This study aimed to establish sex- and age-specific normal values for stress and rest CMR myocardial blood flow (MBF) in healthy volunteers. A total of 151 healthy volunteers recruited from two centres underwent adenosine stress and rest myocardial perfusion CMR. In-line automatic reconstruction and post processing of perfusion data were implemented within the Gadgetron software framework, creating pixel-wise perfusion maps. Rest and stress MBF were measured, deriving myocardial perfusion reserve (MPR) and were subdivided by sex and age. Mean MBF in all subjects was 0.62 ± 0.13 mL/g/min at rest and 2.24 ± 0.53 mL/g/min during stress. Mean MPR was 3.74 ± 1.00. Compared with males, females had higher rest (0.69 ± 0.13 vs. 0.58 ± 0.12 mL/g/min, P < 0.01) and stress MBF (2.41 ± 0.47 vs. 2.13 ± 0.54 mL/g/min, P = 0.001). Stress MBF and MPR showed significant negative correlations with increasing age (r = -0.43, P < 0.001 and r = -0.34, P < 0.001, respectively). Fully automated in-line CMR myocardial perfusion mapping produces similar normal values to the published CMR and PET literature. There is a significant increase in rest and stress MBF, but not MPR, in females and a reduction of stress MBF and MPR with advancing age, advocating the use of sex- and age-specific reference ranges for diagnostic use.

What Is a Normal Testosterone Level for Young Men? Rethinking the 300 ng/dL Cutoff for Testosterone Deficiency in Men 20-44 Years Old.

There is an age-related decline in male testosterone production. It is therefore surprising that young men are evaluated for testosterone deficiency with the same cutoff of 300 ng/dL that was developed from samples of older men. Our aim is to describe normative total testosterone levels and age-specific cutoffs for low testosterone levels in men 20 to 44 years old. We analyzed the 2011-2016 National Health and Nutrition Examination Surveys, which survey nationally representative samples of United States residents. Men 20 to 44 years old with testosterone levels were included. Men on hormonal medications, with a history of testicular cancer or orchiectomy, and with afternoon/evening laboratory values were excluded. We separated men into 5-year intervals and evaluated the testosterone levels of each age group, and for all men 20 to 44 years old. We used the American Urological Association definition of a "normal testosterone level" (the "middle tertile") to calculate age-specific cutoffs for low testosterone levels. Our final analytic cohort contained 1,486 men. Age-specific middle tertile levels were 409-558 ng/dL (20-24 years old), 413-575 ng/dL (25-29 years old), 359-498 ng/dL (30-34 years old), 352-478 ng/dL (35-39 years old), and 350-473 ng/dL (40-44 years old). Age-specific cutoffs for low testosterone levels were 409, 413, 359, 352, and 350 ng/dL, respectively. Diagnosis of testosterone deficiency has traditionally been performed in an age-indiscriminate manner. However, young men have different testosterone reference ranges than older men. Accordingly, age-specific normative values and cutoffs should be integrated into the evaluation of young men presenting with testosterone deficiency.

Comparison of Acute Phase Thymus and Activation-Regulated Chemokine (TARC) Levels in Food Protein-Induced Enterocolitis Syndrome and IgE-Dependent Food Allergy.

Introduction: Patients with food protein-induced enterocolitis syndrome (FPIES) have elevated thymus and activation-regulated chemokine (TARC) levels in the acute phase. However, to the best of our knowledge, no study has evaluated TARC levels in the acute phase of immunoglobulin E-dependent food allergy (IgE-FA). If TARC elevation is a specific response to FPIES among FAs, TARC measurement may help distinguish between FPIES and IgE-FA. Thus, we investigated acute phase TARC levels in patients with FPIES and IgE-FA. Methods: Thirty-one episodes in 16 patients with FPIES and 20 episodes (13 were anaphylaxis) in 20 patients with IgE-FA were included. Patients with eczema were excluded. Serum TARC levels within 6 h of allergic reaction onset and age-adjusted TARC ratios (TARC levels divided by age-specific normal TARC values) were compared between the groups. Results: The median age was 1.1 and 3.6 years in the FPIES and IgE-FA groups, respectively (P < 0.001). The median (range) serum TARC (pg/mL) levels were significantly higher in the FPIES group than in the IgE-FA group [1,283 (410-3,821) versus 377 (109-1,539); P < 0.001]. The median (range) age-adjusted TARC ratios were also significantly higher in the FPIES group [2.56 (0.57-7.86) versus 1.08 (0.15-2.17); P < 0.001]. The area under the curve (AUC) for TARC to distinguish FPIES from IgE-FA was 0.926, and the AUC for the age-adjusted TARC ratio was 0.850. The odds ratio for FPIES diagnosis per 1,000 pg/mL increase in TARC was 31.6 (P = 0.002), and the odds ratio adjusted by age was 17.1 (P = 0.016). Conclusion: Acute phase TARC levels were higher in patients with FPIES than in patients with IgE-FA. The increase in acute phase TARC levels was considered to be a specific response to FPIES among FAs. Measurement of TARC levels in the acute phase may help differentiate FPIES from IgE-FA.

