Patterns of surveillance for late effects of BCR-ABL tyrosine kinase inhibitors in survivors of pediatric Philadelphia chromosome positive leukemias.

BACKGROUND: Targeted anticancer therapies such as BCR-ABL tyrosine kinase inhibitors (TKIs) have improved outcomes for chronic myeloid leukemia (CML) and Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph + ALL). However, little is known about long-term risks of TKIs in children. Exposure-based survivorship guidelines do not include TKIs, thus surveillance practices may be variable. METHODS: We retrospectively examined surveillance for cardiac and endocrine late effects in children receiving TKIs for Ph + leukemias, diagnosed at < 21 years between 2000 and 2018. Frequency of echocardiogram (ECHO), electrocardiogram (EKG), thyroid stimulating hormone (TSH), dual-energy x-ray absorptiometry (DXA), and bone age testing were abstracted. Descriptive statistics were stratified by leukemia type. RESULTS: 66 patients (CML n = 44; Ph + ALL n = 22) met inclusion criteria. Among patients with CML, ≥1 evaluation was done: ECHO (50.0%), EKG (48.8%), TSH (43.9%), DXA (2.6%), bone age (7.4%). Among patients with Ph + ALL, ≥1 evaluation was done: ECHO (86.4%), EKG (68.2%), TSH (59.1%), DXA (63.6%), bone age (44.4%). Over a median 6.3 and 5.7 years of observation, respectively, 2% of patients with CML and 57% with Ph + ALL attended a survivorship clinic. CONCLUSIONS: Despite common exposure to TKIs in survivors of Ph + leukemias, patterns of surveillance for late effects differed in CML and Ph + ALL, with the latter receiving more surveillance likely due to concomitant chemotherapy exposures. Targeted therapies such as TKIs are revolutionizing cancer treatment, but surveillance for late effects and referral to survivorship clinics are variable despite the chronicity of exposure. Evidence based guidelines and longer follow-up are needed.

Four-Year Follow-Up of the World's First Pediatric Bilateral Hand-Forearm Transplants: Do They Grow as Expected?

BACKGROUND: In 2015, the first bilateral pediatric hand-forearm transplant was performed in an 8-year-old boy. The growth rate of the transplanted upper extremities was unknown at the time. METHODS: Forearm and hand radiographs were obtained annually. Radius and ulna measurements were performed by multiple coauthors and mathematically normalized using a standardized methodology. The Greulich and Pyle atlas was used to estimate hand bone age. RESULTS: From July of 2015 to July of 2019, unadjusted bone length (metaphysis to metaphysis) increased 38.8 and 39.6 mm for the left radius and ulna, and 39.5 and 35.8 mm for the right radius and ulna, respectively. Distal physes of the donor limbs increasingly contributed to overall bone length relative to proximal physes. Normalized growth between the two limbs was statistically similar. At each annual follow-up, the bone age increased by 1 year. CONCLUSIONS: Successful pediatric hand-forearm transplantation offers the advantage of growth similar to that of nontransplanted pediatric patients. The transplanted distal physes contributes more to the overall growth, paralleling normal pediatric growth patterns. Chronologic age parallels the increase in bone age. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.

Forensic age assessment of living adolescents and young adults at the Institute of Legal Medicine, Münster, from 2009 to 2018.

Due to high migration inflows to Europe, forensic age assessment of living persons has clearly gained importance. If there is a legal justification for X-ray examinations without a medical indication, the Study Group on Forensic Age Diagnostics (AGFAD) recommends the combination of a physical examination with anamnesis, an X-ray examination of the hand and a dental examination with evaluation of an orthopantomogram for age assessments of adolescents and young adults. If the development of the hand skeleton has been completed, an additional CT examination of the clavicles is to be performed. To demonstrate the outcome of forensic age assessments according to AGFAD recommendations with regard to migrants of doubtful minority declaration, this study analyzes the expert reports carried out at the Institute of Legal Medicine, Münster, from 2009 to 2018. A total of 597 age assessments were performed during the study period. A total of 227 age assessments were issued on behalf of youth welfare offices in the legal area of social law, 282 in family law proceedings, 76 in criminal proceedings, and 12 age assessments in immigration law proceedings. In 211 out of 597 cases, the stated age was compatible with the findings of the age assessment. In the remaining 386 cases, the average difference between the stated age and the minimum age was 1.9 years. The average difference between stated age and most probable age was 5.1 years. Of the 521 age assessments carried out outside criminal proceedings, 197 unaccompanied minors with questionable age minority (37.8%) have reached the age of majority beyond doubt. A total of 388 unaccompanied minors (74.5%) have most probably reached the age of majority. Forensic age assessments with the AGFAD methodology make an important contribution to legal certainty, the welfare of the child, and the fair distribution of resources.

