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Entheses are acknowledged as skeletal markers capable of revealing several biological and behavioral aspects of past individuals and populations. However, entheseal changes (ECs) of juvenile individuals have not yet been studied with a systematic approach. This contribution aims at investigating the morphological changes occurring at the femoral insertion of the gluteus maximus and tibial origin of the soleus muscles to highlight a potential link between the morphological features of those entheses and skeletal maturity in relation to sex, age, and locomotor developmental patterns. The sample consisted of 119 skeletons (age‐at‐death: 0–30 years) belonging to the Documented Human Skeletal Collection of the Certosa Cemetery (Bologna, Italy). The entheseal variation during the last stages of skeletal maturation in young adults was assessed using existing recording standards. A recording protocol for each enthesis was developed for immature individuals to subdivide the morphological variability into discrete categories. Univariate, bivariate, and multivariate statistical analyses were performed to investigate the variation of entheseal morphologies and measurements in relation to bone metrics, degree of epiphyseal closure, sex, age, and locomotor developmental patterns. A statistically significant relationship was observed between ECs morphological patterns and age for both entheses, while sexual differences were negligible. A relationship between ECs morphological pattern and locomotor milestones emerged only for the gluteus maximus. Even though further testing is needed on other documented skeletal collections, our protocol could be usefully applied in forensic and archaeological fields and serving as important reference for evolutionary investigations. [ABSTRACT FROM AUTHOR]

Adolescence is a timed process with an onset, tempo, and duration. Nevertheless, the temporal dimension, especially the pace of maturation, remains an insufficiently studied aspect of developmental progression. The primary objective is to estimate the precise influence of pubertal maturational tempo on the configuration of associative brain regions. To this end, the connection between maturational stages and the level of hierarchical organization of large‐scale brain networks in 12‐13‐year‐old females is analyzed. Skeletal maturity is used as a proxy for pubertal progress. The degree of maturity is defined by the difference between bone age and chronological age. To assess the level of hierarchical organization in the brain, the temporal dynamic of closed eye resting state high‐density electroencephalography (EEG) in the alpha frequency range is analyzed. Different levels of hierarchical order are captured by the measured asymmetry in the directionality of information flow between different regions. The calculated EEG‐based entropy production of participant groups is then compared with accelerated, average, and decelerated maturity. Results indicate that an average maturational trajectory optimally aligns with cerebral hierarchical order, and both accelerated and decelerated timelines result in diminished cortical organization. This suggests that a "Goldilocks rule" of brain development is favoring a particular maturational tempo. [ABSTRACT FROM AUTHOR]

The floating toe deformity is classified as a forefoot deformity wherein the distal portion of the toe does not establish touch with the ground, resulting in a suspended or elevated position while the finger is in a relaxed state. At first, it garnered considerable interest as a complication It is worth noting that this condition is particularly common in children under the age of 8, which usually disappears as the individual reaches maturity. Studies have shown that with the aggravation of floating toe deformity, its adverse effects on patients' gait and overall quality of life also increase. Despite the prevalence of floating toe deformity in clinical settings, there is a lack of comprehensive literature investigating its underlying causes and potential preventive strategies. This scope review follows the preferred reporting items for systematic reviews and meta‐analyses extension for scoping reviews (PRISMA‐ScR) statement guidelines for scope reviews. The literature was obtained from various full‐text databases, including China National Knowledge Infrastructure Database (CNKI), Wanfang Database, PubMed, and Web of Science Database. Our search focused on published literature related to floating toes, Weil osteotomy, and distal metatarsal osteotomy, up until March 1, 2023. The literature search and data analysis are conducted by two independent reviewers. If there are any disagreements, a third researcher will participate in the discussion and negotiate a decision. Furthermore, two experienced foot and ankle surgeons conducted a thorough literature analysis for this review. Sixty‐two articles were included. Through the clinical analysis of the structural changes of the forefoot before and after operation, the classification of floating toe was described, the causes of pathological floating toe were summarized, and the possible intervention measures for the disease were put forward under the advice of foot and ankle surgery experts. We comprehensively summarize the current knowledge system about the etiology of floating toe and put forward the corresponding intervention strategy. We recommend that future studies will focus on the improvement of surgical procedures, such as the combination of Weil osteotomy, proximal interphalangeal (PIP) arthrodesis and flexor tendon arthrodesis. [ABSTRACT FROM AUTHOR]

Background/Aims: Dental trauma resulting in tooth intrusion is a severe injury of permanent dentition, with a prevalence of 0.5%–1.9% among traumatic dental injuries. Currently, treatment guidelines for intruded permanent teeth depend on root development and the degree of intrusion. However, the categorization of tooth maturity as mature or immature simplifies a complex continuum of root development stages. This study aims to investigate the impact of various stages of root development on the success of spontaneous re‐eruption (SRE) of intruded teeth. Materials and Methods: This retrospective study analysed data from 80 children (125 teeth) aged 6–12 years who experienced dental intrusion between 2018 and 2022. Root maturation was classified based on Cvek's classification, eight were categorized as stage 1, 29 as stage 2, 44 as stage 3, 25 as stage 4, and 19 as stage 5. Intruded teeth with immature roots (Cvek's class 1–4) underwent SRE, while mature teeth (Cvek's class 5) were treated with SRE, orthodontic repositioning, or surgical repositioning based on the degree of intrusion. Primary outcome measures were successful re‐eruption and secondary outcomes included observed complications during follow‐up. Results: Regression analysis revealed that the patient's age, degree of root maturation, and degree of intrusion significantly affected spontaneous re‐eruption (p <.05). SRE was more successful in teeth with Cvek's stages 1 and 2 compared to stages 3 and 4. Complications were associated with the treatment method, degree of root immaturity, and degree of intrusion. Conclusion: The study demonstrates that as root maturation progresses, the likelihood of re‐eruption decreases, and the risk of pulp necrosis and infection increases. Therefore, teeth in later stages of immaturity (Cvek stage 4) should be repositioned orthodontically or surgically without waiting for spontaneous re‐eruption. [ABSTRACT FROM AUTHOR]

