Associations between the rates of elongation of the short bones of the hand

Data from serial radiographs of 40 children were used to study the rates of total, diaphyseal and epiphyseal elongation of the bones of the hand from 3–13 years. Communality indices were calculated from complete correlation matrices for each sex. These indices tended to be lower for boys than girls. Communality indices for distal phalanges were lower than for the other bones and those for epiphyseal elongation were lower than those for total or diaphyseal elongation. Correlations between groups of bones in their rates of elongation were higher in rows of bones than in rays. There were statistically significant neighborhood effects and a slight tendency to marginal effects in the correlations between rates of elongation in rows of bones; neither of these effects was present in rays.     

Correlations between rates of epiphyseal and diaphyseal elongation in the short bones of the hand

Serial annual radiographs of the hand have been used to analyze the rates of elongation of the epiphyses and diaphyses of the metacarpals and phalanges in children at ages from 3 to 13 years. The rates of elongation for many corresponding ephiphyses and diaphyses (i.e., of the same bone) are negatively correlated but to an extent that is not statistically significant for any particular bone. This tendency toward negative correlations is found for most of these bones although the correlation coefficients for most of the metacarpals are positive in each sex. Within rays, the correlation indices between the rates of elongation for corresponding epiphyses and diaphyses (i.e., of the same bone) have larger negative or smaller positive values than for those between either adjacent and non-corresponding or non-adjacent and non-corresponding epiphyses and diaphyses (i.e., not of the same bone but of either adjacent or non-adjacent bones). The communality indices for the ratio between the rates of epiphyseal and diaphyseal elongation in particular bones are more highly correlated in the girls than in the boys and within the rows than within the rays. Some implications of the tendency to negative correlations between the rates of elongation of corresponding epiphyses and diaphyses have been discussed.     

Associations between the rates of maturation of the bones of the hand-wrist

Skeletal maturation rates for the age interval 3 to 13 years were analyzed using bone-specific assessments (Greulich-Pyle) of serial radiographs of 40 children. The mean rates of skeletal maturation resembled those of the population from which the atlas standards had been derived. There was a linear trend of skeletal age against chronological age for most bones in each sex. Regression lines were fitted to these data and the b values of the regression lines were calculated. Communality indices were calculated from an intercorrelation matrix of these b values. There was a statistically significant rank order correlation between the sexes in the communality indices. They tended to be higher in the girls than in the boys and were relatively low for the radius, ulna and carpals. Communality indices within groups of bones were high in all rows, especially the metacarpals, but in each sex they were comparatively low in the first ray (metacarpal plus the phalanges of the corresponding digit) and in the fifth ray of the boys. Neighborhood effects on the levels of association of maturation rates were present, particularly in the carpus, but marginal effects were not noted.     

Principal component analysis of the elongation of metacarpal and phalangeal bones

A hypothesis that the first principal component computed from the covariance matrix of logarithms reflected the specific growth rates of corresponding bones was taken to analyze the growth pattern of the tubular bones of the hand. The total length of 19 tubular bones of the right hand was measured on standardized radiographs of Japanese children (33 boys, 33 girls). Metacarpals in boys and bones of the fifth digit in girls showed higher growth coefficients. The second, third and fourth proximal, and the third and fourth middle phalanges showed lower coefficients for both sexes. These observations suggest the signs of proximal row dominance in boys and of fifth ray dominance in girls in the elongation of the hand bones. A marked sex difference was found in the fifth middle phalanx. In girls the growth coefficients of this bone was much larger than any other bones, but was moderate in boys.     

Rates of change in width and length-width ratios of the diaphyses of the hand

The minimum width and the length of each diaphysis of the hand were measured on serial radiographs of 20 boys and 20 girls. These radiographs were taken close to each birthday at ages from 3 to 13 years inclusive. The corresponding length-width ratios were calculated from these parameters. The b values (indicating rates of change) were calculated for width and length-width ratio in each diaphysis in each child. Communality indices (mean r between b values) were calculated for individual diaphyses. These communality indices reflect the associations between each diaphysis and all the other diaphyses of the hand in their rates of change in width and length-width ratio. The sex differences were not statistically significant for mean b values but they were significant for the communality indices for width (boys higher) and length-width ratio (girls higher). Statistically significant neighborhood effects were present in communality indices for widths within rays for the girls and for ratios within rays for both sexes. There were statistically significant marginal effects in communality indices for widths in the girls within rows and for length-width ratios in the boys within rays.     

Growth curves of children with Down syndrome.

