Growth Velocity Research Articles

6715 Short Adult Height in Childhood Cancer Survivors: Prevalence, Risk Factors, and Genetic Contribution

Abstract Disclosure: T. Yoshida: None. J. Baedke: None. F. Wang: None. W. Moon: None. Y. Sapkota: None. J. Miguel Martínez: None. T.E. Merchant: None. C.L. Wilson: None. K.K. Ness: None. M.M. Hudson: None. Y. Yasui: None. A. Delaney: None. Background: Survivors of childhood cancer are at elevated risk for short adult height (SAH) due to cancer and/or its treatment. In the general population, height is a highly polygenic trait; heritability is estimated to be 70-80%. However, the contribution of genetic factors to SAH among childhood cancer survivors is unknown. In addition, the contribution of chemotherapy agents to risk of SAH among survivors has not been established. We assessed: 1) prevalence of SAH; 2) contribution of genetic factors; and 3) impact of cancer therapy including chemotherapy, on SAH in a large cohort of childhood cancer survivors. Methods: Participants included 4461 childhood cancer survivors aged ≥18 years (female 47.5%, mean age 33.2 years old) with measured height information. SAH was defined as height <3rd percentile for age and sex based on the Centers for Disease Control growth charts. Cancer and treatment history were extracted from medical records. We calculated multi-ancestry height polygenic score (PGS) using the latest methodology developed from 5.4 million individuals of diverse ancestries with more than 1 million variants, where lower score associates with shorter height. With a random sample of 75% of survivors, we fit a multivariable logistic regression model for SAH with the PGS, chemotherapy exposures/doses, corticosteroid exposures/doses, and established risk factors for SAH (e.g., age at cancer diagnosis, radiotherapy exposure) as covariates (main model). The remaining 25% of survivors served for validation of the main model and for the calculation of the population attributable fractions (PAF) of the PGS and cancer treatments. Results: The prevalence of SAH was 8.9% among all survivors (9.3% in males; 8.5% in females) and differed widely by primary cancer diagnosis. SAH was associated with lower PGS [odds ratio (OR) 0.47, 95% confidence interval (CI) 0.40-0.55 for a one standard deviation increase], alkylating agent exposure of >12000 mg/m2 (OR 2.19, 95% CI 1.41-3.38, vs. non-exposure), and spinal radiotherapy (OR 3.65, 95% CI 2.23-6.00, vs. non-exposure). Radiotherapy exposure to the hypothalamic-pituitary region and younger age at cancer diagnosis was also associated with SAH in a dose-response manner. The area under the ROC curve of the main model in the validation dataset was 0.80 (95% CI 0.74-0.87), suggesting good predictive ability for SAH by the model. The PAF of SAH calculated from the multiplicative logistic regression model of SAH was 85.7% for cancer treatments and 30.2% and 60.2% for having PGS below the median and the 90th percentile, respectively. Conclusions: Cancer treatments are the primary contributor to SAH risk among survivors with a PAF of 85.7%. Exposure to high-dose alkylating agents contributes to this along with radiotherapy. Inherited genetic factors also affect SAH among survivors but to a much lesser degree than cancer treatments. Presentation: 6/3/2024

6367 Growth gone Awry: A Rare Case of Acromegaly in a 16-Year-Old Female with Panhypopituitarism Secondary to Craniopharyngioma on Low Doses of Growth Hormone with Low IGF-1 levels

Abstract Disclosure: L.M. Ayala Castro: None. J. Ye Tay: None. A. Diaz: None. This report highlights a rare case of a 16-year-old female with panhypopituitarism due to craniopharyngioma, where GH replacement therapy triggered acromegaly features despite having low IGF-1 levels. Background: Craniopharyngiomas are the most common tumors causing acquired pituitary deficiencies in children. Various mechanisms contribute to acromegaly, and hypersensitivity to hormonal treatment in this benign tumor emerges as a plausible avenue for investigation. Case Presentation: A 16-year-old female diagnosed with craniopharyngioma at age 5 developed secondary panhypopituitarism. Baseline hormonal profiles indicated markedly reduced levels of IGF-1 and insulin growth factor–binding protein 3 (IGF-BP3). Despite the established condition, GH treatment was initiated at age 8 for potential growth and development benefits. Before commencing GH therapy, a bone age assessment revealed normal skeletal development. However, GH replacement therapy led to an unexpectedly robust response, resulting in physical changes consistent with acromegaly. Paradoxically, laboratory evaluations showed low IGF-1 levels. Imaging studies, including pituitary MRI, ruled out new abnormalities or tumors. As the patient approached peak adult height at 16, having been on adult GH therapy since age 13, a decision was made to discontinue GH replacement therapy and address acromegaly symptoms. Frequent follow-up visits were planned to assess growth velocity, monitor hormonal levels, and evaluate potential adverse effects. Discussion: This case demonstrates an unusual sensitivity to exogenous GH, resulting in an exaggerated response contrary to expected IGF-1 elevation. Atypical IGF-1 levels may suggest alterations in liver physiology, GH receptor signaling pathways (e.g., Laron Syndrome), or downstream defects in IGF-1 synthesis. Further research is crucial to elucidate the underlying mechanisms. Conclusion: Only 3 cases of acromegaly as a side effect of GH replacement therapy have been reported in the literature. We report a further case that underscores the complexity of managing hormonal imbalances, especially in unique patient populations with panhypopituitarism secondary to craniopharyngioma. The unexpected response to GH treatment emphasizes the need for individualized approaches and vigilant monitoring.

