Bone Age Research Articles

Comparison of bone age assessment methods using a hand radiography in patients with active growth plate and anteromedial knee instability

Background Bone age is essential for pediatric patients with active growth zones and anteromedial instability to facilitate optimal treatment strategy and minimize postoperative complications. However, many people are unaware of various tools for determining bone age, including classical methods and modern machine learning techniques.The objective was to show and compare different methods for calculating bone age and determining surgical strategy for patients with anteromedial instability of the knee joint.Material and methods All-Inside anterior cruciate ligament reconstruction was performed for 20 patients. Wrist radiographs were performed for bone age assessment using the "point scoring system" of Tanner and Whitehouse and the "atlas matching" method of Greulich and Pyle. Machine learning programs were used in addition to standard bone age assessments.Results The findings showed an average difference of 21 months (80 %) in a group of 20 individuals with bone age ahead of the passport age and an average difference of 18 months (20 %) in patients with retarded bone age.Discussion The findings showed the difference between chronological and bone age and could be encountered in scientific articles on endocrinology and pediatrics. No scientific studies on the use of the methods could be found in the specialty “trauma and orthopaedics”.Conclusion Bone age assessment, prediction of children's target height are essential for surgical treatment of patients with open growth plates.

The impact of sports participation on cognitive functions and academic performance among youth aged 10 to 14 years: A comprehensive investigation

Sports practice is essential for young people to perform better in the various pillars of their lives. Considering the maturational stage, this study aimed to investigate the effects of practicing sports on cognitive aspects (inhibitory control) and academic performance (report card).Seventy-five young people aged between 10 and 14 of both sexes were analyzed and divided into two groups: group I (Non-sporty), involved only in school physical education, and group II (Sporty), involved in sports initiation in addition to school physical education. Inhibitory control was assessed using the Go/No Go test and the 5-digit test (FDT). Maturation was determined using the bone age equation, and academic performance was assessed on the basis of school report card grades. There were no significant correlations between bone age, performance on cognitive tests and academic performance based on report card grades (p ≥ 0.05). However, the cognitive tests revealed a significant disparity between the two groups. The sportsmen had significantly fewer errors in all phases of the FDT test (p < 0.05) than their non-sporting peers. In addition, the sports group showed superior inhibitory control, as evidenced by better performance in the Go/No Go test [7.58 ± 0.14; p = 0.001]. It is concluded that regardless of the correlation between maturational development, cognitive aspects and academic performance, systematized sports practice has a beneficial effect on the cognitive abilities of young people, since sports players showed better cognitive performance than non-sports players.

The Impact of Methylphenidate on Pubertal Maturation and Bone Age in ADHD Children and Adolescents: Results from the ADHD Drugs Use Chronic Effects (ADDUCE) Project

Objective: The short-term safety of methylphenidate (MPH) has been widely demonstrated; however the long-term safety is less clear. The aim of this study was to investigate the safety of MPH in relation to pubertal maturation and to explore the monitoring of bone age. Method: Participants from ADDUCE, a two-year observational longitudinal study with three parallel cohorts (MPH group, no-MPH group, and a non-ADHD control group), were compared with respect to Tanner staging. An Italian subsample of medicated-ADHD was further assessed by the monitoring of bone age. Results: The medicated and unmedicated ADHD groups did not differ in Tanner stages indicating no higher risk of sexual maturational delay in the MPH-treated patients. The medicated subsample monitored for bone age showed a slight acceleration of the bone maturation after 24 months, however their predicted adult height remained stable. Conclusion: Our results do not suggest safety concerns on long-term treatment with MPH in relation to pubertal maturation and growth.

An artificial intelligence-based bone age assessment model for Han and Tibetan children.

