Ultra-processed foods in a rural Ecuadorian community: associations with child anthropometry and bone maturation.

Frequent ultra-processed food (UPF) consumption is consistently associated with poor health outcomes. Little is known about UPF intake during early childhood and its effects on growth. We assessed UPF in relation to child anthropometry, bone maturation, and their nutrition profiles in a rural Ecuadorian community. Covariate-adjusted regression models estimated relationships between UPF intake from a 24-hour Food Frequency Questionnaire and three outcomes: linear growth, weight status and bone maturation. Nutrient Profiling Models (NPM) evaluated a convenience sample of UPF (n 28) consumed by children in the community. In this cohort (n 125; mean age = 33·92 (sd 1·75) months), 92·8 % consumed some form of UPF the previous day. On average, children consuming UPF four to twelve times per day (highest tertile) had lower height-for-age z-scores than those with none or a single instance of UPF intake (lowest tertile) (ß = -0·43 [se 0·18]; P = 0·02). Adjusted stunting odds were significantly higher in the highest tertile relative to the lowest tertile (OR: 3·07, 95 % CI 1·11, 9·09). Children in the highest tertile had significantly higher bone age z-scores (BAZ) on average compared with the lowest tertile (ß = 0·58 [se 0·25]; P = 0·03). Intake of savoury UPF was negatively associated with weight-for-height z-scores (ß = -0·30 [se 0·14]; P = 0·04) but positively associated with BAZ (ß = 0·77 [se 0·23]; P < 0·001). NPM indicated the availability of unhealthy UPF to children, with excessive amounts of saturated fats, free sugars and sodium. Findings suggest that frequent UPF intake during early childhood may be linked to stunted growth (after controlling for bone age and additional covariates), despite paradoxical associations with bone maturation.

Bone Age Reading by DXA Images should not Replace Bone Age Reading by X-ray Images.

X-ray image of the hand is the most used technique to estimate bone age in children. For the analysis of bone mineral density using DXA in children, bone age may help to adjust such measurement in some cases. During image acquisition in DXA, an anteroposterior image of the hand may be acquired and used to evaluate bone age but few studies have evaluated the agreement between conventional X-ray and DXA images. The aim of the study was to determine bone age estimation agreement between conventional X-ray images and DXA in children and adolescents aged 5 to 16 years of age. We performed an analytical cross-sectional study of 711 healthy subjects. Subject´s bone age, both in conventional X-ray, and DXA images were read independently by two expert evaluators blinded for chronological age. Intraobserver and inter-observer reproducibility were evaluated using Intraclass Correlation Coefficient (ICC), and the agreement between bone age estimations made by both evaluators was analyzed using ICC and Bland-Altman analysis. General agreement between techniques measured through ICC was 0.99 with a mean difference of 6 months between techniques being older the ages obtained by DXA. The agreement limits were around ±2 years, which means that 95% of all differences between techniques were covered within this range. We found a high level of ICC agreement in bone age readings from X-ray and DXA images although we observed overestimation of bone age measurements in DXA. Differences between techniques were greater in women than in men, especially at the ages corresponding to puberty. Bone age measurement in DXA images appears not to be reliable; hence it should be suggested to perform conventional radiography of the hand to assess bone age taking into account that X-ray images have better resolution.

Sex-Specific Pathways Lead to Statural Growth Impairment in Children with Crohn's Disease.

OBJECTIVES: To examine the underlying mechanisms that lead growth impairment to occur more commonly in males than females with Crohn's disease (CD). STUDY DESIGN: Children and adolescents with CD were enrolled in a prospective multicenter longitudinal cohort study. Height Z-score difference was computed as height Z-score based on chronological age (height chronological age-Z-score) minus height Z-score based on bone age (height bone age-Z-score) using longitudinal data. Specific serum cytokines were measured, hormone Z-scores were calculated based on bone age (bone age-Z), and their longitudinal associations were examined. RESULTS: There were 122 children with CD (63% male) who completed 594 visits. The mean ± SD chronological age was 11.70 ± 1.79 years. The mean ± SD height chronological age-Z-score was -0.03 ± 0.99 in males and -0.49 ± 0.87 in females. The mean ± SD height bone age-Z-score was 0.23 ± 0.93 in males and 0.37 ± 0.96 in females. The magnitude of the mean height Z-score difference was greater in females (-0.87 ± 0.94) than males (-0.27 ± 0.90; P = .005), indicating growth was better in females than males. The following negative associations were identified: in females, interleukin (IL)-8 (P < .001) and IL-12p70 (P = .035) with gonadotropin-bone age-Z-scores; IL-8 (P = .010), IL-12p70 (P = .020), and interferon-γ (P = .004) with sex hormone-bone age-Z-scores, and IL-8 (P = .044) and interferon-γ (P < .001) with insulin-like growth factor 1-bone age-Z-scores; in males, IL-1 beta (P = .019) and IL-6 (P = .025) with insulin-like growth factor 1-bone age-Z-scores. CONCLUSIONS: Our data suggest that sex-specific molecular pathways lead to growth impairment in children with CD (primarily growth hormone/insulin-like growth factor-1 axis in males and primarily hypothalamic-pituitary-gonadal axis in females). Mapping these sex-specific molecular pathways may help in the development of sex-specific treatment approaches targeting the underlying inflammation characteristic of CD.

Relationship of Biological Maturation with Muscle Power in Young Female Athletes.