7291 From Vaginal Bleeding to Genetic Complexity: McCune Albright Syndrome in a Toddler; Emphasizing Atypical Manifestations, Diagnostic Challenges, and Comprehensive Management

Abstract Disclosure: A.G. Martinez Sanchez: None. N. Fernandez: None. C.L. Bustamante Escobar: None. Background: McCune Albright Syndrome (MAS) is a rare genetic disorder characterized by a triad of peripheral precocious puberty, irregular café-au-lait spots, and bone fibrous dysplasia. It is often caused by post-zygotic somatic mutations in the GNAS1 gene. We present a case of a patient initially presenting with precocious puberty, whose diagnostic journey revealed MAS with atypical manifestations. Presentation: A 23-month-old girl was brought to the emergency department after her mother noticed vaginal bleeding during a diaper change; denied any trauma, fever, rash, or dysuria. Patient developed accelerated growth about six months earlier, followed by pubic hair three months prior and bilateral thelarche two weeks before presentation. The patient had no exposure to endocrine disruptors. The physical examination revealed a well-developed child, in the 92nd percentile for weight and 97th for height. Additionally, breast buds, fine hair on the labia, and minimal blood at the vaginal introitus, with no apparent signs of trauma. Initial laboratory findings showed prepubertal LH and FSH levels, elevated estradiol 120 pg/ml (prepubertal range <10) and advanced bone age (4.2 years). Normal levels of testosterone, 17-hydroxyprogesterone, and DHEA sulfate. Pelvic ultrasound demonstrated an enlarged uterus (5.6 x 1.8 x 2.4 cm) and a large cystic lesion (4.4 cm) on the right ovary. During a follow-up at the endocrinology department one week later, a meticulous examination identified an irregular café-au-lait spot measuring about 2cm over the occipital right side of her scalp. Further tests, including GnRH stimulation test, tumor markers (LDH, b-HCG, CEA, and Ca19-9), brain MRI and bone scan, yielded normal findings. Given the presentation consistent with Peripheral precocious puberty, Letrozole was initiated at 1.25 mg daily. Three months later, her growth velocity remained accelerated. However, there was a decrease in both breast tissue and uterus size (4.2 x 1.2 x 1.7 cm), and the ovarian cyst was resolved. Genetic testing in blood indicated no mutations. To conduct a thorough assessment, the insulin-like growth factor (IGF-1) level was measured and found to be 200 ng/mL (normal range 56-144 ng/mL). Unfortunately, obtaining prolactin levels was challenging due to difficult intravenous (IV) access. Conclusion: This case reveals the complexity of MAS in precocious puberty, emphasizing atypical features that add complexity to the diagnosis. Identifying an irregular café-au-lait spot served as a diagnostic indicator, revealing the diverse clinical presentations. The challenges of relying solely on genetic testing for diagnosis are evident due to the mosaic nature and tissue-specific distribution of the mutation, as highlighted by the absence of mutations in this patient. Long-term management requires ongoing monitoring and a multidisciplinary approach for optimal patient outcomes. Presentation: 6/1/2024