Age estimation at death by the study of chest plate radiographs: establishing a Tunisian male score.

We aim to establish a Tunisian score for age estimation through the study of chest plate's radiographs of a Tunisian male sample. We have focused on the study of 128 chest plate radiographs of Tunisian male individuals. We have established a score of eight criteria. The total score ranges from 8 to 32. Three observers scored double-blind the X-ray films. We studied the correlation of each criterion as well as the total score with chronological age for each observer. We also tested the reproducibility and the repeatability of criteria and total score. We calculated the estimated age for each score. We studied the relationship between the estimated age and the chronological age. The correlation between the total score and the chronological age has been good for the three observers (0.746, 0.756 and 0.742). The total score gives an estimation of age with a standard deviation of ± 5.88 years and a confidence interval of 95%, the interval's width increases gradually from 6.9 years to 23 years.

Normative Data of Pulmonary Function Tests and Radiographic Measures of Chest Development in Children Without Spinal Deformity: Is a T1-T12 Height of 22 cm Adequate?

STUDY DESIGN: Retrospective case series. OBJECTIVES: To develop normative data of pulmonary function tests (PFTs) and radiographic measures of chest development in normal children and to determine if the prior proposed T1-T12 height of 22 cm for spinal fusion in a growing child is adequate for pulmonary function based on normative PFT values at skeletal maturity. SUMMARY OF BACKGROUND DATA: Shortening of the spine from T1-T12 is a concern with early thoracic fusion for spinal deformity, as it has a deleterious effect on the development of the pulmonary system. METHODS: Children with mild asthma who had pulmonary function tests (PFTs) >90% and without chest or spinal deformity were identified. PFT data included absolute forced vital capacity (FVC), %-predicted FVC, absolute forced expiratory volume in one second (FEV1), %-predicted FEV1, and FEV1/FVC. Radiographic measurements performed on chest radiographs included T1-T12 height, coronal chest width (CCW), and space available for the lung (SAL) bilaterally. These data were analyzed for all patients and for patients with T1-T12 heights 22-24 cm. To assess the impact of T1-T12 shortening on PFTs at skeletal maturity, spirometric standards for healthy adult lifetime nonsmokers were used. RESULTS: Of 1,797 PFT studies, 149 children (average age 12.4 ± 3.0 years; girls, 97) were analyzed. For the entire cohort, PFT values were as follows: FVC 3.0 ± 0.9 L, %-predicted FVC 103.9% ± 10.6%, absolute FEV1 2.7 ± 0.9 L, %-predicted FEV1 106.9% ± 11.1%, and FEV1/FVC 90.7% ± 2.6%. The averages for T1-T12 height was 25.6 ± 3.8 cm, CCW 25.5 ± 3.4 cm, and SAL bilaterally 19.0 ± 3.5 cm. For the 21 patients (girls 11; average age 9.7 ± 1.4 years) with T1-T12 heights 22-24 cm, absolute FVC was 2.2 ± 0.3 L, %-predicted FVC was 104.0% ± 13.0%, absolute FEV1 was 2.0 ± 0.3 L, %-predicted FEV1 was 108.2% ± 15.0%, and FEV1/FVC was 91.0% ± 2.7%. If these kids with 22-24 cm T1-T12 heights maintained the same thoracic height, they were calculated to have %-predicted FVC of 44% (girl) and 42% (boy) and %-predicted FEV1 of 42% (girl) and 43% (boy) at skeletal maturity (15 years old). CONCLUSIONS: Percent-predicted FEV1 and FVC values for normal children with a T1-T12 height of 22 cm at skeletal maturity were <50%. Though this analysis does not take into consideration radial expansion of the chest or children with scoliosis (idiopathic, congenital, neuromuscular), these values are concerning and may not be adequate to guarantee that children with early-onset scoliosis who are fused with T1-T12 heights of 22 cm will have an asymptomatic pulmonary status in adulthood. LEVEL OF EVIDENCE: Level IV.

