Bone Age Research Articles

Bassa statura non sindromica e ritardo puberale: non solo ritardo costituzionale di crescita e pubertà

A 14-year-old boy with suspected constitutional delay of growth and puberty (CDGP) presented with short stature, absence of secondary sex characteristics, bone age delayed by one year and family history of CDGP in his mother. The external genitalia were normal. Re-evaluated at the age of 17 years and 7 months (as he missed several visits), he presented with a short near-final height (bone age consistent with chronological age) below the target height, signs of progressed virilization, but insufficient testicular volume. The prevalence of nonsyndromic 46,XX testicular disorder is estimated at 1:20,000 males. In 80% of cases the condition is due to the presence of the SRY gene on the X chromosome, resulting from abnormal paternal meiosis. It is characterized by short stature, hypergonadotropic hypogonadism and sterility. The need for routine screening of gonadal cancer is still a matter of debate. Treatment of this condition consists of testos-terone replacement from the pubertal age. Psychological support should also be warranted since the communication of the diagnosis. The case suggests that non-syndromic 46,XX testicular disorder should be considered when evaluating a boy with hypogonadism and short stature, especially in patients with suspected CDGP who have progressive virilization and advancement of bone age, despite no increase in testicular volume.

The Impact of Artificial Intelligence on Radiologists’ Reading Time in Bone Age Radiograph Assessment: A Preliminary Retrospective Observational Study

The Impact of Artificial Intelligence on Radiologists’ Reading Time in Bone Age Radiograph Assessment: A Preliminary Retrospective Observational Study

A Phase 2 Study of PEGylated Recombinant Human Growth Hormone for 52 Weeks in Short Children Born Small for Gestational Age in China

ABSTRACTObjectiveChildren born small for gestational age (SGA) are at increased risk of health issues. This study evaluated the efficacy, safety and optimal dose of PEGylated‐recombinant human growth hormone (PEG‐rhGH) in these children.DesignIn this multicentre, randomised, open‐label, Phase 2 trial conducted at nine clinical sites in China, patients were randomised 1:1 to receive subcutaneous injections of PEG‐rhGH at 0.1 mg/kg/week (low dose) or 0.2 mg/kg/week (high dose) for 52 weeks.PatientsNinety‐six children were born SGA.MeasurementsThe primary endpoint was the change in height standard deviation score (HT‐SDS) at Week 52.ResultsAt Week 52, the change in HT‐SDS in the high‐ and low‐dose groups was 0.923 ± 0.352 (p < 0.0001) and 0.511 ± 0.336 (p < 0.0001), respectively (least‐squares means difference, 0.410; 95% confidence interval 0.270–0.551; p < 0.0001). Height velocity (9.94 ± 1.55 vs. 8.37 ± 1.50 cm/year) was also significantly higher in the high‐dose than in the low‐dose group (p < 0.0001). Change in insulin‐like growth factor (IGF)‐1 SDS was 1.867 ± 1.747 and 1.168 ± 1.193 in the high‐ and low‐dose groups, respectively (p = 0.0189). IGF‐1/IGF binding protein‐3 and bone maturity were improved in both groups at Week 52. Most treatment‐emergent adverse events were mild to moderate; the safety profile was similar in both groups.ConclusionsPEG‐rhGH at either dose for 52 weeks was effective and well tolerated in children born SGA. Patients in the high‐dose group achieved greater improvement in HT‐SDS than in the low‐dose group.Trial RegistrationClinicalTrials. gov identifier: NCT02375620

Vertebral fracture prevalence and risk factors for fracture in the Gambia, West Africa: the Gambian bone and muscle ageing study

