Precision errors and least significant changes in paediatric forearm measurements of bone density, mass, dimensions, mechanostat parameters and soft tissue composition by Stratec XCT-2000L.

OBJECTIVES: The peripheral quantitative computed tomography (pQCT) is gaining popularity in the field of paediatric densitometry, however, very little is known about the precision errors of this method in diseased children. The aim of the study was to evaluate the precision errors of bone density, mass, dimensions, strength, mechanostat parameters and soft tissue at the forearm in diseased children. METHODS: Stratec XCT 2000L apparatus was used. The measurement sites were 4% and 66% of the forearm length. The study group consisted of 60 patients (31 girls) aged 5,7-18,0 yrs. RESULTS: We observed week relationships between precision errors and body size with r from -0,37 to 0,28. Relative precision errors (CV%RMS) were from 0,85% for radius 66% cortical bone density to 3,82% for fat cross-sectional area to muscle cross-sectional area ratio. Least significant change (LSC) was from 2,73% to 10,59%, respectively. CONCLUSION: Presented study reveal pQCT method at the forearm in diseased children as relatively precise technique. The results may help with planning and interpretation of pQCT studies in diseased children.

Bone health in long-term survivors of pediatric acute lymphoblastic leukemia. An assessment by peripheral quantitative computed tomography.

BACKGROUND: Loss of bone mineral is a common concomitant of the treatment of acute lymphoblastic leukemia (ALL) due mainly to chemotherapy, especially with corticosteroids. Osteopenia/osteoporosis may be encountered long into survivorship. Measurement of bone mineral density (BMD) by dual-energy X-ray absorptiometry is limited to two-dimensionality and cannot distinguish trabecular from cortical bone. METHODS: A sample of 74 subjects, ages 13.5-38.3 years more than 10 years from diagnosis, underwent peripheral quantitative computed tomography (pQCT) at metaphyseal (trabecular bone) and diaphyseal (cortical bone) sites in the radius and tibia. pQCT provides three-dimensional assessment of bone geometry, density, and architecture. RESULTS: Average values in multiple metrics were similar to those in healthy individuals, but deficits in both trabecular and cortical bones were revealed by lower Z scores using an ethnically comparable sample of healthy individuals. Connectivity, a measure of bone architecture and a surrogate measure of bone strength, was lower in females than males. Survivors of standard-risk ALL had greater connectivity in and more compact trabecular bone than high-risk survivors who had received more intensive osteotoxic chemotherapy. There were no statistically significant differences in any of the metrics at any of the sites between subjects who had or had not a history of fracture, cranial irradiation, or use of a bisphosphonate. CONCLUSIONS: These long-term survivors of ALL have somewhat compromised bone health, but data in comparable healthy populations are limited. Longitudinal studies in larger and more ethnically diverse cohorts will provide greater insight into bone health in this vulnerable population.

Peripheral quantitative computed tomography of the lower leg in children and adolescents: bone densities, cross-sectional sizes and muscle distribution reference data.

OBJECTIVES: Peripheral quantitative computed tomography is utilised in increasing numbers of paediatric studies, however, very little is known about the reference limits for pQCT tibia measurements. The purpose of this study was to establish country-specific reference data for bone densities, cross-sectional sizes, strength and regional muscle distribution measured by pQCT in children and adolescents. METHODS: Stratec XCT 2000L apparatus was used. The measurement sites were 4%, 14%, 38% and 66% of the tibia length. The study group consisted of 222 participants (103 girls) aged 4,3-19,4 yrs. ANCOVA was used to assess the main determinants of pQCT outcomes. The LMS method was used to fit the percentile curves for each outcomes. RESULTS: Weight and age were the main determinants for most of the pQCT outcomes. Smoothed percentile curves were developed by age and by height for both sexes. CONCLUSION: In this study we present reference data for bone densities, cross-sectional size and strength as well as for regional muscle distribution measured by pQCT at certain sites of the lower leg to allow simple calculation of reliable Z scores.

Forearm bone density, cross-sectional size and muscle cross-sectional area in adolescents with diabetes mellitus type 1 assessed by peripheral quantitative computed tomography.