Bone age as a correction factor for the analysis of trabecular bone score (TBS) in children.

Trabecular bone score (TBS) is a tool to improve evaluation of DXA scans, barely used in children. We proposed to evaluate TBS with bone age (BA) compared to chronological age (CA). In girls, TBS value using BA is constant until age 8, and in boys until age 10, and then starts to increase steadily. This data may help widen TBS use in pediatric populations. INTRODUCTION: Trabecular bone score (TBS) is a software-based tool for the analysis of DXA images to assess bone microarchitecture in the lumbar region. It is used widely in adults to improve evaluation of fracture risk, yet it has been rarely studied in children and no normal curves have been developed for pediatrics. The purpose of this study was to evaluate bone (skeletal) age compared to chronological age to determine which is better in the pediatric population since both bone age (BA) and trabecular density are equally susceptible to change in response to similar factors. METHODS: Total body, lumbar region, and non-dominant hand scans were obtained with an iDXA device in all participants. DXA scans of lumbar region for TBS analysis and AP images of non-dominant hand-for-BA were obtained for 565 children (269 female) aged 4to 19. RESULTS: Simple correlation was calculated and r2 values for TBS and chronological age were obtained by linear regression, with low correlations (0.36 for boys and 0.38 for girls), and then we created Loess curves to show the change for consecutive ages. In girls, the curve forms a U shape with a nadir point at approximately age 10. We then replaced chronological age with BA, and significant change was seen in the girls' curve, where a turning point is seen at age 8. In boys, a similar trend shows a turning point at age 10. Finally, BA-corrected TBS curves were constructed using LMS, obtaining curves with percentiles. CONCLUSIONS: The use of BA in the analysis and interpretation of TBS may help widen its use in pediatric populations by enabling the appearance of normative data, but more information is needed to confirm this finding.

Worldwide tendency and focused research in forensic anthropology: A bibliometric analysis of decade (2008-2017).

PURPOSE: The objective of this study was to illustrate the global research productivity and tendency of forensic anthropology in recent ten years (2008-2017) by bibliometric analysis. METHODS: "Forensic anthropology" was used as the Medical Subject Headings term and topic in PubMed and Web of Science Core Collection. RESULTS: As 5130 articles retrieved, two independent investigators evaluated all of them respectively. After restricting the published year, excluding duplicated and irrelevant articles, 1663 articles were available. The total of 219 countries and regions contributed to this research and the United States was the most productive country. There were 201 peer-reviewed journals including all of articles and two of them were identified as core journals according to Bradford's law. Eight of the top 10 productive authors were from developed countries. The top 10 cited articles were published by authors from developed countries with half in the United States. Sex estimation and age estimation were the most popular topics. CONCLUSIONS: With the basic and recognized methodology administered in this study, it provided a relative broad view to evaluate the scientific research capacity of forensic anthropology and reveal the worldwide tendency in this field.

Fat-free mass in adolescent athletes: Accuracy of bioimpedance equations and identification of new predictive equations.

