Should we consider the sex when estimating bone age from hand bone biometrics?

BACKGROUND: Recently, it was proposed to estimate age from the biometric information of hand bones. We observed that these estimations became less precise as children get older, especially from the age of 13-15 years. OBJECTIVE: This study aimed to evaluate the influence of considering sex for age estimation based on hand bones biometrics. MATERIALS AND METHODS: The study sample consisted of metacarpals and proximal phalanges measurements collected on 1003 medical images performed at Nancy and Marseille Hospitals of individuals aged under 21 years. This sample was divided into two subgroups delineated by the age of 13, as it is a relevant legal threshold for most European countries. First, the influence of sex on the hand bones biometrics and on the estimated age was evaluated. Then, based on these results, new sex-specific age estimation formulas were constructed from linear models and their precision was assessed using residual analysis, in comparison with previous global formulas. RESULTS: An influence of sex was only highlighted from the age of 13 and for the total study sample. Thus, new sex-specific age estimation formulas were built for the [1-21] global sample and the [13-21] subsample. Even though the differences with the previous formulas were minor, age was more accurately estimated when sex was considered. CONCLUSION: Considering sex in age estimation is relevant when relying on hand bone biometrics. A new tool was proposed to select the most appropriate age estimation formula, based on the discriminant analysis result and the a priori knowledge of the sex.

Identification of Frailty in a Population of Former Immigrant Workers in the South of France.

BACKGROUND: Frailty is unevenly distributed across the world but also within different populations in the same country. OBJECTIVES: This study sought to identify frailty in former immigrant workers, known as Chibanis, living in an immigrant hostel in Marseille. The secondary objective was to describe health care access, as well as any chronic diseases reported. DESIGN, PARTICIPANTS AND SETTING: Our descriptive, observational, monocentric study conducted from January to April 2021 included 67 Chibanis, living in an immigrant hostel in Marseille. MEASUREMENTS AND RESULTS: Almost all this population (97%), with a median age of 77 years, presented at least one frailty criterion: 7.5% were malnourished, 55.2% had a grip strength of < 27 kg, and 41.8% were on multiple drugs. Majority of Chibanis (86.6%) had multimorbidity. CONCLUSION: Identifying frailty in this population of Chibanis must be proposed through a specific, adapted care pathway including referral to a specialist.

Forensic use of the Greulich and Pyle atlas: prediction intervals and relevance.

OBJECTIVE: The Greulich and Pyle (GP) atlas is one of the most frequently used methods of bone age (BA) estimation. Our aim is to assess its accuracy and to calculate the prediction intervals at 95% for forensic use. METHODS: The study was conducted on a multi-ethnic sample of 2614 individuals (1423 boys and 1191 girls) referred to the university hospital of Marseille (France) for simple injuries. Hand radiographs were analysed using the GP atlas. Reliability of GP atlas and agreement between BA and chronological age (CA) were assessed and prediction intervals at 95% were calculated. RESULTS: The repeatability was excellent and the reproducibility was good. Pearson's linear correlation coefficient between CA and BA was 0.983. The mean difference between BA and CA was -0.18 years (boys) and 0.06 years (girls). The prediction interval at 95% for CA was given for each GP category and ranged between 1.2 and more than 4.5 years. CONCLUSION: The GP atlas is a reproducible and repeatable method that is still accurate for the present population, with a high correlation between BA and CA. The prediction intervals at 95% are wide, reflecting individual variability, and should be known when the method is used in forensic cases. KEY POINTS: • The GP atlas is still accurate at the present time. • There is a high correlation between bone age and chronological age. • Individual variability must be known when GP is used in forensic cases. • Prediction intervals (95%) are large; around 4 years after 10 year olds.

Influence of socioeconomic status and body mass index on bone age.