Abstract There are limited data describing the epidemiology of vertebral fractures (VF) from resource-limited settings, where the ageing population is growing most rapidly. We aimed to determine the prevalence, incidence, and risk factors for VF in The Gambia, West Africa. The Gambian Bone and Muscle Ageing Study is a prospective observational study in men and women aged 40 years and over. Rural participants had baseline measurements and plasma samples collected and were followed up 6-8 years later; urban participants had a single measurement. DXA scans were obtained to assess areal bone mineral density (aBMD), body composition and VF. Prevalence and incidence were calculated. Risk factors for prevalent and incident fracture were tested using logistic regression, in men and women separately, with and without adjustment for age and BMI. At baseline, 581 individuals (298 women) had useable scans, 214 (127 women) at follow-up. Prevalence of VF was 14.8%. Those with VF were older (65.6(11.2) vs 61.7(12.3) years, P=.01) and had lower aBMD Z-scores. For example, in women, a 1SD increase in femoral neck Z-score resulted in a lower risk of having a prevalent VF (OR [95% CI]) 0.51 [0.38, 0.73]. In men, lumbar spine Z-scores were predictive of prevalent fracture; (0.71 [0.53, 0.97]). The incidence of VF over follow-up was 12.1%. Low BMD and grip strength were associated with the odds of having an incident VF. Given the importance of prevalent VF in predicting future VF and other fragility fractures in other populations, our findings are a major cause for concern. VF prevalence in Gambian older adults is similar to elsewhere despite fractures not being a perceived issue. Risk factors were like those identified elsewhere including age, aBMD and bone resorption. Understanding the impact of these fractures is important in a region where health of the ageing population needs to be prioritized.

Magnesium Membrane Shield Technique for Alveolar Ridge Preservation: Step-by-Step Representative Case Report of Buccal Bone Wall Dehiscence with Clinical and Histological Evaluations

Background/Objectives: Despite the increased use of new resorbable magnesium membranes, there are no reported cases or studies on the use of resorbable magnesium membranes in combination with bone grafts for alveolar ridge preservation (ARP) in cases with severe buccal bone wall dehiscence. This case report aimed to evaluate the effectiveness of the magnesium membrane shield technique in conjunction with bone grafting for ARP, assessing both clinical outcomes and histological bone regeneration. Methods: A 44-year-old female patient presented with a vertical fracture on tooth 24 (FDI Notation System) accompanied with complete destruction of the buccal bone wall. The treatment plan included tooth extraction, ARP using a combination of anorganic bovine bone and autologous bone grafting, and the application of a magnesium membrane as a shield to the pre-existing buccal wall. Six months post-procedure, a bone biopsy was taken from the implant site using a trephine bur. Results: Clinical and radiological evaluations six months after the procedure demonstrated sufficient bone volume for implant placement. Additionally, in the next three months, soft tissue conditioning with a provisional crown resulted in an aesthetically and functionally satisfactory outcome. Histological analysis of the bone biopsy revealed well-formed new bone in direct contact with residual biomaterial, with no signs of inflammation. Osteocytes were clearly visible within the newly formed bone matrix, indicating successful bone maturation. Active osteoblasts were observed along the bone-biomaterial interface, suggesting ongoing bone remodeling and integration. Additionally, histomorphometric evaluation revealed 47% newly formed bone, 32% soft tissue, and 19% residual biomaterial. Conclusions: This case demonstrates the potential of the magnesium shield technique as an ARP technique in cases with severe buccal wall dehiscence. The technique yielded satisfactory clinical outcomes and promoted successful bone regeneration, as confirmed by histological analysis.

A critical comparative study of the performance of three AI-assisted programs for bone age determination.