Background: Predictive analytics is gaining popularity as an aid to treatment planning for patients with bone metastases, whose expected survival should be considered. Decreased psoas muscle area (PMA), a morphometric indicator of suboptimal nutritional status, has been associated with mortality in various cancers, but never been integrated into current survival prediction algorithms (SPA) for patients with skeletal metastases. This study investigates whether decreased PMA predicts worse survival in patients with extremity metastases and whether incorporating PMA into three modern SPAs (PATHFx, SORG‐NG, and SORG‐MLA) improves their performance. Methods: One hundred eighty‐five patients surgically treated for long‐bone metastases between 2014 and 2019 were divided into three PMA tertiles (small, medium, and large) based on their psoas size on CT. Kaplan–Meier, multivariable regression, and Cox proportional hazards analyses were employed to compare survival between tertiles and examine factors associated with mortality. Logistic regression analysis was used to assess whether incorporating adjusted PMA values enhanced the three SPAs' discriminatory abilities. The clinical utility of incorporating PMA into these SPAs was evaluated by decision curve analysis (DCA). Results: Patients with small PMA had worse 90‐day and 1‐year survival after surgery (log‐rank test p < 0.001). Patients in the large PMA group had a higher chance of surviving 90 days (odds ratio, OR, 3.72, p = 0.02) and 1 year than those in the small PMA group (OR 3.28, p = 0.004). All three SPAs had increased AUC after incorporation of adjusted PMA. DCA indicated increased net benefits at threshold probabilities >0.5 after the addition of adjusted PMA to these SPAs. Conclusions: Decreased PMA on CT is associated with worse survival in surgically treated patients with extremity metastases, even after controlling for three contemporary SPAs. Physicians should consider the additional prognostic value of PMA on survival in patients undergoing consideration for operative management due to extremity metastases. [ABSTRACT FROM AUTHOR]

"Rauisuchia" is a non‐monophyletic group of quadrupedal and carnivorous pseudosuchians that inhabited the entire world during the Middle–Upper Triassic period (Anisian/Ladinian–Rhaetian). In South America, "rauisuchians" reached the largest sizes among continental carnivores. Despite their important ecological role, some aspects of their palaeobiology have been poorly examined. Here, we study appendicular bones, dorsal ribs and osteoderms of two genera, the Argentinean Fasolasuchus tenax (PVL 3850, holotype) and the Brazilian Prestosuchus chiniquensis (SNSB‐BSPG AS XXV) respectively. The femur of F. tenax is formed by laminar fibrolamellar bone, which is composed of non‐fully monorefringent woven‐fibred matrix and primary osteons; the dorsal rib has a Haversian bone composition with an external fundamental system recorded and the osteoderm is formed by well‐organised parallel‐fibred bone. The femur, humerus and fibula of P. chiniquensis are mostly composed of strongly arranged parallel‐fibred bone and a laminar vascularisation. The minimal ages obtained correspond to 9 years for F. tenax (based on the maximum number of growth marks in the osteoderm) and 4 years for P. chiniquensis (obtained from the highest count of growth marks in the femur and in the humerus). F. tenax attained somatic and skeletal maturity, while P. chiniquensis was near to reaching skeletal and sexual maturity, but it was somatically immature. The overall rapid growth rate and the high and uniform vascularisation seems to imply that these features are common in most of "rauisuchians", except in P. chiniquensis. [ABSTRACT FROM AUTHOR]

Summary: The United Nations Convention on the Rights of the Child emphasizes the importance of allowing children and adolescents to influence decisions that are important to them following their age and maturity. This paper explores the principles, practices, and implications around using parental versus child/adolescent consent when participating in social science research and policy development. Experiences from two studies are presented: The Confronting Obesity: Co‐creating policy with youth (CO‐CREATE) and the Health Behaviour in School‐aged Children (HBSC) study, a World Health Organization (WHO) Collaborative Cross‐National study. Although parental consent may be an important gatekeeper for protecting children and adolescents from potentially harmful research participation, it may also be considered an obstacle to the empowerment of children and adolescents in case they want to share their views and experiences directly. This paper argues that evaluation of possible harm should be left to ethics committees and that, if no harm related to the research participation processes is identified and the project has a clear perspective on collaborating with the target group, adolescents from the age of 12 years should be granted the legal capacity to give consent to participate in the research project. Collaboration with adolescents in the development of the research project is encouraged. [ABSTRACT FROM AUTHOR]

Background: Survival is an important factor to consider when clinicians make treatment decisions for patients with skeletal metastasis. Several preoperative scoring systems (PSSs) have been developed to aid in survival prediction. Although we previously validated the Skeletal Oncology Research Group Machine‐learning Algorithm (SORG‐MLA) in Taiwanese patients of Han Chinese descent, the performance of other existing PSSs remains largely unknown outside their respective development cohorts. We aim to determine which PSS performs best in this unique population and provide a direct comparison between these models. Methods: We retrospectively included 356 patients undergoing surgical treatment for extremity metastasis at a tertiary center in Taiwan to validate and compare eight PSSs. Discrimination (c‐index), decision curve (DCA), calibration (ratio of observed:expected survivors), and overall performance (Brier score) analyses were conducted to evaluate these models' performance in our cohort. Results: The discriminatory ability of all PSSs declined in our Taiwanese cohort compared with their Western validations. SORG‐MLA is the only PSS that still demonstrated excellent discrimination (c‐indexes>0.8) in our patients. SORG‐MLA also brought the most net benefit across a wide range of risk probabilities on DCA with its 3‐month and 12‐month survival predictions. Conclusions: Clinicians should consider potential ethnogeographic variations of a PSS's performance when applying it onto their specific patient populations. Further international validation studies are needed to ensure that existing PSSs are generalizable and can be integrated into the shared treatment decision‐making process. As cancer treatment keeps advancing, researchers developing a new prediction model or refining an existing one could potentially improve their algorithm's performance by using data gathered from more recent patients that are reflective of the current state of cancer care. [ABSTRACT FROM AUTHOR]

Palaeohistological analysis has numerous applications in understanding the palaeobiology of extinct dinosaurs. Recent developments of synchrotronradiation- based X-ray micro-tomography (SXMT) have allowed the nondestructive assessment of palaeohistological features in fossil skeletons. Yet, the application of the technique has been limited to specimens on the millimetre to micrometre scale because its high-resolution capacity has been obtained at the expense of a small field of view and low X-ray energy. Here, SXMT analyses of dinosaur bones with widths measuring ~3 cm under a voxel size of ~4 mm at beamline BL28B2 at SPring-8 (Hyogo, Japan) are reported, and the advantages of virtual-palaeohistological analyses with large field of view and high X-ray energy are explored. The analyses provide virtual thin-sections visualizing palaeohistological features comparable with those obtained by traditional palaeohistology. Namely, vascular canals, secondary osteons and lines of arrested growth are visible in the tomography images, while osteocyte lacunae are unobservable due to their micrometre-scale diameter. Virtual palaeohistology at BL28B2 is advantageous in being non-destructive, allowing multiple sampling within and across skeletal elements to exhaustively test the skeletal maturity of an animal. Continued SXMT experiments at SPring-8 should facilitate the development of SXMT experimental procedures and aid in understanding the paleobiology of extinct dinosaurs. [ABSTRACT FROM AUTHOR]

