Normal Chinese Children Research Articles

Digital anatomical features of morphological development in the atlantoaxial synchondroses in children aged 1 to 6 years old: a retrospective study of CT images.

To investigate the anatomical indexes and anatomical positional indexes of the atlantoaxial synchondroses in normal Chinese Han children aged 1-6 years, and to analyze the changing law of the atlantoaxial cartilage union with the growth and development of age and its influence on the atlantoaxial ossification in children. A retrospective collection of CT imaging of 160 cases of normal cervical spine in children aged 1 to 6 years old was conducted. The cases were divided into six age groups, with each group representing a one-year age range. Measure the morphological anatomical indicators and anatomical positional indicators of the atlantoaxial synchondroses. Record and statistically analyze the measurements of each indicator. Measurements were taken on various parameters of the atlantoaxial synchondroses. TD, SD, height, area, and perimeter all gradually decreased among the groups. Distance between bilateral atlantal anterolateral synchondroses increased gradually from Group A to Group F, while the angle formed along the long axis in the cross-section showed a decreasing trend. Distance between the axoid dentolateral synchondroses and between the neurocentral synchondroses increased gradually from Group A to Group F, with the angle value in the cross-section showing a gradual decrease, and distance from the odontoid apex increasing from Group A to Group F. The atlantoaxial synchondroses gradually decrease in size with age, and ossification levels increase with age, with faster ossification occurring during a 1-2 years-old period. The anterolateral synchondroses, dentolateral synchondroses, and neurocentral synchondroses all gradually ossify towards the lateral direction with increasing age.

Efficacy and Long-term Safety of Telbivudine Usage During Second or Third Trimester in Hepatitis B Surface Antigen Positive Mothers With High Viral Load: A 10-year Prospective Study.

The study is to evaluate the efficacy and long-term safety of telbivudine (LdT) usage for hepatitis B surface antigen (HBsAg) positive pregnant women with high viral load. The efficacy and safety of LdT during pregnancy were not assessed from a long-term perspective. HBsAg-positive pregnant women were enrolled and grouped according to antiviral initiation time. Group A (n=100) and group B (n=100) were treated with LdT initiated in the second or third trimester. Group C (n=90) received no antiviral treatment. The efficacy and safety of LdT treatment were compared and infants were followed-up at 1, 5, and 10 years. Denver developmental screening test was conducted at 5 years. Viral loads before delivery in LdT-treated groups were lower than that in group C and group A was lower than that in group B ( P <0.001). No infants in LdT-treated groups were infected whereas 8.8% (8/90) infants in group C had positive HBsAg (χ 2 =23.20, P <0.001). All LdT-treated mothers were well tolerated and no LdT-related adverse events in infants were reported. Part of the physical growth index of infants was higher than Chinese standard values (SV) and showed significant differences. In groups A and B, the developmental screening test qualified rate of 100% (48/48) and 97.96% (48/49) showed no significant difference compared with 92% in normal Chinese children (χ 2 =5.72, P =0.06). Treatment initiated during the second trimester could strengthen the success of mother-to-child transmission blockage. LdT treatment during pregnancy is safe for both mothers and infants in the long term.

Unbiased age-specific structural brain atlases for Chinese pediatric population

In magnetic resonance (MR) imaging studies of child brain development, structural brain atlases usually serve as important references for the pediatric population, in which individual images are spatially normalized into a common or standard stereotactic space. However, the popular existing pediatric brain atlases (e.g., National Institutes of Health pediatric atlases, NIH-PD) are mostly based on MR images obtained from Caucasian populations and thus are not ideal for the characterization of the brains of Chinese children due to neuroanatomical differences related to genetic and environmental factors. Here, we use an unbiased template construction algorithm to create a set of age-specific Chinese pediatric (CHN-PD) atlases based on high-quality T1-and T2-weighted MR images from 328 cognitively normal Chinese children aged 6–12 years. The CHN-PD brain atlases include asymmetric and symmetric templates, sex-specific templates and tissue probability templates, and contain multiple age-specific templates at one-year intervals. A direct comparison of the CHN-PD and NIH-PD atlases reveals dramatic anatomical differences mainly in the bilateral frontal and parietal regions. After applying the CHN-PD and NIH-PD atlases to two independent Chinese pediatric datasets (N = 114 and N = 71), we find that the CHN-PD atlases result in significantly higher accuracy than the NIH-PD atlases in both predicting “brain age” and guiding brain tissue segmentation. These results suggest that the CHN-PD brain atlases are necessary for studies of the typical and atypical development of the Chinese pediatric population. These CHN-PD atlases have been released on the Neuroimaging Informatics Tools and Resources Clearinghouse (NITRC) website (https://www.nitrc.org/projects/chn-pd).