To date, AI-supported programs for bone age (BA) determination for medical use in Europe have almost only been validated separately, according to Greulich and Pyle (G&P). Therefore, the current study aimed to compare the performance of three programs, namely BoneXpert, PANDA, and BoneView, on a single Central European population. For this retrospective study, hand radiographs of 306 children aged 1-18 years, stratified by gender and age, were included. A subgroup consisting of the age group accounting for 90% of examinations in clinical practice was formed. The G&P BA was estimated by three human experts-as ground truth-and three AI-supported programs. The mean absolute deviation, the root mean squared error (RMSE), and dropouts by the AI were calculated. The correlation between all programs and the ground truth was prominent (R2 ≥ 0.98). In the total group, BoneXpert had a lower RMSE than BoneView and PANDA (0.62 vs. 0.65 and 0.75 years) with a dropout rate of 2.3%, 20.3% and 0%, respectively. In the subgroup, there was less difference in RMSE (0.66 vs. 0.68 and 0.65 years, max. 4% dropouts). The standard deviation between the AI readers was lower than that between the human readers (0.54 vs. 0.62 years, p < 0.01). All three AI programs predict BA after G&P in the main age range with similar high reliability. Differences arise at the boundaries of childhood. Question There is a lack of comparative, independent validation for artificial intelligence-based bone age estimation in children. Findings Three commercially available programs estimate bone age after Greulich and Pyle with similarly high reliability in a central European cohort. Clinical relevance The comparative study will help the reader choose a software for bone age estimation approved for the European market depending on the targeted age group and economic considerations.

Anastrozole improves height outcomes in growing children with congenital adrenal hyperplasia due to 21-OHD.

Hyperandrogenemia resulting in estrogen-mediated accelerated bone maturation and early growth plate fusion contributes to short stature in children with congenital adrenal hyperplasia (CAH) due to 21OHD. Aromatase inhibitors block androgen conversion to estrogen and have been used off-label in children with short stature to improve adult height. There are no adequately powered studies examining the use of aromatase inhibitors in children with CAH with advanced bone age and reduced predicted adult height. Records of CAH patients treated with anastrozole were reviewed. Z-scores of bone age, predicted adult height and height corrected for bone age were examined over an 8-year period. Outcome changes were analyzed using weighted mixed-effects models, adjusting for sex, diagnosis, age at diagnosis, and average hydrocortisone dose before and during treatment with anastrozole. In 60 patients (26 females, 52 classic, 8 non-classic) started on anastrozole therapy, the mean bone age Z-score decreased from 4.2 to 2.0 at 4 years and 1.3 at 6 years (both p <0.001); predicted adult height Z-score improved from -2.1 to -0.45 at 4 years and 0.18 at 6 years (both p <0.001); corrected height Z-scores improved from -1.7 to -0.33 at 4 years and 0.18 at 6 years (p <0.001). There was no significant difference in the average total daily hydrocortisone dose used before or during treatment. Anastrozole decreased the rate of bone maturation and led to improved height outcomes, indicating that anastrozole could have a role as an adjunct therapy in children with CAH and advanced bone age.

Gonadal changes in children and adolescents with congenital adrenal hyperplasia.

Testicular adrenal rest tumours (TARTs) are a common cause of infertility in males with congenital adrenal hyperplasia (CAH). Ovarian adrenal rest tumours (OARTs) and polycystic ovaries (PCO) can impair ovarian function in female patients with CAH. We aim to detect gonadal changes in children and adolescents with CAH. This study was conducted on 50 CAH patients (30 females and 20 males) with 21-hydroxylase deficiency (21-OHD), with a mean age of 10.35 ± 2.36 years. Testicular ultrasonography and pelvic magnetic resonance imaging (MRI) were done in males and females respectively. Glucocorticoid doses and biochemical data were obtained from the patients' medical records. TARTs were detected in 10/20 male patients (50 %). There was a significant relation between presence of TARTs, body mass index (BMI) standard deviation score (SDS), and bone age (p=0.017 and 0.023; respectively). There was no significant relation between presence of TARTs, laboratory parameters, or treatment received (p>0.05). Of those subjected to genetic analysis, 48 % had I2 splice (c.290-13A/C>G) followed by P30L (c.89C>T) (40.7 %). P30L (c.89C>T) was the most common allele among the patients with TARTs (42.9 %). There was no significant relation between presence of TARTs, the genotype, alleles, or the genotype groups (p>0.05). Only one female patient had radiological evidence of bilateral polycystic ovaries and none had OARTs. The prevalence of TARTs in our study was high (50 %). Screening for TARTs in males with CAH is crucial; however, routine ovarian imaging in CAH females is not indicated unless ovarian dysfunction is present.

