Correlation of skeletal maturation with stature and body weight of southern Chinese girls in Hong Kong

Correlations of skeletal maturation with stature and body weight were studied in one hundred and seventeen Southern Chinese girls aged eleven years nine months and twelve years three months born and brought up in Hong Kong. The skeletal maturation was assessed from the left hand and wrist radiographs by the Greulich and Pyle Atlas Method. The early maturers in skeletal development were significant taller and heavier than the late maturers with p less than 0.001.     

Comparison of Tanner-Whitehouse and Greulich-Pyle methods in a large scale Danish Survey

In Denmark no systematic investigation of skeletal development had been made prior to this investigation which involved 1009 school children aged 7–18 years in a transverse examination. The skeletal age was estimated according to the American atlas of Greulich-Pyle. The English system of Tanner-Whitehouse was also applied. In this latter method the stage of development of 20 selected bones in the hand and wrist is rated on a scale of 8 (in one case 9) possible stages. Each bone is awarded points according to its stage of development. These points are totalled for the 20 bones and reference to a table gives the skeletal age. The problem with this system is that the later stages of carpal bone development cannot be reliably placed on the scale. Their point system is calculated in such a way that a difference of one stage in rating of a single carpal bone in older children would give rise to a difference of up to two years in the skeletal age estimation. For younger children the method is, however, quite reliable. The investigation has shown that Greulich-Pyle's atlas can be applied to Danish children of 7-18 years of age provided that a correction of six months is made. A variable error of about four months was found when using Greulich-Pyle compared to about two months with Tanner-Whitehouse.     

Mandibular biomechanics after marginal resection: Correspondences of simulated volumetric strain and skeletal resorption

Serious mandibular diseases such as tumor or osteonecrosis often require segmental or marginal mandibulectomy, the latter with improved outcome thanks to preserved mandibular continuity. Nevertheless, gradual osteolytic and/or osteosclerotic skeletal changes frequently indicate repetitive resections. Based on the fundamental adaptivity of bone to mechanical loads, the question arose whether resection-related anatomical alterations trigger relevant pathological skeletal adaptations. For a clinical case after mandibular box resection due to progressive osteoradionecrosis (ORN), routine biomechanical loading was simulated by finite element method, respecting pathology-related anatomy, tissue properties, and biting capacity. By 3D-visualization of the mandible’s pathological development from follow-up-CT’s over four years, remarkable correspondences of skeletal resorptions and increased unphysiological strain were revealed. Higher unphysiological load was correlated with more serious and earlier skeletal alterations. Three months post-operatively, serious buccal destruction at the distal resection corner occurred in correspondence with dominant tensile strain. At the resection, elevated strain caused by reduced alveolar height corresponded to skeletal compromise, observed 8–9 months post-operatively. ORN-related lesions, diagnosed before resection, entailed unphysiological strain coinciding with local skeletal alterations. Simulations with “healthy” instead of pathological tissue coefficients induced quantitative improvements of 25–33%, but without fundamental change. These results suggest a decisive contribution of resection-related biomechanical skeletal adaptations to this patient’s mandibular decline with hemimandibulectomy about 2.5 years after the first resection. However, mechanical stress concentrations in sharp angles as the distal resection corner and reduced stability due to decreased alveolar height generally bear the danger of pathological biomechanics and severe skeletal adaptations for patients after mandibular box resection.     

Problems in the aging of skeletal juveniles: Perspectives from maturation assessments of living children

We employ samples of children of known chronological age to demonstrate the significance of random and systematic effects on maturation in both dental and skeletal development. Differences between chronological age for dental age in young healthy Canadian children can be as much as 100% of the actual age of the children. For skeletal development by reference to Greulich-Pyle standards, three samples of known-age children from Mexico document parallel effects: 1) 183 six-year-old children have skeletal-based ages with a 95% confidence interval of 4–8 years; 2) 80% of 217 4.0–4.5-year-old children are underaged by 1–3 years; and 3) 130 children of skeletal age between 39 and 44 months are actually between 4 and 7.4 chronological years of age. The Mexican samples are drawn from a population living under conditions of environmental stress with chronic mild to moderate protein-energy malnutrition and moderate to high levels of infectious disease. These children may parallel those from the past, whose remains are studied by skeletal biologists or paleoanthropologists. Our findings reinforce concerns expressed in extant studies regarding the accuracy of age-at-death reconstructions. © 1996 Wiley-Liss, Inc.     