There is still no consensus on how biological maturation (BM) affects the muscle power of upper and lower limbs in young people. The objective was to verify associations between BM and muscle power, as well as to compare the muscle power of upper (ULP) and lower limbs (LLP) among young athletes in different stages of BM. The sample consisted of 79 female athletes (10.9 ± 1.11 years old). Regarding BM, the sample was divided into three groups: delayed BM, synchronized BM, and accelerated BM. BM was identified by subtracting chronological age from bone age (BA). BA was measured by a mathematical model based on anthropometry. The muscular power of the upper limbs was analyzed by the medicine ball launch test, and that of the lower limbs was analyzed by the countermovement jump on a force platform. BM and BA correlated with ULP (BA: r =0.74; BM: r =0.65) and LLP (BA: r = 0.50; BM: r =0.41). In the comparisons of the tests of ULP and LLP, the groups with synchronized and accelerated BM were superior to the group with delayed BM. The advance of BM is associated with the ULP and LLP, as well as the advance of the BM affects muscle power in young female athletes. This occurs due to the increase in body mass resulting from the advancement of BM, which may favor the predominance of lean body mass, assisting in the production of muscle strength.

Reproducibility and inter-observer agreement of Greulich-Pyle protocol to estimate skeletal age among female adolescent soccer players.

BACKGROUND: Skeletal age (SA) is considered the best method of assessing biological maturation. The aim of this study was to determine intra-observer (reproducibility) and inter-observer agreement of SA values obtained via the Greulich-Pyle (GP) method. In addition, the variation in calculated SAs by alternative GP protocols was examined. METHODS: The sample was composed of 100 Portuguese female soccer players aged 12.0-16.7 years. SAs were determined using the GP method by two observers (OB1: experience < 100 exams using GP; OB2: experience > 2000 exams using several methods). The radiographs were examined using alternative GP protocols: (wholeGP) the plate was matched to the atlas as an overall approach; (30-boneGP) bone-by-bone inspections of 30-bones; (GPpmb) bone-by-bone inspections of the pre-mature bones only. For the 30-boneGP and GPpmb approaches, SA was calculated via the mean (M) and the median (Md). RESULTS: Reproducibility ranged 82-100% and 88-100% for OB1 and OB2, respectively. Inter-observer agreement (100 participants multiplied by 30 bones) was 92.1%. For specific bones, agreement rates less than 90% were found for scaphoid (81%), medial phalange V (83%), trapezium (84%) and metacarpal V (87%). Differences in wholeGP SAs obtained by the two observers were moderate (d-cohen was 0.79). Mean differences between observers when using bone-by bone SAs were trivial (30-boneGP: d-cohen less than 0.05; GPpmb: d-cohen less than 0.10). The impact of using the mean or the median was negligible, particularly when analyses did not include bones scored as mature. CONCLUSION: The GP appeared to be a reasonably reproducible method to assess SA and inter-observer agreement was acceptable. There is evidence to support a recommendation of only scoring pre-mature bones during later adolescence. Further research is required to examine whether these findings are consistent in younger girls and in boys.

Bone age determination in eutrophic, overweight and obese Brazilian children and adolescents: a comparison between computerized BoneXpert and Greulich-Pyle methods.

BACKGROUND: Bone age determination is usually employed to evaluate growth disorders and their treatment. The Greulich-Pyle method is the simplest and most frequently used type of evaluation, but it presents huge interobserver variability. The BoneXpert is a computer-automated method developed to avoid significant bone age variability among distinct observers. OBJECTIVE: To compare the BoneXpert and Greulich-Pyle methods of bone age determination in eutrophic children and adolescents, as well as in overweight and obese pediatric patients. MATERIALS AND METHODS: The sample comprised 515 participants, 253 boys (159 eutrophic, 53 overweight and 41 obese) and 262 girls (146 eutrophic, 76 overweight and 40 obese). Left hand and wrist radiographs were acquired for bone age determination using both methods. RESULTS: There was a positive correlation between chronological age and Greulich-Pyle, chronological age and BoneXpert, and Greulich-Pyle and BoneXpert. There was a significant increase (P<0.05) in bone age in both the Greulich-Pyle and BoneXpert methods in obese boys when compared to eutrophic or overweight boys of the same age. In girls, there was an increase in bone age in both obese and overweight individuals when compared to eutrophic girls (P<0.05). The Greulich-Pyle bone age was advanced in comparison to that of BoneXpert in all groups, except in obese boys, in which bone age was similarly advanced in both methods. CONCLUSION: The BoneXpert computer-automated bone age determination method showed a significant positive correlation with chronological age and Greulich-Pyle. Furthermore, the impact of being overweight or obese on bone age could be identified by both methods.