The aim of this study was to explore the association between developing coronal‐plane leg alignment and activity levels during adolescence. We performed a cross‐sectional cohort study with individuals from soccer club academies and an age‐matched control population. Outcome measures were the hip knee angle (HKA), medial proximal tibial physeal angle (MPTPhyA), lateral distal femoral physeal angle (LDFPhyA) on full leg length magnetic reasonance imagine scans, and the physical activity questionnaire (PAQ) score. The cohort comprised 57 elite male soccer players, 34 male and 34 female controls aged 11−21 years. Mean HKA became more varus with age, with little change after 16 years or skeletal maturity. Skeletally mature elite male soccer players were significantly more varus than male controls with a HKA 2.28° less than male controls (p < 0.001). Skeletally mature male controls had a HKA 1.34° less than female controls (p < 0.001). A negative correlation existed between HKA and PAQ score (coefficient −0.24, p = 0.029). A positive correlation existed between HKA and MPTPhyA (coefficient 0.32, p = 0.008). In conclusion, high activity levels during adolescence are associated with the development of varus leg alignment. Mean HKA becomes more varus with age until skeletal maturity. The development of varus alignment may represent a physiological adaptation to load at the proximal tibial physis. Clinical Significance: A time period may exist for intervention before the development of varus leg alignment in young athletes, such as training load modification or proximal tibial morphology monitoring. [ABSTRACT FROM AUTHOR]

Aim: To describe the particular craniofacial characteristics of Van der Woude syndrome(VWS) patients compared to patients with a non‐syndromic cleft (CG1) and to a malocclusive healthy population (CG2). Material and methods: Retrospective case‐control study. A sample of 110 matched‐patients was recruited (VWS (n = 7), CG1 (n = 49), CG2 (n = 49)). Subsequently, 37 radiometric variables were analysed and the dental‐skeletal ages were determined. The intra/inter‐observer method errors were quantified. Descriptive statistics were computed, and different inferential analysis tests were used depending on the normality of the data (Chi‐square test, Fisher's exact test, paired Student's T‐test, Mann–Whitney U test) (p‐value < 0.05). Pairwise comparisons were corrected by Bonferroni's criteria. Results: VW‐patients presented specific craniofacial characteristics and morphology. A marked tendency to the vertical growth pattern was found in VW‐patients compared to CG1‐CG2 (p < 0.001); at the sagittal level, skeletal class II caused by mandibular retrognathism, with a greatly increased ANB angle compared to CG1 (p = 0.042). Dental analysis showed that the lower incisor was more retruded and retroclined (p < 0.05 in all cases) and the interincisal angulation was increased (p < 0.001 (CG2)). At the profile level, an open nasolabial angle (p = 0.040; CG1) and a more protruding lower lip with respect to the Sn‐Pg plane (p = 0.040 (CG1); p = 0.044 (CG2)) were observed. Conclusions: VW‐patients present particular characteristics in the facial skeletal structures. There is a critical necessity to increase the evidence regarding specific clinical features and orofacial pathology of rare diseases such as VWS, which will help to these minorities to gain access in the future to a better quality of care with precise treatment and diagnostic necessities. [ABSTRACT FROM AUTHOR]

Introduction: Avascular necrosis (AVN) is a severe complication of sickle cell disease (SCD) and involves principally the femoral head. Few data exist about the prevalence of lesions in other segments. Methods: In this cross‐sectional study, 42 children (20 males and 22 females) underwent a magnetic resonance imaging (MRI) of the spine, upper arms, and femurs. The primary outcome was to define the prevalence and locations of bone infarcts. Results: Forty‐two patients completed the study; the total median age was 11.9 years (interquartile range = 9.5–13.9). Eleven patients (26.2%) were positive for altered bone findings for a total of 32 lesions. Most of the lesions were in the humerus 17 (53.1%), 11 (34.4%) in the femurs, and 4 (12.5%) in the vertebrae. The median number of vaso‐occlusive crises (VOCs) was two and four for patients without and with bone lesions, respectively (p =.01). The annual rate of VOC is the best marker for the positive MRI (odds ratio = 82.6; p =.03), and it is correlated with the number of sites involved (p =.02). Conclusions: Our study highlights that the prevalence of skeletal lesions could be underestimated, and it provides the basis for clinical reasoning and tailored therapy in SCD children. [ABSTRACT FROM AUTHOR]

Accurate analysis of the maturity grade of the reference bone in the wrist is critical for bone age assessment. The main difference between the maturity grades of the reference bone in the wrist X‐ray image is the difference in the texture and morphological characteristics of the bone, and the difference in the characteristics between adjacent levels is small, which brings great challenges in bone age assessment. The hamate (the wrist bone in line with the 4th and 5th fingers) is one of the most important reference bones in the standards of skeletal maturity of the hand and wrist for the Chinese (CHN) method. Aiming at the problem of hamate maturity level evaluation, a method of hamate maturity level classification based on feature enhanced residual network and probability joint judgment is proposed. In this method, we propose the enhanced characteristic residual network (ECR‐Net) is proposed to enhance the feature extraction capability of the network and improve the loss function to reduce the impact of cross‐grade errors on the accuracy of bone age assessment. On this basis, multiple convolutional neural networks to make joint probabilistic judgments are relied on to obtain the final hamate maturity grade. The proposed ECR‐Net achieves a macro accuracy of 96.92% on the hamate maturity evaluation, and there are no errors across two levels. Also, this approach achieves a macro accuracy of 97.15% when the probabilistic joint judgment method is employed while avoiding errors that span more than two levels. The network model and method proposed in this paper have good accuracy and practicability for the automatic identification of the hamate maturity level, which is of great significance for the accurate assessment of bone age. [ABSTRACT FROM AUTHOR]