Background: Manual bone age assessment (BAA) is associated with longer interpretation time and higher cost and variability, thus posing challenges in areas with restricted medical facilities, such as the high-altitude Tibetan Plateau. The application of artificial intelligence (AI) for automating BAA could facilitate resolving this issue. This study aimed to develop an AI-based BAA model for Han and Tibetan children. Methods: A model named "EVG-BANet" was trained using three datasets, including the Radiology Society of North America (RSNA) dataset (training set n = 12611, validation set n = 1425, and test set n = 200), the Radiological Hand Pose Estimation (RHPE) dataset (training set n = 5491, validation set n = 713, and test set n = 79), and a self-established local dataset [training set n = 825 and test set n = 351 (Han n = 216 and Tibetan n = 135)]. An open-access state-of-the-art model BoNet was used for comparison. The accuracy and generalizability of the two models were evaluated using the abovementioned three test sets and an external test set (n = 256, all were Tibetan). Mean absolute difference (MAD) and accuracy within 1year were used as indicators. Bias was evaluated by comparing the MAD between the demographic groups. Results: EVG-BANet outperformed BoNet in the MAD on the RHPE test set (0.52 vs. 0.63years, p < 0.001), the local test set (0.47 vs. 0.62years, p < 0.001), and the external test set (0.53 vs. 0.66years, p < 0.001) and exhibited a comparable MAD on the RSNA test set (0.34 vs. 0.35years, p = 0.934). EVG-BANet achieved accuracy within 1year of 97.7% on the local test set (BoNet 90%, p < 0.001) and 89.5% on the external test set (BoNet 85.5%, p = 0.066). EVG-BANet showed no bias in the local test set but exhibited a bias related to chronological age in the external test set. Conclusion: EVG-BANet can accurately predict the bone age (BA) for both Han children and Tibetan children living in the Tibetan Plateau with limited healthcare facilities.

Optimizing calibration of modern skeletal maturity systems.

Greulich and Pyle is the most used system to estimate skeletal maturity but has significant drawbacks, prompting the development of newer skeletal maturity systems, such as the modified Fels skeletal maturity systems based on knee radiographs. To create a new skeletal maturity system, an outcome variable, termed a "skeletal maturity standard," must be selected for calibration of the system. Peak height velocity and 90% of final height are both considered reasonable skeletal maturity standards for skeletal maturity system development. We sought to answer two questions: (1) Does a skeletal maturity system developed using 90% of final height estimate skeletal age as well as it would if it was instead developed using peak height velocity? (2) Does a skeletal maturity system developed using 90% of final height perform as well in lower extremity length prediction as it would if it was instead developed using peak height velocity? The modified Fels knee skeletal maturity system was recalibrated based on 90% of final height and peak height velocity skeletal maturity standards. These models were applied to 133 serially obtained, peripubertal antero-posterior knee radiographs collected from 38 subjects. Each model was used to estimate the skeletal age of each radiograph. Skeletal age estimates were also used to predict each patient's ultimate femoral and tibial length using the White-Menelaus method. The skeletal maturity system calibrated with 90% of final height produced more accurate skeletal age estimates than the same skeletal maturity system calibrated with peak height velocity (p < 0.05). The 90% of final height and peak height velocity models made similar femoral and tibial length predictions (p > 0.05). Using the 90% of final height skeletal maturity standard allows for simpler skeletal maturity system development than peak height velocity with potentially more accuracy.

Possible involvement of HtrA1 serine protease in the onset of osteoporotic bone extracellular matrix changes

