Pubertal Growth Spurt Research Articles

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.

The estimation of pubertal growth spurt parameters using the superimposition by translation and rotation model in Korean children and adolescents: a longitudinal cohort study.

Understanding the characteristics of the pubertal growth spurt in Korean children and adolescents can serve as crucial foundational data for researching puberty and growth-related disorders. This study aims to estimate the key parameters of pubertal growth, specifically the age and magnitude of the pubertal growth spurt, utilizing longitudinal data from a cohort of Korean children and adolescents. This study used mixed longitudinal height data from a cohort of Korean elementary, middle, and high school students aged 7-18 years. The Superimposition by Translation and Rotation (SITAR) model, a shape-invariant growth curve model, was utilized to estimate a reference height velocity curve for the entire dataset and individual curves via random effects to evaluate pubertal growth parameters. Altogether, 3,339 height measurements (1,519 for boys and 1,820 for girls) from 270 individuals (123 boys and 147 girls) were analyzed. The average age of growth spurt onset in Korean boys was 10.17 ± 0.61 years (mean ± SE), with peak height velocity occurring at 12.46 ± 0.69 years of age (9.61 ± 1.26 cm/year). Korean girls, contrarily, experience their growth spurt at an earlier age (8.57 ± 0.68 years), with peak height velocity occurring at 10.99 ± 0.74 years of age (8.32 ± 1.09 cm/year). An earlier onset of puberty in both sexes is associated with a shorter growth spurt duration (0.63 years for boys and 0.58 years for girls) and a higher peak height velocity (1.82 cm/year for boys and 1.39 cm/year for girls). These associations were statistically significant for both sexes (all p < 0.0001). This study is the first to use the height velocity curve from the SITAR model to examine the pubertal growth spurt of Korean children and adolescents. The estimated timing and magnitude of the pubertal growth spurt, and their relationships can be useful data for clinicians and researchers.

Puberty changes the natural history of idiopathic scoliosis: three prediction models for future radiographic curve severity from 1563 consecutive patients.

Understanding idiopathic scoliosis (IS) natural history during growth is essential for shared decision-making between patients and physicians. We developed a retrospective model with the largest available sample in the literature and we aimed to investigate if using three peri-pubertal growth periods provides better prediction than a unique model. Secondary analysis of a previous study on IS natural history data from radiographs before and at the first consult. Three groups: BEFORE (age 6-10), AT (age 11-Risser 2) and AFTER (from Risser 3) the pubertal growth spurt. Available predictors: Cobb angle, curve type, sex, observation time, and Risser score. We used linear mixed-effects models to predict future Cobb angles in each group. We internally validated prediction accuracy with over 100 patients per group (3 to 5-fold cross-validation). We included 1563 participants (275 BEFORE, 316 AFTER, 782 females and 190 males AT). Curves increased over time mostly in AT, importantly in BEFORE, but also in AFTER. All models performed better than the general one. In BEFORE, 74.2% of the predictions were within ± 5o, 71.8% in AFTER, 68.2% in AT females, and 60.4% in males. The predictors (baseline curve, observation time also squared and cubic, and Risser score) were similar in all the models, with sex influencing only AFTER. IS curve severities increase differently during growth with puberty stages. Model accuracy increases when tailored by growth spurt periods. Our models may help patients and clinicians share decisions, identify the risk of progression and inform treatment planning.

Bodily growth and the intervertebral disc: a longitudinal MRI study in healthy adolescents