Growth curves of 105 children with Down syndrome (50 boys and 55 girls) were established. At birth height, weight and head circumference of Down syndrome children were lower than these parameters in controls. This delay remained stable until puberty. For weight there was no clear-cut pubertal growth spurt. For stature, the prepubertal growth spurt occurred earlier (at the age of 11 years in boys and 9 1/2 years in girls) than in controls but was less marked. As a result, Down syndrome patients had a short stature with a quite normal weight. These reference curves, available since prenatal diagnosis of Down syndrome is performed routinely, are helpful for monitoring normal and abnormal development in Down syndrome patients.     

Associations between the rates of maturation and growth in the short bones of the hand

Serial radiographs of the hand-wrist were used to analyze the associations within bones between the rates of change in skeletal maturity, diaphyseal and epiphyseal lengths and diaphyseal width. In previous studies of these children, it has been shown that these rates are linear in relation to chronological age. The associations between the rates of change in these parameters were analyzed using the slopes (b values) for regression lines flitted to the data in each child. In individual bones, most of the correlation coefficients were moderate to low; some were negative. For most associations in each sex they were relatively high for metacarpal II. The rates of skeletal maturation and diaphyseal elongation were correlated more highly in the girls than in the boys but the rates of skeletal maturation and epiphyseal elongation were correlated more highly in the boys. When bones were considered in groups, relatively high correlations were noted for the metacarpals and ray II, lower correlations were common for the middle and distal phalanges. There was no evidence of real neighborhood effects but marginal effects were present.     

Polymorphisms in genes involved in folate metabolism as maternal risk factors for Down syndrome

Down syndrome is a complex genetic and metabolic disorder attributed to the presence of three copies of chromosome 21. The extra chromosome derives from the mother in 93% of cases and is due to abnormal chromosome segregation during meiosis (nondisjunction). Except for advanced age at conception, maternal risk factors for meiotic nondisjunction are not well established. A recent preliminary study suggested that abnormal folate metabolism and the 677C-->T polymorphism in the methylenetetrahydrofolate reductase (MTHFR) gene may be maternal risk factors for Down syndrome. The present study was undertaken with a larger sample size to determine whether the MTHFR 677C-->T polymorphism was associated with increased risk of having a child with Down syndrome. Methionine synthase reductase (MTRR) is another enzyme essential for normal folate metabolism. A common polymorphism in this gene was recently associated with increased risk of neural tube defects and might also contribute to increased risk for Down syndrome. The frequencies of the MTHFR 677C-->T and MTRR 66A-->G mutations were evaluated in DNA samples from 157 mothers of children with Down syndrome and 144 control mothers. Odds ratios were calculated for each genotype separately and for potential gene-gene interactions. The results are consistent with the preliminary observation that the MTHFR 677C-->T polymorphism is more prevalent among mothers of children with Down syndrome than among control mothers, with an odds ratio of 1.91 (95% confidence interval [CI] 1.19-3.05). In addition, the homozygous MTRR 66A-->G polymorphism was independently associated with a 2. 57-fold increase in estimated risk (95% CI 1.33-4.99). The combined presence of both polymorphisms was associated with a greater risk of Down syndrome than was the presence of either alone, with an odds ratio of 4.08 (95% CI 1.94-8.56). The two polymorphisms appear to act without a multiplicative interaction.     

The effect of a pattern in palmar interdigital II on a-b ridge count in black and white Down syndrome cases and controls

An unconfirmed study by Fang (Ph.D. thesis, Univ. of London, 1950) in Britain showed that individuals with Down syndrome had lower total a-b ridge counts in palmar Interdigital area II (ID II) than a group of controls. This study compares 603 white Down syndrome cases and 93 black Down syndrome cases with 668 white and 402 black controls. Our results confirm those of Fang in that the Down syndrome cases in both racial groups had lower total a-b ridge counts than their respective controls. In addition, the black controls and Down syndrome cases had lower a-b ridge counts than their white counterparts. The mean a-b ridge count was significantly lower in individuals with a pattern in ID II compared to individuals without a pattern in ID II in both the Down syndrome and control groups. Some of the lower a-b ridge counts in the Down syndrome samples can be accounted for by the fact that there is an increased frequency of a pattern in ID II in Down syndrome cases. Both Down syndrome and normal individuals who had a pattern unilaterally had a lower than expected a-b ridge count on the contralateral hand that did not have a pattern. There was a tendency also for increased asymmetry in Down syndrome cases with a pattern in ID II.     

Pericardial effusion due to hypothyroidism in Down syndrome: report of four cases

Pericardial effusion may be the first sign of congenital or acquired hypothyroidism and will completely resolve after thyroxin therapy. Hypothyroidism is more common in Down syndrome population than normal population. In this report we present four infants with Down syndrome who have pericardial effusion due to congenital hypothyroidism. All of these children with Down syndrome were admitted to our clinic with pericardial effusion. Pericardial effusion was completely resolved with thyroxin therapy without pericardiosentesis. Any child with Down syndrome who present with dyspnea and cardiomegaly should be suspected of having pericardial effusion due to hypothyroidism and echocardiography examination should be performed immediately. Pericardial effusion due to hypothyroidism will completely resolve with L-thyroxin therapy without pericardiosentesis. In conclusion, since a delayed diagnosis of hypothyroidism is likely and may favor the development of massive pericardial effusion and because of the difficult diagnosis of the hypothyroidism in Down syndrome, periodic follow-up of thyroid function tests are important.     