BACKGROUND/AIMS: To evaluate the relationship of socioeconomic status (SES) and body mass index (BMI) with skeletal maturation in children from Marrakech (Morocco). METHODS: SES, BMI z-score and bone age (BA) were measured in a cohort of 623 children (280 boys and 343 girls, chronological age (CA) ranged from 6.6 to 18.8 years, mean 14.1 years). BA estimation was performed with the Greulich and Pyle atlas. Two social groups (privileged and unfavorable SES) were defined. A multiple linear regression analysis was performed to assess the relationship between BA-CA and age-and sex-specific BMI z-score. RESULTS: Global maturation delay was seen in the sample (BA-CA -0.56; SD 1.29). There was a significant relationship between skeletal maturation (BA-CA) and child BMI z-score among both genders. Bone age was more advanced in children with a greater BMI z-score. Privileged SES was positively associated with children's BA-CA for girls but there was no association for boys. In the boys' sample, there was no evidence that BA-CA variations with BMI z-score depended on socioeconomic status (p=0.664). Whatever the gender of the child, a greater BMI z-score increases the maturation. CONCLUSION: The multiple linear regression analysis is an interesting approach to understand the links between skeletal maturation, BMI and SES. In Moroccan children, excess weight is associated with privileged SES.

Lens cell targetting for gene therapy of prevention of posterior capsule opacification.

Posterior capsule opacification is the main complication of cataract surgery. Using adenovirus-mediated gene transfer, we recently reported that it was feasible to prevent PCO by overexpressing pro-apoptotic molecules such as pro-caspase 3 or Bax in the residual lens epithelial cells post-cataract surgery. However, this approach is feasible only if gene transfer can be restricted to the residual cells responsible for PCO. Initially, we tested an adenovirus (human serotype 5, HAd5), a lentivirus (HIV) and an oncoretrovirus (MLV) vector for the their in vivo transduction efficiency of rabbit lens cells. We found that HAd5 vectors were the most efficient (>90% of the cells could be transduced). Six potential lens-specific promoters were then cloned into HAd5 vectors and assayed for their ability to target expression to a specific population of cells, using in vitro, ex vivo and in vivo rabbit tissues and human lens capsular bags. We found that the LEP503, MIP and Filensin promoters induced strong lens-specific expression of a reporter gene, in human lens cells. Following this ex vivo assay, we showed in a rabbit PCO model that gene transfer could be spatially restricted to the capsular bag by confining the vector with Matrigel. Our combined approach using a lens-specific promoter and a biocompatible gel should render feasible a novel therapeutic strategy for PCO that targets the remaining lens cells.

Prevention of posterior capsule opacification by the induction of therapeutic apoptosis of residual lens cells.

Posterior capsule opacification (PCO) is a common complication of cataract surgery. Using adenovirus(Ad)-mediated gene transfer, we overexpressed the proapoptotic molecules p53, procaspase 3, Bax, and TRAIL to induce therapeutic programmed cell death of residual lens cells to prevent PCO. Overexpressed TRAIL did not induce apoptosis in cultured rabbit lens cells or in human lens cells. Overexpressed p53 induced apoptosis of lens cells in vitro and ex vivo, but was unable to prevent PCO in vivo. Overexpressed procaspase 3 was associated with engagement of many components of the apoptotic pathway, including cleavage of intracellular caspase targets such as PARP and inter-nucleosome DNA fragmentation. Even when only slightly overexpressed, Bax caused apoptosis of transduced rabbit and human lens cells by engaging the mitochondrial pathway, including catalytic activation of the caspases. A single in vivo injection of Ad vectors expressing either Bax or procaspase 3 into the capsular bag at the end of phacoemulsification prevented PCO in rabbits. These experiments show that Ad-mediated Bax or procaspase 3 overexpression is capable of inducing therapeutic programmed cell death in vitro and in vivo in residual lens cells and preventing PCO in a rabbit model of PCO. Manipulation of proapoptotic molecule expression could be a novel gene therapy approach for prevention of PCO.

Type-I collagen production by human odontoblast-like cells in explants cultured on cyanoacrylate films. Electron-immunolocalization of fibronectin at cell/film interface.

Odontoblast-like cells derived from human tooth pulps were maintained in explant culture and grown either on glass coverslips only (used as control) or on glass coverslips coated with cyanoacrylate films. Ultrastructural and cyto-morphometric evidence showed that cells exposed to cyanoacrylate, in contrast to controls, display a significant decrease of rough endoplasmic reticulum and mitochondria. In addition, immunofluorescent staining and radioimmunoassays for type-I collagen suggested disturbances in production for the exposed cells. The use of anti-fibronectin antibodies with electron-microscopic immunoperoxidase-labelling demonstrated that the adherence of cells to cyanoacrylate can involve both adhesion plaques and fibronectin. These results therefore suggest that there were no apparent differences in the adhesion interaction of cells between glass and cyanoacrylate substrates.