BACKGROUND CONTEXTLow back pain (LBP) among children and adolescents is a growing global concern. Disc degeneration (DD) is considered a significant factor in the clinical symptom of LBP. Both LBP and DD become more prevalent as adolescents transition into emerging adulthood. However, the relationship between growth during the pubertal growth spurt and the morphology of lumbar discs has yet to be elucidated. PURPOSEThis study aimed to assess the relationship between bodily growth during the pubertal growth spurt and the morphology of lumbar discs at age 18. STUDY DESIGNThis study was a prospective longitudinal cohort study. PATIENT SAMPLEA randomly selected cohort of healthy children was examined at ages 8, 11, and 18. Participants with complete data sets (semi-structured interview, anthropometric measurements and lumbar spine MRI) at age 11 and 18 were included in this analysis (n=59). OUTCOME MEASURESThe morphological characteristics of lumbar discs were evaluated on MRI. Anthropometric measures including height, sitting height and weight were obtained to calculate the Body Surface Area (BSA) and the Body Mass Index (BMI). METHODSThe morphology of the lumbar discs was evaluated on T2-weighted mid-sagittal MRI using the Pfirrmann classification. A disc with a Pfirrmann grade of 3 or higher was considered degenerated at age 18. The relationship between relative growth between ages 11 and 18 (adjusted to sex and baseline values) and DD at age 18 was assessed. To analyze the relationship between the relative increase in BSA and DD, the participants were categorized into three equal-sized categories (tertiles). For all other anthropometric measures, the analysis was based on the relative increase in each measure between ages 11 and 18. RESULTSIn the highest tertile of relative increase in BSA (≥43%), 76% of participants had at least 1 disc with a Pfirrmann grade 3 or higher at age 18 while only 10% and 21% of participants in the lowest and medium tertiles had DD, respectively. The sex- and baseline-adjusted odds ratio (OR) for DD at age 18 for every additional 10% increase in BSA was 1.08 (1.02–1.15). The sex- and baseline-adjusted OR (95% CI) for DD at age 18 was 10.5 (1.60–68.7) and 7.92 (1.19–52.72) with every additional 10% increase in height and sitting height, respectively. For every additional 10% increase in weight, the adjusted OR for DD at age 18 was 1.51 (1.12–2.04) and for BMI 1.05 (1.01–1.09). CONCLUSIONSMore relative growth between ages 11 and 18 is significantly associated with the occurrence of DD in emerging adulthood. Among the measures investigated, height and sitting height are nonmodifiable. Maintaining an ideal body weight during the pubertal growth spurt may be beneficial for the health of the lumbar discs.

Pediatric spinal alignment and spinal development

BackgroundKnowledge of the growth spurt and remaining growth is essential for managing musculoskeletal diseases in children. Accurate prediction of curve progression and timely interventions are crucial, particularly for conditions like adolescent idiopathic scoliosis (AIS). MethodsThis study conducted a comprehensive review and synthesis of existing literature on spinal growth, skeletal maturity classifications, and the evolution of sagittal alignment parameters during childhood and adolescence. Key anatomical elements involved in spinal development, natural history of spinal growth, and skeletal maturity assessment systems were analyzed. ResultsThe analysis highlighted that key parameters such as Pelvic incidence (PI), Pelvic tilt (PT), and Lumbar lordosis (LL) increase significantly with growth, especially during the pubertal growth spurt. In contrast, Sacral slope (SS) remains relatively constant, and Thoracic kyphosis (TK) shows a slight increase. Additionally, there is a posterior shift in the center of gravity as children grow, reflecting progressive postural maturation. The study also reviewed and compared various maturity classification systems, noting the reliability and clinical implications of systems like the Sanders Maturity Stage (SMS) and Tanner-Whitehouse III. ConclusionsReliable maturity classification systems, such as the Sanders Maturity Stage (SMS) and Tanner-Whitehouse III, allow for tailored treatments to individual growth patterns. Integrating these classification systems into clinical practice enables precise prediction of curve progression and timely therapeutic interventions. This includes options from bracing to surgical techniques like growing rods or vertebral body tethering (VBT), with growth modulation being a key factor in achieving successful outcomes.

Nutrient and Hormonal Effects on Long Bone Growth in Healthy and Obese Children: A Literature Review.

Longitudinal bone growth is mediated through several mechanisms including macro- and micronutrients, and endocrine and paracrine hormones. These mechanisms can be affected by childhood obesity as excess adiposity may affect signaling pathways, place undue stress on the body, and affect normal physiology. This review describes the physiology of the epiphyseal growth plate, its regulation under healthy weight and obesity parameters, and bone pathology following obesity. A literature review was performed utilizing PubMed, PMC, NIH, and the Cochrane Database of Systematic Reviews pertinent to hormonal and nutritional effects on bone development, child obesity, and pathologic bone development related to weight. The review indicates a complex network of nutrients, hormones, and multi-system interactions mediates long bone growth. As growth of long bones occurs during childhood and the pubertal growth spurt, pediatric bones require adequate levels of minerals, vitamins, amino acids, and a base caloric supply for energy. Recommendations should focus on a nutrient-dense dietary approach rather than restrictive caloric diets to maintain optimal health. In conclusion, childhood obesity has profound multifaceted effects on the developing musculoskeletal system, ultimately causing poor nutritional status during development. Weight loss, under medical supervision, with proper nutritional guidelines, can help counteract the ill effects of childhood obesity.