Distribution of Anterior Chamber Parameters in Normal Chinese Children and the Associated Factors.

To describe the distribution of anterior chamber depth (ACD), anterior chamber volume (ACV), and anterior chamber angle (ACA) and establish the associated factors in the pediatric population in Shanghai, China. In this cross-sectional study, children aged 6 to 18 years from 9 primary and middle schools in Shanghai were enrolled. The Pentacam Scheimpflug camera was used to measure anterior eye chamber parameters. The distribution of ACD, ACV, ACA, and their associations with age, sex, body mass index, cycloplegic refractive error, axial length, intraocular pressure, and other parameters were analyzed. A total of 1321 children were included, with a mean age of 9.65±2.95 years. The mean ACA, ACD, and ACV values were 37.95±7.96 degrees, 3.22±0.23 mm and 194.89±28.95 mm, respectively, and were higher in boys than in girls. ACV and ACD had similar growth trend curves with age, whereas ACA was stable. Overall, 5% of the tested children had ACA values ≤24.91 degrees. Greater ACV, deeper ACD, shorter pupil diameter, shorter axial length, and thinner apex corneal thickness were the independent factors associated with wider ACA (R=13.0%, P<0.001). As one of diagnostic indicators of angle closure, ACA was stable with age. The results of this study should improve the current understanding of the distribution of anterior chamber parameters and the main factors affecting their variation.

Long-term safety and efficacy of telbivudine in infants born to mothers treated during the second or third trimesters of pregnancy.

Telbivudine, an FDA pregnancy category B drug, has been found to reduce hepatitis B virus (HBV) perinatal transmission with no safety concerns in infants aged up to 1year. This study evaluated the long-term efficacy and safety of telbivudine in 214 infants born to 210 pregnant women with chronic hepatitis B infection who were treated with telbivudine during pregnancy (weeks 20-32 of gestation). The infants were followed for up to 5years after birth. The efficacy endpoint was the rate of perinatal transmission, which was established by HBsAg and HBV DNA levels at 7 and 12months. Safety endpoints included head circumference, weight, height, congenital abnormality and hospitalization rates. In addition, the Denver Developmental Screening Test was performed in 92 randomly selected infants. None of the 214 infants born to these women were infected with HBV, and all had effective serum hepatitis B surface antibody (HBsAb) levels. Compared with Chinese standard values, there were few differences in the infants' mean head circumference, weight, and height values. No birth defects were diagnosed, and the congenital abnormality rate was 0.934%. Serious adverse events requiring hospitalization occurred in 20 infants (9.35%). The qualified Denver Developmental Screening Test rate in 92 infants was 97.82%, which was comparable to a rate of 92% in normal Chinese children. Thus, treatment with telbivudine during the second or third trimesters of pregnancy safely blocked perinatal transmission of HBV. Infants born to telbivudine-treated mothers showed normal growth and development during long-term follow-up of up to 5years.

Magnetic resonance imaging evaluation of acetabular orientation in normal Chinese children.