Differences in maternal age-specific rates of Down syndrome between Jews of European origin and of North African or Asian origin.

Rates of Down syndrome in livebirths in West Jerusalem in 1964-1975 were studied in relation to the mother's continent of birth or, if she was born in Israel, to the maternal grandfather's continent of birth. In women of European origin the crude livebirth rate of Down syndrome was 1.3 per 1,000 livebirths. This crude rate and the maternal age-specific rates in this group were very close to those observed in a Swedish study and two studies of white livebirths in the United States. For West Jerusalem women of North African or Asian origin the crude rate was about 2.4 per 1,000 livebirths, and at all maternal ages except the youngest their rates were higher than for women of European origin. The summary adjusted relative risk for a Down syndrome livebirth for all those of North African or Asian origin, compared to those for women of European origin, was about 1.56. If attention is restricted to mothers born outside of Israel, the adjusted relative risk for mothers born in Europe, the Americas or English speaking countries of the British commonwealth compared to those born in North Africa or Asia was 1.97, consistent with a two-fold difference in the likelihood of a Down syndrome livebirth between thes two groups. To our knowledge this is the first report of ethnic differences in maternal age specific rates of Down syndrome that cannot be plausibly explained by differences in ascertainment.     

Hospital Admissions in Children with Down Syndrome: Experience of a Population-Based Cohort Followed from Birth

Objective

Children with Down syndrome, the most common genetic cause of intellectual disability, are prone to multiple and varied health-related problems. This study describes patterns of hospitalisations for children and young people with Down syndrome in Western Australia.

Methods

Birth records were linked to the Western Australian population-based Intellectual Disability database to identify all children born with Down syndrome in Western Australia between 1 January, 1983 and 31 December, 1999. These records were linked to the Hospital Morbidity Data System to provide information on all hospitalisations up to 31 December, 2004. Hospitalisation data, coded using ICD-9CM or ICD-10 (v0.5) were grouped into clinically relevant categories using the primary diagnosis. Rates of hospital admission for all and specific diagnoses were expressed in 1000-person-years at-risk and median age at first admission and length of stay were calculated.

Results

Of the 405 children, 395 had one or more hospital admissions, totalling 3786 admissions for all children and an estimated 39.5 person-years in hospital. On average, children were admitted 9.7 times, with an estimated rate of 757.2 admissions per 1000pyr (95% CI: 680, 843). A quarter of all admissions occurred in the first year of life. The average hospital length of stay was 3.8 days (95% CI: 3.7, 4.1). Upper respiratory tract conditions affected the most children (58.5%) and accounted for 12.1% of all admissions. Other disorders which affected a high percentage of children were ear/hearing conditions (50.6%), disorders of the oral cavity (38.0%) and lower respiratory tract conditions (37.5%). Overall, children with Down syndrome were hospitalised at a rate five times (95% CI = 4.3–6.2) that of the general population.

Conclusion

Children with Down syndrome are at increased risk of morbidity for varied causes underlining the importance of comprehensive and targeted primary care for this group.     

Anti-inflammatory plasma cytokines in children and adolescents with Down syndrome

Cytokines participate in many physiological processes including the regulation of immune and inflammatory responses. Production of some important cytokines in children with Down syndrome (DS) is depressed or increased. In this study we analysed the selected anti- inflammatory cytokines: interleukin-4 (IL-4), interleukin-10 (IL-10), interleukin-13 (IL-13) in plasma of children and adolescents with DS. The study group consisted of 20 patients with Down syndrome and 33 healthy subjects at the age of 5-17 years. Levels of: IL-4, IL-10 and IL-13 in plasma samples were determined by specific enzyme- linked immunosorbent assay (ELISA) techniques according to manufacturer's instructions. IL-4 was detectable in 25% subjects with Down syndrome and in 28.6% healthy subjects. IL-13 was detectable in 15% patients with Down syndrome and in 15.2% healthy subjects, respectively. IL-10 was detectable in 1 of 20 patients with Down syndrome and in 2 of 33 healthy subjects only. No significant correlations between measurable cytokine levels and age and gender were found. No significant increased concentration of selected anti- inflammatory cytokines were detected.     