What imaging does my AIS patient need? A multi-group survey of provider preferences.

Adolescent idiopathic scoliosis (AIS) is a common diagnosis managed by pediatric orthopedic surgeons with nonoperative radiographic monitoring representing a cornerstone of treatment. Differences in practices and techniques for obtaining radiographic studies contribute to variation, cost of care, and hamper data aggregation. We surveyed several large organizations dedicated to children's orthopedics or scoliosis care to obtain a consensus for radiographic evaluation of AIS. A REDCap-based survey was developed across four institutions and beta-tested by staff and fellows from a single institution. The finalized survey was distributed to members of POSNA, PSSG, and SOSORT, and shared on social media. Participants were asked to rank the importance of various datapoints in radiographic assessment of the spinal deformity, skeletal maturity, and study indications during initial, subsequent, preoperative, and final office visits for AIS. Response rate for the overall group was 26%. Cobb angle was considered the most important (> 94%) radiographic index across all time points. For positioning, 46% of respondents favored arms bent touching clavicles as the ideal positioning for X-rays, and another 24% favored arms down with palms forward (Table2). The majority of respondents obtain lateral X-rays at the first visit (99%) and at the preoperative visit (70%). At the preoperative visit, sagittal contour (86%), apex location (85%), and Lenke classification (73%) were considered important factors to record. Flexibility studies are primarily obtained at the preoperative visit (89%) and 81% of respondents prefer bending films as the flexibility technique of choice. Regarding measures of skeletal maturity, Sanders bone age was considered to be the most important by over 70% of respondents across initial, subsequent, preoperative and brace wean visits (Fig.2). MRIs were obtained routinely by 34% of respondents and only when the patient had a concerning symptom or finding for 67% of respondents. Despite large variations in radiographic examination of AIS, large areas of agreement were found. It is important to establish standards for positioning patients, evaluating skeletal maturity, and obtaining assessments including lateral views, flexibility studies, and advanced imaging. Establishing common practices for radiographic evaluation of AIS will allow for less variation in care and for critical questions to be answered through registry formation and large multicenter data collection. This study establishes current practitioner opinion on the radiographic evaluation of the AIS patient. Minimum data sets are useful for data aggregation and answering research questions in the face of data variability. Level V.

"The Association between Vitamin D Deficiency and Childhood Obesity and Its Impact on Children’s Serum Calcium, Alkaline Phosphatase, and Bone Age"

ObjectiveThe research aimed to investigate the Association between Vitamin D deficiency and childhood obesity and its Impact on children’s serum calcium, alkaline Phosphatase, and bone Age MethodsThe study analyzed clinical data from 159 school-aged children who underwent medical examinations. The children were divided into a 25-(OH)D3 deficiency group and a non-25-(OH)D3 deficiency group based on their serum 25-hydroxy Vitamin D3 levels. The two groups were compared regarding BMI, TC, TG, FBG, HbA1c, Ca, ALP, and bone age differences. ResultsIndividuals with a deficiency in 25-(OH)D3 exhibited higher levels of BMI, TC, TG, and ALP, and lower levels of Ca and bone age than those without the deficiency. These differences were statistically significant (P<0.05). Further analysis revealed a negative association between 25-(OH)D3 levelsa positive correlation between Ca and bone age, and a positive correlation with, BMI, TC, TG, and ALP. ConclusionThe deficiency of 25-(OH)D3 in school-aged children is linked to obesity and impacts bone growth. Monitoring vitamin D levels is crucial for clinical practitioners.