6996 Optimal Growth Hormone Response Despite Low Insulin-Like Growth Factor-1: Clinical Picture of an A67T IGF-1 Variant

Abstract Disclosure: E.M. Bomberg: Research Investigator; Self; Novo Nordisk. Z. Wu: Employee; Self; Quest Diagnostics. I. Motorykin: Employee; Self; Quest Diagnostics. J. Torkelson: None. N. Schmitz: None. A. Drilling: None. M.J. McPhaul: Employee; Self; Quest Diagnostics. B.S. Miller: Advisory Board Member; Self; Abbvie, Ascendis Pharma, Biomarin, Bristol-Myers Squibb, Eton Pharmaceuticals, EMD Serono, Endo Pharmaceuticals, GenSci, Novo Nordisk, Pfizer, Inc., Provention Bio, Sanofi, Tolmar. Consulting Fee; Self; Abbvie, Ascendis Pharma, Biomarin, Bristol-Myers Squibb, Eton Pharmaceuticals, EMD Serono, Endo Pharmaceuticals, GenSci, Provention Bio, Sanofi, Tolmar. Grant Recipient; Self; Alexion Pharmaceuticals, Inc., Abbvie, Aeterna Zentaris, Amicus, Foresee Pharmaceuticals, Lumos Pharma, Lysogene, Novo Nordisk, OPKO Health, Pfizer, Inc., Prevail Therapeutics, Sangamo Therapeutics. Research Investigator; Self; Alexion Pharmaceuticals, Inc., Abbvie, Aeterna Zentaris, Amicus, Foresee Pharmaceuticals, Lumos Pharma, Lysogene, Novo Nordisk, OPKO Health, Pfizer, Inc., Prevail Therapeutics, Sangamo Therapeutics. Speaker; Self; Biomarin, Novo Nordisk, Pfizer, Inc., Tolmar. Introduction: Insulin-like growth factor-1 (IGF-1) measurements are used for growth hormone (GH) deficiency screening and helpful in monitoring GH treatment effectiveness. However, IGF-1 variants have been reported with mass spectrometry (MS)-based assays, potentially limiting interpretation of reported results. Clinical Case: A 14-year-old male presented for short stature. Evaluation was non-revealing aside from low serum IGF-1 measured via liquid chromatography (LC)-MS assay (58 ng/mL; -3.8 standard deviation score [SDS]), and IGF-Binding Protein 3 (3.7 ug/mL; -1.7 SDS). Height was 148.2 cm (1st percentile, -2.08 SDS; mid-parental height 172.7 cm [31st percentile, -0.48 SDS]), pubertal exam Tanner stage 2, and bone age 2.5 years delayed. A GH stimulation test showed a peak GH of 8.1 ug/L; brain MRI was normal. GH was started at 0.29 mg/kg/wk. One month later, IGF-1 remained low (89 ng/mL; -3.2 SDS) and GH was increased to 0.36 mg/kg/wk, and over time to 0.52 mg/kg/wk due to persistently low IGF-1 (-2.9 to -2.3 SDS), despite reports of good compliance and significant catch-up growth (height increased to 19th percentile, -0.84 SDS). He reported no significant side effects during GH treatment. At 17.5 years old, he returned to clinic reporting self-discontinuing GH 1 month prior. Height was at the 27th percentile (171.5 cm, -0.59 SDS), he was fully pubertal, IGF-1 128 ng/mL (-3.1 SDS), and bone age 1.5 years delayed. Further review of IGF-1 linked reports accompanying lab values directly entered into the electronic health record (EHR; starting 2021) described the presence of a rare heterozygous IGF-1 functional variant with unknown clinical significance based on MS data. Concentration of the variant was expected to be identical to that reported for the wild type IGF-1 protein, potentially explaining the lower than expected values. Analysis of the raw LC-MS data (variant peak at m/z 1098.09, isotopic peak index [IP6], relative retention time [rRT]=0.00 min) was consistent with either an A67T or A70T IGF-1 variant. To resolve this ambiguity, the specimen was reanalyzed with an LC-tandem MS/MS fragmentation method, which identified distinguishing peaks at m/z 503.28 (y5 ion) and 305.18 (y3 ion) characteristic of A67T, a known benign variant. Conclusions: Benign IGF-1 variants should be considered in cases of unexplained low IGF-1 levels, including when these remain low despite increasing GH doses, good adherence, and optimal growth velocity. Presence of IGF-1 variants should not affect GH stimulation results (e.g., GH levels), however, may lower reported IGF-1 levels used to determine need for diagnostic testing and followed when monitoring GH response. Careful review of IGF-1 lab reports and full abstraction of these into the EHR should be performed. Knowing a variant is benign could help providers set lower wild-type IGF-1 targets when monitoring GH response to avoid unnecessarily high GH doses. Presentation: 6/3/2024