Assessing the Efficacy of Early versus Late Orthodontic Intervention in the Management of Class II Malocclusion: A Comparative Analysis

ABSTRACT Background: Class II malocclusion is a common orthodontic issue characterized by the excessive protrusion of the upper teeth relative to the lower teeth. Early intervention during mixed dentition has been advocated to guide skeletal growth and potentially reduce the severity of malocclusion. Materials and Methods: A comparative analysis was conducted to evaluate the efficacy of early (before the pubertal growth spurt) versus late (after the pubertal growth spurt) orthodontic intervention in managing Class II malocclusion. A cohort of 100 patients diagnosed with Class II malocclusion was divided into two groups: early intervention group (n = 50) and late intervention group (n = 50). Treatment outcomes including changes in overjet, molar relationship, and cephalometric measurements were assessed before and after orthodontic treatment. Results: In the early intervention group, the mean reduction in overjet was 5.2 mm (SD = 1.3), while in the late intervention group, it was 3.8 mm (SD = 1.6). The improvement in molar relationship was greater in the early intervention group (mean change = 4.5 mm, SD = 1.1) compared to the late intervention group (mean change = 3.1 mm, SD = 1.4). Cephalometric analysis revealed significant differences in skeletal and dental parameters between the two groups, with greater improvements observed in the early intervention group. Conclusion: Early orthodontic intervention shows superior efficacy in managing Class II malocclusion compared to late intervention. Early treatment leads to greater reductions in overjet, improvements in molar relationship, and favorable changes in skeletal and dental parameters. These findings underscore the importance of timely orthodontic intervention, particularly during the mixed dentition stage, for optimal management of Class II malocclusion.

Application of the twin-block appliance combined with braces in the treatment of a patient with distal occlusion

Relevance. Distal occlusion is one of the most frequently encountered anomalies in orthodontic practice among patients with both temporary and permanent dentitions. When selecting a treatment method for this anomaly, it is crucial to consider several significant factors, including the craniofacial stage of skeletal maturity and the type of jaw growth. Special attention should be given to the method of treating patients with incomplete skeletal growth using a twin-block appliance, followed by continued orthodontic treatment with fixed orthodontic appliances (braces).Clinical case description. This article presents a clinical case of treating a patient with distal occlusion in the peripubertal stage of skeletal growth, which is the most optimal for the initial stage of orthodontic treatment.Conclusion. Sequential treatment of distal occlusion during the pubertal growth spurt using a twin-block appliance and braces allows achieving the most physiological jaw relationship, ensuring proper functioning of the dentoalveolar system and harmonious development of the body as a whole.

Relationship of disc degeneration after pubertal growth spurt to future low back pain: a longitudinal cohort study.

In this longitudinal cohort study, we investigated the relationship of disc degeneration (DD) after pubertal growth spurt to future low back pain (LBP). A group of healthy volunteers underwent a semi-structured interview about LBP without trauma and a 1.5T lumbar MRI at ages 18 and 34. A Pfirrmann Summary Score (PSS) was calculated by adding up the Pfirrmann grades of the three lowest lumbar discs of each subject (range 3-15). The relationship of PSS at age 18 to LBP at age 34 was analyzed. Forty-one participants had full data at both time points. Mean PSS at age 18 was 6.8 (SD 1.1) and 5.6 (SD 1.2) for participants with or without LBP at age 34, respectively (p = 0.009). The OR (95% CI) of PSS at age 18 for LBP at age 34 was 5.46 (1.22 to 24.47) when adjusted for sex, BMI, smoking and physical activity. All participants but one with PSS greater than 6 at age 18 reported LBP at age 34. This is the first study to suggest that DD may be associated with future LBP and the critical time frame seems to be the pubertal growth spurt. Every 1-point increase in Pfirrmann grade at age 18 increased the risk of LBP 5.5-fold at age 34 when adjusted for sex, BMI, smoking and physical activity at age 34. All participants but one with at least one disc with Pfirrmann grade 3 or higher at age 18 reported LBP at age 34.