Maxillofacial growth in children with unilateral cleft lip and palate following secondary alveolar bone grafting: an interim evaluation

This study evaluates the effect of alveolar bone grafting on the maxillofacial growth in children of mixed dentition with unilateral complete cleft lip-cleft palate. Twenty patients received an iliac crest alveolar bone graft between the ages of 6 years 10 months and 10 years 10 months, whereas 20 matched controls between the ages of 6 years 11 months and 10 years 6 months did not. Geometric morphometric assessments were used to localize alterations between the initial and final cephalographs in the two groups of cleft children, using Procrustes analysis and thin-plate spline analysis, in addition to conventional cephalometric techniques. It is concluded that no statistically significant difference in maxillofacial growth was found between the cleft children having received secondary alveolar bone grafting and the nongraft controls in general during the first to third postoperative years. Further investigation will be undertaken to determine the long-term effects after the age of skeletal maturity.     

Early surgical intervention in Apert's syndactyly

The hand deformities in Apert's syndrome are among the most complex congenital hand problems to reconstruct due to the skeletal malalignment, symphalangism, and progressive functional deficits with growth. Ten children with Apert's syndactyly underwent early surgical intervention (mean age 8.4 months) as part of a staged program of digital separation leading to completion of both hands by the age of 2 years. The incidence of major complications was low, rate of revision (18 percent) acceptable, and the aesthetic result very satisfactory. Long-term functional results tend to reflect the effect of progressive intrinsic disease despite preservation of skeletal alignment and digital form with growth. However, the aesthetic improvement and potential for greater functional gains at a young age support the concept of early surgical intervention in this syndrome.     

Long term retention of 237Np in rats

This interim report summarizes the results of observations during the first year after a single injection of 237Np nitrate (0.2 or 1.0 mg/kg body weight) into adult female rats and further preliminary data obtained with young animals. The retention of 237Np was followed by whole body counting and serial sacrifice of groups of animals. The retention data could be fitted to three-component exponential equations which show no major differences between the two 237Np dose levels. The half-times and extrapolated initial fractions calculated from the first two exponential terms indicate that one fraction, representing about 40 per cent of the injected 237Np was excreted within the first 5 days and an additional 15 per cent within the first 5 months, while the rest was excreted with a half-time of about 3.5 years. This final long term component is assumed to indicate the rate of loss of 237Np from the skeletal compartment. In young animals both whole-body and skeletal retention of 237Np during the first 5 months of observation was about 50 per cent higher than in the adults. Several soft tissue tumours, mostly mammary tumours, have appeared to approximately the same extent in both control and 237Np treated adult rats but no osteosarcomas were detected up to 15 months after injection of 237Np.     

Biochemical and palaeopathological investigations on weaning and infant mortality in the early Middle Ages

Weaning age of the children of the early medieval population at Wenigumstadt (Ldkr. Aschaffenburg, southern Germany, 500-700 AD) was estimated by stable nitrogen isotope analysis of bone collagen. The onset of weaning was by one year of age, when solid vegetal food subsequently replaced breast milk. In total, the change from mother's milk to solid adult food took about three years, the infants being fully weaned at this age. While the growing infant was sufficiently supported in utero and during the first months of life, the weanling's diet was insufficient for further growth and development. Starting with about 18 months of age, more and more symptoms of malnutrition are detectable on the skeletal remains, and the peak of both morbidity and mortality is reached at four years of age. Especially unspecific stress markers like Harris' lines and enamel hypoplasia clearly indicate the infants' risk of falling ill or die between three and four years of age. Malnutrition weakens the immune response, therefore the majority of inflammations detectable on the skeleton are found among the inadequately nourished children. The assumption that weaning is responsible for pathological skeletal lesions and early death in history is thus supported by archaeometry.     