Accurate birth weight prediction from fetal biometry using the Gompertz model

ObjectivesMonitoring of fetal growth and estimation of birth weight is of clinical importance. During pregnancy, ultrasound fetal biometry values including femur length, head circumference, abdominal circumference, biparietal diameter are measured and used to place fetuses on “growth charts”. There is no simple growth-model-based, predictive formula in use for fetal biometry. Estimation of fetal weight at birth currently depends on ultrasound data taken a short time before birth. Study designOur cohort (“Seethapathy cohort”) consists of ultrasound biometry measurements and other data for 774 pregnant women in Chennai, India, 2015–2017. We use the Gompertz model, a standard model for constrained growth, with just three intuitive parameters, to model the growth of fetal biometry, and a machine learning (ML) model trained on these parameters to predict birth weight (BW). ResultsThe Gompertz model convincingly fits the growth of fetal biometry values. Two Gompertz parameters—t0 (inflection time) and c (rate of decrease of growth rate)—seem universal to all fetuses, while the third, A, is an overall scale specific to each fetus, capturing individual variation. On the Seethapathy cohort we can infer A for each fetus from ultrasound data available by the 24 or 35 weeks. Our ML model predicts birth weight with < 8 % error, outperforming published methods that have access to late-term ultrasound data. The same model gives an 8.4 % error in BW prediction on an independent validation cohort of 365 women. ConclusionsThe Gompertz model fits fetal biometry growth and enables birth weight estimation without need of late-term ultrasounds. Aside from its clinical predictive value, we suggest its use for future growth standards, with almost all variation described by a single scale parameter A.

Directionally solidified NiCoCrFeAlW eutectic high-entropy alloy: Microstructure and mechanical properties

The NiCoCrFeAlW eutectic high-entropy alloy exhibits a balanced combination of ductility and strength. This study examines the microstructure evolution and mechanical properties of the Ni30Co30Cr10Fe10Al18W2 alloy at varying growth velocities (10, 20, 50, 100, and 200 μm/s), which in its as-cast state, features a microstructure that includes both coarse dendrites and lamellar eutectic. The structure of the coarse dendrites is characterized by an ordered body-centered cubic (B2) phase, while the lamellar eutectic, features a combination of face-centered cubic (FCC) and ordered B2 phases. The microstructure, characterized by lamellar and dendritic structures that are parallel to the growth direction after directional solidification, undergoes a morphological transition at the solid-liquid interface from a planar to a dendritic form as growth velocity increases. The tensile fracture strength initially increases with the growth velocity, reaching a peak of 1286 MPa at a velocity of 50 μm/s, and then subsequently decreases as the growth velocity continues to increase. Directional solidification results in an increase in sample elongation with increasing growth velocity, achieving an elongation of 22.5% at 200 μm/s. An examination of the deformation mechanism reveals that the lamellar structure, composed of the more ductile FCC phase and the harder B2 phase, effectively harmonizes the plasticity and strength of the alloy. Therefore, directional solidification significantly adjusts the eutectic microstructure's orientation, thereby enhancing the mechanical properties along the direction of solidification.

Growth charts of Brazilian girls with Turner syndrome without the use of GH or oxandrolone

ObjectiveThe development of specific growth charts for Turner Syndrome (TS) promotes adequate assessment of growth and weight gain, and earlier diagnosis of comorbidities, and may help to analyze the effectiveness of treatments to promote growth and puberty. The aim of this study was to construct a growth chart with the largest possible series of patients with a cytogenetic diagnosis of TS from a Brazilian reference center. MethodsThis is a longitudinal study, with 259 cases of TS born between 1957 and 2014 and followed between 1975 and 2019, without the use of GH or oxandrolone. 3,160 height measurements and 2,918 wt measurements were used, with subsequent calculation of the Body Mass Index (BMI). For data analysis, the “GAMLSS” package of the “R” software was used. ResultsThe mean target height was 157.8 cm (standard deviation 5.2; median 160.4 cm). The mean height of patients with TS at 20 years of age was 145.6 cm (standard deviation 5.9; median 146.7 cm). Height, weight, and BMI by age graphs were developed for TS girls between 2 and 20 years. ConclusionThese growth charts may be used to monitor the growth of girls with TS and to verify the effect of adjuvant treatments on promoting growth.

In situ observation and numerical analysis of temperature gradient effects on growth velocity during directional solidification of silicon

AbstractThe &lt; 110 &gt; directional solidification of silicon under varying overall temperature gradients was investigated using an in situ observation system. The growth velocity of an atomically rough interface was found to decrease with increasing temperature gradient. A theoretical model of the thermal field taking undercooling into account was developed to describe this phenomenon and was demonstrated to be valid. The results of this work indicate that the reported linear relationship between growth velocity (V) and undercooling (ΔT), given by V (mm s−1) = 120ΔT (K), is most accurate in the case of a rough interface. In the case that the overall temperature gradient is small, the melting point isotherm moves rapidly such that it becomes more difficult for the interface to keep pace with the isotherm compared with a large temperature gradient. This effect leads to increased undercooling at the interface and consequently a rapid growth velocity. Thermal field calculations confirm that a rapid increase in the ratio of the temperature gradient in the crystal to that in the melt should increase the latent heat release, again providing a more rapid growth velocity.