High-temperature requirement A1 (HtrA1), a multidomain serine protease acting on Extracellular matrix (ECM) rearrangement, is also secreted by osteoblasts and osteoclasts. Recent and conflicting literature highlights HtrA1's role as a controller of bone remodeling, proposing it as a possible target for pathologies with unbalanced bone resorption, like Osteoporosis (OP). To add knowledge on this molecule function in bone physiopathology, here we compared HtrA1 distribution in the ECM of healthy (H) and OP bone tissue, also examining its localization in the sites of new bone formation. HtrA1 was homogeneously expressed in the mature bone ECM of H tissue showing a 55.6 ± 16.4% of the stained area, with a significant (p=0.0001) decrease in OP percentage stained area (21.1 ± 13.1). Moreover, HtrA1 was present in the endosteum and cells involved in osteogenesis, mainly in those “entrapped” in woven bone, whereas osteocytes in mature lamellar bone were negative. Based on our previous observation in OP tissue of a significantly increased expression of Decorin and Osteocalcin, both involved in bone mineralization and remodeling and equally substrates for HtrA1, we speculate that HtrA1 by controlling the proper amount of Decorin and Osteocalcin favors normal bone maturation and mineralization. Besides, we suggest that late-osteoblasts and pre-osteocytes secrete HtrA1 in the adjacent matrix whilst proceeding with their maturation and that HtrA1 expression is further modified during the remodeling from woven to the lamellar bone. Overall, our data suggest HtrA1 as a positive regulator of bone matrix formation and maturation: its reduced expression in mature OP bone, affecting protein content and distribution, could hamper correct bone remodeling and mineralization.

MPFL Reconstruction and Implant-Mediated Guided Growth in Skeletally Immature Patients With Patellar Instability and Genu Valgum

Background: There is a higher rate of failure of isolated MPFL reconstruction in skeletally immature patients with patellar instability compared to skeletally mature patients. Genu valgum is a known risk factor for patellar instability. There is potential for concomitant surgical correction of genu valgum to achieve better clinical outcomes and to decrease failure rates of MPFL reconstruction. Purpose: To evaluate outcomes of combined medial patellofemoral ligament (MPFL) reconstruction and implant-mediated guided growth (IMGG) in skeletally immature patients with patellar instability and genu valgum. Study Design: Case series; Level of evidence, 4. Methods: In a multicenter study, all skeletally immature patients with recurrent patellar instability and genu valgum who underwent MPFL reconstruction using hamstring graft and IMGG using a transphyseal screw or tension band plate for the distal femur and/or proximal tibia were included. The knee valgus angle and mechanical axis were measured on full-length radiographs and anatomic risk factors were measured on MRI. Patients were followed until correction of their lower limb alignment and implant removal or until skeletal maturity. Clinical outcomes, including complications, were analyzed. Results: A total of 31 patients (37 knees) were included in the study. The mean age and skeletal age of the cohort were 12.4 and 12.9 years, respectively. Simultaneous MPFL reconstruction and IMGG were performed in 26 of 37 knees; 11 underwent staged procedures. Twenty knees had transphyseal screws and 17 knees had tension band plates for IMGG. The knee valgus corrected from a mean of 12.4° to 5.1° in 12.1 months. Implants were removed from 22 of 37 knees once genu valgum was corrected. There was no significant difference (P = .65) in the correction rate between plates (0.7 deg/month) and screws (0.6 deg/month). Ten complications occurred in 4 patients (7 knees) and included 5 patellar redislocations, 2 rebound valgus, 1 varus overcorrection, 1 knee arthrofibrosis, and 1 implant loosening. For children <10 years of age, 3 of 6 (50%) knees had patellar redislocations and 5 of 6 knees had a complication. This was statistically significant (P = .003) compared with patients >10 years of age. Similarly, for patients with bilateral knee involvement, 5 of 12 (42%) knees had patellar redislocations and a total of 8 complications occurred in this subset. This was statistically significant (P < .001) compared with patients with unilateral involvement. Conclusion: IMGG with plates or screws in the setting of combined MPFL reconstruction improves genu valgum. Children <10 years of age and those with bilateral instability with genu valgum remain difficult subsets to treat with higher complication rates.