Neonatal skeletal maturation in congenital hypothyroidism and its prognostic value for psychomotor development at 3 years in patients treated early

Neonatal skeletal maturation was assessed by different methods based on the bone centres in the knee and ankle region in 46 infants with true-positive (patients) and 17 infants with false-positive screening tests (controls). The patients and controls did not differ in mean age at X-ray examination and age at the start of treatment (14.5 +/- 5.7 days). One of the methods used to score the size of femoral and tibial epiphyses was just as good as the other ones tested, but has the advantage of being the easiest to use and therefore clinically most suitable. Skeletal maturity assessed by this method correlated best with serum T4 (r = 0.62, p less than 0.01). Griffiths tests were performed in 37 of the 46 patients at 28-48 months of life. The best correlation obtained between neonatal skeletal maturity and Griffiths global developmental quotient at 3 years of age was r = 0.58 (p less than 0.001). Although statistically significant, it was too weak to be of clinical value in identifying individual patients at risk. We conclude that an assessment of skeletal maturation is not useful for the prognosis of psychomotor development in individual patients with congenital hypothyroidism receiving treatment within the first 2 weeks of life.     

Skeletal growth in school children: maturation and bone mass

Skeletal growth and development was evaluated in 322 white children (age 6 to 14) using three different methods: (1) ¹²⁵I photon absorptiometry, (2) compact bone measures on radiographs, and (3) Greulich-Pyle skeletal age from hand-wrist radiographs. Bone mineral content, measured by photon absorptiometry, increased at an incremental rate of about 8.5% each year. Skeletal age was a poor predictor of skeletal status, i.e., bone mineral content (14% error), and did not decrease the predictive error substantially more than did chronological age. Gross morphology (height and weight) was in fact a better predictor of bone mineral content than were skeletal age, chronological age, and radiographic morphometry. Skeletal age deviations were correlated with deviations in body size. A bone mineral index was devised which was independent of body size and this index was also independent of skeletal age. Skeletal age is imprecise (3 to 6 months error) and the range of variation in normal children (13 months) overlaps the maturational delay of the malnourished and diseased. The difficulties in using skeletal maturation are discussed and it is suggested that particular maturational indices be used which better indicate skeletal growth than does a composite skeletal age.     

Chronic losartan administration reduces mortality and preserves cardiac but not skeletal muscle function in dystrophic mice

Duchenne muscular dystrophy (DMD) is a degenerative disorder affecting skeletal and cardiac muscle for which there is no effective therapy. Angiotension receptor blockade (ARB) has excellent therapeutic potential in DMD based on recent data demonstrating attenuation of skeletal muscle disease progression during 6–9 months of therapy in the mdx mouse model of DMD. Since cardiac-related death is major cause of mortality in DMD, it is important to evaluate the effect of any novel treatment on the heart. Therefore, we evaluated the long-term impact of ARB on both the skeletal muscle and cardiac phenotype of the mdx mouse. Mdx mice received either losartan (0.6 g/L) (n = 8) or standard drinking water (n = 9) for two years, after which echocardiography was performed to assess cardiac function. Skeletal muscle weight, morphology, and function were assessed. Fibrosis was evaluated in the diaphragm and heart by Trichrome stain and by determination of tissue hydroxyproline content. By the study endpoint, 88% of treated mice were alive compared to only 44% of untreated (p = 0.05). No difference in skeletal muscle morphology, function, or fibrosis was noted in losartan-treated animals. Cardiac function was significantly preserved with losartan treatment, with a trend towards reduction in cardiac fibrosis. We saw no impact on the skeletal muscle disease progression, suggesting that other pathways that trigger fibrosis dominate over angiotensin II in skeletal muscle long term, unlike the situation in the heart. Our study suggests that ARB may be an important prophylactic treatment for DMD-associated cardiomyopathy, but will not impact skeletal muscle disease.     

Height, weight, and lines of arrested growth in young Guatemalan children

A cross-sectional study of height, weight and skeletal maturity as judged from radiographs of hand and wrist, of 1,412 children under seven years of age (694 boys and 718 girls) living in rural Guatemala was performed. Height and weight were compared to standards prepared by the Institute of Nutrition of Central America and Panama (INCAP). Skeletal age was assessed by the Tanner-Whitehouse and the Greulich and Pyle methods. All x-rays were read by the senior author. The children surveyed were significantly shorter and lighter than well noruished Guatemalan children. Differences were evident by age six months and at a maximum by age five years. Both methods showed skeletal age to lag behind chronological age so that the Guatemalan rural children mature at slower rates than either the British children or the Ohio, U.S.A., children, from whom the two sets of standards were developed. Children of both sexes with radio-opaque transverse lines at the metaphysis showed a consistent tendency to be shorter than children without such lines. Boys but not girls showed similar trends for weight. In general, the data are consistent with the view that the physical development in boys is more severely retarded by an adverse environment than that of girls.     