Study Of Association Between Dental Caries And Nutritional Status Among Children Attending OPD Of A Tertiary Care Center - A Retrospective Study

Aim: The purpose is to study the association between nutritional status and dental carries in children attending outpatient department of a tertiary care centre. Materials and methods: A total of 342 children aged up to 16 years attending the department of District Early Intervention and Care (DEIC) of a Government Medical College and Hospital were selected for this study. The nutritional status was evaluated using BMI for age and converted into Z score by plotting into age and gender specific WHO growth charts. Dental caries status was recorded according to WHO criteria. The obtained data were subjected to statistical analysis. Results: The prevalence of underweight was 49.2% and prevalence of dental caries was 61.7%. Significant association between Caries and undernutrition was noted in ages between 2 to 10 years. Conclusion: Undernutrition is a risk factor for dental caries. It is important to identify and determine all the factors leading to undernutrition in children especially aged 2 to 10 and execute action plans for timely diagnosis and intervention.

Argentine reference charts for head circumference from birth to 19 years of age.

Introduction. Head circumference (HC) is an indicator of brain growth; growth charts are necessary to determine normal or pathological variations. Objectives. To present the first Argentine HC reference charts between birth and 19 years of age and to compare them with the Nellhaus charts, which have been used in our country to date. Population and methods. These references were developed based on combined data from the National Survey on Nutrition and Health of 2018 and cross-sectional studies conducted between 2004 and 2007 in the provinces of Buenos Aires and La Pampa, which included 8326 healthy children and adolescents. Growth curves were adjusted using the LMS method. To assess the differences between these reference charts and the Nellhaus charts, at different ages, the 2nd, 50th, and 98th percentiles were plotted. Results. HC showed a variable increase in size with age, which was greater in the first years of life, and a slight increase at puberty. The values for the 98th percentile of the Argentine reference charts werehigher than those of the Nellhaus charts at all ages. The values for the 2nd percentile of the national reference were lower than those of the Nellhaus charts during the first 2 years of life, similar between 3 and 7 years of age, and higher after this age. Conclusions. The Argentine curves adequately describe the growth pattern of HC. The differences found with the Nellhaus charts may be attributed to secular changes.

A retrospective study to assess adolescent nutritional deficiencies and the association with post-COVID-19 status

ABSTRACT Introduction: Adolescents represent 16% of the world’s population and around 21% of the Indian population. A study was done to assess the double burden of malnutrition, the proportion of inadequate intake of some important macronutrients and micronutrients, and the impact of COVID-19 pandemic on nutrient intakes among adolescents. Methodology: Retrospective data analysis of the adolescents presented at the Adolescent Health Clinic at a teaching hospital (tertiary care level) in Andhra Pradesh, India, between September 2022 and December 2022 was done in the current study. Results: A total of 800 adolescents were studied with the mean age of the participants as 15.8 (±2.38) years of age. Among the participants, the majority (59%) were immunized with Td vaccination at 10 years and/or 16 years, 21% were not immunized, and the rest 20% did not remember the status. Only 17 participants had a history of COVID-19 infection in the past. The majority (62.75%) of the participants belong to normal nutrition status as per BMI for age WHO growth charts. There is a significant difference in the nutrition status between males and females belonging to overweight and obese subgroups. There is no significant difference in the intake with respect to past COVID-19 status. Almost all the participants take inadequate amounts of carbohydrates (calories), pyridoxine, folate, iron, calcium, vitamin D3, and retinol. Protein intake is inadequate in 63% of participants, and the deficient intake rises with the age with respect to both EAR and RDA guidelines. Conclusion: A large proportion of adolescents suffer from the double burden of malnutrition in South India, and almost all the adolescents do not get the recommended intake of most of the macro- and micronutrients in their diet following the lockdown and online schooling due to the COVID-19 pandemic.

Mtoto Wetu Growth and Temperature Monitoring System for Tanzania Child Healthcare Clinics

In most government maternal and child health (MCH) clinics in sub-Saharan countries caregivers rely on manual methods for data acquisition, storage, and analysis, leading to challenges such as errors, inefficiencies, and limited accessibility. Recognising the transformative potential of digital technology, this design aims to innovate the child growth monitoring paradigm by introducing a comprehensive Digitized Child Growth Monitoring System. The "Mtoto Wetu Growth and Temperature Monitoring System" is a comprehensive framework designed to monitor and assess the growth and temperature patterns of infants and young children on a monthly basis. This system integrates various components, including anthropometric measurements, temperature monitoring, immunisation schedule, automated growth chart generation, and parental, caregiver, and health care professionals’ involvement, to provide a holistic approach to child health monitoring. Implemented with standardised protocols, training sessions, and robust data management systems, the monitoring system aims to facilitate early detection of growth abnormalities, and health concerns. By promoting early intervention, preventive care measures, parental empowerment, and continuity of care, the Mtoto Wetu system strives to optimise health outcomes, foster parental engagement, and promote health equity among children. The system was able to provide results with a small amount of error compared to the standard weighing machines, tap measure and digital thermometer