Age-related topographic map of magnetic resonance diffusion metrics in neonatal brains.

Accelerated maturation of brain parenchyma close to term‐equivalent age leads to rapid changes in diffusion‐weighted imaging (DWI) and diffusion tensor imaging (DTI) metrics of neonatal brains, which can complicate the evaluation and interpretation of these scans. In this study, we characterized the topography of age‐related evolution of diffusion metrics in neonatal brains. We included 565 neonates who had MRI between 0 and 3 months of age, with no structural or signal abnormality—including 162 who had DTI scans. We analyzed the age‐related changes of apparent diffusion coefficient (ADC) values throughout brain and DTI metrics (fractional anisotropy [FA] and mean diffusivity [MD]) along white matter (WM) tracts. Rate of change in ADC, FA, and MD values across 5 mm cubic voxels was calculated. There was significant reduction of ADC and MD values and increase of FA with increasing gestational age (GA) throughout neonates' brain, with the highest temporal rates in subcortical WM, corticospinal tract, cerebellar WM, and vermis. GA at birth had significant effect on ADC values in convexity cortex and corpus callosum as well as FA/MD values in corpus callosum, after correcting for GA at scan. We developed online interactive atlases depicting age‐specific normative values of ADC (ages 34–46 weeks), and FA/MD (35–41 weeks). Our results show a rapid decrease in diffusivity metrics of cerebral/cerebellar WM and vermis in the first few weeks of neonatal age, likely attributable to myelination. In addition, prematurity and low GA at birth may result in lasting delay in corpus callosum myelination and cerebral cortex cellularity.

Reference centiles for left ventricular longitudinal global and regional systolic strain by automated functional imaging in healthy Egyptian children.

Two-dimensional speckle tracking echocardiography-derived left ventricular longitudinal systolic strain is an important myocardial deformation parameter for assessing the systolic function of the left ventricle. Strain values differ according to the vendor machine and software. This study aimed to provide normal reference values for global and regional left ventricular longitudinal systolic strain in Egyptian children using automated functional imaging software integrated into the General Electric healthcare machine and to study the correlation between the global longitudinal left ventricular systolic strain and age, body size, vital data, and some echocardiographic parameters. Healthy children (250) aged from 1 to 16 years were included. Conventional echocardiography was done to measure the left ventricular dimensions and function. Automated functional imaging was performed to measure the global and regional peak longitudinal systolic strain. The global longitudinal strain was -21.224 ± 1.862%. The regional strain was -20.68 ± 2.11%, -21.06 ± 1.84%, and -21.86 ± 2.71% at the basal, mid, and apical segments, respectively. The mean values of the systolic longitudinal strain become significantly more negative from base to apex. Age differences were found as regard to global and regional longitudinal strain parameters but no gender differences. The global peak longitudinal systolic strain correlated positively with age. No correlations were found with either the anthropometric parameters or the vital data. Age-specific normal values for two-dimensional speckle tracking-derived left ventricular longitudinal regional and global systolic strain are established using automated functional imaging.