南宁地区唐氏综合征患者的细胞遗传学研究

为了探讨中国南宁地区唐氏综合征患者染色体核型分布及其特点, 对广西壮族自治区妇幼保健院1994年以来的500例疑似唐氏综合征(Down syndrome, DS)患者进行外周血染色体核型分析, 130例确诊为DS患者。其中, 单纯型21-三体为86.15%(112/130); 易位型为8.46%(11/130); 嵌合型为5.39%(7/130)。在单纯型21-三体中性别比为女∶男=1∶1.8; 93.08% 的唐氏综合征患儿由年轻母亲(<35岁)所生, 另有6.92% 由高龄产妇所生。结果表明, 南宁地区86% 以上唐氏综合征患者的染色体核型是单纯型21-三体, 男性唐氏综合征患儿明显高于女性患儿。     

Mutation rates for unbalanced Robertsonian translocations associated with Down syndrome. Evidence for a temporal change in New York State live births 1968--1977.

The mutation rate for translocation Down syndrome was investigated for New York State live births for each of the years 1968--1977 using data from the New York State Chromosome Registry. The overall rate was 2.5 X 10(-5) per gamete (1.4 X 10(-5) for G/21 and 1.0 X 10(-5) for D/21 rearrangements), about 20% higher than rates previously reported by two other studies. For the first 5-year period, 1968--1972, the rate was 1.8 X 10(-5), and for the second 5-year period, 3.1 X 10(-5); there was an abrupt change in 1973 and 1974 to rates more than twice that in the 3 preceding years. These rates were derived by applying completeness estimates for all cases of Down syndrome, mostly 47,trisomy 21, in the jurisdiction to cases with translocation Down syndrome mutations. If completeness corrections are ignored and only the minimum boundaries of rates are considered, however, the increase in 1973 and 1974 was even greater compared with the previous 3 years. The trends, if not attributable to an undetected artifact, may have been caused by an increased frequency of mutant zygotes and/or enhanced intrauterine survival of mutant translocations.     

Molecular changes in fetal Down syndrome brain

Trisomy of human chromosome 21 is a major cause of mental retardation and other phenotypic abnormalities collectively known as Down syndrome. Down syndrome is associated with developmental failure followed by processes of neurodegeneration that are known to supervene later in life. Despite a widespread interest in Down syndrome, the cause of developmental failure is unclear. The brain of a child with Down syndrome develops differently from that of a normal one, although characteristic morphological differences have not been noted in prenatal life. On the other hand, a review of the existing literature indicates that there are a series of biochemical alterations occurring in fetal Down syndrome brain that could serve as substrate for morphological changes. We propose that these biochemical alterations represent and/or precede morphological changes. This review attempts to dissect these molecular changes and to explain how they may lead to mental retardation.     

Recurrence risks for down syndrome

Summary The recurrence risks for Down syndrome due to an inherited translocation are estimated from empirical data in the literature for two maternal age groups: mothers under 30 and mothers 30 and over. These risks were found to be approximately 0.3% and 0.05%, respectively. The probability for two Down syndrome sibs both having an inherited translocation was estimated as about 18.2% for the former age group and 2.7% for the latter. The relative effectiveness in preventing Down syndrome births by karyotyping affected children is discussed.     

Changes in the incidence of Down syndrome in Sweden during 1968–1982

Summary A continuous increase in the incidence of Down syndrome in Sweden was noted during 1979–1981. This increase mainly occurred among children of younger mothers and was more pronounced for hte males than for the females. There was no evidence of a significant seasonal variation, increased frequency of prematurely born children, or decrease in the number of cases aborted after prenatal diagnosis. An analysis of the whole 15-year period indicates that the incidence of Down syndrome has increased slowly in both sexes, and that there might have been a superimposed cyclic variation limited to the males.     

Risk of Down syndrome in relatives of trisomy 21 children. A case-control study

We conducted a case-control study in families of Down syndrome children with classical trisomy 21 (n = 188) and in a control group of families of children referred to the same hospital for benign diseases (n = 185). The low sibling number does not allow any conclusion about the risk for sibs but our results do not support an increased incidence of Down syndrome among second and third degree relatives of trisomy 21 children. The choice of the control group and the restriction to close relatives protect us against biases which may have interfered in previous studies reporting recurrence in families.     

Frequency of Down syndrome in livebirths by single-year maternal age interval: results of a Massachusetts study.

An analysis of rates of intra-state Down syndrome livebirths to Massachusetts residents by single-year maternal age interval in 1958-1965 inclusive was carried out. A gradual increase of rate of the Down syndrome occurred from age 20 to about age 31, and a steeper increase thereafter. Different regression equations were derived in the 20-31 and the 33-45 age group. The regression equations were ln y = 0.04515 x -1.45759 for those age 20-31 and ln y = 0.24302x-7.57870, for those age 33-45, where y = rate per 1,000 and x = maternal age. The regression-derived rates are slightly lower than those reported in similar analyses of data from Sweden and New York State, but they are not markedly discrepant.