Fetal body composition reference charts and sexual dimorphism using magnetic resonance imaging

BackgroundThe American Academy of Pediatrics advises that the nutrition of preterm infants should target a body composition similar to that of a fetus in utero. Still, reference charts for intrauterine body composition are missing. Moreover, data on sexual differences in intrauterine body composition during pregnancy are limited. ObjectiveThe objective of this study was to create reference charts for intrauterine body composition from 30 to 36+6 weeks post-conception and to evaluate the differences between sexes. MethodsIn this single-center retrospective study, data of 197 normal developing fetuses in late gestation was acquired at 3T magnetic resonance imaging (MRI) scans, including True Fast Imaging with Steady State Free Precession and T1-weighted 2-point Dixon sequences covering the entire fetus, were included. Deep Convolutional Neural Networks were utilized to automatically segment the fetal body and subcutaneous adipose tissue. The fetus's body mass (BM), fat signal fraction (FSF), fat mass (FM), FM percentage (FM%), fat-free mass (FFM), and FFM percentage (FFM%) were calculated. Using the Generalized Additive Models for Location, Scale, and Shape (GAMLSS) method, reference charts were created, and sexual dimorphism was examined using analysis of covariance (ANCOVA). A P-value below 0.05 is deemed significant. ResultsThroughout late gestation, BM, FSF, FM, FM%, and FFM increased, while the FFM% decreased. Reference charts and gestational age and sex-specific percentiles are provided. Males exhibited significantly higher BM (7.2%; 95% confidence interval [95% CI], 1.9-12.4%), FFM (8.5%; 95% CI, 3.7- 13.4%), and FFM% (1.2%; 95% CI, 0.6-1.7%) and lower FSF (-3.6%; 95% CI, -5.6-[-1.8]%) and FM% (-1.2%; 95% CI, -1.7-[-0.6]%), (P<0.001) compared with females, with no significant difference in FM between sexes (P=0.126). ConclusionsMRI-derived intrauterine body composition growth charts are valuable for tracking growth in preterm infants. This study demonstrated that sexual differences in body composition are already present in the intrauterine phase.

Foramen Ovale Pulsatility Index as an Early Affected Doppler Study among Abnormal Growth Fetuses: A Recent Insight for Practice Based on a Prospective Study.

Routine Doppler study is a common tool for early diagnosis of Fetal Growth Restriction (FGR) and Small for Gestational Age (SGA) patients. It aimed to determine the role of the Foramen Ovale Pulsatility Index (FOPI) study beside routine Doppler study among patients with FGR and SGA fetuses. This prospective study was conducted on 35 FGR, 32 SGA, and 33 Appropriate for Gestational Age (AGA) fetuses. Demographic data, amniotic fluid index, neonatal outcome, and Doppler velocimetry, including Umbilical Artery Pulsatility Index (UMAPI), Uterine Artery Pulsatility Index (UTAPI), Middle Cerebral Artery Pulsatility Index (MCAPI), Ductus Venosus Pulsatility Index (DVPI), and FOPI were documented. Kolmogorov-Smirnov normality test, one-way ANOVA, Mann-Whitney U, Kruskal-Wallis, non-parametric pairwise comparisons adjusted for Bonferroni correction, Pearson correlation test, Chi square, Fisher's exact test, and Receiver Operating Characteristic Curve (ROC) analysis with Youden's Index (sensitivity+specificity-1) to estimate cut-off point were used to analyze the data at significance level <0.05 for all tests. FOPI cut-off points were 2.24 (sensitivity=77%, specificity=94%) and 1.15 (sensitivity=90%, specificity=20%) to predict FGR and SGA, respectively. FOPI showed a positive correlation with UMAPI and UTAPI (r=0.52 and r=0.30, P<0.001 and P=0.006, respectively), but not with MCAPI and DVPI (r=0.08 and r=0.12, P=0.50 and P=0.30, respectively). Besides, UMAPI, UTAPI, and FOPI were altered among patients with stages I and II FGR. Umbilical cord potential hydrogen (umbilical cord pH), 1- and 5-min Apgar score significantly increased by Birth weight centile; however, UMAPI, FOPI, and UTAPI significantly decreased. UMAPI is recommended to predict short-term neonatal morbidities and demonstrate the early or late onset FGR. Besides, FOPI is suggested as the first-line Doppler study to detect abnormal growth velocity. More studies are warranted, especially considering long-term neonatal morbidities.