Growth During Pubertal Induction in Girls With Turner Syndrome: A Retrospective Cohort Analysis

Abstract Context Patients with Turner syndrome (TS) often present with short stature and ovarian insufficiency. The optimal method of pubertal induction to maximize adult height (AH) is unknown. Objective To identify variables related to pubertal induction that are associated with growth and AH. Methods This retrospective cohort analysis of patients attending a specialized TS clinic at a quaternary children's hospital included patients with TS (n = 107) who attended the clinic between 2015 and 2021. Among them, 51 received estradiol for pubertal induction. Main outcome measures were changes in height SD score (ΔHeightSDS) during pubertal induction and AH. Age at pubertal induction, bone age delay, mid-parental height (MPH), growth hormone treatment, and karyotype were assessed as predictors of AH and ΔHeightSDS. Associations between karyotype and comorbidities were also assessed. Results AH was predicted by MPH (0.8 cm/cm, P = .0001) and bone age delay (−1.84 cm/year, P = .006). ΔHeightSDS was predicted by growth hormone dose (0.09 SDS/mg/m2/week; P = .017), bone age delay (−1.37 SDS/year; P = .003), and age at pubertal induction (0.44 SDS/year; P = .001). There was an interaction between bone age delay and pubertal induction age (P = .013), with the combination of younger age at pubertal induction and a less-delayed bone age associated with a lower ΔHeightSDS. Karyotype did not influence AH or ΔHeightSDS but did affect rates of other comorbidities. Conclusion Decisions around timing of pubertal induction in patients with TS should be tailored to the individual. The current approach to estrogen supplementation needs to be refined in order to facilitate pubertal induction in a physiological manner without compromising height.

Once-Weekly Somapacitan as an Alternative Management of Growth Hormone Deficiency in Prepubertal Children: A Systematic Review and Meta-Analysis of Randomized Controlled Trial.

Growth hormone treatment has effectively restored normal growth in children with growth hormone deficiency (GHD); however, it poses challenges in compliance with a daily growth hormone injection regimen, leading to low adherence and persistence rates. Once-weekly Somapacitan is a potential alternative for treating children with GHD. This study aimed to evaluate the efficacy, safety, and adherence of once-weekly subcutaneous Somapacitan compared to daily growth hormone injection in prepubertal children with GHD. A search for the published records was carried out on 17 October 2023 utilizing the searching feature available on PubMed, Embase, and Scopus. Primary study outcomes included (1) efficacy, measured by height velocity (HV), standard deviation score (SDs), height SDs, insulin-like growth factor-SDs (IGF-I SDs), and bone age vs. chronological age ratio (BA vs. CA); (2) safety, assessed through adverse events and injection site reactions; and (3) adherence, determined by the percentage of the sample completing treatments. Secondary outcomes evaluated disease burden scores, divided into three subgroup domains: emotional well-being, physical functional, and social well-being scores. We retrieved 6 studies that were eligible for the systematic review (417 versus 186 for intervention and control, respectively). Only 2 of the total included studies were eligible for pooled analysis (175 versus 82 for intervention and control, respectively). The efficacy profile of Somapacitan was similar to daily growth hormones, indicated by HV (mean difference (MD = 0.04; p = 0.96), HV SDs (MD = -0.71; p = 0.09), height SDs (MD = 0.11; p = 0.69), IGF-I SDs (MD = 0.06; p = 0.70), and CA vs. BA (MD = 0.67; p = 0.70)), demonstrated similar and non-inferior outcomes. Treatment adherence is 3 times higher in the Somapacitan group as compared to control (OR = 3.02; p = 0.03) with adherence rates reaching 95% and 88% for Somapacitan and Norditropin®, respectively. The disease burden measurement is similar in Somapacitan and daily growth hormones (MD = -0.62; p = 0.83), as indicated by the Growth Hormone Deficiency-Child Impact Measure. In almost all outcomes, the level of confidence is strong. The confidence level in the data is generally strong, but for CA vs. BA and the subgroup of severe adverse events with heterogeneity >50%, the confidence level is moderate. Although the efficacy and safety profiles of Somapacitan were found to be similar to those of daily growth hormones, a reduced frequency of once-weekly Somapacitan injections led to increased adherence. PROSPERO registration: CRD42023473209.

Bone age assessment based on different MRI modalities of the proximal humerus epiphysis: the comparisons of T1WI, T2WI, and PDWI

Bone age assessment based on different MRI modalities of the proximal humerus epiphysis: the comparisons of T1WI, T2WI, and PDWI

Early breast development in girls: the power of greyscale sonography and sonoelastography.