OBJECTIVES: The aims of this study were to evaluate the effect of biological maturity on body composition in Brazilian adolescent athletes, to verify the accuracy of previous bioimpedance predictive equations for estimating fat-free mass (FFM), and to develop new predictive equations, considering sexual and skeletal maturity. METHODS: There were 318 Brazilian adolescent athletes (52% male) involved in this study. FFM was determined using single-frequency (50 kHz) bioelectrical impedance analysis (BIA) and dual-energy x-ray absorptiometry (DXA), which was used as the reference method. The adolescents were classified into skeletally mature using bone age (both sexes), and sexually mature using menarche occurrence (female). The effect of maturity on bioelectrical values was tested using bioelectrical impedance vector analysis. Three predictive BIA equations to estimate FFM were selected from the reviewed literature. Lin's concordance correlation coefficient and Bland-Altman test were used to test the concordance and accuracy of BIA equations. Stepwise multiple regression was used to develop new predictive equations, considering BIA vectors, age, skeletal, and sexual maturity. RESULTS: DXA and BIA results showed wide limits of disagreement for FFM for all the three equations. Two new equation models were developed, including age and skeletal maturity for both sexes and menarche status for females. Both models showed high R2 (males = 0.92 and females = 0.84). CONCLUSIONS: The assessment of body composition in adolescent athletes should consider sexual (female) or skeletal (male) maturity. The newly proposed equations showed promising results in Brazilian adolescent athletes. A test in different groups and populations is necessary to evaluate the general suitability of the equations in adolescents.

Correlation between craniofacial growth and upper and lower body heights in subjects with Class I occlusion.

OBJECTIVE: To correlate skeletal age, standing height, upper and lower body lengths, and selected craniofacial growth features in a sample of growing individuals, and to model craniofacial growth using multivariate regression. METHODS: This was a retrospective cross-sectional study with 447 African black boys and girls, between the ages 8 and 16 years, who attended the dental clinic at one hospital. The skeletal maturational age was determined from hand-wrist radiographs using the Greulich and Pyle atlas. Craniofacial measurements representing maxillary length (Ar-ANS), mandibular length (Ar-Gn), and lower facial height (ANS-Me) were calculated from lateral cephalograms in habitual occlusion. Body lengths were clinically measured in centimeters. RESULTS: Moderate correlations (r=0.42 to 0.68) were observed between skeletal age and the three selected craniofacial measurements. Statistically significant correlations were also found between the craniofacial measurements and both upper and lower body lengths. The mandibular length had a stronger correlation with the upper body length than with the lower body length. Multiple regression analyses to determine maxillary and mandibular lengths suggested that sex, upper and lower body lengths might be used to determine maxillary length; while skeletal age, upper and lower body lengths might help determine mandibular length. CONCLUSIONS: Based on the relatively strong correlation between upper body length and mandibular length, further research in this area may warrant its use as a predictor for mandibular growth modification timing.

Correlation between craniofacial growth and upper and lower body heights in subjects with Class I occlusion

ABSTRACT Objective: To correlate skeletal age, standing height, upper and lower body lengths, and selected craniofacial growth features in a sample of growing individuals, and to model craniofacial growth using multivariate regression. Methods: This was a retrospective cross-sectional study with 447 African black boys and girls, between the ages 8 and 16 years, who attended the dental clinic at one hospital. The skeletal maturational age was determined from hand-wrist radiographs using the Greulich and Pyle atlas. Craniofacial measurements representing maxillary length (Ar-ANS), mandibular length (Ar-Gn), and lower facial height (ANS-Me) were calculated from lateral cephalograms in habitual occlusion. Body lengths were clinically measured in centimeters. Results: Moderate correlations (r=0.42 to 0.68) were observed between skeletal age and the three selected craniofacial measurements. Statistically significant correlations were also found between the craniofacial measurements and both upper and lower body lengths. The mandibular length had a stronger correlation with the upper body length than with the lower body length. Multiple regression analyses to determine maxillary and mandibular lengths suggested that sex, upper and lower body lengths might be used to determine maxillary length; while skeletal age, upper and lower body lengths might help determine mandibular length. Conclusions: Based on the relatively strong correlation between upper body length and mandibular length, further research in this area may warrant its use as a predictor for mandibular growth modification timing.