Infant feeding and weaning practices in Roman Egypt.

Current knowledge of infant feeding and weaning practices during the Roman period in Egypt is limited to scanty documentary and iconographic evidence. Stable nitrogen and carbon isotope analysis provides another avenue to explore this question. A sample of 49 infant and juvenile human skeletal remains from the Kellis 2 cemetery in the Dakhleh Oasis, Egypt, was used to determine patterns of infant feeding and weaning. delta(15)N values indicate that supplementary foods were introduced at around 6 months of age, and that weaning was complete by 3 years of age. By 6 months of age, delta(13)C values become increasingly enriched over adult values, and reach peak enrichment at approximately 1.5 years of age. Beyond this age, delta(13)C gradually declines to approach adult values. This enrichment in infant delta(13)C values is indicative of consumption of (13)C-enriched supplementary foods. Based on isotopic study of faunal and botanical remains from the ancient village of Kellis, we conclude that at approximately 6 months of age, infants were fed milk of goat and/or cow.     

男性青少年脂肪组织分布与相对骨龄的关系——Fels追踪研究

本文对Fels追踪研究中8—17岁男性青少年的相对骨龄与脂肪分布类型之间的关系做了分析。按体重/身高~2调整后,如用每个年龄的三种皮褶厚度(ST)指数的均值表示脂肪分布类型的话,8—12岁时,脂肪分布类型呈外周型分布,但13岁后开始朝向心型发展呈全身性分布。如用肩胛下ST/(肩胛下ST+肱三头肌区ST)的比例表示的话,那么14—17岁时,相对骨龄早者(简称早组)与相对骨龄晚者(简称晚组)相比,前者有较明显的向心型分布倾向。13—14岁时,早组的上述比值的年增长明显大于晚组。但是,按脂肪分布类型指数等级的基线和体重/身高~2调整之后,7、11或14岁时的相对骨龄不能预测17岁时的脂肪分布类型指数的等级。所以,我们可以得出这样的结论:如按本文的比例指数加以定量的话,脂肪分布类型与男性青少年的相对骨龄只有微弱的关系。他们的脂肪分布类型可能与其它成熟指征(如男性青春期的第二性征)有明显的关系。     

Skeletal maturity of Japanese children in Western Kyushu

This paper describes the skeletal maturity status of Japanese children in Western Kyushu and its variation within Japanese populations. Hand-wrist skeletal maturity was assessed by the Tanner-Whitehouse (1975) (TW2) method from radiographs of 500 boys and 485 girls aged from 4 to 15 years. Western Kyushu children showed retarded skeletal maturity scores (RUS, carpals, and 20-bone) under the age of 12 years for boys and 10 years for girls, and thereafter they were advanced in relation to the British standard. Within Japanese populations the present sample showed delayed maturity compared to Tokyo children, but was close to that of Sapporo children throughout the age range studied. However, the expected effect of secular trend suggested skeletal maturity more advanced for Tokyo children and somewhat advanced one for Sapporo children compared to that of Western Kyushu children.     

Phosphomannosyl receptors of lysosomal enzymes in cardiac and skeletal muscles of young and old mice

The endogenous activity and the binding of high-uptake beta-N-acetylglucosaminidase were assayed in the membranes of heart and skeletal muscles of young (2 months) and old (15 months) NMRI-mice (Mus musculus) to evaluate the age-related changes in the phosphomannosyl receptors of lysosomal enzymes in muscular membranes. The total activities of beta-N-acetylglucosaminidase were significantly higher in cardiac and skeletal muscles of old than young mice. The total and the specific (inhibited by mannose-6-phosphate) binding of beta-N-acetylglucosaminidase to the membranes of cardiac muscle, but not to those of skeletal muscle, were higher in old mice than in young ones. The endogenous activity of beta-N-acetylglucosaminidase was significantly higher in the membranes of skeletal muscles of old mice than in those of young mice. The membranes of heart muscles did not show any difference in the endogenous activities. The saturation properties of the binding of beta-N-acetylglucosaminidase to the phosphomannosyl receptors were very similar in the membranes of heart and skeletal muscles of both age groups. We conclude that during aging the number of phosphomannosyl receptors of lysosomal enzymes increases in the membranes of heart muscle while the occupancy of phosphomannosyl receptors with endogenous ligands increases in the membranes of skeletal muscle.     