Forensic bone age assessment of hand and wrist joint MRI images in Chinese han male adolescents based on deep convolutional neural networks.

In Chinese criminal law, the ages of 12, 14, 16, and 18 years old play a significant role in the determination of criminal responsibility. In this study, we developed an epiphyseal grading system based on magnetic resonance image (MRI) of the hand and wrist for the Chinese Han population and explored the feasibility of employing deep learning techniques for bone age assessment based on MRI of the hand and wrist. This study selected 282 Chinese Han Chinese males aged 6.0-21.0 years old. In the course of our study, we proposed a novel deep learning model for extracting and enhancing MRI hand and wrist bone features to enhance the prediction of target MRI hand and wrist bone age and achieve precise classification of the target MRI and regression of bone age. The evaluation metric for the classification model including precision, specificity, sensitivity, and accuracy, while the evaluation metrics chosen for the regression model are MAE. The epiphyseal grading was used as a supervised method, which effectively solved the problem of unbalanced sample distribution, and the two experts showed strong consistency in the epiphyseal plate grading process. In the classification results, the accuracy in distinguishing between adults and minors was 91.1%, and the lowest accuracy in the three minor classifications (12, 14, and 16 years of age) was 94.6%, 91.1% and 96.4%, respectively. The MAE of the regression results was 1.24 years. In conclusion, the deep learning model proposed enabled the age assessment of hand and wrist bones based on MRI.

Deciphering Growth Patterns in Korean Children With Sotos Syndrome Through the Development of a Disease-Specific Growth Chart.

Sotos syndrome (SS) is a rare disorder characterized by overgrowth, distinctive facial features, and intellectual disability that is primarily caused by NSD1 pathogenic variants or 5q35 microdeletions. We retrospectively analyzed the clinical characteristics and 339 anthropometric measurements over an average of 4.3 years of follow-up in 57 Korean children with SS. Sex-specific percentile curves for height, weight, and head circumference were developed using a generalized additive model that included factors such as location, scale, and shape. Males with SS demonstrated higher height before the age of 12.0, greater weight before 10.0, and larger head circumference before 15.5 compared to age- and sex-matched controls. Females with SS displayed higher height before 17.0, greater weight before 10.5, and larger head circumference before 12.0 compared to controls. Bone age was advanced compared to chronological age in 40% of males and 8% of females at their last visit. The predicted and target adult heights were not significantly different between groups. In subgroup analysis, the intragenic variant group (n = 48) showed a higher mean standard deviation score of height and weight in males, and head circumference in females compared to the microdeletion group (n = 9). Korean children with genetically confirmed SS exhibited overgrowth in height, weight, and head circumference. Overgrowth phenotypes were more prominent in patients with NSD1 intragenic variants than in those with microdeletions. This is the first study to provide reference data on the growth of Korean children with SS.

Response of children with Turner syndrome with different types of karyotype abnormalities to growth hormone treatment.

Short stature is the main characteristic of Turner syndrome (TS) patients and growth hormone (GH) therapy has been essential for achieving the final adult height (Ht). In the present study, the response of TS patients with different types of karyotype abnormalities to GH therapy was analyzed. The clinical parameters of 194 TS patients registered in the LG Growth Study were retrospectively reviewed. Data for 4 groups of subjects were obtained as follows: monosomy X (n=56); X structural abnormality (n=26); X mosaicism without structural abnormality (n=41); X mosaicism with structural abnormality (n=71). Clinical characteristics and growth response parameters were compared over 3 years of GH treatment. The baseline Ht standard deviation score (SDS) of all patients was -2.85±0.86. The baseline Ht SDS, body mass index SDS, and chronological age (years)-bone age (years) were significantly different based on chromosomal abnormalities. The growth velocity (GV; cm/yr) in the first year was the highest and significantly different among the groups. The GV in the second year also showed an increase in the X mosaicism without structural abnormality group compared with the monosomy X group. The change in Ht SDS (ΔHt SDS) over 3 years was not statistically different between karyotypes. The response to 3 years of GH therapy did not differ based on the karyotype of TS patients although the initial Ht SDS was the lowest in the monosomy X group.