Accurate distinction between central pubertal precociousness (PP) and premature thelarche (PT) is important to guide treatment. Both greyscale ultrasonography (US) and sonoelastography can be used to examine breast tissue. The aim of this study is to investigate the performance of breast US and strain elastographic (SE) in the diagnosis of increased breast volume in girls. Sixty-three girls with breast development up to 8 years of age and diagnosed with PP and PT were included in the prospective study. Basal luteinizing hormone (LH), follicle-stimulating hormone (FSH), and estradiol (E2) values were obtained. Each bud was considered as a unit in US. Mediolateral (ML) and anteroposterior diameters (AP) were measured, and US grading was performed. Breast SE was examined, and strain index (SI) was calculated. US and laboratory findings were compared. Of the 121 buds examined, 39 (32.2%) were with PP (6.97 ± 2.44 years) and 82 (67.8%) were with PT (6.51 ± 2.52 years). Diameters were correlated with bone age, LH, FSH, and US grade. The mean AP showed a moderate difference in favour of PP between the groups (P < .06). The mean ML was higher in PP (P < .01). There was a difference in mean SI values (P < .004). Sensitivity and specificity were 71% and 61% for ML and 72% and 56% for SI, respectively. Both ML and US grading may help discriminate PP from PT. The role of sonoelastography requires further investigation. Ultrasound and SE show significant differences between PP and PT, but these are not sufficiently reliable to be of clinical use. The contribution of sonoelastography requires further study before it can be recommended. However, SI of breast tissue can be helpful in distinguishing PP and PT from other causes of early increase in breast volume.

Change in Posterior Tibial Slope Angle After Displaced Pediatric Tibial Tubercle Fracture: A Model for Growth Modulation in the ACL-Deficient Knee.

Increased posterior tibial slope angle (PTSA) has been shown to be an important risk factor for anterior cruciate ligament (ACL) injury. PTSA modulation is not utilized routinely to reduce risk of primary rupture or graft failure. Displaced tibial tubercle (TT) fractures in the skeletally immature are associated with potential growth arrest and may be used as a model to study PTSA changes in this setting. To quantify the change in PTSA (ΔPTSA) after operative treatment of displaced TT fractures in skeletally immature patients. It was hypothesized that there would be a progressive decrease in PTSA after TT injury and that rate of ΔPTSA would be highest during peak growth velocity. Case series; Level of evidence, 4. Included were 22 patients (n = 23 knees; mean chronological and bone age at injury, 14 years; 86% male) who underwent surgery for displaced TT fracture. PTSA was measured on lateral radiographs at time of surgery and subsequent follow-up, and bone age at the time of injury was determined using radiographic standards. The rate of ΔPTSA for individual patient, total cohort, and sex-based subgroup trends were determined via linear regression (degrees per month; positive value indicates relatively anterior). Individual patient regression coefficients were averaged into bone age cohorts. Average follow-up was 17 months (range, 6-52 months). The mean PTSA was -12°± 2.4° at the time of injury, and the mean ΔPTSA for the cohort was 0.30°± 0.31° per month (range, -0.27° to 0.97° per month). Linear regression demonstrated a significant relationship between months postfixation and PTSA, demonstrating a ΔPTSA of 0.31° per month (95% confidence interval [CI], 0.24° to 0.38°; P < .001). The highest ΔPTSA was seen at bone age 14 years (mean, 0.58°± 0.44° per month). The mean absolute change in PTSA from injury to final follow-up was 4.1° (range, -3.4° to 21°). Our data suggested that PTSA becomes more anterior after operatively treated pediatric TT fractures and that ΔPTSA may be influenced by bone age. This concept may be useful in considering surgical modulation of excessive PTSA in the pediatric ACL-deficient knee.

Newborn screening-detected 21-hydroxylase deficiency: growth pattern is not associated with the genotype.