There are no data regarding the acetabular orientation on magnetic resonance imaging (MRI); this study investigates the changes of acetabular orientation with age in normal Chinese children.We retrospectively analyzed the medical records of children who underwent hip MRI examination at our hospital from January 2009 to December 2015. A total of 180 patients with normal MRI reading of the hip joints were included and were divided into 14 groups according to age: from 6 months of age and then for each year from 1 to 16 years. The bony and cartilage acetabular anteversion angle (AAA), acetabular inclination angle (AIA), and acetabular index (AI) were measured. Total bony and cartilage femoral head coverage angles were measured on axial section total femoral head coverage angle (a-TCA) and coronal section total femoral head coverage angle (c-TCA).The mean bony AAA and AIA were 12.2 ± 2.5° and 50.9 ± 2.5°, respectively; both of them stayed constant from the age of 6 months to 16 years. Similar results were found in cartilage AAA (12.1 ± 2.5°) and AIA (41.2 ± 3.0°). There was no difference between bony and cartilage AAA, but bony AIA was significantly larger than cartilage AIA. Bony AI was 24.1 ± 2.4° at the age of 6 months, decreasing to 12.5 ± 2.3° by 12 to 13 years of age; cartilage AI (5.9 ± 1.7°) maintained a steady value with age. The mean bony a-TCA and c-TCA at 6 months were 117.0 ± 5.8° and 127.5 ± 5.1°, increasing to 144.5 ± 4.6° and 140.7 ± 2.5° at the age of 16 years. However, the cartilage a-TCA (145.2 ± 7.2°) and c-TCA (154.1 ± 5.7°) did not change significantly with age.Both bony and cartilage AAA and AIA remain constant up to the age of 16 years in normal Chinese pediatric population. Although the cartilage coverage of femoral head by the acetabulum remains unchanged with age, the bony coverage of femoral head increases.

Anterior-Chamber Angle and Axial Length Measurements in Normal Chinese Children.

To establish the physiological distribution of anterior-chamber angle parameters and axial length (AL) in a randomly sampled cohort of Chinese children. This was a prospective, cross-sectional study on randomly sampled Chinese children ages 7 to 15 years. Complete ophthalmologic examination was carried out on all participants; anterior-segment parameters and ALs were measured using Fourier-domain optical coherence tomography and automated biometers. Associations between the age, the sex, the refractive error, the iris thickness, the AL, and anterior-chamber depth (ACD) and angle measurements were analyzed using multiple correlation and regression tests. The relationship between the AL and other factors was studied by a linear regression analysis. Only the right eye data were analyzed for statistical purpose. A total of 541 children were enrolled in this study. There were no differences in angle parameters between sexes (P>0.05), but boys had a longer AL (P<0.01). The AL increased logarithmically with age in children (P<0.01, R=0.5552, b=6.18). Although the magnitude of myopia also increased with AL, this association was less robust (P<0.05, R=0.0917, b=-0.88). A multiple regression test indicated that the age and the ACD were independently associated with the increase in angle width (b=0.37 to 0.50 and 0.51 to 0.60, respectively; P<0.001). All angle measurements increased with age and were positively correlated with the ACD in children 7 to 15 years of age. The AL increased logarithmically with age.

Corneal Epithelium Thickness Profile in 614 Normal Chinese Children Aged 7-15 Years Old.

The purpose of the study is to describe the values and distribution of corneal epithelium thickness (CET) in normal Chinese school-aged children, and to explore associated factors with CET. CET maps were measured by Fourier-domain optical coherence tomography (FD-OCT) in normal Chinese children aged 7 to 15 years old from two randomly selected schools in Shanghai, China. Children with normal intraocular pressure were further examined for cycloplegic autorefraction, corneal curvature radius (CCR) and axial length. Central (2-mm diameter area), para-central (2- to 5-mm diameter area), and peripheral (5- to 6-mm diameter area) CET in the superior, superotemporal, temporal, inferotemporal, inferior, inferonasal, nasal, superonasal cornea; minimum, maximum, range, and standard deviation of CET within the 5-mm diameter area were recorded. The CET was thinner in the superior than in the inferior and was thinner in the temporal than in the nasal. The maximum CET was located in the inferior zone, and the minimum CET was in the superior zone. A thicker central CET was associated with male gender (p = 0.009) and older age (p = 0.037) but not with CCR (p = 0.061), axial length (p = 0.253), or refraction (p = 0.351) in the multiple regression analyses. CCR, age, and gender were correlated with para-central and peripheral CET.