Adolescent obesity has risen dramatically in the last few decades. While adult obesity may be osteoprotective, the effects of obesity during adolescence, which is a period of massive bone accrual, are not clear. We used a murine model of induced adolescent obesity to examine the structural, mechanical, and compositional differences between obese and healthy weight bone in 16‐week‐old female C57Bl6 mice. We also examined the effects of a return to normal weight after skeletal maturity (24 weeks old). We found obese adolescent bone exhibited decreased trabecular bone volume, increased cortical diameter, increased ultimate stress, and increased brittleness (decreased plastic energy to fracture), similar to an aging phenotype. The trabecular bone deficits remained after return to normal weight after skeletal maturity. However, after returning to normal diet, there was no difference in ultimate stress nor plastic energy to fracture between groups as the normal diet group increased ultimate stress and brittleness. Interestingly, compositional changes appeared in the former high‐fat diet mice after skeletal maturity with a lower mineral to matrix ratio compared to normal diet mice. In addition there was a trend toward increased fluorescent advanced glycation endproducts in the former high‐fat diet mice compared to normal diet mice but this did not reach significance (p < 0.05) due to the large variability. The skeletal consequences of adolescent obesity may have lasting implications for the adult skeleton even after return to normal weight. Given the rates of adolescent obesity, skeletal health should be a concern. [ABSTRACT FROM AUTHOR]

Taste cells are a heterogeneous population of sensory receptors that undergo continuous turnover. Different chemo‐sensitive cell lines rely on action potentials to release the neurotransmitter onto nerve endings. The electrical excitability is due to the presence of a tetrodotoxin‐sensitive, voltage‐gated sodium current (INa) similar to that found in neurons. Since the biophysical properties of neuronal INa change during development, we wondered whether the same also occurred in taste cells. Here, we used the patch‐clamp recording technique to study INa in salt‐sensing cells (sodium cells) of rat fungiform papillae. We identified these cells by exploiting the known blocking effect of amiloride on ENaC, the sodium (salt) receptor. Based on the amplitude of INa, which is known to increase during development, we subdivided sodium cells into two groups: cells with small sodium current (SSC cells; INa < 1 nA) and cells with large sodium current (LSC cells; INa > 1 nA). We found that: the voltage dependence of activation and inactivation significantly differed between these subsets; a slowly inactivating sodium current was more prominent in LSC cells; membrane capacitance in SSC cells was larger than in LSC cells. mRNA expression analysis of the α‐subunits of voltage‐gated sodium channels in fungiform taste buds supported the functional data. Lucifer Yellow labelling of recorded cells revealed that our electrophysiological criterion for distinguishing two broad groups of taste cells was in good agreement with morphological observations for cell maturity. Thus, all these findings are consistent with developmental changes in the voltage‐dependent properties of sodium‐taste cells. Key points: Taste cells are sensory receptors that undergo continuous turnover while they detect food chemicals and communicate with afferent nerve fibres.The voltage‐gated sodium current (INa) is a key ion current for generating action potentials in fully differentiated and chemo‐sensitive taste cells, which use electrical signalling to release neurotransmitters.Here we show that, during the maturation of rat taste cells involved in salt detection (sodium cells), the biophysical properties of INa, such as voltage dependence of activation and inactivation, change significantly.Our results help reveal how taste cells gain electrical excitability during turnover, a property critical to their operation as chemical detectors that relay sensory information to nerve fibres. [ABSTRACT FROM AUTHOR]

Introduction: Biological maturity level has shown to affect sport performance in youths. However, most previous studies have used noninvasive methods to estimate maturity level. Thus, the main aim of the present study was to investigate the association between skeletal age (SA) as a measure of biological maturation level, match locomotion, and physical capacity in male youth soccer players. Method: Thirty‐eight Norwegian players were followed during two consecutive seasons (U14 and U15). Match locomotion was assessed with GPS‐tracking in matches. SA, assessed by x‐ray, physical capacities (speed, strength and endurance) and anthropometrics were measured in the middle of each season. Analysis of associations between SA, match locomotion, and physical capacities were adjusted for the potential confounding effect of body height and weight. Results: In matches, positive associations were found between SA and maximal speed and running distance in the highest speed zones. Further, SA was associated with 40 m sprint time and countermovement jump (CMJ) height, and with intermittent‐endurance capacity after adjusting for body height (U14). Associations between SA and leg strength and power, and between SA and absolute VO2max were not significant after adjusting for body weight. There was no association between SA and total distance covered in matches. Conclusion: Biological maturity level influence match locomotion and performance on physical capacity tests. It is important that players, parents and coaches are aware of the advantages more mature players have during puberty, and that less mature players also are given attention, appropriate training and match competition to ensure proper development. [ABSTRACT FROM AUTHOR]

Maturation progresses at different times and at different rates between individuals. Thus, differences in maturity status exist among players in the same chronological age‐based category, especially in U14 players. The purpose of this prospective study was to describe injury burden according to the relative skeletal maturity status in U14 elite academy football players. From 2011 to 2020, injuries and individual exposure (training and match) were prospectively recorded in 183 male U14 players. Skeletal age (SA) was assessed using the Tanner‐Whitehouse 2 method. Relative skeletal maturity status [SA minus chronological age (CA)] was classified as follows: early (SA–CA > 0.5), on‐time (SA–CA ± 0.5), and late (SA–CA < −0.5). Overall and specific injury burden (days lost/1000 h) and rate ratios for comparisons between groups were calculated. Overall injury burden was 2.8 times higher (3.6 times in training) in early maturers compared with late maturers. Growth‐related injuries were the most burdensome injuries in all three groups, but significant differences were not found between groups. Muscle injuries were 4 times more burdensome in early maturers compared with on‐time and late maturers. Besides, joint/ligament injuries were 7 and 12 times less burdensome in late maturers than in on‐time and late maturers, respectively. Significant differences between groups in overall and specific injury burden were not found in matches. Our results showed different injury patterns in U14 early, on‐time, and late maturers. Hence, monitoring maturity seems crucial to detect potential injuries that cause the greatest disruption, and facilitate design of targeted injury prevention programs. [ABSTRACT FROM AUTHOR]

Degeneration of articular cartilage is often triggered by a small tissue crack. As cartilage structure and composition change with age, the mechanics of cracked cartilage may depend on the tissue age, but this relationship is poorly understood. Here, we investigated cartilage mechanics and crack deformation in immature and mature cartilage exposed to a full‐thickness tissue crack using indentation testing and histology, respectively. When a cut was introduced, tissue cracks opened wider in the mature cartilage compared to the immature cartilage. However, the opposite occurred upon mechanical indentation over the cracked region. Functionally, the immature‐cracked cartilages stress‐relaxed faster, experienced increased tissue strain, and had reduced instantaneous stiffness, compared to the mature‐cracked cartilages. Taken together, mature cartilage appears to withstand surface cracks and maintains its mechanical properties better than immature cartilage and these superior properties can be explained by the structure of their collagen fibrous network. [ABSTRACT FROM AUTHOR]