Spanish version of Jenkins Sleep Scale in physicians and nurses: psychometric properties from a Peruvian nationally representative sample

ObjectiveTo evaluate the psychometric properties of the Spanish version of Jenkins Sleep Scale with 4 items (JSS-4) of the Peruvian health system's (PHS) nurses and physicians. MethodsWe carried out a psychometric study based on secondary analysis in a sample from a nationally representative survey that used acomplex sampling design. The participants were physicians and nurses aged 18–65 years, working in PHS private and public facilities, who have fulfilled all JSS-4 items. We performed a confirmatory factor analysis. Reliability was evaluated via two estimates - classic alpha (α) and categorical omega (ω) coefficients. Also, we tested the invariance across groups of variables. The convergent validity was evaluated based on the relation between JSS-4 and PHQ-2 using Pearson's correlation coefficient and effect size (Cohen's d). Also, we designed normative values based on percentiles. ResultsWe included 2100 physicians and 2826 nurses in the analysis. We observed that the unidimensional model has adequate goodness-of-fit indices and values of α and ω coefficients.No measurement invariance was found between the groups of professionals and age groups; however, invariance was achieved between sex, monthly income, work-related illness, and chronic illness groups. Regarding the relation with other variables, the JSS-4 has a small correlation with PHQ-2. Also, profession and age-specific normative values were proposed. ConclusionJSS-4 Spanish version has adequate psychometric properties in PHS nurses and physicians.

Normal sex and age-specific parameters in a multi-ethnic population: a cardiovascular magnetic resonance study of the Canadian Alliance for Healthy Hearts and Minds cohort

BackgroundDespite the growing utility of cardiovascular magnetic resonance (CMR) for cardiac morphology and function, sex and age-specific normal reference values derived from large, multi-ethnic data sets are lacking. Furthermore, most available studies use a simplified tracing methodology. Using a large cohort of participants without history of cardiovascular disease (CVD) or risk factors from the Canadian Alliance for Healthy Heart and Minds, we sought to establish a robust set of reference values for ventricular and atrial parameters using an anatomically correct contouring method, and to determine the influence of age and sex on ventricular parameters.Methods and resultsParticipants (n = 3206, 65% females; age 55.2 ± 8.4 years for females and 55.1 ± 8.8 years for men) underwent CMR using standard methods for quantitative measurements of cardiac parameters. Normal ventricular and atrial reference values are provided: (1) for males and females, (2) stratified by four age categories, and (3) for different races/ethnicities. Values are reported as absolute, indexed to body surface area, or height. Ventricular volumes and mass were significantly larger for males than females (p < 0.001). Ventricular ejection fraction was significantly diminished in males as compared to females (p < 0.001). Indexed left ventricular (LV) end-systolic, end-diastolic volumes, mass and right ventricular (RV) parameters significantly decreased as age increased for both sexes (p < 0.001). For females, but not men, mean LV and RVEF significantly increased with age (p < 0.001).ConclusionUsing anatomically correct contouring methodology, we provide accurate sex and age-specific normal reference values for CMR parameters derived from the largest, multi-ethnic population free of CVD to date.Clinical trial registrationClinicalTrials.gov, NCT02220582. Registered 20 August 2014—Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT02220582.

Causes of Anemia Due to Diminished Red Blood Cell Production in Pediatrics

The critical feature that distinguishes the anemias discussed in this article is the presence of an inappropriately low reticulocyte count for the degree of anemia. This is consistent with nutritional deficiencies, decreased erythropoietin levels, aplastic anemia, or inherited bone marrow failure syndromes. In addition, bone marrow replacement by a benign or malignant process, including those associated with ineffective erythropoiesis (eg, congenital dyserythropoietic anemias), comprise the differential diagnosis. Anemia causes increased morbidity and mortality in pediatric population; the absolute reticulocyte count (ARC) can be calculated by multiplying the percent reticulocytes by the RBC count/L. In a patient with anemia, ARC values within the “normal range” (generally 50-100 × 109/L) indicate an inappropriate response and suggest that there is an underlying red cell production issue due to intrinsic or extrinsic factors, or a combination of the two. The mean corpuscular volume (MCV) is another valuable red cell index that narrows the differential diagnosis of anemia due to diminished production. It is critical, however, to check age-specific normal values for MCV and to recognize that certain diseases can present with low, normal, and/or high MCVs. Finally, the red cell distribution width (RDW) assists in differentiating whether the anemia is likely due to a mixed process (wide RDW) or from a single cause (normal RDW). However, the management of anemia depends on the etiology. Early diagnosis and prompt treatment improve the quality of life of patients.

Gingivosupraperiosteoplasty following Presurgical Maxillary Orthopedics Is Associated with Normal Midface Growth in Complete Unilateral and Bilateral Cleft Patients at Mixed Dentition.