Treatment modalities for management of skeletal and dental Class III malocclusion – A case series

Class III malocclusion is a challenging phenomenon to comprehend. Research done to determine the cause of Class III malocclusion revealed that the deformity affects all aspects of the craniofacial system, not only the jaws. Skeletal and dentoalveolar abnormalities coexist in the majority of patients with Class III malocclusion. Orthognathic surgery, dentoalveolar compensation, and growth modification are the three main therapies available for skeletal Class III malocclusion. Until the pubertal growth spurt, growth modification needs to be started. Thereby, in order to deal with skeletal Class III malocclusion in a grownup, orthognathic surgery collectively with conventional orthodontic therapy will be required in order optimize facial esthetics as well as attain stable occlusion. The objectives of the case series are to highlight different approaches to resolving skeletal Class III malocclusion, which includes orthognathic surgery, orthopedic appliance therapy, and extractions.

Correlations between Dental Age, Skeletal Age, and Mandibular Morphologic Index Changes in Turkish Children in Eastern Anatolia and Their Chronological Age during the Pubertal Growth Spurt Period: A Cross-Sectional Study.

In age determination, different methods aiming to obtain the closest result to chronological age have been investigated so far. The most commonly used one among these is the radiological method, which is usually used to evaluate the developmental stages of wrist bones or teeth. In our study, we assessed bone age estimations using the Gilsanz-Ratib atlas (GRA), which has recently become commonly used for children aged 9 to 15 years; evaluated the dental age, determined with Cameriere's European method; conducted morphometric measurements of the mandibular bone; and then examined their relationships with chronological age. The results of our study reveal that, in children during the puberty growth spurt, Cameriere's EU formula might have higher accuracy in estimating chronological age in younger age groups, while the GRA might be more accurate for older ages. Additionally, we conclude that of the mandibular morphometric measurements, condylar height and tangential ramus height show strong positive correlations with age. As a result, we conclude that the morphometric measurements evaluated in the present study can be used as auxiliary methods in forensic anthropology and forensic dentistry.

Growth and Adult Height Attainment in Danish Transgender Adolescents Treated with GnRH Analog and Sex Hormones

Abstract Background Endogenous sex steroids influence the pubertal growth spurt and adult height. However, the impact of puberty suppression and sex steroids on growth in transgender adolescents is sparsely studied. Aim We investigated pubertal growth, serum IGF-I and IGFBP-3, and adult height of transgender adolescents receiving hormone therapy. Methods Observational study of a national cohort (2016-2023) comprising 219 transgender adolescents &amp;lt;18 years of age. Treatment consisted of gonadotropin-releasing hormone agonist (GnRHa) combined with estradiol or testosterone (adjusted to serum concentrations between 0 and +2 standard deviations (SDs) corresponding to the gender identity). Results Adult height was within ±2 SD for sex assigned at birth. Most trans girls reached adult height within references of girls. For trans girls (bone age ≤15 years before treatment), a growth spurt was observed during estradiol therapy. IGF-I and height SDS declined during oral estradiol administration (-0.13 SDS per month, p=0.059, and -0.02 SDS, p=0.001, respectively). We observed significantly lower adult height compared to target height for trans girls (-2.7 cm, p=0.01), and significant differences between height SDS before treatment and at adult height (-0.35 SDS, p&amp;lt;0.001). Half of the trans boys remained short (&amp;lt;-2 SD) compared to references for boys, and most completed growth spurt before initiation of treatment. IGFBP-3 declined following testosterone treatment. There was a significant difference between height SDS before treatment and at adult height (-0.17 SDS, p&amp;lt;0.001). Discussion and Conclusion The minor reduction in adult height of trans girls after hormone treatment may be beneficial to some, whereas trans boys did not experience height gain.

Age-related changes in densitometry and histomorphometry of long bone during the pubertal growth spurt in male rats.

Because experimental studies to determine the developmental toxicity of exposure to various substances in children are impossible, many studies use immature male rats. This study aimed to provide normative data for longitudinal bone growth with age during the puberty in male rats. In order to evaluate long bone growth and mineralization we examined bone size and bone density by dual-energy X-ray absorptiometry, analyzed histomorphometry of the growth plate, and serum hormone levels relevant to bone growth from postnatal day (PD)20 to PD60. The length and weight of long bones increased strongly by PD40, and no further increase was observed after PD50. On the other hand, tibial growth plate height decreased sharply after PD50 along with a reduction in the number of cells and columns, which was probably responsible for the absence of further lengthening of long bones. Parameters related to bone formation such as bone area ratio, and the thickness and number of trabeculae, also increased significantly between PD40 and PD50. Furthermore, serum levels of IGF-1 peaked at PD30 and testosterone increased rapidly on and after PD40, when IGF-1 levels were going down. These changes may participate in the parallel increase in mineral acquisition, as well as lengthening of long bones. Our findings provide comprehensive data for changes in bone density, histomorphometry of long bones, and hormone levels relevant to bone growth during the growth spurt. This will be useful for planning animal toxicological studies, particularly for deciding on the appropriate age of animals to use in given experiments.