Corneal Thickness Profile and Associations in Chinese Children Aged 7 to 15 Years Old.

Corneal thickness (CT) maps of the central (2-mm diameter), para-central (2 to 5-mm diameter), peripheral (5 to 6-mm diameter), and minimum (5-mm diameter) cornea were measured in normal Chinese school children aged 7 to 15 years old using Fourier-domain optical coherence tomography. Multiple regression analyses were performed to explore the effect of associated factors [age, gender, refraction, axial length and corneal curvature radius (CCR)] on CT and the relationship between central corneal thickness (CCT) and intraocular pressure (IOP). A total of 1228 eyes from 614 children were analyzed. The average CCT was 532.96 ± 28.33 μm for right eyes and 532.70 ±28.45 μm for left eyes. With a 10 μm increase in CCT, the IOP was elevated by 0.37 mm Hg, as measured by noncontact tonometry. The CT increased gradually from the center to the periphery. The superior and superior nasal regions had the thickest CTs, while the thinnest points were primarily located in the inferior temporal cornea. The CCT was associated with CCR (p = 0.008) but not with gender (p = 0.075), age (p = 0.286), axial length (p = 0.405), or refraction (p = 0.985). In the para-central region and the peripheral cornea, increased CT was associated with younger age, male gender, and a flatter cornea.

Determination of plasma cholesterol sulfate by LC–APCI-MS/MS in the context of pediatric autism

Cholesterol sulfate (CS) has various biological functions. Previously, plasma CS was measured primarily as a means to diagnose X-linked ichthyosis; however, a recent hypothesis suggests that CS deficiency might be related to autism. As such, an assay capable of measuring both very high (in the case of X-linked ichthyosis) and very low (in the case of autism) plasma CS levels is required. Here we describe a novel LC–APCI-MS/MS method for the determination of CS in human plasma, and we propose normal CS ranges for children, based on studies of a local population of normal Chinese children between the ages of 2 and 10. In addition, we have used this method to measure plasma CS in autistic children. CS was isolated by solid-phase extraction, and quantified by isotope-dilution LC–APCI-MS/MS in negative ion mode monitoring 465.3>97.1m/z (CS) and 472.3>97.1m/z (CS-d7). Mean recovery of the assay ranged from 88.1 to 112.7%; within- and between-run imprecisions have CVs less than 7.2 and 8.1%, respectively. The assay was linear up to at least 100µmolL−1. The reference interval of plasma CS in males (range: 1.16–4.23µmolL−1) was found to be higher than in females (range: 0.86–3.20µmolL−1). Comparison of normal and autistic children showed no statistically significant difference in the plasma CS level. In conclusion, a robust LC–APCI-MS/MS method for plasma CS was developed, and a pediatric reference interval was derived from applying the method to normal and autistic children.

Automated determination of bone age in a modern chinese population.

Rationale and Objective. Large studies have previously been performed to set up a Chinese bone age reference, but it has been difficult to compare the maturation of Chinese children with populations elsewhere due to the potential variability between raters in different parts of the world. We re-analysed the radiographs from a large study of normal Chinese children using an automated bone age rating method to establish a Chinese bone age reference, and to compare the tempo of maturation in the Chinese with other populations. Materials and Methods. X-rays from 2883 boys and 3143 girls aged 2–20 years from five Chinese cities, taken in 2005, were evaluated using the BoneXpert automated method. Results. Chinese children reached full maturity at the same age as previously studied Asian children from Los Angeles, but 0.6 years earlier than Caucasian children in Los Angeles. The Greulich-Pyle bone age method was adapted to the Chinese population creating a new bone age scale BX-China05. The standard deviation between BX-China05 and chronologic age was 1.01 years in boys aged 8–14, and 1.08 years in girls aged 7–12. Conclusion. By eliminating rater variability, the automated method provides a reliable and efficient standard for bone age determination in China.