Passive orthodontic appliances and gingivosupraperiosteoplasty are adjuncts that can be used by surgeons at the time of primary cleft lip repair. These treatments, along with the surgical technique of cleft lip and palate repair, may impact midface growth. The objective of this study was to describe the authors' protocol for unilateral and bilateral cleft lip repair and to evaluate midfacial growth in a cohort of patients at mixed dentition who had undergone presurgical passive orthodontic appliance therapy and gingivosupraperiosteoplasty at the time of unilateral and bilateral cleft lip repair. Fifteen complete unilateral and 15 complete bilateral cleft lip and palate patients underwent passive orthodontic appliance treatment and primary lip repair with gingivosupraperiosteoplasty. Lateral cephalograms were analyzed by three blinded reviewers. Mean cephalometric measurements at mixed dentition were compared to cephalometric values for noncleft patients, unilateral cleft lip and palate patients who did not undergo gingivoperiosteoplasty or presurgical treatment, and unilateral cleft lip and palate patients who underwent gingivoperiosteoplasty/nasoalveolar molding with independent samples t tests. Mean cephalometric values were within age-specific normal values for sella-nasion-A point, sella-nasion-B point, A point-nasion-B point, and facial axis. Eighty-seven (13/15) percent of unilateral cleft lip and palate patients and 93 percent (14/15) of bilateral cleft lip and palate patients did not exhibit skeletal class III malocclusion. There was no significant difference between cephalometric values for our patients and patients who did not receive gingivosupraperiosteoplasty or presurgical treatment or who underwent the gingivoperiosteoplasty/nasoalveolar molding protocol. Presurgical passive orthodontic appliances, combined with gingivosupraperiosteoplasty at the time of lip repair, leads to normal maxillary development in most patients at mixed dentition. Assessment of midface growth at skeletal maturity is required. Therapeutic, IV.

Age-Specific Normative Values of Lumbar Spine Trabecular Bone Score (TBS) in Taiwanese Men and Women

Trabecular bone score (TBS) is a novel method for assessing trabecular microarchitecture. Normative values of TBS are available for various populations of the world but are not yet available for Taiwanese adults. Therefore, the purpose of this study was to estimate age-specific, normative TBS curves for Taiwanese men and women. Medical records of general health examinations from a regional hospital in Southern Taiwan were reviewed. Individuals aged 30–90 years with data on lumbar spine bone mineral density (BMD) were included. TBS was retrospectively calculated from dual-energy X-ray absorptiometry scans using TBS iNsight software. Of the 12,028 patients included, 4533 (37.7%) were male and the mean age was 55.8 years. The mean TBS was 1.392 (standard deviation (SD) 0.089) for men and 1.344 (SD 0.107) for women. In women, TBS declined at a rate of 0.0004/year among those aged 30.0–45.9 years, 0.0106/year among those 46.0–60.7 years, and 0.0028/year among those 60.8–90.0 years. In men, TBS declined at a constant rate of 0.0023/year over the entire age range. In conclusion, age-adjusted, normative curves of TBS for Taiwanese men and women are presented, which could be used to facilitate the use of TBS in assessing bone status in clinical practice.

General Spanish population normative data analysis for the EORTC QLQ-C30 by sex, age, and health condition

PurposeGeneral population normative data for the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 questionnaire facilitates interpretation of data assessed from cancer patients. This study aims to present normative data of the general Spanish population.Methods/patientsData were obtained from a prior larger study collecting EORTC QLQ-C30 norm data across 15 countries. Data were stratified by sex and age groups (18–39, 40–49, 50–59, 60–69 and > 70 years). Sex and age distribution were weighted according to population distribution statistics. Sex- and age-specific normative values were analysed separately, as were participants with versus those without health conditions. Multiple linear regression was used to estimate the association of each of the EORTC QLQ-C30 scales with the determinants age, sex, sex-by-age interaction term, and health condition.ResultsIn total, 1,165 Spanish individuals participated in the study. Differences were found by sex and age. The largest sex-related differences were seen in fatigue, emotional functioning, and global QOL (Quality of Life), favouring men. The largest age differences were seen in emotional functioning, insomnia, and pain, with middle-aged groups having the worst scores. Those > 60 years old scored better than those < 60 years old on all scales except for physical functioning. Participants with no health conditions scored better in all QLQ-C30 domains.ConclusionsThe present study highlights differences in HRQOL between specific sex/age strata and especially between people with and without a health condition in the general Spanish population. These factors must be considered when comparing general population HRQOL data with that of cancer patients.