Free Vascularized Proximal Fibular Epiphyseal Transfer For Hip Reconstruction Following Septic Necrosis In Children.

Septic necrosis of the femoral head and neck in children represents a challenging problem. Several reconstructive techniques have been described but with disappointing long-term results. Vascularized epiphyseal transfer utilizing the proximal fibula have been successfully used for reconstruction of the proximal humerus and distal radius and only scarcely used for hip reconstruction. This cohort represents the largest reported series of epiphyseal transfer for hip reconstruction following septic necrosis in children. A total of 18 patients with an average age at surgery of 5.4 years were included. The average follow-up was 3.6 years (range 2.3 to 6.8y). Transient postoperative foot drop was observed in 4 patients. Radiographic resorption of the transferred fibula occurred in 2 cases. Longitudinal growth averaged 7.3mm/year, and the physis width increased by an average of 2.7mm/year. The rate of longitudinal growth was fastest after the age of 10 years (18.5mm/y), which coincides with the pubertal growth spurt. All successful transfers had an open growth plate on final follow-up radiographs. Ten patients had limb length discrepancy of an average 2.8cm (range 1 to 8cm). Thirteen patients had satisfactory functional according to the criteria of Hunka et al. Three patients had unsatisfactory results; one had painful nonunion at the fibula-femur junction, and the other two had limited flexion range of 45 degrees. The average postoperative neck-shaft angle was 96.4 degrees which decreased by an average of 8 degrees at the final follow-up. Three patients underwent a valgus subtrochanteric osteotomy to correct a severe varus deformity. The final neck-shaft angle correlated significantly with the functional results where it averaged 96 degrees in the satisfactory group and 57 degrees in the unsatisfactory group. Vascularized epiphyseal transfer presents a promising treatment for children with septic necrosis of the femoral head and neck in whom other methods have failed to provide satisfactory long-term results. We recommend the procedure be done before the age of 5 years for optimum results. Level-IV.

Interobserver Reliability of Cervical Vertebral Maturation Staging

Background: the accurate identification of a patient's maturation stage, particularly during the pubertal growth spurt, takes on heightened importance, particularly when addressing cases of dentoskeletal problem Active growth determination is crucial for orthodontic treatment. Objectives: The objective of this study was to determine interobserver reliability of Cervical Vertebrae Maturation (CVM) stagingMaterial and Methods: This cross-sectional correlational study, conducted in the Department of Orthodontics on 70 subjects. Ten orthodontic clinicians, including 4 orthodontists and 6 orthodontic residents, with no prior experience in CVM staging, underwent comprehensive training. The study involved assessing 70 lateral cephalograms with clear visibility of cervical vertebrae, evaluated by two independent examiners using the Baccetti et al. staging system. The collected data were analyzed using R programming, including descriptive statistics for age, Spearman's correlation, and Cohen's Kappa for assessing interobserver agreement, with stratification by gender. Results: The mean age of participants was 12.60±3.93 years, with 38 females (54.29%) and 32 males (45.71%). The study revealed varying levels of agreement between two observers for different CVM stages, ranging from perfect agreement in CS1 to strong agreement in CS3. CS4, CS5, and CS6 also showed varying agreement rates. Additionally, there was robust and statistically significant agreement (p&lt;0.001) between observers in cervical maturation staging, supported by a high Spearman's rho value (r=0.927). Furthermore, substantial agreement was observed with a Kappa value of 0.748, indicating a strong consensus in cervical staging assessments.Conclusion: Cervical vertebral maturation staging is reliable in term of inter-observers agreement. Keywords: Cervical vertebral maturation, Interobserver agreement, Growth assessment

Determination of the pubertal growth spurt by artificial intelligence analysis of cervical vertebrae maturation in lateral cephalometric radiographs