Correlación entre la edad cronológica y dental con los estadios de maduración vertebral en pacientes de 5 a 15 años / Correlation between the chronological and dental age with the vertebral maturation stages in patients from 5 to 15 years old

El uso de un método rápido y efectivo para la estimación de la maduración esquelética de los pacientes pediátricos es fundamental para la aplicación oportuna de tratamientos ortopédicos/ortodónticos. En Odontología Pediátrica, la toma de una radiografía panorámica, como método diagnóstico de rutina, puede servir para estimar con precisión el estadio de maduración en estos pacientes, mediante el cálculo de la edad dental. El objetivo del presente trabajo fue determinar la correlación entre las edades cronológica y dental con los estadios de maduración esquelética de las vértebras cervicales, a través del método estadístico no paramétrico con Rho de Spearman. Se utilizó un diseño observacional, transversal y analítico. La muestra consistió en 516 expedientes de pacientes entre los 5 y 15 años de edad, sistémicamente sanos, con radiografías panorámica y lateral de cráneo, tomadas en la misma fecha. Se determinó la edad cronológica de cada paciente según su historia clínica. Se realizó el cálculo de la edad dental de cada paciente con el método de Demirjian, y se determinó el estadio de maduración de vértebras cervicales con el método de Lamparski. Se determinó una correlación de 72 % entre la edad cronológica y la maduración ósea vertebral; una correlación del 66 % entre la edad dental y la maduración ósea, y una correlación del 86 % entre la edad cronológica y la dental. De acuerdo con estos resultados, tanto la edad cronológica y dental presentan una alta correlación con la edad de maduración vertebral. Se concluye así que la edad dental y cronológica son indicadores apropiados para estimar el estadio de maduración esquelética de los pacientes pediátricos.

The use of fast and effective methods for estimating the skeletal maturity for pediatric patients, is fundamental for the opportune application of orthopedic/orthodontic treatments. In pediatric dentistry, the panoramic radiography as a routine diagnostic method, can be used to estimate the stage of maturation in these patients, through the calculation of dental age. The aim of the present study is to determine the correlation between the chronological and dental ages, with the cervical vertebrae stages of skeletal maturity, through the non-parametric Spearman statistical method. An observational, transversal, and analytical design was employed. The sample consisted of 516 records from patients between 5 and 15 years of age, systemically healthy, with panoramic and lateral skull radiographs taken on the same date. The chronological age of each patient was determined according to the clinical history. Dental age of each patient was calculated with the Demirjian approach, and the stage of maturation of cervical vertebrae was determined by means of the Lamparski method. The results showed a correlation of 72 % between chronological age and bone maturation, a correlation of 66 % between dental age and bone maturation, and a correlation of 86 % between chronological and dental age. It is concluded that both chronological and dental age exhibit a high correlation with the correspondent stage of vertebral maturity. Thus, dental and chronological age are appropriate indicators to estimate, with high precision the stage of skeletal maturation in pediatric patients.

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.

SOFT syndrome in a patient from Chile.

SOFT syndrome (MIM614813) is an extremely rare primordial dwarfism caused by biallelic mutations in the POC1A gene. It is characterized by prenatal short stature, onychodysplasia, facial dysmorphism, hypotrichosis, and variable skeletal abnormalities including hypoplastic pelvis and sacrum, small hands, and cone-shaped epiphyses, as well as delayed bone age. To the best of our knowledge, only eight POC1A mutations have been reported in humans to date. We report a 7-year-old Chilean girl with SOFT syndrome arising from a novel POC1A mutation c. 649C>T, p.Arg217Trp. Although her clinical features were largely compatible with SOFT syndrome, hand X-ray examinations at 3.5 and 6 years unexpectedly showed normal bone age. Automated bone age determination was performed using image analysis software, BoneXpert. This case highlights the importance of the accumulation of patients with POC1A mutations to further elucidate the detailed clinical features of SOFT syndrome.

Correlación en la determinación de la edad ósea radiológica mediante el método de Greulich y Pyle versus la evaluación automatizada utilizando el software BoneXpert / Correlation in radiological bone age determination using the Greulich and Pyle method versus automated evaluation using BoneXpert software

Resumen: Objetivo: Determinar el grado de correlación en la valoración de la edad ósea radiológica mediante el método de Greulich y Pyle versus la evaluación automatizada por el programa computacional BoneXpert® entre los años 2013-2016. Material y Método: Estudio de correlación de técnicas diag nósticas de 1500 radiografías de carpo para evaluar la edad ósea, en pacientes menores de 16 años pertenecientes a Clínica Alemana de Santiago. Las radiografías con evaluación de la edad ósea por el Atlas de Greulich y Pyle (GP) por 1 de 7 radiólogos pediatras fueron sometidas al programa BoneX pert (BE) para la evaluación automatizada de la edad ósea. Se tomó 100 casos al azar para un análisis/ re-análisis del método BE, para conocer su precisión. Se analizó el nivel de correlación de las medicio nes por coeficiente de correlación (r de Pearson) y la variabilidad de las mediciones mediante análisis de Bland-Altman. Resultados: Se incluyeron 1.493 casos, se excluyeron 7 por falla en técnica de la radiografía, 922 de sexo femenino (61.8%), mediana de edad cronológica 9.96 años y 11.12 años para los varones (p 0,001). La correlación entre la edad ósea manual GP y la edad ósea automatizada BE entre los lectores varió entre 0,91 y 0,93. El análisis de Bland-Altman indicó una diferencia promedio entre la edad ósea manual y la edad ósea BE de 0,19 años (IC 0,13 a 0,25). En el análisis/re-análisis de 100 casos al azar mediante BoneXpert, la correlación fue de 1,0. Conclusión: El análisis automatizado mediante BoneXpert permite una evaluación estandarizada, de baja variabilidad, y alta concordancia.