Objectives: Puberty is a crucial part of life, representing the biological transition from childhood to adulthood. With the aim of expanding current knowledge of pubertal development and the life course in past populations, this study provides the first investigation of puberty in pre‐Roman Italy. Materials and methods: Nine skeletal and dental puberty indicators were assessed in a sample of 84 Etruscan and Samnite individuals (8.0–23.9 years) from Pontecagnano (southern Italy, seventh–fourth centuries BC) to garner insights into the timing and duration of different pubertal stages. Results: Adolescents from Pontecagnano entered puberty at 10–12 years and completed pubertal development at approximately 20–21 years. Menarche occurred between 14 and 17 years. Remarkable variability in pubertal timing and an overall prolonged pubertal tempo were observed. Unexpectedly, females completed puberty at the same age as males. Discussion: The onset and completion of puberty in Pontecagnano are mostly in line with pubertal trends emerging from other bioarchaeological studies and historical sources. The considerable inter‐individual variability in pubertal timing seen at the site probably reflects its great sociocultural heterogeneity, whilst the prolonged pubertal tempo could represent an adaptive mechanism in response to environmental disruptors. These may have included endemic diseases characteristic of Pontecagnano's marshy environment and pollutants produced by the Etruscan and Samnite metallurgical industries. Moreover, the role of catch‐up growth in favouring better pregnancy outcomes could explain why female puberty appears particularly stretched. The importance of exploring pubertal development in past societies without culturally biased assumptions is emphasised. [ABSTRACT FROM AUTHOR]

Canonical Wnt signaling plays an important role in skeletal development, homeostasis, and both endochondral and intramembranous repair. While studies have demonstrated that the inhibition of Wnt signaling impairs intramembranous bone regeneration, how its activation affects intramembranous bone regeneration has been underexplored. Therefore, we sought to determine the effects of activation of canonical Wnt signaling on intramembranous bone regeneration by using the well‐established marrow ablation model. We hypothesized that mice with a mutation in the Wnt ligand coreceptor gene Lrp5 would have accelerated intramembranous bone regeneration. Male and female wild‐type and Lrp5‐mutant mice underwent unilateral femoral bone marrow ablation surgery in the right femur at 4 weeks of age. Both the left intact and right operated femurs were assessed at Days 3, 5, 7, 10, and 14. The intact femur of Lrp5 mutant mice of both sexes had higher bone mass than wild‐type littermates, although to a greater degree in males than females. Overall, the regenerated bone volume in Lrp5 mutant male mice was 1.8‐fold higher than that of littermate controls, whereas no changes were observed between female Lrp5 mutant and littermate control mice. In addition, the rate of intramembranous bone regeneration (from Day 3 to Day 7) was higher in Lrp5 mutant male mice compared to their same‐sex littermate controls with no difference in the females. Thus, activation of canonical Wnt signaling increases bone mass in intact bones of both sexes, but accelerates intramembranous bone regeneration following an injury challenge only in male mice. [ABSTRACT FROM AUTHOR]

Aim: To determine the rates of medical investigations, complications, interventions, and outcomes in children with achondroplasia. Method: Children and adolescents with achondroplasia born between 2000 and 2019, aged between 0 and 18 years of age, and seen at The Children's Hospital at Westmead skeletal dysplasia clinic were included. Data were collected retrospectively from clinical records. Standard descriptive statistics were used for analysis. Results: The study included 108 participants, 58 males and 50 females. Ninety‐nine participants (91.7%) entered the study at birth. The other nine (8.3%) participants entered the study after birth (mean age = 2 years 4 months, SD = 1 year 8 months). The median age of exit from the study was 8 years 8 months (IQR = 8 years 9 months) with a median follow‐up of 8 years 8 months (IQR = 8 years 9 months). Fifty‐two (48%) participants presented with craniocervical stenosis, 15 (13.9%) with hydrocephalus, 66 (61.1%) with hearing impairment, 44 (40.7%) with sleep‐disordered breathing, 46 (42.6%) with lower‐limb malalignment, 24 (22.2%) with thoracolumbar kyphosis, 10 (9.3%) with symptomatic spinal stenosis, 12 (11.1%) with obesity, and 16 (14.8%) who had at least one admission for respiratory illness. Two children died during the study period. Interpretation: We report contemporary rates of medical complications in an Australian population of children with achondroplasia. Recommendations for surveillance in clinical practice are discussed. This information will help guide clinicians with their expectant management of achondroplasia and provide prognostic information to the families of children with achondroplasia. [ABSTRACT FROM AUTHOR]

Aim: This study investigated the prevalence of scoliosis in a large, population‐based cohort of individuals with cerebral palsy (CP) at skeletal maturity to identify associated risk factors that may inform scoliosis surveillance. Methods: Young people with CP born between 1990 and 1992 were reviewed through routine orthopaedic review or a transition clinic. Classification of CP was recorded by movement disorder, distribution, gross and fine motor function. Clinical examination was undertaken and those with clinical evidence of scoliosis or risk factors had radiographs of the spine. Scoliosis severity was measured and categorised by Cobb angle. Results: Two hundred and ninety‐two individuals were evaluated (78% of the birth cohort) at a mean age of 21 years, 4 months (range 16–29 years). Scoliosis (Cobb angle >10°) was found in 41%, with strong associations to the Gross Motor Function Classification System (GMFCS), Manual Abilities Classification System (MACS) and dystonic/mixed movement disorders. Those at GMFCS V were 23.4 times (95%CI 9.9–55.6) more likely to develop scoliosis than those at GMFCS I. Severe curves (Cobb >40°, 13% of the cohort) were found almost exclusively in those functioning at GMFCS IV and V, and were 18.2 times (95%CI 6.9–48.5) more likely to occur in those with dystonia than those with spasticity. Conclusions: Scoliosis was very common in young people with CP, with prevalence and severity strongly associated with GMFCS and MACS level and dystonic movement disorder. Severe curves were almost exclusively found in non‐ambulant children. Clinical screening for scoliosis should occur for all children with CP, with radiographic surveillance focusing on those functioning at GMFCS IV and V. [ABSTRACT FROM AUTHOR]