Normalizing growth in children with congenital adrenal hyperplasia due to 21-hydroxylase deficiency (21OHD-CAH) requires a long-term maintenance of a fragile balance between hydrocortisone (HC) replacement and androgen suppression. The growth pattern in children with 21OHD-CAH diagnosed by clinical symptoms has been evaluated in numerous retrospective studies. The aim of this study was to evaluate growth of patients with 21OHD-CAH detected by newborn screening (NBS), prior to clinical symptoms. Nation-wide NBS for 21OHD-CAH was implemented in the Czech Republic in 2006. Since then, 1,317,987 neonates were screened (2006-2017) and 21OHD-CAH was confirmed in 108 patients. Growth was evaluated as height-standard deviation score (SDS) at regular time-points, related to bone age and compared to recent population standards. In 88 patients, available data allowed long-term evaluation of growth, HC and fludrocortisone doses (in half-year intervals), with a median observation period of ten years. Body height in affected children was shorter between years 1-9 of life with a nadir at age 1-3 years. Their height did not differ from general population at the age 10-12 years. There were not found differences according to 21OHD-CAH severity. NBS is an effective secondary prevention tool for the early detection of 21OHD-CAH which improves growth patterns. A significant growth deceleration was observed during infancy and early childhood periods but with following height normalization. Growth pattern was not associated with the genotype of 21OHD, if patients have been detected by NBS.

Clinical details of individuals with Rauch-Steindl syndrome due to NSD2 truncating variants.

Rauch-Steindl syndrome (RAUST) is a very rare genetic syndrome caused by a pathogenic variant in NSD2 on chromosome 4p16.3. Although NSD2 was previously thought to be the major gene in Wolf-Hirschhorn syndrome (WHS), a contiguous gene syndrome of chromosome 4p16.3 deletion, RAUST has been found to present different facial and clinical features from WHS. In this study, we report the details of two newly diagnosed individuals with RAUST in order to better understand the molecular and clinical features of RAUST. Whole-genome sequencing was performed on two individuals with psychomotor delay and growth failure. Detailed clinical evaluation of growth parameters, craniofacial features, electroencephalogram (EEG), magnetic resonance imaging of the brain, and developmental assessment were performed. Both individuals had de novo truncating variants in NSD2. One had a novel variant (c.2470C>T, p.Arg824*), and the other had a recurrent variant (c.4028del, p.Pro1343Glnfs*49). Both exhibited characteristic RAUST facial features, growth failure, and mild psychomotor delay. A novel finding of RAUST was seen in individual 2, a Chiari malformation type 1, and both showed delayed bone age. They lacked common WHS features such as congenital heart defects, cleft lip/palate, and seizures (EEG with abnormal findings). We present a novel variant and clinical presentations of RAUST, expand the molecular and clinical diversity of RAUST, and improve our understanding of this rare syndrome, which is distinct from WHS. Further researches are needed on more RAUST cases and on functional analysis of NSD2.

Age Estimation Using Machine Learning Algorithms with Parameters Obtained from X-ray Images of the Calcaneus.

Determination of bone age is a critical issue for forensics, surgery, and basic sciences. This study aims to estimate age with high accuracy and precision using Machine Learning (ML) algorithms with parameters obtained from calcaneus x-ray images of healthy individuals. The study was carried out by retrospectively examining the foot X-ray images of 341 people aged 18-65 years. Maximum width of the calcaneus (MW), body width (BW), maximum length (MAXL), minimum length (MINL), facies articularis cuboidea height (FACH), maximum height (MAXH), and tuber calcanei width (TKW) parameters were measured from the images. The measurements were then grouped as 20-45 years of age, 46-64 years of age, 65 and older, and age estimation was made by using these at the input of ML models. As a result of the ML input of the measurements obtained, a 0.85 Accuracy (Acc) rate was obtained with the Extra Tree Classifier algorithm. The accuracy rate of other algorithms was found to vary between 0.78 and 0.82. The contribution of parameters to the overall result was evaluated by using the shapley additive explanations (SHAP) analyzer of Random Forest algorithm and the MAXH parameter was found to have the highest contribution in age estimation. As a result of our study, calcaneus bone was found to have high accuracy and precision in age estimations.