Abstract: Objective: To determine the degree of correlation in the radiological bone age assessment using the Greulich and Pyle method versus automated assessment through BoneXpert® software between 2013 and 2016. Material and Method: Correlation study of diagnostic techniques of 1500 carpal X-rays to assess bone age in patients under 16 years of age from Clínica Alemana de Santiago. X-rays with bone age assessment using the Atlas of Greulich and Pyle (GP) by 1 out of 7 pediatric radiologists, were analyzed using the BoneXpert (BE) software for automated bone age assessment. 100 cases were taken at random for analysis/re-analysis using the BoneXpert method to determine its accuracy. The level of correlation of the measurements was analyzed using the correlation coefficient (Pearson's r) and the variability of the measurements using the Bland-Altman analysis. Results: 1493 cases were assessed, seven were excluded due to failure in the X-ray technique, 922 females (61.8%), with a median chronological age of 9.96 years and 11.12 years for males (p 0.001). The correlation between manual bone age (GP) and automated bone age using BoneXpert method among radiologists ran ged from 0.91 to 0.93. The Bland-Altman analysis indicated an average difference between manual bone age and bone age using the BoneXpert method of 0.19 years (CI 0.13 to 0.25). In the analysis/ re-analysis of 100 random cases using the BoneXpert software, the correlation was 1.00 (100% accu racy). Conclusion: The automated analysis using BoneXpert allows for standardized, low-variability, and high-concordance assessment.

Advanced bone age as an indicator facilitates the diagnosis of precocious puberty / Idade óssea avançada como um indicador de facilitação do diagnóstico de puberdade precoce

Abstract Objective: Diagnosis of central precocious puberty has always been challenging in clinical practice. As an important method in the diagnosis of central precocious puberty, luteinizing hormone-releasing hormone stimulation test is complex and time-consuming. In many cases, clinical traits are inconsistent with luteinizing hormone-releasing hormone stimulation test results, therefore not reliable for diagnosis. In this study, the authors intended to find an indicator that predicts the results of the luteinizing hormone-releasing hormone stimulation test among subjects with early pubertal signs. Methods: Cases of 382 girls with early breast development before 8 years old and luteinizing hormone-releasing hormone stimulation test before 9 years old were included and underwent follow-up tests. Patients with peak luteinizing hormone level ≥5 IU/L were considered positive in the luteinizing hormone-releasing hormone stimulation test. Anthropometric data, body mass index, bone age evaluation, blood hormones levels of luteinizing hormone, estradiol, follicle-stimulating hormone, and uterine and ovarian volumes were analyzed. Results: Subjects with positive results in the initial test demonstrated early bone maturation, accelerated growth, and elevated basal blood luteinizing hormone, estradiol, and follicle-stimulating hormone levels, when compared with subjects with negative results in the initial test. Subjects with positive results in the follow-up test presented a more advanced bone age and more accelerated linear growth, when compared with subjects with negative results in the follow-up test. Conclusions: According to the statistical analysis, advanced bone age is the most effective predictor of the result of luteinizing hormone-releasing hormone stimulation test.

Resumo Objetivo: O diagnóstico da puberdade precoce central sempre foi complicado na prática clínica. Como um importante método no diagnóstico de puberdade precoce central, o teste de estimulação do hormônio liberador do hormônio luteinizante é complexo e demorado. Em muitos casos, as características clínicas são incompatíveis com os resultados do teste de estimulação do hormônio liberador do hormônio luteinizante e, assim, não são confiáveis para o diagnóstico. Neste estudo, visamos constatar um indicador que previsse os resultados do teste de estimulação do hormônio liberador do hormônio luteinizante entre indivíduos com sinais puberais precoces. Métodos: Foram incluídos casos de 382 meninas com desenvolvimento precoce das mamas antes dos 8 anos de idade e teste de estimulação do hormônio liberador do hormônio luteinizanteantes dos 9 anos e elas foram submetidas a testes de acompanhamento. Os resultados das pacientes com nível máximo de hormônio luteinizante ≥ 5 IU/L foram consideradas positivos no teste de estimulação do hormônio liberador do hormônio luteinizante. Foi feita uma análise dos dados antropométricos, do índice de massa corporal, da avaliação da idade óssea, dos níveis sanguíneos de hormônio luteinizante, volumes uterinos e ovarianos de estradiol (E2) e do hormônio folículo-estimulante. Resultados: Os indivíduos com resultado positive no teste inicial demonstraram maturação precoce do osso, crescimento acelerado e níveis sanguíneos elevados de hormônio luteinizante, estradiol e hormônio folículo-estimulante, em comparação aos indivíduos com resultados negativos no teste inicial. Os indivíduos com resultados positivos no teste de acompanhamento apresentaram um maior avanço na idade óssea e crescimento linear mais acelerado, em comparação aos indivíduos com resultados negativos no teste de acompanhamento. Conclusões: De acordo com a análise estatística, a idade óssea avançada é o indicador mais efetivo do resultado do teste de estimulação do hormônio liberador do hormônio luteinizante.

Maturation of cervical vertebrae and chronological age in children and adolescents.