OBJECTIVES: The mechanical components of bone strength (size, shape and density) in adolescents with T1DM are not extensively studied. METHODS: The studied group comprises 39 adolescents, aged 11,9-18,0 yrs. The bone and muscle properties were investigated at the forearm (66% and 4% site). All measurements were performed using pQCT method. RESULTS: The mean Z-score calculated for the ratio of the total cortical bone cross-sectional area to muscle cross-sectional area at 66% was lower than zero in girls (-0,93+/-1,06; p=0,0042). Significant differences between Tanner stages were noted in boys for mean Z-scores for bone masses, cross-sectional dimensions and strength. CONCLUSIONS: T1DM girls revealed a decreased ratio of cortical bone area/muscle area, reflecting disturbed adaptation of the cortical shaft to the muscle force. When the Z-scores of cortical shell dimensions were investigated, cases in Tanner stage 5 diverged from "less mature" individuals, which may suggests that bone shaft development in these individuals was impaired, affecting both size and strength.

Peripheral quantitative computed tomography of the distal and proximal forearm in children and adolescents: bone densities, cross-sectional sizes and soft tissues reference data.

OBJECTIVES: Peripheral quantitative computed tomography (pQCT) is gaining popularity in the field of paediatric bone densitometry, however, very little is known about reference limits. The purpose of this study was to develop country-specific reference data for bone densities, cross-sectional sizes, strength and regional tissue distribution measured by pQCT at the distal and proximal forearm in children and adolescents aged 5-19 yrs. METHODS: Stratec XCT 2000L apparatus was used. Measurement sites were 4% and 66% of the forearm length on non-dominant arm. Studied group comprised 221 participants (103 girls) aged 4.5-19.5 yrs. The LMS method was used to fit percentile curves for each outcomes. RESULTS: Smoothed percentile curves were developed for following outcomes: trabecular volumetric bone mineral density, total volumetric bone mineral density, distal total bone cross-sectional area, cortical volumetric bone mineral density, cortical cross-sectional area, proximal total bone cross-sectional area, polar strength strain index, fat cross-sectional area and muscle cross-sectional area. CONCLUSIONS: In this study we present reference data for bone densities, cross-sectional size and strength as well as for regional tissue distribution measured by pQCT at the distal and proximal forearm in children 5-19 yrs in a way allowing simple calculation of reliable Z scores.

Nutritional therapy complications in children with ultra-short bowel syndrome include growth deficiency but not cholestasis.

AIM: Children with ultra-short bowel syndrome (USBS) have not been extensively studied to date because the condition is rare. The aim of the study was to assess the nutritional status of children with USBS receiving home parenteral nutrition, using citrulline serum concentration and cholestasis. METHODS: We studied 17 patients with USBS, with a median age of 6.6 years and median duration of parenteral nutrition of 6.6 years. The study was carried out at The Children's Memorial Health Institute, Warsaw, from January 2014 to January 2015. RESULTS: The median standard deviation score (SDS) was -1.2 for body mass according to chronological age, -1.72 according to height and -0.59 according to height for age. Patients requiring seven days per week parenteral nutrition had a citrulline concentration below 10 µmol/L. Decreased bone-mineral density was observed in 87% of the patients. Low values of 25-hydroxyvitamin D were found in 53% of the children. None of the patients had elevated conjugated bilirubin levels above 34.2 µmol/L. CONCLUSION: Children with USBS were growth deficient according to their chronological age, with frequent abnormal bone mineralisation and vitamin D deficiency. Children requiring parenteral nutrition seven days a week had citrulline concentrations below 10 µmol/L. Cholestasis was not seen.

Low dairy calcium intake is associated with overweight and elevated blood pressure in Polish adults, notably in premenopausal women.

OBJECTIVE: Dietary Ca is now being recognized to play an important role not only in skeletal integrity, but also in the regulation of energy and metabolism. The aim of the present study was to estimate the relationship of dairy Ca intake with BMI and blood pressure (BP) in a sample derived from the Polish population. DESIGN: Ca intake was calculated from an interviewer-administered semi-quantitative FFQ. BMI was calculated from measured weight and height, and BP was measured by a physician. SETTING: Cross-sectional epidemiological study on osteoporosis risk factors in Poland. SUBJECTS: Randomly selected healthy adult persons (n 1259; 750 women and 509 men). RESULTS: Dairy Ca intake was significantly lower in individuals with overweight/obesity (BMI≥25·00 kg/m2) and/or with elevated BP (systolic/diastolic ≥140/≥90 mmHg) than in those with normal body mass and BP, respectively. Ca intake was negatively correlated with BMI (r=-0·12, P<0·001), systolic BP (r=-0·11, P<0·001) and diastolic BP (r=-0·08, P<0·01). Daily dairy Ca intake below 1000 mg was a predictor for BMI≥25·0 kg/m2 (OR=1·44, P<0·005). This relationship was stronger in women, particularly premenopausal women. CONCLUSIONS: The obtained results indicate the role of low dairy Ca intake in the development of obesity and hypertension, notably in premenopausal women.