Comparison of growth hormone stimulation tests in prepubertal children with short stature according to response to growth hormone replacement.

Growth hormone (GH) stimulation tests are essential tools for diagnosing GH deficiency (GHD). We aimed to compare L-dopa, insulin, and arginine-induced stimulation tests based on response to GH replacement. We retrospectively collected data from a review of patients who underwent the GH stimulation test. A total of 138 patients diagnosed with idiopathic short stature were categorized into group I. The remaining 135 patients, who were diagnosed with GHD and treated for 1 year, were classified into 2 subgroups: group IIa, consisting of patients with an increase of at least 0.5 in height standard deviation score (SDS), and group IIb, patients with an increase of less than 0.5 in height SDS. At the initial visit, group IIa exhibited significantly lower insulin-like growth factor binding protein-3 (IGF-BP3) and higher body mass index (BMI) SDS compared to the other groups. Following 1 year of treatment, group IIb showed significantly lower height SDS, height SDS gain, growth velocity, predicted adult height SDS, weight SDS, and a higher insulin-like growth factor-1 SDS than group IIa. Bone age and IGF-BP3 were inversely associated, and BMI SDS and IGF-BP3 were positively associated with height SDS gain in GHD patients. The specificity and accuracy rates were 50.3% and 70.3% for the L-dopa-induced stimulation test, 72.3% and 86.6% for the insulin tolerance test (ITT), and 64.7% and 87.2% for the arginine-induced stimulation test (ArST). The ArST demonstrated lower specificity compared to the ITT. However, patients undergoing ArST experienced fewer side effects, suggesting that a careful selection of stimulation tests is crucial in diagnosing GHD.

The association of vitamin D insufficiency with the prevalence of obesity in children: implications for serum calcium levels, alkaline phosphatase activity, and bone maturation

BackgroundVitamin D deficiency has been identified as a potential risk factor for various adverse health outcomes. However, its specific role in metabolic regulation and skeletal development in school-aged children is not fully understood. This study aimed to explore the correlation between vitamin D deficiency and childhood obesity rates, and its impact on serum calcium, alkaline phosphatase, and bone age in children.MethodsThe study analyzed clinical data from 159 school-aged children who underwent medical examinations. Participants were divided into the 25-hydroxyvitamin D3 (25(OH)D3) deficiency group and the 25(OH)D3 normal group based on their serum levels. We compared body mass index (BMI), total cholesterol (TC), triglycerides (TG), Ca, ALP, bone age, fasting blood glucose (FBG), and hemoglobin A1c (HbA1c) between the two groups. Logistic regression and Spearman correlation analyses were performed to further investigate relationships between 25(OH)D3 levels and metabolic and bone-related markers.ResultsThis study showed that the 25(OH)D3 deficiency cohort exhibited significantly higher BMI, TC, TG, and ALP levels, with lower Ca levels and delayed bone age compared to the normal group. Logistic regression analysis identified Ca, ALP, and bone age as significant predictors of 25(OH)D3 deficiency. Subgroup analysis showed that in the 25(OH)D3 deficient group, children with higher BMI had elevated TC, ALP levels, and delayed bone age, while Ca levels were lower. Correlation analysis confirmed the predictive value of these markers for 25(OH)D3 deficiency.ConclusionOur findings demonstrate that 25(OH)D3 deficiency is strongly associated with obesity in school-aged children and may negatively affect normal skeletal development. Regular monitoring of 25(OH)D3 levels in school-aged children is essential for ensuring proper growth and development, especially in those at risk for obesity.