RESUMO Objetivo: correlacionar a idade esquelética, a estatura, as alturas corporais superior e inferior, e algumas características específicas do crescimento craniofacial, em uma amostra de indivíduos em crescimento, e delinear o crescimento craniofacial usando regressão multivariada. Métodos: esse estudo transversal retrospectivo foi feito com 447 meninos e meninas negros africanos, com idades entre 8 e 16 anos, atendidos na clínica odontológica de um hospital. A maturação esquelética, em anos, foi determinada a partir de radiografias de mão e punho, usando o atlas de Greulich e Pyle. As medidas craniofaciais representando o comprimento maxilar (Ar-ENA), o comprimento mandibular (Ar-Gn) e a altura facial anterior inferior (ENA-Me) foram calculadas a partir de cefalogramas laterais em oclusão habitual. Os comprimentos corporais foram medidos clinicamente, em centímetros. Resultados: correlações moderadas (r = 0,42 a 0,68) foram observadas entre a idade esquelética e as três medidas craniofaciais selecionadas. Também foram encontradas correlações estatisticamente significativas entre as medidas craniofaciais e as alturas corporais superior e inferior. O comprimento mandibular teve uma correlação mais forte com a altura corporal superior do que com a inferior. As análises de regressão múltipla para determinar os comprimentos maxilar e mandibular sugeriram que o sexo e as alturas corporais superior e inferior podem ser usados para determinar o comprimento maxilar, enquanto a idade esquelética e as alturas corporais superior e inferior podem ajudar a determinar o comprimento mandibular. Conclusões: com base na correlação relativamente forte entre a altura corporal superior e comprimento mandibular, pesquisas adicionais nessa área poderiam justificar seu uso como indicador para o período de modificação do crescimento mandibular.

Edad cronológica y maduración ósea cervical en niños y adolescentes / Chronological age and cervical vertebral maturation among children and adolescents

Introducción: en las prácticas médicas, ortopédicas y odontológicas se ha reconocido la importancia de diferenciar la edad cronológica de la edad esquelética o maduración ósea. La estimación del desarrollo óseo a partir de las vértebras cervicales es un método que se ha comprobado como confiable. Objetivo: relacionar los estadios de maduración ósea desde las vértebras cervicales según lo describe Baccetti y la edad cronológica en niños y adolescentes entre 8 y 14 años que asistieron a una clínica odontológica. Métodos: la muestra seleccionada fue probabilística y estuvo conformada por un total de 130 niños de la ciudad de Cali, Colombia. Se tomó una radiografía lateral de cráneo y se evaluaron los estadios de maduración ósea vertebral cervical bajo los estándares del método descrito por Baccetti. Resultados: el coeficiente de correlación entre la edad cronológica y estadios de maduración cervical fue r= 0,69, lo que muestra una moderada relación entre estas dos variables para los niños estudiados. Los estadios de maduración y el sexo explicaron el 50,4 % de la variabilidad de la edad cronológica. Para todos los estadios de maduración se encontraron diferencias significativas (p< 0,001). Los niños varones presentaron mayores estadios iniciales de maduración, aunque no se encontró diferencias significativas en función del sexo (p> 0,05). Conclusiones: Se logra determinar un modelo para explicar la variación de la edad cronológica del niño en función del estadio de maduración ósea cervical y el sexo del niño basado en la relacion positiva moderada entre la edad cronologica y la maduración osea evidenciada hasta el estadio C3(AU)

Introduction: the importance of distinguishing chronological from skeletal age or bone maturation has been recognized in medical, orthopedic and dental practice. Estimation of bone development on the basis of cervical vertebrae has proved to be a reliable method. Objective: relate the stages of bone maturation based on cervical vertebral development as described by Baccetti to the chronological age of children and adolescents aged 8-14 years attending a dental clinic. Methods: probabilistic sampling was used to select 130 children from the city of Cali, Colombia. Lateral skull radiography was performed to evaluate the stages of cervical vertebral bone maturation using the method described by Baccetti. Results: the correlation coefficient between chronological age and cervical maturation stage was r= 0.69, showing a moderate relationship between the two variables for the children studied. Maturation stages and gender accounted for 50.4 % of the variability in chronological age. Significant differences were found for all maturation stages (p< 0.001). Boys had higher initial maturation stages, though significant differences were not found between the genders (p> 0.05). Conclusions: It is possible to determine a model to explain the change in chronological age depending on the stage of cervical bone maturation and sex of the child, based on moderate positive relationship between chronological age and bone maturation evidenced through C3 stadium(AU)

Morphometric analysis of cervical vertebrae in relation to mandibular growth.