Relationship between apolipoprotein E genotype and cerebral palsy in Chinese Han children

The present study was undertaken to investigate the relationship between apolipoprotein E genotype and cerebral palsy in the Chinese Han children. 120 Chinese Han children with cerebral palsy age range from 1 to 12 years old were selected as CP group including 86 spastic and 34 dyskinetic children, 120 normal Chinese Han children age range from 1 to 12 years old as control group. Apolipoprotein E DNA was obtained from blood cell. Polymerase chain reaction‐restricted fragment length polymorphism (PCR‐RFLP) was used to determine allele and apolipoprotein E genotype in CP group and control group. The severity of impairment was assessed by gross motor function classification system (GMFCS). The results showed that gene frequency of the ε4 allele in CP group was higher than control group. Gene frequency of the ε4 allele in GMFCS level IV and level V children was higher than in GMFCS level I, level II, level III ones in CP group. The difference of gene frequency of the ε4 allele between spastic children and in dyskinetic ones was not significant.ConclusionGene frequency of the ε4 allele was associated with cerebral palsy in the Chinese Han children, particularly with GMFCS level IV and level V ones, but it was no association with CP children who was the spastic or the dyskinetic.

Correlation between hand and total body bone density in normal Chinese children

Hand bone mineral density (BMD) in adults was found to be significantly correlated with various skeletal sites, including the total body. However, the relationships between hand and total body bone measurements have yet to be explored for children. We conducted a cross-sectional study of 892 normal Chinese children (511 males, 381 females) aged 5–14 years by measuring the BMD and bone mineral content (BMC) at the total hand, upper limb, subtotal body, and total body using dual-energy X-ray absorptiometry (DXA). We found that hand BMD and BMC increased with age for both genders. Female children had significantly higher hand BMD and BMC than males. Age explained more variance in hand BMD for females (R2=0.727) than for males (R2=0.596). For both genders, hand BMD and BMC correlated highly with age, weight, height, total body lean mass, and BMD and BMC at the upper limb, subtotal body, and total body (r=0.730–0.965, p<0.001) and moderately with body mass index and total body fat mass (r=0.525–0.701, p<0.001). Therefore, the hand DXA scan can potentially be a new tool for the clinical assessment of bone health in children.

Functional Independence Measure for Children: A Comparison of Chinese and Japanese Children

The Functional Independence Measure for Children (WeeFIM) is a simple-to-administer scale for assessing functional independence across 3 domains (self-care, mobility, cognition) in children. There are normative data from America and Japan. In 2001 to 2002, the authors created a normative Chinese WeeFIM profile and compared this with the American one. In this study, they aimed to compare their Chinese normative data with the Japanese one. Methods. A random sampling of 445 normal Chinese children from different social classes in Hong Kong was conducted in the community. It was conducted via face-to-face interviews with the mother, and a normative database was created. Results. Similar to the Japanese children, the WeeFIM total score and 3 main domain subscores (self-care, mobility, and cognition) increased progressively with age. In the self-care domain, Chinese children achieved modified independence or level 6 earlier in all items except toileting. For the mobility domain, the item chair transfer was achieved earlier in the Chinese children, whereas toilet transfer, stair, tub transfer, and locomotion were achieved later in Chinese children. As for cognition domain, the item problem solving was achieved earlier but comprehension, social interaction, and memory were achieved later in the Chinese children. The authors’ results showed the same pattern of increasing WeeFIM score with increasing chronological age, which is similar to the Japanese children. There are 3 patterns of WeeFIM score achievement in this Chinese cohort. As for the Japanese children, the 3 patterns of WeeFIM score achievement from independent to dependent are 1) rapid change, 2) gradual change, and 3) linear change. Conclusions. WeeFIM is a validated standardized tool for assessing the outcome of rehabilitation programs. It should be widely used to assess rehabilitative achievement in children from different ethnic origins. The authors’ previous study and this current study demonstrated that the authors’ normative WeeFIM profile showed similar results to the American and Japanese children. However, there are minor differences in the WeeFIM scoring in the 3 main domains, which might be due to cultural differences between ethnic groups. Thus, usage of the WeeFIM with a different age criteria in achieving independence according to local culture should be adopted.