ObjectiveThis study aimed to assess the performance of a convolutional neural network (CNN) model in detecting the pubertal growth spurt by analyzing cervical vertebrae maturation (CVM) in lateral cephalometric radiographs (LCRs). Study designIn total, LCRs of patients from 6 to 17 years old were selected. Three radiologists independently and blindly classified the maturation stages on the LCRs and defined the difficulty of each classification. Subsequently, the stage and level of difficulty were determined by consensus. LCRs were distributed between training, validation, and test sets across four CNN-based models. The models’ responses were compared with the radiologists’ reference standard, and the architecture with the highest success rate was selected for evaluation. Models were developed using full and cropped LCRs with original and simplified maturation classifications. ResultsIn the simplified classification, the Inception-v3 CNN yielded accuracy of 74% and 75%, with recall and precision values of 61% and 62%, for full and cropped LCRs, respectively. It achieved 61% and 62% success rates with full and cropped LCRs, respectively, reaching 72.7% for easy-to-classify cropped cases. ConclusionOverall, the CNN model demonstrated potential for determining whether the patient's maturation status regarding the pubertal growth spurt through images of the cervical vertebrae. It may be useful as an initial assessment tool or as an aid for optimizing the assessment and treatment decisions of the clinician.

A148 OSTEOSARCOMA GASTROINTESTINAL METASTASIS: A RARE ENTITY IN ADULTS

Abstract Background Osteosarcoma is highly aggressive and is the most common primary bone malignancy for both children and adults with a bimodal age distribution. The first peak coincides with pubertal growth spurt and the second is in the seventh and eighth decade of life. They frequently metastasize to the lungs. Metastasis to the gastrointestinal tract is extremely rare and to our knowledge, there have only been 15 cases reported in the literature since 1987, of those only three in the second peak. Aims Describe a case of 61-year-old female with periampullary metastatic osteosarcoma. Describe the demographics of osteosarcoma patients who develop gastrointestinal metastasis. Methods Search Pubmed using the terms: ("Osteosarcoma"[MeSH Terms] OR "Osteosarcoma"[Title/Abstract]) AND ("Gastrointestinal Tract"[MeSH Terms] OR "Gastrointestinal Tract"[Title/Abstract] AND "Case Reports"[Publication Type]. 113 articles were identified and screened by title. 15 articles were further screened by abstract or full text. 7 articles were identified. the remainder 7 articles were located by screening the references of the previously identified articles. Results A 61-year-old woman with a medical history significant for metastatic Osteosarcoma was referred to Gastroenterology clinic July 2023 for anemia investigation. Her Osteosarcoma was first diagnosed in the left femur in 2009. She was known for extensive bilateral lung metastasis, subcutaneous metastatic deposits, and distant bone metastasis. She had undergone over 37 surgeries and multiple sessions of radiotherapy. Aside from neoadjuvant and adjuvant chemotherapy for the primary tumor and the first occurrence of lung metastasis, she refused to undergo further cycles of chemotherapy. She had a 60 mg/dl hemoglobin drop from a previous one in December 2023 and intermittent melena. On gastroscopy, she was found to have a 2 cm bleeding mass in the periampullary area. The pathology report of the biopsies was consistent with metastatic osteosarcoma. It showed fragments of ampullary mucosa incorporating a malignant spindle cell neoplasm with a fascicular growth pattern, including scattered osteoclast-like giant cells, morphologically consistent with the known history of metastatic osteosarcoma. Of the 15 cases published, 9 were in patients 27 years old and younger, 3 were in patients 50 and older, and 3 were only available as titles. 50% of cases presented with intussusception while the rest had anemia or melena. The site of metastasis was the jejunum in the majority of patients (58%). Other sites included the ileum, stomach, colon, and esophagus. Only one other patient had periampullary metastasis. All patients had lung metastasis. Conclusions Gastrointestinal metastasis of osteosarcoma remains a rare occurrence. Our case report describes the second case reported in the literature of periampullary metastasis and the first case reported in older patients Funding Agencies None

Trans-ancestral genome-wide association study of longitudinal pubertal height growth and shared heritability with adult health outcomes