Manifestações clínicas e imaginológicas do querubismo: Um relato de caso

Introduction: Kerubism is a rare hereditary disorder characterized by bilateral enlargement of the gnathic bones in children, with a tendency to spontaneous remission at puberty. In some cases, it can develop without a family history. Aim: This report presents a case of non-hereditary cherubism affecting the dentition in a 7-year-old patient. Case report: A 7-year-old male patient complained of a bilateral increase in volume on the face in the mandibular body and ramus, which had been developing for 3 years, asymptomatically and with slow growth, with no history of similar cases in the family. Intraorally, the increase in volume extended from the canine to the molar, bilaterally, with anomalies in the teeth involved. Hematological tests were within limits. Panoramic radiography and facial CT revealed multiple multiloculated lesions in the mandibular body and ramus bilaterally. An incisional biopsy was performed under local anesthesia, which revealed the presence of multinucleated giant cells. Based on the clinical, imaging and histopathological findings, the final diagnosis was kerubism. Due to the self-limiting behavior of the pathology, surgical interventions were not necessary and the case will be followed up. Discussion: Although the lesions tend to be symmetrical, here they were more prominent on the right side. The radiographic features were typical of the disease. The lesions can cause malocclusions due to ectopic eruptions, as seen in this case. Despite the hereditary characteristic, there was no family history of the disease. Histological and laboratory analyses are important to rule out other fibro-osseous lesions, but clinical and radiographic aspects are paramount in the diagnosis. Once the bone matures, the lesion tends to regress. However, cosmetic surgery may still be necessary afterwards. Conclusion: The diagnosis of the disease should be based mainly on clinical and imaging findings, since histological analysis is of limited value. Once confirmed, the case should be followed up and surgical interventions postponed if necessary at a later date.

Long-term efficacy of a triptorelin 3-month depot in girls with central precocious puberty.

Three-month gonadotropin-releasing hormone agonists (GnRHas) are expected to achieve better compliance in patients with central precocious puberty (CPP) compared to the monthly formulation. However, 1-month depot remains the dominant choice for conventional treatment worldwide. Our study aimed to investigate the long-term efficacy of a 3-month GnRHa for CPP treatment. In this retrospective study, 69 Korean girls with CPP were prescribed either triptorelin pamoate (TP) 3-month depot (n=29) or triptorelin acetate (TA) 1-month depot (n=40) and were followed for 1 year after the end of treatment. Auxological, radiological, and biochemical data were collected every 6 months. Baseline characteristics were similar between the 2 groups. In the TP 3-month depot group, 27 of 29 patients (93.1%) exhibited suppressed luteinizing hormone level (below 2.5 IU/L) after 6 months of treatment, and this suppression level was reserved until the final injection. The degree of bone age advancement in the TP 3-month depot group decreased from 1.8±0.4 years at the start of treatment to 0.6±0.5 years at 1-year posttreatment. The gain in predicted adult height (PAH) 1 year after the end of treatment was similar between the TP 3-month and TA 1-month depot groups (5.2±3.1 and 5.3±2.4 cm, respectively; p=0.875). A 3-month depot of triptorelin effectively inhibited gonadal and sex hormones, suppressed bone maturation, and increased PAH. For patient convenience, we suggest a 3-month GnRHa regimen as a promising CPP treatment option.

Demystifying the Radiography of Age Estimation in Criminal Jurisprudence: A Pictorial Review.

Skeletal radiographs along with dental examination are frequently used for age estimation in medicolegal cases where documentary evidence pertaining to age is not available. Wrist and hand radiographs are the most common skeletal radiograph considered for age estimation. Other parts imaged are elbow, shoulder, knee, and hip according to suspected age categories. Age estimation by wrist radiographs is usually done by the Tanner-Whitehouse method where the maturity level of each bone is categorized into stages and a final total score is calculated that is then transformed into the bone age. Careful assessment and interpretation at multiple joints are needed to minimize the error and categorize into age-group. In this article, we aimed to summarize a suitable radiographic examination and interpretation for bone age estimation in living children, adolescents, young adults, and adults for medicolegal purposes.