Objective: The purpose of the study was to evaluate the agreement between the Fels and Greulich‐Pyle methods for the assessment of skeletal age (SA) in female youth soccer players. Methods: The sample included 441 Portuguese players 10.08–16.73 years of age who regularly participated in organized and competitive soccer. Standardized radiographs of the left hand‐wrist were obtained and analyzed by an experienced examiner. SA was estimated with the Fels and Greulich‐Pyle (GP) methods. Differences between SA and chronological age (CA) were used to define skeletal maturity groups: late, average and early maturing. In addition to descriptive statistics, Cohen's kappa and Lin concordance correlation coefficients were used to evaluate agreement between methods. Results: Intraindividual differences in SA based on the two methods varied between 0.10 to 1.47 years among age groups with larger mean differences at older ages. Agreement of maturity classifications between methods was 74% at younger ages (under‐13: kappa = 0.48; under‐14: kappa = 0.39; Lin CCC = 0.68) and declined with increasing CA (under‐17: 19% agreement; kappa = 0.001; Lin CCC = 0.11). About 19% of the total sample was skeletally mature with the Fels method and an SA was not assigned; in contrast, no players were skeletally mature with the GP method. Conclusions: GP SAs were systematically lower than Fels SAs among female soccer players. Intraindividual variability in SAs between methods was considerable. The findings highlight the impact of method on estimates of maturity status. [ABSTRACT FROM AUTHOR]

Objective: Frailty is the physiological stress that individuals suffer during their life. In past populations, frailty is conventionally assessed through the occurrence of different biomarkers of biological stress. Some efforts have been made to propose indexes that combine all biomarkers. However, these indices have some critical limitations: they cannot be used on incomplete skeletons, do not consider the severity and/or healing of lesions, and assign equal importance to different biomarkers. To address these limitations, we propose a new index to assess frailty in skeletal individuals. Material and Methods: By statistically analyzing a large amount of osteological data available from the Museum of London, and using a Logit model, we were able to define a different weight for each reported biomarker of frailty, based on their importance in increasing the risk of premature death for the individuals. Results: The biological index of frailty (BIF) is the weighted mean of all biomarkers scored on the individuals, according to a different degree of importance assigned to each one. It also considers the severity and healing of the biomarkers when this is relevant to diagnose frailty. We applied BIF on a sample of Monastics and Non‐Monastics from medieval England and compared it with the skeletal index of frailty (SFI). Discussion BIF is the first frailty index that gives a different weight to each skeletal biomarker of stress, considers both severity and healing of the lesions, and can be applied on partial skeletal remains. The comparison with SFI showed that BIF is applicable to a larger number of skeletal individuals, revealing new differences between the Monastic and the Non‐Monastic groups. [ABSTRACT FROM AUTHOR]

Judging the maturity level of each hand‐wrist reference bone is the core issue in bone age assessment. Relying on the superiority of convolutional neural networks in feature representation, deep learning is widely studied for the automatic bone age assessment. However, an efficient but complex deep learning network requests a large dataset with bone‐maturity‐level labels for training, restricting its large‐scale application in bone maturity classification. For this reason, we transform the bone‐maturity‐level classification problem into the similarity matching problem. Also, we propose a general structure based on Siamese network by merging two inputs into a two‐channel input and introducing a dual attention mechanism, to create an Attentional Two‐Channel Network (ATC‐Net). This paper takes the intermediate phalanges III as an example to assess the performance of the similarity matching method and the ATC‐Net. Experiments show that our method can perform better on small datasets, which effectively makes up for the data shortage problem. The ATC‐Net used for classification significantly reduces the evaluation time compared with other classical networks. It reduces the time of assessing one sample by about 49% as compared to VGG‐16. And more importantly, it achieves the highest classification accuracy of 92.74% among all investigated networks. [ABSTRACT FROM AUTHOR]

Aim: Denosumab increases bone mineral density through inhibition of the receptor activator of nuclear factor κ‐Β ligand (RANKL). RANKL has known immunomodulatory effect. The largest study to date that reviewed denosumab efficacy in osteoporosis demonstrated an increased incidence of serious adverse events of infection (SAEI). We aimed to further evaluate risk of infection and SAEI in denosumab‐treated patients. Method: PubMed, Embase, Cochrane Central Register of Controlled Trials, and Web of Science were searched for randomized controlled trials. Studies comparing denosumab 60 mg every 6 months with placebo or bisphosphonate for treatment of low bone mineral density were included. Trials were excluded for use of denosumab in cancer patients treated for skeletal‐related events, immunosuppressed patient populations, or for comparison to teriparatide. Risk ratios (RR) with a 95% confidence interval (CI) were pooled using a fixed effects model, or a random effects model if heterogeneity occurred. Results: Twenty‐four randomized controlled trials (20 470 patients) were analyzed. An increased incidence of any infection (RR 1.11; 95% CI 1.02‐1.20; P = 0.02) was observed in denosumab‐treated patients compared with bisphosphonates, but not when compared with placebo. In contrast, a higher incidence of SAEI (RR 1.21; 95% CI 1.03‐1.43; P = 0.02) was seen with denosumab when compared with placebo, but not compared with bisphosphonates. Conclusion: Denosumab‐treated patients with low bone mineral density have slightly increased incidence of SAEI compared with placebo, but not when compared with bisphosphonates. Application of these results requires consideration of the entire body of data available regarding denosumab safety. [ABSTRACT FROM AUTHOR]

The aims of this study were to calculate the estimated dental age and the degree of skeletal maturity in patients with cerebral palsy and control patients (i.e., without a diagnosis of cerebral palsy) and to compare the findings with the chronological age of patients in both study groups. In this cross‐sectional study, the European formula and the Willems method were used to estimate the dental age of 52 patients with cerebral palsy and 104 control patients, all aged between 7 and 15 years. For all patients, their estimated dental age was compared with their chronological age. The degree of skeletal maturity of 35 patients with cerebral palsy and 104 control patients was estimated according to Baccetti's method. There was no statistically significant difference in the deviation of the estimated dental age from the chronological age between patients with cerebral palsy and control patients when the European formula or the Willems method was applied. No difference was found in the frequency of Baccetti's stages between patients with cerebral palsy and control patients in the same age category, for both sexes. To estimate dental age in patients with cerebral palsy, the European formula is preferable for orthodontic purposes and the Willems method is preferable for forensic purposes. Using Baccetti's method it was not possible to detect potential differences in skeletal maturity between patients with cerebral palsy and controls. [ABSTRACT FROM AUTHOR]

Improvements in surgical management usually occur slowly so changes are only recognised when, with maturity, surgeons look back at earlier protocols. Prostate cancer management, on the other hand, has undergone radical change since it was first described, but with identifiable milestones, some of which were quite dramatic. [ABSTRACT FROM AUTHOR]