In maxillary orthopedics and related areas, it is essential to determine patient growth peak in order to provide timely diagnosis and treatments. This requires the use of biological indicators that enable children and adolescents to be assigned to maturation stages. The aim of this study was to determine the correlation between cervical vertebrae maturation stages and chronological age in children and adolescents. In this study were evaluated 93 lateral cranium radiographs of 6- to 17-year-old patients who visited the Postgraduate Maxillary Orthopedics Clinic at the School of Dentistry at Universidad del Zulia. Two examiners made independent assessments of cervical vertebrae maturation stage using the method described by Baccetti et al. For each stage, descriptive statistics for chronological age were evaluated, classified according to sex. In addition, parametric and non-parametric tests were performed in which p <0.05 was considered significant. Mean age of the children and adolescents studied was 9.6 years, with standard deviation 2.5 years. The correlation coefficient (r= 0.771) certified a high positive correlation between bone maturation and chronological age. This correlation coefficient was highly positive for girls (r=0.858) and moderately positive for boys (r=0.688). The model obtained explains 59.4 % of the variation between bone maturation and chronological age, evidencing an average age increase of three years when maturation stage increases by approximately 1 year. The results suggest that although the degree of covariance between chronological age and maturation stages was highly positive in this study, chronological age does not allow bone maturation to be determined precisely, since it may be influenced by genetic and/or environmental factors.

En ortopedia maxilar y áreas afines resulta esencial determinar el pico de crecimiento de los pacientes para establecer diagnósticos y tratamientos oportunos para lo cual es necesario utilizar indicadores biológicos, que permiten ubicar a los niños y adolescentes en estadios de maduración. El objetivo de este estudio fue determinar la correlación de los estadios de maduración de las vértebras cervicales según la edad cronológica en niños y adolescentes. Se evaluaron 93 imágenes de radiografías lateral de cráneo, de pacientes entre 6 y 17 años de edad que asistieron a la clínica del Posgrado de Ortopedia Maxilar de la Facultad de Odontología de La Universidad del Zulia, dos examinadores estimaron de forma independiente el estadio de maduración de las vértebras cervicales, utilizando el método descrito por Baccetti et al. y para cada estadio se evaluaron los estadísticos descriptivos de la edad cronológica categorizando según sexo, además se realizaron pruebas paramétricas y no paramétricas donde un p <0,05 fue considerado como significativo. La edad media de los niños y adolescentes estudiados resultó de 9,6 años y una desviación típica de 2,5 años. El coeficiente de correlación (r=0,771) certificó una correlación positiva alta entre maduración ósea y edad cronológica, igual producto se obtuvo en el caso de las niños y adolescentes del sexo femenino (r=0,858), mientras los del sexo masculino obtuvieron una correlación positiva moderada (r= 0,688). El modelo obtenido explica el 59,4 % de la variación entre maduración ósea y edad cronológica, lo cual evidencia el aumento de la edad promedio en tres años, cuando el estadio de maduración aumenta 1 año aproximadamente. Los resultados registrados sugieren que, aunque el grado de covarianza entre edad cronológica y estadios de maduración en esta investigación fue positiva alta, la edad cronológica no permite determinar con exactitud la maduración ósea, pudiendo estar influenciada por factores genéticos y/o ambientales.

Advanced bone age as an indicator facilitates the diagnosis of precocious puberty.

OBJECTIVE: Diagnosis of central precocious puberty has always been challenging in clinical practice. As an important method in the diagnosis of central precocious puberty, luteinizing hormone-releasing hormone stimulation test is complex and time-consuming. In many cases, clinical traits are inconsistent with luteinizing hormone-releasing hormone stimulation test results, therefore not reliable for diagnosis. In this study, the authors intended to find an indicator that predicts the results of the luteinizing hormone-releasing hormone stimulation test among subjects with early pubertal signs. METHODS: Cases of 382 girls with early breast development before 8 years old and luteinizing hormone-releasing hormone stimulation test before 9 years old were included and underwent follow-up tests. Patients with peak luteinizing hormone level ≥5IU/L were considered positive in the luteinizing hormone-releasing hormone stimulation test. Anthropometric data, body mass index, bone age evaluation, blood hormones levels of luteinizing hormone, estradiol, follicle-stimulating hormone, and uterine and ovarian volumes were analyzed. RESULTS: Subjects with positive results in the initial test demonstrated early bone maturation, accelerated growth, and elevated basal blood luteinizing hormone, estradiol, and follicle-stimulating hormone levels, when compared with subjects with negative results in the initial test. Subjects with positive results in the follow-up test presented a more advanced bone age and more accelerated linear growth, when compared with subjects with negative results in the follow-up test. CONCLUSIONS: According to the statistical analysis, advanced bone age is the most effective predictor of the result of luteinizing hormone-releasing hormone stimulation test.

Maturation of cervical vertebrae and chronological age in children and adolescents

In maxillary orthopedics and related areas, it is essential to determine patient growth peak in order to provide timely diagnosis and treatments. This requires the use of biological indicators that enable children and adolescents to be assigned to maturation stages. The aim of this study was to determine the correlation between cervical vertebrae maturation stages and chronological age in children and adolescents. In this study were evaluated 93 lateral cranium radiographs of 6to 17yearold patients who visited the Postgraduate Maxillary Orthopedics Clinic at the School of Dentistry at Universidad del Zulia. Two examiners made independent assessments of cervical vertebrae maturation stage using the method described by Baccetti et al. For each stage, descriptive statistics for chronological age were evaluated, classified according to sex. In addition, parametric and nonparametric tests were performed in which p <0.05 was considered significant. Mean age of the children and adolescents studied was 9.6 years, with standard deviation 2.5 years. The correlation coefficient (r=0.771) certified a high positive correlation between bone maturation and chronological age. This correlation coefficient was highly positive for girls (r=0.858) and moderately positive for boys (r=0.688). The model obtained explains 59.4 % of the variation between bone maturation and chronological age, evidencing an average age increase of three years when maturation stage increases by approximately 1 year. The results suggest that although the degree of covariance between chronological age and matu ration stages was highly positive in this study, chronological age does not allow bone maturation to be determined precisely, since it may be influenced by genetic and/or environmental factors (AU)