Applications of artificial intelligence in age estimation: a review

Age estimation is a legally significant issue, particularly in underdeveloped and developing countries, due to factors such as inadequate civil registration systems and irregular migration. While various techniques are employed for age estimation using traditional methods, it is known that factors including age, gender, chronic illness, race, and geographical region can result in discrepancies between skeletal age and chronological age. This complicates the process of achieving accurate age estimation. This review aims to discuss recent research on artificial intelligence applications in light of current literature. Artificial intelligence and machine learning have enabled machines to acquire human-like capabilities in thinking, learning, problem solving, and decision making, leading to significant progress in achieving faster and accurate results. In the field of forensic medicine, methods such as linear discriminant analysis, K-Nearest Neighbors, support vector machines, random forests, and artificial neural networks have been employed to classify data and conduct studies on age estimation. Research has focused on five regions: the carpal bones, ossification centers, the middle phalanx of the hand, the third metacarpal, and the radius and ulna. Additionally, facial angles and width obtained through tomographic examinations, as well as measurements of the calcaneus and cuboid bones, panoramic dental radiographs, volumetric analysis of teeth and pulp using Cone Beam Computed Tomography, and analysis of bloodstains on microRNAs, have been analyzed for their distribution across different age. The results demonstrate that artificial intelligence applications can be utilized in age estimation with a high accuracy rate (85-95%). Age estimation using artificial intelligence enhances data-driven decision-making processes, improves the quality of services, and contributes to societal benefit. Therefore, we believe that incorporating artificial intelligence applications alongside traditional methods in age estimation will yield more meaningful outcomes.

Charting the growth through intelligence: A SWOC analysis on AI-assisted radiologic bone age estimation.

Bone age estimation (BAE) is based on skeletal maturity and degenerative process of the skeleton. The clinical importance of BAE is in understanding the pediatric and growth-related disorders; whereas medicolegally it is important in determining criminal responsibility and establishing identification. Artificial Intelligence (AI) has been used in the field of the field of medicine and specifically in diagnostics using medical images. AI can greatly benefit the BAE techniques by decreasing the intra observer and inter observer variability as well as by reducing the analytical time. The AI techniques rely on object identification, feature extraction and segregation. Bone age assessment is the classical example where the concepts of AI such as object recognition and segregation can be used effectively. The paper describes various AI based algorithms developed for the purpose of radiologic BAE and the performances of the models. In the current paper we have also carried out qualitative analysis using Strength, Weakness, Opportunities and Challenges (SWOC) to examine critical factors that contribute to the application of AI in BAE. To best of our knowledge, the SWOC analysis is being carried out for the first time to assess the applicability of AI in BAE. Based on the SWOC analysis we have provided strategies for successful implementation of AI in BAE in forensic and medicolegal context.

Effect of Local Zoledronic Acid Application in Alveolar Bone Healing: An Experimental Study.

This experimental study aimed to assess the three-dimensional and histological changes of the alveolar socket with local application of ZA. Nine male New Zealand white rabbits were randomly allocated into 4-, 8-, and 12-week groups after the extraction of 4 incisor teeth. The upper and lower right sockets were filled with ZA + collagen sponge (ZA-CS group), while the left sockets were filled with collagen sponge alone (CS group) postoperatively. At 4, 8, and 12 weeks (T1, T2, and T3) after the extraction, radiographic and histomorphometric evaluations were conducted for both groups. The increase in alveolar bone density of the ZA-CS group at T2 and T3 was significantly higher than the CS group (P＜0.01). Three-dimensional evaluations demonstrated no statistically significant differences in ridge height and width between the 2 groups at T2 and T3. On histological evaluation, the ZA-CS group included significantly fewer TRAP-positive cells than the CS group at T1 (P＜0.05). In ALP staining, all cases in both groups were classified as positive at each time point. Masson trichrome staining showed significantly higher mean red collagen volume fraction in the ZA-CS group (76.09%, 79.64%) than in the CS group (66.17%, 69.22%) at T2 and T3, respectively (P＜0.05 and ＜0.01). Although local ZA application with collagen sponge did not reduce alveolar ridge contraction, it improved the bone density and maturity of newly formed bone after tooth extraction.