Nonlinear mechanics of phase-change-induced accretion

In this paper, we formulate a continuum theory of solidification within the context of finite-strain coupled thermoelasticity. We aim to fill a gap in the existing literature, as the existing studies on solidification typically decouple the thermal problem (the classical Stefan’s problem) from the elasticity problem, and often limit themselves to linear elasticity with small strains. Treating solidification as an accretion problem, with the growth velocity correlated with the jump in the heat flux across the boundary, it presents an initial boundary-value problem (IBVP) over a domain whose boundary location is a priori unknown. This IBVP is solved numerically for the specific example of radially inward solidification in a spherical container. Several parametric studies are conducted to compare the numerical results with the rigid cases in the literature and gain insights into the role of elastic deformations in solidification.

Improving Accessibility and Delivery of Healthcare Services to Underserved Children through Technology: A Comprehensive Approach of Literature Review

This study investigates the use of technology to improve healthcare accessibility and delivery for children in underprivileged communities through article review comprehensively. A literature review with qualitative method that involved four distinct steps. In the initial stage, the search was conducted using Google Scholar (GS) and Scopus website. The second stage was filtering, which entails selecting the journals that will be examined. The last stage was analysis the articles, this analysis uses a 4-step PRISMA process to identify 123 articles published from 2019 to 2024 in Scopus journal. The review was evaluated the efficacy of telemedicine, mobile health applications, and wearable devices in monitoring and addressing children's health, while considering genetic predispositions and underlying medical issues that influence growth patterns. The research emphasizes the importance of a comprehensive strategy in evaluating child growth and development, utilizing health data to tailor interventions. Online systems, such as mobile phones and PDAs, can support healthcare workers in underserved rural areas. The integration of technology is essential for addressing unique challenges in underserved areas and ensuring access to high-quality healthcare services for all children. Current monitoring methods include regular check-ups, growth charts, and developmental screenings, with advancements in technology providing new tools like mobile health apps and wearable devices. Involving various stakeholders in the evaluation process is crucial, with participatory research focusing on community empowerment, ownership, and capacity building. Online systems offer efficient and accessible ways to track health data but may come with privacy concerns and data breach risks. The study focuses on the effectiveness of online systems for monitoring child health indicators, discussing data collection methods, sampling strategies, and ethical considerations. Findings reveal the need to address areas such as limited social interaction and incorporate interactive activities and group projects into online curriculum. Understanding the impact of online learning on students' health and well-being is crucial for tailoring approaches to ensure comprehensive support. The research findings have significant implications for child health policy and practice, emphasizing the importance of social connection and mental well-being in online learning environments.

Impact of BMI on childhood growth, pubertal timing, and bone maturation: A comprehensive review and clinical implications

Introduction: Childhood obesity and undernutrition significantly affect growth patterns, pubertal timing, and bone maturation, leading to long-term health implications. Materials and Methods: A comprehensive literature review was conducted using databases such as PubMed, Google Scholar, and Scopus. Twenty-four studies, including a total of 40,732 patients, were analyzed from two tables examining the impact of BMI, growth patterns, pubertal timing, and bone maturation. Results: Children with high BMI exhibit accelerated linear growth during early childhood, that may be driven by elevated leptin levels, which stimulate growth before puberty. Despite early growth advantages, these children experience reduced height gain during adolescence due to advanced bone maturation and earlier closure of growth plates. High BMI is strongly linked to early puberty, especially in girls, as increased adipose tissue raises leptin levels, triggering early pubertal onset. Boys, however, show variability in pubertal timing, with severe obesity sometimes delaying puberty. In contrast, children with low BMI or undernutrition demonstrate delayed linear growth and delayed puberty. Nutritional deficits lead to reduced growth velocity, delayed pubertal onset, and extended pubertal periods due to a lack of adipose tissue and hormonal deficiencies in leptin and kisspeptin. Nutritional rehabilitation promotes catch-up growth, allowing for extended growth potential by delaying growth plate closure. However, full recovery may not occur in cases of prolonged or severe undernutrition. Advanced bone age in high BMI children shortens the pubertal growth spurt, while delayed bone maturation in undernourished children offers a prolonged period for potential growth, contingent on timely nutritional support. Conclusion: Timely interventions for childhood obesity and undernutrition are critical to improving growth outcomes and preventing long-term developmental delays. Early identification, nutritional rehabilitation, and lifestyle modifications can help optimize growth and pubertal development by addressing both advanced and delayed growth trajectories.