En ortopedia maxilar y áreas afines resulta esencial determinar el pico de crecimiento de los pacientes para establecer diagnósticos y tratamientos oportunos para lo cual es necesario utilizar indicadores biológicos, que permiten ubicar a los niños y adolescentes en estadios de maduración. El objetivo de este estudio fue determinar la correlación de los estadios de maduración de las vértebras cervicales según la edad cronológica en niños y adolescentes. Se evaluaron 93 imágenes de radiografías lateral de cráneo, de pacientes entre 6 y 17 años de edad que asistieron a la clínica del Posgrado de Ortopedia Maxilar de la Facultad de Odontología de La Universidad del Zulia, dos examinadores estimaron de forma independiente el estadio de maduración de las vértebras cervicales, utilizando el método descrito por Baccetti et al. y para cada estadio se evaluaron los estadísticos descriptivos de la edad cronológica categorizando según sexo, además se realizaron pruebas paramétricas y no paramétricas donde un p <0,05 fue considerado como significativo. La edad media de los niños y adolescentes estudiados resultó de 9,6 años y una desviación típica de 2,5 años. El coeficiente de correlación (r=0,771) certificó una correlación positiva alta entre maduración ósea y edad cronológica, igual producto se obtuvo en el caso de las niños y adolescentes del sexo femenino (r=0,858), mientras los del sexo masculino obtuvieron una correlación positiva moderada (r= 0,688). El modelo obtenido explica el 59,4 % de la variación entre maduración ósea y edad cronológica, lo cual evidencia el aumento de la edad promedio en tres años, cuando el estadio de maduración aumenta 1 año aproximadamente. Los resultados registrados sugieren que, aunque el grado de covarianza entre edad cronológica y estadios de maduración en esta investigación fue positiva alta, la edad cronológica no permite determinar con exactitud la maduración ósea, pudiendo estar influenciada por factores genéticos y/o ambientales (AU)

Comparação entre métodos de avaliação de altura final em adolescentes com baixa estura variante do normal / Comparison of methods for final height assessment in adolescents with a normal variant short stature

INTRODUCTION: Patients with low stature normal variant growth have peculiar evolutionary patterns making it difficult to precisely define when final stature will be reached, since prediction methods are based on parameters of difficult quantification, such as bone age. OBJECTIVE: To assess the agreement between two methods for prediction of final height based on family target range regarding the final height reached by adolescents with a diagnosis of normal variant short stature. METHODS: Thirty-three subjects were evaluated using height of parents for the calculation of family target range and Bayley-Pinneau and Tanner-Whitehouse methods for prediction of final height. Spearman correlation coefficient was calculated to correlate final height with the mean of the family target range, and the St. Laurent concordance coefficient was used to assess concordance between final stature and predictive methods. RESULTS: 87.9% (29/33) subjects kept short stature at the end of growth and 90.9% (30/33) had a final height within family target range. A very strong positive correlation (Cs = 0.77; p < 0.01) was observed between parental mean and final height. Bayley-Pinneau method showed a 0.47 concordance coefficient with final height (95% CI: 0.34; 0.57), and Tanner-Whitehouse 3 method showed a concordance coefficient of 0.58 (95% CI: 0.41; 0.75. CONCLUSION: The strong positive correlation observed demonstrates the significant influence of parental height on final height. Neither method showed good concordance when used as a predictor of final height, with height values being overestimated.

INTRODUÇÃO: Pacientes com baixa estatura variante normal do crescimento têm padrões evolutivos peculiares dificultando definir com precisão quando a estatura final será atingida, visto que os métodos de previsão baseiam-se em parâmetros de difícil quantificação, como a idade óssea. OBJETIVO: Avaliar a concordância entre dois métodos de previsão da estatura final e do canal familiar com a altura final atingida (padrão ouro) por adolescentes com diagnóstico de variantes normais da baixa estatura atendidos em ambulatório de avaliação de problemas de crescimento. MÉTODO: Foram avaliados 33 sujeitos utilizando-se as estaturas dos pais para o cálculo do canal familiar e da média parental e os métodos Bayley-Pinneau e Tanner- Whitehouse 3 para as previsões de estatura final. Também foram calculados o coeficiente de correlação de Spearman para correlacionar a estatura final com a média do canal familiar, e o coeficiente de concordância de St. Laurent para avaliar a concordância entre a estatura final e os métodos de previsão. RESULTADOS: 87,9% (29/33) permaneceram com Baixa Estatura ao término do crescimento e 90,9% (30/33) apresentaram estatura final dentro do canal familiar. Observou-se correlação positiva muito forte (Cs = 0,77; p < 0,01) entre a média parental e a altura final. O método de Bayley-Pinneau apresentou coeficiente de concordância com a altura final de 0,47 (IC 95%: 0,34; 0,57), o de TW3, 0,58 (IC 95%: 0,41; 0,75). CONCLUSÃO: A correlação positiva forte demonstra a influência significativa da altura dos pais na estatura final. Nenhum dos dois métodos apresentou boa concordância ao serem utilizados como preditores de estatura final, pois os valores das alturas foram superestimados principalmente pelo método de Bayley-Pinneau.