Background: Post‐operative nausea and vomiting (PONV) is often encountered following corrective scoliosis surgery in children, frequently attributed to high‐dose opiate administration. PONV is a frequent cause of prolonged hospital stay. Mechanisms related to transient partial duodenal compression by narrow angulation of the superior mesenteric artery (SMA) and aorta following scoliosis surgery are poorly understood and might be implicated in PONV. This study investigates relationships between biomechanical anatomic variations of the SMA and aorta, and its relationship with clinically significant PONV following scoliosis surgery in children. Methods: Children undergoing elective spinal arthrodesis for adolescent idiopathic scoliosis were assessed by preoperative abdominal ultrasound and spinal X‐ray prior to surgery. Post‐operative assessment of clinically significant PONV is compared to preoperative imaging and clinical variables. Results: Thirteen patients (11 female and two male), with a mean age of 14 years and 1 month were included. Five patients (38.5%) developed clinically significant PONV. A significant association was observed between the coronal aorto‐mesenteric orientation and PONV (P = 0.035). Of the five patients who developed PONV, two had direct coronal angulation of the SMA, one had left angulation and two had right angulation. Patients with significant PONV had narrower aorto‐mesenteric distances which approached significance (P = 0.06). No other preoperative variable reached significance. Conclusion: Patients with coronal aorto‐mesenteric orientation preoperatively appear at greater risk of developing significant PONV following scoliosis surgery, independent of opiate requirements, prompting consideration of transient partial duodenal obstruction as an important factor in the mechanisms of PONV. A coronal aorto‐mesenteric orientation theory (CAMOT) is proposed to explain this biomechanical vascular 'scissor'. [ABSTRACT FROM AUTHOR]

Objective: The aim of the present study was to explore the surgical treatment and prognosis of 27 cases of neurofibromatosis type 1 with severe dystrophic kyphosis. Methods: We performed surgical treatment for scoliosis and kyphosis caused by dystrophic curves at Peking Union Medical College Hospital, Beijing, China from December 2015 to December 2017. The study included 21 patients with moderate to severe kyphosis, 12 males and 9 females, with an average age of 14.95 ± 6.05 years. All patients had kyphosis angles greater than 70° and had more than four skeletal developmental defects. A total of 6 patients with severe kyphosis, 2 males and 4 females, with an average age of 12.5 years, had more than five skeletal developmental defects with a kyphosis angle greater than 90° or a lumbar kyphosis angle greater than 40°. According to the patient's own situation, we adopted a low‐grade surgery scheme (grades 1 or 2) or a high‐grade surgery scheme (grades 3–6). The low‐grade surgery was mainly lower articular surface resection or pontodestomy, and the high‐grade surgery was mainly apical vertebral body or upper discectomy. All patients were followed up to determine their prognosis. Results: Statistical analysis showed that there was a significant difference in preoperative and postoperative scores between the two groups (P < 0.05), and scoliosis correction showed that surgical treatment had a significant effect on scoliosis kyphosis. The mean follow‐up time was 66.7 months. Follow‐up results showed that 50% of complications after internal fixation were related to high‐level surgery. Complications included displacement of the titanium cage, removal of the lamina hook, formation of pseudoarthrosis, and internal fixation failure (with a rate of 7.7%–14.3%). In contrast, there were no associated symptoms for low‐grade surgery. In addition, the results showed that gender, age, extent of resection, height, and body mass index had no significant effect on preoperative, postoperative, and prognostic indicators of patients (P > 0.05). Conclusion: Early identification of dysplastic scoliosis‐related deformities plays an important role in surgical planning and prognosis, and low‐level surgical procedures are more favorable for patients' prognosis. [ABSTRACT FROM AUTHOR]

Normocalcaemic primary hyperparathyroidism is a condition that can present with intermittent hypercalcemia or may evolve into hypercalcemic primary hyperparathyroidism. This milder biochemical entity remains incompletely understood because of a lack of long‐term health outcomes regarding both medical and surgical approaches to its management. Medical therapies have shown some efficacy. A limited number of studies have found that bisphosphonates increase bone mineral density, and calcimimetics may decrease the risk of nephrolithiasis in patients with normocalcaemic primary hyperparathyroidism. Studies have also described patient outcomes after applying the same surgical criteria used for patients with hypercalcaemic primary hyperparathyroidism to those with the normocalcaemic form of the disease. These studies suggest that parathyroid surgery appears to be effective in normalizing elevated serum parathyroid hormone concentrations and decreasing adverse renal and skeletal outcomes in patients with normocalcaemic hyperparathyroidism. Given the available data and overall lack of consensus regarding the optimal management of these patients, a reasonable approach is to tailor treatment to the individual patient by considering their risk factors for new or accelerated bone loss, kidney stones, diminished quality of life, and cardiovascular disease. [ABSTRACT FROM AUTHOR]

Background: Few publications in the literature examine enhanced recovery after scoliosis surgery (ERAS) in children, despite significant scientific interest in adults. The objective of the current study was to describe an ERAS protocol for surgical correction of adolescent idiopathic scoliosis (AIS) and its results. Methods: ERAS outcomes were measured in two patient cohorts. Historical controls and ERAS groups were selected from patients managed for scoliosis surgery in 2015 and 2018, respectively. The ERAS protocol included fasting minimization, carbohydrate loading, the avoidance of background morphine infusions, perioperative opioid‐sparing protocols, the use of a cooling brace, early physiotherapy, feeding and oral medications, and the early removal of urinary catheters and surgical drains. The main outcome of the study was hospital length of stay. Results: Overall, 82 controls and 81 ERAS patients were recruited. ERAS protocols were observed in over 80% of patients for almost items. Median length of hospital stay was significantly lower in the ERAS group (‐ 3 [95% confidence interval: −2; −4] days). Median morphine consumption was reduced by 25% and 35% on days 2 and 3, respectively. The incidence of PONV did not differ between the two groups, and the incidence of constipation decreased slightly but significantly in the ERAS group on day 2. Pain intensity at rest and movement were lower in the ERAS group at day 2 and 3. Conclusions: The current study suggests an ERAS protocol after adolescent idiopathic scoliosis surgery is associated with reduced hospital length of stay and improved postoperative care. [ABSTRACT FROM AUTHOR]