INTRODUCTION: Cervical vertebral maturation (CVM) methods have been criticized because of their subjective nature. The aims of this study were (1) to analyze the morphometric changes in the outline of the second to fourth cervical vertebrae with growth and (2) to test the validity of the CVM method for determining the mandibular growth peak. METHODS: Lateral cephalograms of 25 participants from ages 10 to 16 years were acquired from the Burlington Growth Study, and the CVM stage was qualitatively determined. Mandibular and cervical vertebral semilandmarks were then digitized, and point distribution models were used to describe the morphometric templates of the vertebrae in relation to chronologic age and the timing of peak mandibular growth. Mixed model analysis was used to determine the relationship between mandibular length, sex, CVM stage, and chronologic age. RESULTS: Morphometric changes of the second to fourth cervical vertebrae during growth were consistent with the CVM descriptions. However, mandibular length changes were not significantly associated with CVM stages after adjusting for chronologic age. Morphometric templates of vertebral shapes before and during the mandibular growth peak were similar, with changes detectable only after the growth peak had passed. Morphometric vertebral shape changes varied between the sexes. CONCLUSIONS: Morphometric changes of the cervical vertebrae and the CVM method could not accurately identify the mandibular growth peak.

A radiographic study of estimating age by deciduous mandibular canine and molar root resorption.

BACKGROUND AND AIM: Root resorption of deciduous teeth is an important aspect of dental development; however, the accuracy of using root resorption as a method of estimating age has not been reported. The aim of this study was to assess the accuracy of estimating age from fractions of resorbed root in mandibular deciduous canines and molars, using published reference data. METHODS: The sample was 940 dental panoramic radiographs of dental patients aged 3-16. Deciduous mandibular canine and molar roots were staged into levels of resorption (one quarter, one half and three quarters). Reliability of root fractions was assessed using 193 duplicate readings and calculated using Kappa. Age was estimated using Moorrees et al. (1963), Fanning (1961), and O'Meara and Knott (1967), and the difference between dental and chronological ages tested using t-test. Accuracy was defined as a difference not significant to zero (P<0.05). RESULTS: Results show that assessment of levels of root resorption was excellent (Kappa 0.88-0.94). Some root fractions of molars estimated age accurately; however, the standard deviation was more than 2 years. The average difference between dental and chronological ages ranged from 0.12 to -2.04 years with standard deviation values up to 2 years and the most accurate method was O'Meara and Knott (1967). CONCLUSION: Fractions of deciduous root resorption can help to predict age.

Validation of adult height prediction based on automated bone age determination in the Paris Longitudinal Study of healthy children.

BACKGROUND: An adult height prediction model based on automated determination of bone age was developed and validated in two studies from Zurich, Switzerland. Varied living conditions and genetic backgrounds might make the model less accurate. OBJECTIVE: To validate the adult height prediction model on children from another geographical location. MATERIALS AND METHODS: We included 51 boys and 58 girls from the Paris Longitudinal Study of children born 1953 to 1958. Radiographs were obtained once or twice a year in these children from birth to age 18. Bone age was determined using the BoneXpert method. Radiographs in children with bone age greater than 6 years were considered, in total 1,124 images. RESULTS: The root mean square deviation between the predicted and the observed adult height was 2.8 cm for boys in the bone age range 6-15 years and 3.1 cm for girls in the bone age range 6-13 years. The bias (the average signed difference) was zero, except for girls below bone age 12, where the predictions were 0.8 cm too low. CONCLUSION: The accuracy of the BoneXpert method in terms of root mean square error was as predicted by the model, i.e. in line with what was observed in the Zurich studies.