BackgroundPubertal growth patterns correlate with future health outcomes. However, the genetic mechanisms mediating growth trajectories remain largely unknown. Here, we modeled longitudinal height growth with Super-Imposition by Translation And Rotation (SITAR) growth curve analysis on ~ 56,000 trans-ancestry samples with repeated height measurements from age 5 years to adulthood. We performed genetic analysis on six phenotypes representing the magnitude, timing, and intensity of the pubertal growth spurt. To investigate the lifelong impact of genetic variants associated with pubertal growth trajectories, we performed genetic correlation analyses and phenome-wide association studies in the Penn Medicine BioBank and the UK Biobank.ResultsLarge-scale growth modeling enables an unprecedented view of adolescent growth across contemporary and 20th-century pediatric cohorts. We identify 26 genome-wide significant loci and leverage trans-ancestry data to perform fine-mapping. Our data reveals genetic relationships between pediatric height growth and health across the life course, with different growth trajectories correlated with different outcomes. For instance, a faster tempo of pubertal growth correlates with higher bone mineral density, HOMA-IR, fasting insulin, type 2 diabetes, and lung cancer, whereas being taller at early puberty, taller across puberty, and having quicker pubertal growth were associated with higher risk for atrial fibrillation.ConclusionWe report novel genetic associations with the tempo of pubertal growth and find that genetic determinants of growth are correlated with reproductive, glycemic, respiratory, and cardiac traits in adulthood. These results aid in identifying specific growth trajectories impacting lifelong health and show that there may not be a single “optimal” pubertal growth pattern.

Estimation of Salivary Bone Specific Alkaline Phosphatase as a Biomarker for Assessing Skeletal Maturity Indicator

ABSTRACT Background: Evaluation of skeletal maturation plays a substantial role in selection of orthodontic treatment strategies. Recently, new noninvasive methods of assessing biological mediators have been introduced to assess skeletal maturity. There is a marked rise in the value of these mediators during pubertal growth spurts. When these mediators emerge as the assessment tool for skeletal maturity determination, it can reduce radiation exposure and beneficial to the patient. Hence, the goal of this study is to validate the calculation of salivary alkaline phosphatase (ALP) as a noninvasive skeletal maturity indicator by estimating the Bone Alkaline Phosphatase (B-ALP) level in whole unstimulated saliva at different stages of skeletal maturity and correlating B-ALP level with different stages of skeletal development using cervical vertebral maturation index (CVMI) and hand-wrist MP3 (third finger middle phalanx). Materials and Methods: The test group included 90 subjects aged between 8 and 18 years requiring orthodontic treatment. The salivary samples were collected and examined by ALP kit following the manufacturer’s instructions and assessed using photo-spectrometer at 405 nm. The skeletal age was assessed using handwrist radiographs; skeletal age was determined by modified MP3 staging. Lateral cephalograms of each individual were also collected and tracing done for assessing skeletal age with CVM staging. The collected data were analyzed statistically with analysis of variance for intergroup comparison of ALP levels and Kruskal–Wallis test for intergroup comparison of CVM and MP3 stages. Results and Conclusion: Salivary ALP activity during the peak pubertal period was markedly increased when compared to pre- and post-peak values. Salivary ALP activity was in correlation with the cervical vertebral maturation and MP3 stages showing peak values at the pubertal stages. Thus, salivary B-ALP can serve as a noninvasive method of skeletal maturity assessment as an adjunct to conventional skeletal maturity indicators.

Facial soft tissue changes in adolescent patients treated with three different functional appliances: a randomized clinical trial.

Patients with Class II, division 1 malocclusion generally seek treatment to improve facial esthetics. Therefore, the orthodontist needs to know the changes in the soft profile produced by functional appliances. This study evaluated the soft tissue profile changes in patients treated during the peak of the pubertal growth spurt. Thirty selected patients were randomized into three treatment groups: Twin Block (TB), Herbst with dental anchorage (HDA), and Herbst with skeletal anchorage (HSA). All patients had computed tomographic images: pretreatment (T1) and after 12 months of active treatment (T2). Twenty-four soft tissue cephalometric measures were analyzed. The normality of all data was assessed by the Shapiro-Wilk test. Intragroup comparisons were analyzed using the t-paired test; the inter-group comparisons were determined through ANOVA and the post-hoc Tukey test. At T1, no significant differences were observed between groups. At T2, in the intragroup comparison, facial soft tissue changes were statistically significant in the three groups for the lower lip, sulcus inferioris, facial soft tissue convexity in HDA group and TB group, and H angle in HDA group and HSA group, and soft tissue pogonium in TB group. In the inter-group comparison, no statistically significant differences were observed. It can be concluded that there were significant changes in soft tissue measurements that benefited Class II, division 1 patient's facial profile treated with the functional appliances Twin Block, Herbst, and Herbst with skeletal anchorage. Nevertheless, no significant differences were detected among the effects obtained by the three treatment protocols.