Nutritional Status and Growth Outcomes in Pediatric Idiopathic Growth Hormone Deficiency: A Retrospective Study in Turkey

Objective: Growth and development in children are significantly influenced by nutritional status. Nutritional deficiencies such as low hemoglobin (Hb), ferritin, vitamin B12, and vitamin D have been linked to impaired growth. This study aims to evaluate the impact of these nutritional markers on growth outcomes in children with idiopathic growth hormone deficiency (IGHD) undergoing recombinant growth hormone therapy (rhGH). Material and Methods: A cross-sectional, retrospective study was conducted on 100 children with IGHD, aged under 16, diagnosed between 2000 and 2023. Data were collected from medical records, including height, body mass index (BMI), pubertal status, bone age, and nutritional markers [Hb, ferritin, vitamin B12, 25-hydroxy-vitamin D3 (25(OH)D3]. Growth parameters were assessed at the start and end of the first year of rhGH treatment. Results: The cohort had a median age of 11.3 years; 30% were female, and 50% were prepubertal. The median height standard deviation score (SDS) was -2.8, and median BMI SDS was -0.7. Prevalence of nutritional deficiencies included 23% with low Hb, 31% with low ferritin, 44% with low 25(OH)D3, and 15% with low vitamin B12. Despite these deficiencies, no significant differences were observed in height SDS or growth velocity when grouped by nutritional markers or supplementation status. Growth velocity showed a significant positive correlation with Hb levels and mid-parental height (MPH). Conclusion: Nutritional deficiencies were common among IGHD patients; there was no significant difference in terms of growth-related metrics in the first year of the rhGH therapy in comparisons between the groups with and without common nutritional deficiencies. This finding underscores the resilience of growth in the presence of these deficiencies. In contrast, growth velocity correlated positively with Hb levels and MPH, suggesting that these factors may play a significant role in influencing growth. Further research with larger samples and extended follow-up is needed to explore the long-term impact of nutritional supplementation on growth in IGHD.

Specific growth velocity reference charts for monochorionic twin pregnancies.

We aimed to create specific growth velocity reference charts for monochorionic (MC) twin pregnancies and provide additional information for assessing fetal growth in MC twins. This retrospective study collected data from uncomplicated MC twins with serial ultrasound parameters. The four ultrasound parameters, including biparietal diameter, femur length, head circumference, and abdominal circumference, were used to calculate the estimated fetal weight (EFW). Multilevel linear regression models were applied to fit growth velocity charts for each biometric parameter and EFW. Analysis of variance was used to examine differences in birthweight by whether EFW velocity and EFW values were <10th or ≥10th percentiles. The final analysis encompassed a total of 5956 ultrasound examinations conducted on 487 MC twins. The growth velocity of four biparietal diameters exhibited a gradual decrease in a nearly linear fashion progressing from 18 to 37 gestational weeks. The EFW velocity increased steadily from 18 to 36 gestational weeks, reaching a peak of 178.2 g/week, and then the velocity gradually decreased until delivery. At 32 weeks for illustration, the lightest birth weight was observed when both EFW and EFW velocity were <10th percentile (1899 g). The study also found that birth weight was higher when EFW velocity was ≥10th percentile compared with <10th percentile, regardless of EFW being below or above the 10th percentile (2263 and 1906 g, respectively; P < 0.001). We developed specific growth velocity reference charts for MC twins, which could provide a valuable reference point for a more precise evaluation of fetal growth in MC twins. Preliminary findings indicate that the inclusion of fetal growth velocity in monitoring fetal growth provides additional information beyond EFW alone.

New French height velocity growth charts: An innovative big-data approach based on routine measurements.

Height velocity is considered a key auxological tool to monitor growth, but updated height velocity growth charts are lacking. We aimed to derive new French height velocity growth charts by using a big-data approach based on routine measurements. We extracted all growth data of children aged 1 month-18 years from the electronic medical records of 42 primary care physicians, between 1 January 1990 and 8 February 2018, throughout the French metropolitan territory. We derived annual and biannual height velocity growth charts until age 15 years by using the Lambda-Mu-Sigma method. These new growth charts were compared to the 1979 French and 2009 World Health Organisation (WHO) ones. New height velocity growth charts were generated with 193 124 and 209 221 annual and biannual values from 80 204 and 87 260 children, respectively, and showed good internal fit. Median curves were close to the 1979 French or 2009 WHO ones, but SD curves displayed important differences. Similar results were found with the biannual height velocity growth charts. We produced new height velocity growth charts until age 15 years by using a big-data approach applied to measurements routinely collected in clinical practice. These updated growth charts could help optimise growth-monitoring performance.