Relação da idade óssea com antropometria e aptidão física em jovens praticantes de voleibol / Relationship of age with bone and fitness anthropometry practitioners in youth volleyball / Relación de edad ósea con antropometría y condición física en jugadores jóvenes de vóleibol

Resumo O estudo teve como objetivo correlacionar a idade óssea, os componentes antropométricos e a aptidão física em 149 crianças de 8 a 14 anos. Foram aferidos estatura, massa corporal, perímetros de braço e de perna, perímetros de braço e de perna corrigidos, diâmetros bicristailíaco e biacromial, dobras cutâneas tricipital e perna, teste motores de agilidade, velocidade de membros superiores e força explosiva de membros inferiores e superiores e o exame de raios X de mão e punho para verificar maturação. Nos resultados, encontramos correlação positiva entre a idade óssea e as demais variáveis, com exceção das dobras cutâneas tricipital, de perna e teste de agilidade. Dessa forma, verificamos a influência da maturação sobre componentes antropométricos e motores. Assim, possibilitamos uma melhor forma de controle dos processos de detecção, seleção e orientação esportiva.

Abstract The study aimed to correlate bone age, anthropometric measurements and physical fitness in 149 young volleyball players between ages 8 and 14. Height, weight, arm and leg circumferences, adjusted arm and leg circumferences, bi-iliac and biacromial breadths, tricipital and leg skin fold thicknesses, physical fitness tests, coordination and explosive strength of the upper and lower limbs were measured, in addition to x-rays of hand and wrist to check for maturation. Results showed positive correlation between bone age and all other variables, except tricipital skinfold, leg skinfold and agility. We concluded that maturation has influence on anthropometric and motor components, leading to a better control in the process of selecting and promoting young athletes.

Resumen El estudio tuvo como objetivo observar la correlación entre edad ósea, variables antropométricas y condición física en 149 niños de 8 a 14 años. Se midieron la estatura, la masa corporal, la circunferencia del brazo y de la pierna, la circunferencia corregida del brazo y de la pierna, el diámetro bi-cresta ilíaca y biacromial, y el pliegue cutáneo del tríceps. Se hicieron pruebas motoras de agilidad de las piernas, de velocidad de los miembros superiores y de fuerza explosiva de los miembros superiores e inferiores, y se hicieron radiografías de la mano y el puño para verificar la maduración. En los resultados se encontró una correlación positiva entre la edad ósea y otras variables, con la excepción del pliegue cutáneo del tríceps y la prueba de agilidad de las piernas. Por tanto, se observa la influencia de la maduración de las variables antropométricas y motoras, lo que permite una mejor manera de controlar los procesos de detección, selección y orientación deportiva.

MRI of the wrist is not recommended for age determination in female football players of U-16/U-17 competitions.

Age determination on magnetic resonance imaging (MRI) of the wrist is a reliable method in male football players to evaluate their eligibility to participate in Under 17 tournaments. MRI of the wrist was performed in 487 female volunteers aged 13-19 years from Brazil, Germany, Malaysia, and Tanzania, and in 139 female football players participating in Under-16 and Under-17 football tournaments. A previously validated method for grading fusion of the distal radial epiphysis in male adolescent was used. Moderate correlation of chronological age and epiphyseal fusion was found in the normative control group (r = .59) and weak correlation in female football players (r = .27). Complete fusion of the distal radial epiphysis was observed in two 15-year-old volunteers of the control group (1.7%) and in 17.6% (3 of 17) of 14-year-old football players. Up to 10.8% (47 of 437) in the control group and 14.4% (20 of 139) of the football players 17 years or younger had complete fused epiphysis. Because of earlier osseous maturity in female adolescents, the grade of fusion of the distal radial epiphysis on MRI is not recommended for pretournament age determination for the age of 17 and younger in female.

Bone age in cerebral palsy.

OBJECTIVE: To compare the chronological age and bone age among cerebral palsy patients in the outpatient clinic and its correlation with the type of neurological involvement, gender and functional status. METHODS: 401 patients with spastic cerebral palsy, and ages ranging from three months to 20 years old, submitted to radiological examination for bone age and analyzed by two independent observers according Greulich & Pyle. RESULTS: In the topographic distribution, there was a significant delay (p<0.005) in tetraparetic (17.7 months), hemiparetic (10.1 months), and diparetic patients (7.9 months). In the hemiparetic group, the mean bone age in the affected side was 96.88 months and the uncompromised side was 101.13 months (p<0.005). Regarding functional status, the ambulatory group showed a delay of 18.73 months in bone age (p<0.005). Comparing bone age between genders, it was observed a greater delay in males (13.59 months) than in females (9.63 months), but not statistically significant (p = 0.54). CONCLUSION: There is a delay in bone age compared to chronological age influenced by the topography of spasticity, functional level and gender in patients with cerebral palsy. Level of Evidence IV, Case Series.