Do our Noses Lead Us Away from the Scent?

In magnetic resonance (MR) imaging studies of child brain development, structural brain atlases usually serve as important references for the pediatric population, in which individual images are spatially normalized into a common or standard stereotactic space. However, the popular existing pediatric brain atlases (e.g., National Institutes of Health pediatric atlases, NIH-PD) are mostly based on MR images obtained from Caucasian populations and thus are not ideal for the characterization of the brains of Chinese children due to neuroanatomical differences related to genetic and environmental factors. Here, we use an unbiased template construction algorithm to create a set of age-specific Chinese pediatric (CHN-PD) atlases based on high-quality T1-and T2-weighted MR images from 328 cognitively normal Chinese children aged 6–12 years. The CHN-PD brain atlases include asymmetric and symmetric templates, sex-specific templates and tissue probability templates, and contain multiple age-specific templates at one-year intervals. A direct comparison of the CHN-PD and NIH-PD atlases reveals dramatic anatomical differences mainly in the bilateral frontal and parietal regions. After applying the CHN-PD and NIH-PD atlases to two independent Chinese pediatric datasets (N = 114 and N = 71), we find that the CHN-PD atlases result in significantly higher accuracy than the NIH-PD atlases in both predicting “brain age” and guiding brain tissue segmentation. These results suggest that the CHN-PD brain atlases are necessary for studies of the typical and atypical development of the Chinese pediatric population. These CHN-PD atlases have been released on the Neuroimaging Informatics Tools and Resources Clearinghouse (NITRC) website (https://www.nitrc.org/projects/chn-pd).

Evaluation of the Activity of Tartrate-resistant Acid Phosphatase Isoform 5b in Normal Chinese Children - A Novel Marker for Bone Growth

Most parents are very concerned about the height of their children. Biochemical markers of bone formation and resorption may provide useful clinical predictors for bone growth. Tartrate-resistant acid phosphatase 5b (TRAcP 5b) has been advocated as a biomarker of osteoclast activity and bone resorption. However, the TRAcP 5b levels of children at different ages are still unknown. It is necessary to accumulate and analyze the data for healthy children at different ages. We use an improved immunoassay for bone TRAcP 5b to examine sera from children to see whether it is a significant marker of bone growth. Serum, including cord blood, was collected from 404 normal Chinese children (age range 0-17 years; 225 male, 179 female). The venous blood was withdrawn from the peripheral vein and stored at 4 degrees C before centrifugation for serum collection. All sera were stored at -70 degrees C and thawed at 37 degrees C immediately before TRAcP 5b levels were measured. Bone-specific alkaline phosphatase (BAP) was also used for comparison with TRAcP 5b levels at different ages. TRAcP 5b levels were extremely high in infants of both genders, gradually decreasing with age (p <0.001). A second peak in TRAcP 5b values occurred at 12-13 and 10-11 years in males and females, respectively (p <0.001). Age alone, as well as age-related changes between the male and female groups, were independent predictors of TRAcP 5b levels (p <0.001). There was no significant between-gender difference in serum TRAcP 5b levels for any age group (p = 0.682). BAP values did not show a significant second peak in females. Age and gender alone, as well as the age-related changes between male and female groups, were independent predictors of BAP values (p <0.001). Preliminary results were established for serum TRAcP 5b and BAP values of normal Chinese children of different ages. Elevated serum TRAcP 5b values were observed during infancy and puberty for both genders. The pattern of this age-related change in serum TRAcP 5b levels is similar to the shape of the standard height velocity curve for healthy children. Values of BAP were less specific than TRAcP 5b. These data may prove valuable as a normal reference in future research about bone markers.