BMI increase during early childhood in boys with cystic fibrosis and early adrenarche.

Increase in body mass index (BMI) in early childhood (1-6 years) was found to be a contributing factor for impaired final height in boys with Cystic Fibrosis (CF). Early adrenarche (before age 9 years in boys) may contribute to an impaired final height by triggering an early acceleration of bone age resulting in a compromised growth spurt during puberty. We aimed to analyze the timing of adrenarche in boys with CF and to associate BMI increase in early childhood to timing of adrenarche. Boys with CF, aged 8-9 years, visiting the CF expertize center Utrecht were included. Since 2018, anthropomorphic, pubertal and endocrine data were collected. Early adrenarche in boys was defined as a dehydroepiandrosterone sulfate (DHEAS) ≥ 1 µmol/L before the age of 9 years. Thirteen boys (mean age 8.55 ± 0.27 years) were enrolled. The median (IQR) DHEAS-level was 1.3 µmol/L (0.71-2.40). Eight boys (61.5%) had an early rise in DHEAS-levels ≥ 1 µmol/L. Mean increase in BMI Z-score between 1 and 6 years of age (ΔBMI1-6) was -0.07 ± 0.86. A significant correlation was found between ΔBMI1-6 and DHEAS-levels at the age of 8-9 years (r = 0.624, p = 0.040). In five boys with early rise in DHEAS, accelerated bone age was found (average 1.55 ± 0.96 years). In this small cohort, 61.5% of boys with CF between 8 and 9 years had an early rise of DHEAS, which was correlated to ΔBMI1 -6 between 1 and 6 years. Early adrenarche may be caused by ΔBMI1 -6.

The Addition of Hand-specific Skeletal Maturity Parameters Does Not Improve Skeletal Maturity Estimation Accuracy of the Modified Fels Wrist System.

The Modified Fels Wrist system is potentially the most accurate clinically accessible skeletal maturity system utilizing hand or wrist radiographs. During development, parameters distal to the metacarpals were excluded. We attempted to further optimize the Modified Fels wrist system through the inclusion of hand parameters distal to the metacarpals. Forty-three new anteroposterior (AP) hand radiographic parameters were identified from the Fels and Greulich and Pyle (GP) skeletal maturity systems. Twelve parameters were eliminated from further evaluation for poor correlation with skeletal maturity, poor reliability, and lack of relevance in the peripubertal years. In addition to the 8 previously described Modified Fels Wrist parameters, 31 hand radiographic parameters were evaluated on serial peripubertal AP hand radiographs to identify the ones most important for accurately estimating skeletal age. This process produced a "Modified Fels hand-wrist" model; its performance was compared with (1) GP only; (2) Sanders Hand (SH) only; (3) age, sex, and GP; (4) age, sex, and SH; and (5) Modified Fels Wrist system. Three hundred seventy-two radiographs from 42 girls and 38 boys were included. Of the 39 radiographic parameters that underwent full evaluation, 9 remained in the combined Modified Fels Hand-Wrist system in addition to chronological age and sex. Four parameters are wrist specific, and the remaining 5 are hand specific. The Hand-Wrist system outperformed both GP and SH in estimating skeletal maturity ( P <0.001). When compared with the Modified Fels Wrist system, the Modified Fels Hand-Wrist system performed similarly regarding skeletal maturity estimation (0.36±0.32 vs. 0.34±0.26, P =0.59) but had an increased (worse) rate of outlier predictions >1 year discrepant from true skeletal maturity (4.9% vs. 1.9%, P =0.01). The addition of hand parameters to the existing Modified Fels Wrist system did not improve skeletal maturity estimation accuracy and worsened the rate of outlier estimations. When an AP hand-wrist radiograph is available, the existing Modified Fels wrist system is best for skeletal maturity estimation. Level III.