Idade óssea na paralisia cerebral / Bone age in cerebral palsy

OBJETIVOS: Determinar a idade óssea nos pacientes com paralisia cerebral (PC) espástica acompanhados no Ambulatório de Doenças Neuromusculares e comparar com a idade cronológica e correlacionar com os diferentes tipos (hemiparético, diparético, tetraparético), sexo e função motora.MÉTODOS: Analisados 401 pacientes com PC espástica, com idade entre três meses e 20 anos, submetidos a radiografias das mãos e punhos bilaterais e anotado a idade óssea por dois observadores independentes de acordo com o Atlas Greulich & Pyle.RESULTADOS: Quanto a distribuição topográfica, houve um atraso significante (p<0,005) nos tetraparéticos (17,7meses), nos hemiparéticos (10,1 meses) e diparéticos (7,9 meses). No grupo de hemiparéticos, a idade óssea média no lado acometido foi de 96,88 meses e no lado não acometido de 101,13 meses (p<0,005). Em relação ao estado funcional, os não deambuladores demonstraram atraso na idade óssea em relação à idade cronológica de 18,73 meses (p<0,005). Observou-se um maior atraso no sexo masculino (13,59 meses) do que no sexo feminino (9,63 meses), mas não estatisticamente significante (p=0,54).CONCLUSÕES: Há um atraso da idade óssea em relação à idade cronológica influenciado pelo tipo de topografia da espasticidade, nível funcional e sexo na PC. Nível de Evidência IV, Série de Casos.

OBJECTIVE: To compare the chronological age and bone age among cerebral palsy patients in the outpatient clinic and its correlation with the type of neurological involvement, gender and functional status.METHODS: 401 patients with spastic cerebral palsy, and ages ranging from three months to 20 years old, submitted to radiological examination for bone age and analyzed by two independent observers according Greulich & Pyle.RESULTS: In the topographic distribution, there was a significant delay (p<0.005) in tetraparetic (17.7 months), hemiparetic (10.1 months), and diparetic patients (7.9 months). In the hemiparetic group, the mean bone age in the affected side was 96.88 months and the uncompromised side was 101.13 months (p<0.005). Regarding functional status, the ambulatory group showed a delay of 18.73 months in bone age (p<0.005). Comparing bone age between genders, it was observed a greater delay in males (13.59 months) than in females (9.63 months), but not statistically significant (p = 0.54).CONCLUSION: There is a delay in bone age compared to chronological age influenced by the topography of spasticity, functional level and gender in patients with cerebral palsy. Level of Evidence IV, Case Series.

Indicadores de maduración esquelética y dental en pacientes de ortodoncia con menarquía / Indicators of skeletal and dental maturation in orthodontics patients presenting menarche

El propósito del presente trabajo fue determinar según la menarquía: la edad ósea, los estadios de maduración esquelética, los estadios de maduración de las vértebras cervicales y los estadios de calcificación del canino y el segundo premolar mandibulares izquierdos. Se realizó un estudio transversal y descriptivo en 30 pacientes femeninas con menarquía que ingresaron en la Clínica de Ortodoncia de la Facultad de Estomatología de La Habana, en el periodo comprendido entre abril de 2004 y septiembre de 2006. A cada paciente se le realizó una telerradiografía lateral de cráneo, una radiografía de la mano izquierda y una radiografía panorámica o periapical de la hemiarcada mandibular izquierda. En cada caso se evaluaron los métodos Taner-Whitehouse 2 (TW2), Grave y Brown, Hassel y Farman y Demirjian. Se estudiaron las variables: edad de aparición de la menarquía, edad ósea, edad cronológica, estadios de maduración esquelética, estadios de maduración de las vértebras cervicales, estadios de calcificación del canino y el segundo premolar mandibulares izquierdos. El promedio de la edad de aparición de la menarquía en esta muestra fue de 12,00 años con una desviación estándar de 1,00 año. Los promedios de la edad ósea fueron superiores a los de la edad cronológica en todos los grupos de edades. Las 30 pacientes estudiadas se encontraban en: estadios de maduración esquelética mayores que 4, estadios de maduración de las vértebras cervicales mayores que 1, estadio H de calcificación del canino mandibular izquierdo y estadios superiores al E para el segundo premolar mandibular izquierdo. En todos los métodos determinados se encontró que la mayoría de las pacientes con menarquía estaban en los estadios de maduración más avanzados(AU)

The aim of present paper was to determine according menarche the bone age, skeletal maturation stages, maturation stage of cervical vertebrae and the stages of calcification of canine and the second left mandibular premolars. A descriptive and cross-sectional study was conducted in 30 female patients with menarche admitted in the Orthodontics Clinic of the Stomatology Faculty of La Habana from April, 2004 to September, 2006. Each patient undergoes a lateral teleradiography of skull, radiography of the left hand and a panoramic of periapical radiography of the left mandibular hemiarcade. In each case the Taner-Whitehouse 2 (TW2), Grave and Brown, Hassel and Farman and Demirjian methods were assessed. Following variables were studied: age at menarche appearance, bone age, chronologic age, skeletal maturation stages, the maturation stages of cervical vertebrae, calcification stages of the canine and the second left mandibular premolar. The age mean of the menarche's appearance in our sample was of 12,00 years with a SD of 1,00 year. Means of bone age were higher than those of chronologic age in all age groups. The 30 study patients were in skeletal maturation stages higher then 4, in maturation stages of cervical vertebrae higher than 1, in H stage of calcification of left mandibular canine and in stages higher than E for the second left mandibular premolar. In all determined methods most of patients with menarche were in more advances maturation stages(AU)