The interaction of relative age with maturation and body size in female handball talent selection.

The relative age effects (RAEs) and biological maturation are two distinct factors that have been identified to affect talent identification and selection. Previous research has suggested that talent selection should include sport-specific technical tasks instead of body size and/or physical test measurements, assuming that the technical tasks are less influenced by variations in maturation. Our purpose was to examine the prevalence of RAEs and to assess biological maturity, body size, and body composition within a single talent selection program for female handball players. Team coaches' recommendations, handball-specific drills, and in-game performance were the selection criteria. Birth distribution of all U14 female handball players were analysed (N = 3198) grouped in two-year age cohort. Measurements of body size, body composition (InBody 720), and bone age were performed in all players who were selected to participate in the selection program (n = 264) (mean±sd age: 13.1±0.6 years) and in a sample of not-selected players (n = 266) (mean±sd age: 13.2±0.6 years). Players were grouped in quarter-year intervals based on their date of birth. Chi-square was used to examine quartile distributions, differences between quartiles were tested with one-way analysis of variance, whereas differences between the selected and not-selected groups were examined with independent sample t-test (Cohen d effect size). Binary logistic regression was used to determine the effects of the predictors on the selection. In terms of all registered players, there was no difference in birth distribution. RAEs appeared at the first selection stage and were evident at all following stages. Quartiles differed only between the first and the last quartiles in body size and muscle mass. Only bone age differed between consecutive quartile or semi-year groups. Body size, body composition, and maturity had a significant, but of moderate power, effect on the selection. Larger body height increased the likelihood of selection by about 12%, larger muscle mass by 12% to 25%, larger bone age by 350-400%, while larger percent body fat decreased selection chances by 7%. The sport-specific criteria could not eliminate the prevalence of the RAEs. Relative age was connected to bone age, but not convincingly to body size and muscle mass. Although bone age had the largest effect on the selection, this was not associated with larger body size or muscle mass. Early maturation increased selection chances mainly during the coaches' subjective evaluation, but not convincingly when sport-specific tasks were applied. Given that differences were mostly evident between players of more than 1.5-year variation in their chronological age, one-year age cohorts within talent selection or the rotation of the cut-off dates of the bi-annual age grouping could be a promising strategy while also including maturation status and relative age in performance evaluations.

An investigation of the relationship between long bone measurements and stature: Implications for estimating skeletal stature in subadults.

The present study introduces new regression formulae that address several challenges of current subadult stature estimation methods by 1) using a large, contemporary, cross-sectional sample of subadult skeletal remains; 2) generating regression models using both lengths and breadths; 3) utilizing both linear and nonlinear regression models to accommodate the nonlinear shape of long bone growth; and 4) providing usable prediction intervals for estimating stature. Eighteen long bone measurements, stature, and age were collected from computed tomography images for a sample of individuals (n = 990) between birth and 20 years from the United States. The bivariate relationship between long bone measurements and stature was modeled using linear and nonlinear methods on an 80% training sample and evaluated on a 20% testing sample. Equations were generated using pooled-sex samples. Goodness of fit was evaluated using Kolmogorov-Smirnov tests and mean absolute deviation (MAD). Accuracy and precision were quantified using percent testing accuracy and Bland-Altman plots. In total, 38 stature estimation equations were created and evaluated, all achieving testing accuracies greater than 90%. Nonlinear models generated better fits compared to linear counterparts and generally produced smaller MAD (3.65 - 15.90cm). Length models generally performed better than breadth models, and a mixture of linear and nonlinear methods resulted in highest testing accuracies. Model performance was not biased by sex, age, or measurement type. A freely available, online graphical user interface is provided for immediate use of the models by practitioners in forensic anthropology and will be expanded to include bioarchaeological contexts in the future.