Visual disorders, the prosopometamorphopsia and prosopagnosia type in the early days after the onset of brain hemorrhagic stroke--a case report.

Presented case report illustrates symptoms of prosopometamorphopsia (PM) and prosopagnosia, observed in the early days after the onset of a hemorrhagic stroke resulting from a complication of endovascular treatment of intracranial aneurysms and the use of anticoagulation therapy. PM is a visual disorder in which faces are perceived as distorted. The female patient described in the present study reported that faces she looked at seemed younger or older than in reality or as if they were dirty, swollen, or with a grimace. She also experienced symptoms of prosopagnosia, which is difficulty of recognizing familiar faces of people (e.g., of her husband and daughter). In the interview 6 months after the first examination, the patient reported spontaneous withdrawal of the visual disturbances.

Determinants of Postpartum Vitamin D Status in the Caucasian Mother-Offspring Pairs at a Latitude of 52°N: A Cross-Sectional Study.

BACKGROUND: High prevalence of vitamin D deficiency in pregnancy is recorded. AIM: To establish determinants of postpartum 25-hydroxyvitamin D (25(OH)D) levels on mothers and offspring. METHODS: 25(OH)D level was measured in cord blood and maternal blood collected ≤3 weeks postpartum. Maternal socioeconomic status, vitamin D intake, sun exposure during pregnancy and maternal and neonatal fat mass (FM; dual X-ray absorptiometry) were assessed within 3 weeks postpartum. RESULTS: A total of 174 mother-offspring pairs were enrolled. Maternal 25(OH)D <20 ng/ml was seen in 32 (51%) of summer and 82 (74%) of winter deliveries. Women with 25(OH)D <20 ng/ml had a 2-fold lower percentage of vitamin D intake of ≥800 IU/day than women with 25(OH)D ≥20 ng/ml (p = 0.02). FM (%) was comparable between groups (p > 0.05). Multiple regression analysis revealed the delivery season, prenatal vitamin D intake ≥800 IU/day and duration of supplementation to be the determinants of maternal 25(OH)D level (R(2) = 0.26, p < 0.001). Maternal 25(OH)D level, season of birth and duration of maternal supplementation explained 83% of the variance in cord blood 25(OH)D level (R(2) = 0.83, p < 0.001). CONCLUSIONS: The key determinants of higher maternal vitamin D status were the summer-autumn season of delivery and prenatal use of ≥800 IU/day of vitamin D. The cord blood 25(OH)D level was mainly determined by maternal 25(OH)D level and season of birth.

Dual-energy X-ray absorptiometry interpretation and reporting in children and adolescents: the revised 2013 ISCD Pediatric Official Positions.

The International Society for Clinical Densitometry Official Revised Positions on reporting of densitometry results in children represent current expert recommendations to assist health care providers determine which skeletal sites should be measured, which, if any, adjustments should be made, reference databases to be used, and the elements to include in a dual-energy X-ray absorptiometry report. The recommended scanning sites remain the total body less head and the posterior-anterior spine. Other sites such as the proximal femur, lateral distal femur, lateral vertebral assessment, and forearm are discussed but are only recommended for specific pediatric populations. Different methods of interpreting bone density scans in children with short stature or growth delay are presented. The use of bone mineral apparent density and height-adjusted Z-scores are recommended as suitable size adjustment techniques. The validity of appropriate reference databases and technical considerations to consider when upgrading software and hardware remain unchanged. Updated reference data sets for all contemporary bone densitometers are listed. The inclusion of relevant demographic and health information, technical details of the scan, Z-scores, and the wording "low bone mass or bone density" for Z-scores less than or equal to -2.0 standard deviation are still recommended for clinical practice. The rationale and evidence for the development of the Official Positions are provided. Changes in the grading of quality of evidence, strength of recommendation, and worldwide applicability represent a change in current evidence and/or differences in opinion of the expert panelists used to validate the position statements for the 2013 Position Development Conference.