Cervical vertebrae maturation index estimates on cone beam CT: 3D reconstructions vs sagittal sections.

OBJECTIVES: The aim of this study was to evaluate the performance of CBCT three-dimensional (3D) reconstructions and sagittal sections for estimates of cervical vertebrae maturation index (CVMI). METHODS: The sample consisted of 72 CBCT examinations from patients aged 8-16 years (45 females and 27 males) selected from the archives of two private clinics. Two calibrated observers (kappa scores: ≥0.901) interpreted the CBCT settings twice. Intra- and interobserver agreement for both imaging exhibition modes was analyzed by kappa statistics, which was also used to analyze the agreement between 3D reconstructions and sagittal sections. Correlations between cervical vertebrae maturation estimates and chronological age, as well as between the assessments by 3D reconstructions and sagittal sections, were analyzed using gamma Goodman-Kruskal coefficients (α = 0.05). RESULTS: The kappa scores evidenced almost perfect agreement between the first and second assessments of the cervical vertebrae by 3D reconstructions (0.933-0.983) and sagittal sections (0.983-1.000). Similarly, the agreement between 3D reconstructions and sagittal sections was almost perfect (kappa index: 0.983). In most divergent cases, the difference between 3D reconstructions and sagittal sections was one stage of CVMI. Strongly positive correlations (>0.8, p < 0.001) were found not only between chronological age and CVMI but also between the estimates by 3D reconstructions and sagittal sections (p < 0.001). CONCLUSIONS: Although CBCT imaging must not be used exclusively for this purpose, it may be suitable for skeletal maturity assessments.

Diagnostic performance of skeletal maturity for the assessment of midpalatal suture maturation.

INTRODUCTION: The aim of this study was to analyze the diagnostic performance of the cervical vertebral maturation (CVM) method in estimating accurately the stages of maturation of the midpalatal suture. METHODS: Cone-beam computed tomography (CBCT) images from 142 subjects (84 female, 58 male; mean age, 14.8 ± 9.7 years) were analyzed by 2 calibrated examiners to define, by visual analysis, the maturational stages of the cervical vertebrae and the midpalatal suture. These CBCT images were required by orthodontists and surgeons for diagnosis and treatment purposes. Positive likelihood ratios (LHRs) were calculated to evaluate the diagnostic performance of the CVM stages in identifying the maturational stages of the midpalatal suture. RESULTS: Positive LHRs greater than 10 were found for several cervical vertebral stages (CSs), including CS1 and CS2 for the identification of midpalatal suture stages A and B, CS3 for the diagnosis of midpalatal suture stage C, and CS5 for the assessment of midpalatal suture stages D and E. These positive LHRs indicated large and often conclusive increases in the likelihood that the CVM stages were associated with specific stages of midpalatal suture maturation. At CS4, there were a moderate positive LHR for stage C and low positive LHRs for stages D and E. CONCLUSIONS: Most CVM stages can be used for the diagnosis of the stages of maturation of the midpalatal suture, so that CBCT imaging may not be necessary in these patients. In the postpubertal period, however, an assessment of the midpalatal suture maturation using CBCT images may be indicated in deciding between conventional rapid maxillary expansion and surgically assisted rapid maxillary expansion. On the other hand, if the CVM stage cannot be assessed, chronologic age may be a viable alternative to predict some midpalatal suture stages (particularly the early stages).

Use of Automated Bone Age for Critical Growth Assessment.

BACKGROUND: We compared the variability of bone age (BA) rating between clinicians and an automated system in children with congenital adrenal hyperplasia (CAH). METHOD: A total of 126 radiographs assessed by 3 clinicians blinded to patient details using Greulich and Pyle (GP) (readers 1, 2, and 3) and BoneXpert (BX). RESULTS: Comparing BA rating with each other, the mean of the absolute differences varied from 0.42 ± 0.53 years (reader 1 and BX) to 0.57 ± 0.58 years (reader 2 and reader 3), P = .368. Comparing ratings that were consistent with all 4 methods (within 1 year of each other, 93/126, 74%) and the remaining, "outliers" (33/126, 26%), the outliers were younger (P = .003), smaller (height, P = .011, weight, P = .000), and prepubertal (P = .001). CONCLUSION: The variability of BA rating in CAH children is similar whether performed by clinicians or an automated system. The greatest variability was in prepubertal children.