Morphometry of the corpus callosum in Chinese children: relationship with gender and academic performance

The corpus callosum has been widely studied, but no study has demonstrated whether its size and shape have any relationship with language and calculation performance. To examine the morphometry of the corpus callosum of normal Chinese children and its relationship with gender and academic performance. One hundred primary school children (63 boys, 37 girls; age 6.5-10 years) were randomly selected and the standardized academic performance for each was ascertained. On the mid-sagittal section of a brain MRI, the length, height and total area of the corpus callosum and its thickness at different sites were measured. These were correlated with sex and academic performance. Apart from the normal average dimension of the different parts of the corpus callosum, thickness at the body-splenium junction in the average-to-good performance group was significantly greater than the below-average performance group in Chinese language (P=0.005), English language (P=0.02) and mathematics (P=0.01). The remainder of the callosal thickness showed no significant relationship with academic performance. There was no significant sex difference in the thickness of any part of the corpus callosum. These findings raise the suggestion that language and mathematics proficiency may be related to the morphometry of the fibre connections in the posterior parietal lobes.

Measurement of ear length in neonates, infants and preschool children in Taiwan.

Ear length is important in the evaluation of congenital anomaly syndrome, such as small ear in Down syndrome. In this research, 4,416 normal Chinese children in Taiwan were enrolled into our study. The sample of 284 full term neonates, 2,742 infants and children aged from one month to three years, and 1,420 preschool children were measured for ear length. We placed a ruler along the greatest vertical axis of the right ear We calculated the mean value and standard deviation of the ear length in normal Chinese neonates, infants and preschool children in Taiwan. No significant sex differences were observed. Twenty patients with Down syndrome were also measured. Compared with the previous study, there was no significant difference between the ear length of Chinese children and that of Caucasian children. The ear length of patients with Down syndrome was indeed smaller than that of the normal children. Due to the correlation of reduced ear length and congenital anomaly, we should set up our own data about the growth of the ear length. Thus we can provide an additional clue to diagnose the congenital anomaly syndromes.

Normal values of inner canthal distance, interpupillary distance and palpebral fissure length in normal Chinese children in Taiwan.

Ocular measurements, including inner canthal distance, outer canthal distance, interpupillary distance, and palpebral fissure length are important in the evaluation of congenital deformities and posttraumatic telecanthus. In this research, 4446 normal Chinese children in Taiwan were enrolled in our study. The sample of 284 full term neonates, 2742 infants and children aged from 1 month to 3 years, and 1420 preschool children were measured for inner canthal distance, outer canthal distance, interpupillary distance and palpebral fissure length. We calculated the mean value and standard deviation of the ocular measurements in normal Chinese newborns, infants and preschool children in Taiwan under 5 years. No significant sex differences were observed. Compared with previous studies, inner canthal distance, outer canthal distance and interpupillary distance in Chinese children in Taiwan were wider than those in Caucasian children, but the palpebral fissure length was not significantly different. We also found that inner canthal distance was wider than palpebral fissure length at the same age; therefore it was not correct to diagnose hypertelorism in Chinese children in Taiwan; as if an imaginary third eye could fit between the eyes. Thus, we suggest that measurements should be adjusted with normal standards specific for race. Consideration of the position of eyes is relevant for the diagnosis of a large number of syndromes.

Real-time ultrasonography of the pancreas in normal Chinese children in Taiwan.

The real-time ultrasound images of the pancreas in 142 children without clinical or laboratory evidence of pancreatic disease prospectively were analyzed to determine normal pancreatic size in Chinese children in Taiwan. Sonographic examinations of the pancreas were performed by sagittal scanning at the epigastrium; the long axis and short axis of the oval cross-sections of both the pancreatic head and body were measured. The relationships between pancreatic dimensions and body height, body weight, surface area and age were evaluated with linear regression analysis. Correlations with body height and age were better than those obtained with body surface area and body weight. Since all the physical parameters had better correlations with the long, rather than the short, axis of the pancreas, this indicated that the growth of the pancreas in children is primarily in the craniocaudal direction rather than the anteroposterior direction.