Early mobilisation and outcome in acute sprains of the neck.

OBJECTIVE--To assess the long term effect of early mobilisation exercises in patients with acute sprains of the neck after road accidents. DESIGN--Single blind randomised prospective study of patients receiving physiotherapy, advice on mobilisation, or on an initial period of rest followed up after two years by postal questionnaire. SETTING--Accident and emergency department in urban hospital. PATIENTS--247 Consecutive patients (mean age at injury 30.6 years) presenting within 48 hours after injury with no pre-existing disease of the neck or serious skeletal injury. Of these, 167 patients responded to the questionnaire; 77 who responded but had not completed their treatment or review course were included in the analysis as a fourth group (non-attenders). MAIN OUTCOME MEASURE--Presence of symptoms after two years. RESULTS--Of the 167 patients (68%) responding, the percentage of patients still with symptoms was not significantly different in those receiving rest or physiotherapy (46%, 12/26 v 44%, 24/54), but that in those receiving advice on early mobilisation was significantly lower (23%, 11/48, p = 0.02). Of the 104 patients without symptoms, 94 (90%) recovered within six months and 62 (60%) within three months. Patients without symptoms who received advice or physiotherapy wore a collar for a significantly shorter time than those with persistent symptoms (mean duration 1.4 (SD 0.7) months v 2.8 (1.6) months, p = 0.005 and 1.6 (1.1) months v 1.8 (1.3) months, p = 0.006 respectively). CONCLUSIONS--Advice to mobilise in the early phase after neck injury reduces the number of patients with symptoms at two years and is superior to manipulative physiotherapy. Prolonged wearing of a collar is associated with persistence of symptoms.     

Endemic disease patterns in Paleopathology: Porotic hyperostosis

Recent research has shown that constitutional factors can elicit a porotic skeletal lesion pattern related to iron-deficiency anemia, even when adequate dietary iron is available. This study considers the pattern of skeletal involvement under conditions of chronic or endemic dietary stress. Analysis focused on 54 subadults aged 0–10 years at death from the Arroyo Hondo site. Early age of onset is documented in the pattern of coincident active periosteal reactions and porotic lesions under 6 months. Endemically inadequate diets affecting pregnant females and their fetuses, acting synergistically with immediately acquired infections, not weaning diets, are the probable major underlying causes for the early onset of iron-deficiency anemia at Arroyo Hondo.     

Fatness and skeletal maturity of Belgian boys 12 through 17 years of age

Relationships between fatness and skeletal maturity are considered in a nationwide sample of 14,259 Belgian boys 12 through 17 years of age (The Leuven Growth Study of Belgian Boys). Absolute fatness was estimated from four skinfolds using the Drinkwater and Ross technique and from the sum of four skinfolds, and was related to skeletal maturity assessed by the Tanner-Whitehouse method (I and II). In addition, comparisons were made between the fattest 5% and leanest 5% of the boys at each age level. Correlations between the indices of fatness and skeletal age and relative skeletal age (the difference between skeletal and chronological ages) are positive and generally low, ranging from 0.12 to 0.39. They tend to decrease with age from 12 to 17 years. Comparisons between the extreme groups indicate that the leanest boys are more delayed in skeletal maturity, by about 0.8 years, than the fattest boys are advanced, by about 0.5 years. Stature data for the same boys are consistent with the skeletal maturity data and thus suggest that the size differences between the extreme groups are due in part to maturity differences. Over the age span 12 through 20 years, the leanest boys are reduced in stature by about – 1.2 standard deviations, while the fattest boys are larger in stature by about +0.6 standard deviation units. The size differences, however, persist after skeletal maturity is attained so that there may be a specific role for fatness in influencing statural growth.