Bayesian calibration for forensic age estimation.

Forensic medicine is increasingly called upon to assess the age of individuals. Forensic age estimation is mostly required in relation to illegal immigration and identification of bodies or skeletal remains. A variety of age estimation methods are based on dental samples and use of regression models, where the age of an individual is predicted by morphological tooth changes that take place over time. From the medico-legal point of view, regression models, with age as the dependent random variable entail that age tends to be overestimated in the young and underestimated in the old. To overcome this bias, we describe a new full Bayesian calibration method (asymmetric Laplace Bayesian calibration) for forensic age estimation that uses asymmetric Laplace distribution as the probability model. The method was compared with three existing approaches (two Bayesian and a classical method) using simulated data. Although its accuracy was comparable with that of the other methods, the asymmetric Laplace Bayesian calibration appears to be significantly more reliable and robust in case of misspecification of the probability model. The proposed method was also applied to a real dataset of values of the pulp chamber of the right lower premolar measured on x-ray scans of individuals of known age.

Bone age assessment with conventional ultrasonography in healthy infants from 1 to 24 months of age.

BACKGROUND: Radiographic bone age determination is part of the routine evaluation of suspected growth disorders. Simplicity and low cost are its major advantages, but although the effective dose of ionizing radiation is low, it should be taken into consideration given its cumulative effect. OBJECTIVES: To assess the chronological ultrasonographic emergence of the ossification centers of the hand and wrist. MATERIALS AND METHODS: Cross-sectional study of healthy patients ages 1 to 24 months (n=498) from Buenos Aires, Argentina. All patients underwent ultrasonographic evaluation of the left hand and wrist to identify the different bone nuclei; a subgroup of infants had their nuclei measured (n=228). RESULTS: Girls showed an earlier emergence of the evaluated nuclei and a trend to a greater size than age-matched boys. Size-for-age relation showed linear increase. Carpal bones (capitate and hamate) were the first to appear, as early as from the first 3 months of life, an age gap not thoroughly present on the radiographic atlas developed by Greulich and Pyle. The distal epiphysis of the radius and the second metacarpophalangeal joint (index finger) followed in order of emergence. The proximal epiphysis of the first metacarpal bone (thumb) was the last to emerge and was infrequently found on boys at age 24 months. Overall, these findings are in accordance with the radiographic atlas. An ultrasonography atlas of the left hand and wrist was outlined for girls and boys. CONCLUSION: Conventional ultrasonography allows proper identification of the ossification centers of the hand and wrist and may become an innocuous follow-up tool for patients with growth disorders.

ASSOCIATION BETWEEN DENTAL AND SKELETAL MATURATION STAGES IN CROATIAN SUBJECTS.

This study investigated the relationships between the stages of calcification of teeth and cervical vertebral maturation. The sample consisted of 295 subjects (129 male and 166 female), mean age 13.36 ± 2.65 (range 7-18) years. Dental age was evaluated from panoramic radiographs according to the method of Demirjian. Cervical vertebral maturation was determined on lateral cephalometric radiographs using cervical vertebrae maturation stages (CVS). For assessing the relationship between cervical vertebral and dental maturation, percentage distributions of the stages of calcification for each studied tooth were calculated. Only in the first CVS stage, boys and girls were of the same age. In all other stages (CVS 2-CVS 6) girls were by 0.98 (range 0.23-1.86) younger than boys. Gender differences in the mineralization pattern were also observed. It was found that dental maturation was finished earlier in female subjects. The highest correlation coefficient between dental and skeletal maturity was found for second premolars. Mineralization pattern of second premolars could be considered as a guideline for prediction of the pubertal growth spurt. Dental maturation stages might be clinically useful as a reliable indicator of facial growth.