There is controversy over whether bone or cartilage is primarily involved in osteoarthritis (OA) pathogenesis; this is important for targeting early interventions. We explored evidence from animal models of knee OA by preforming a systematic review of PubMed, Scopus, and Web of Science for original articles reporting subchondral bone and cartilage pathology in animal models with epiphyseal closure. Extracted data included: method of induction; animal model; cartilage and bone assessment and method; meniscal assessment; skeletal maturity; controls; and time points assessed. Quality scoring was performed. The best evidence was synthesized from high‐quality skeletally mature models, without direct trauma to tissues of interest and with multiple time points. Altogether, 2849 abstracts were reviewed. Forty‐seven papers were included reporting eight different methods of inducing OA, six different species, six different methods of assessing cartilage, five different bone structural parameters, and four assessed meniscus as a potential initiator. Overall, the simultaneous onset of OA in cartilage and bone was reported in 82% of datasets, 16% reported bone onset, and 2% reported cartilage onset. No dataset containing meniscal data reported meniscal onset. However, using the best evidence synthesis (n = 8), five reported simultaneous onset when OA was induced, while three reported bone onset when OA occurred spontaneously; none reported cartilage onset. In summary, there is a paucity of well‐designed studies in this area which makes the conclusions drawn conjectures rather than proven certainties. However, within the limitation of data quality, this review suggests that in animal models, the structural onset of knee OA occurs either in bone prior to cartilage pathology or simultaneously. [ABSTRACT FROM AUTHOR]

Background: The impact of race on prostate cancer skeletal-related events (SREs) remains understudied. In the current study, the authors tested the impact of race on time to SREs and overall survival in men with newly diagnosed, bone metastatic castration-resistant prostate cancer (mCRPC).Methods: The authors performed a retrospective study of patients from 8 Veterans Affairs hospitals who were newly diagnosed with bone mCRPC in the year 2000 or later. SREs comprised pathologic fracture, spinal cord compression, radiotherapy to the bone, or surgery to the bone. Time from diagnosis of bone mCRPC to SREs and overall mortality was estimated using the Kaplan-Meier method. Cox models tested the association between race and SREs and overall mortality.Results: Of 837 patients with bone mCRPC, 232 patients (28%) were black and 605 (72%) were nonblack. At the time of diagnosis of bone mCRPC, black men were found to be more likely to have more bone metastases compared with nonblack men (29% vs 19% with ≥10 bone metastases; P = .021) and to have higher prostate-specific antigen (41.7 ng/mL vs 29.2 ng/mL; P = .005) and a longer time from the diagnosis of CRPC to metastasis (17.9 months vs 14.3 months; P < .01). On multivariable analysis, there were no differences noted with regard to SRE risk (hazard ratio [HR], 0.80; 95% CI, 0.59-1.07) or overall mortality (HR, 0.87; 95% CI, 0.73-1.04) between black and nonblack people, although the HRs were <1, which suggested the possibility of better outcomes.Conclusions: No significant association between black race and risk of SREs and overall mortality was observed in the current study. These data have suggested that efforts to understand the basis for the excess risk of aggressive prostate cancer in black men should focus on cancer development and progression in individuals with early-stage disease. [ABSTRACT FROM AUTHOR]

Injuries are common in elite adolescent athletics, but few studies have addressed risk factors for injury. Growth and maturation are potential risk factors in this population; however, the current body of literature is both inconclusive and considered at high risk of bias. The aim of this study was therefore to examine whether growth rate, maturity status, and maturity tempo are associated with injury risk in an elite sports academy. Anthropometric, skeletal maturity and injury data collected prospectively over four seasons (117 athlete‐seasons) were included in the analyses. Growth rate for stature was associated with greater risk of bone (incidence rate ratio (IRR): 1.5 per one standard deviation increase above the mean; 95% CI: 1.1‐1.9) and growth plate injuries (IRR: 2.1; 1.5‐3.1). Growth rate for leg length was associated with greater overall injury risk (IRR: 1.3; 1.0‐1.7) as well as the risk of bone (IRR: 1.4; 1.0‐1.9) and growth plate injuries (IRR: 2.1; 1.4‐3.0). Athletes with greater skeletal maturity, expressed as skeletal age (IRR: 0.6 per year; 0.5‐0.9) and percentage of predicted mature height (IRR: 0.8 per percent increase; 0.7‐1.0), were less prone to growth plate injuries. Rate of change in skeletal age was associated with an increased risk of bone injuries (IRR: 1.5; 1.0‐2.3). The results of this study suggest that rapid growth in stature and leg length, skeletal maturity status, and maturity tempo represent risk factors for certain injury types in adolescent athletics. [ABSTRACT FROM AUTHOR]

Mammalian neonates are born at a wide range of maturity levels. Altricial newborns are born with limited sensory agency and require extensive parental care. In contrast, precocial neonates are relatively mature physically and often capable of independent function shortly after birth. In extant mammals, placental newborns vary from altricial to precocial, while marsupials and monotremes are all extremely altricial at birth. Bears (family Ursidae) have one of the lowest neonatal−maternal mass ratios in placental mammals, and are thought to also have the most altricial placental newborns. In particular, giant pandas (Ailuropoda melanoleuca) are thought to be exceptionally altricial at birth, and possibly marsupial‐like. Here we used micro‐computer (micro‐computed) tomography scanning to visualize the skeletal anatomy of ursid neonates and compare their skeletal maturity with the neonates of other caniform outgroups. Specifically, we asked whether ursid neonates have exceptionally altricial skeletons at birth compared with other caniform neonates. We found that most bear neonates are similar to outgroup neonates in levels of skeletal ossification, with little variation in degree of ossification between ursine bears neonates (i.e. bears of the subfamily Ursinae). Perinatal giant pandas, however, have skeletal maturity levels most similar to a 42−45‐day‐old beagle fetus (~70% of total beagle gestation period). No bear exhibits the skeletal heterochronies seen in marsupial development. With regards to skeletal development, ursine bears are not exceptionally altricial relative to other caniform outgroups, but characterized largely by the drastic difference between newborn and adult body sizes. A review on the existing hypotheses for ursids' unique reproductive strategy suggests that the extremely small neonatal−maternal mass ratio of ursids may be related to the recent evolution of large adult body size, while life history characteristics retained an ancestral condition. A relatively short post‐implantation gestation time may be the proximal mechanism behind the giant panda neonates' small size relative to maternal size and altricial skeletal development at birth. [ABSTRACT FROM AUTHOR]

Background: Nephrotic syndrome (NS) is the most common glomerular childhood disease. A body of literature has described the long-term renal prognosis of childhood-onset idiopathic NS. However, the nonrenal outcomes have not been studied as much.Aim: We aimed to discuss the long-term non-renal outcomes of childhood NS, highlighting studies with a follow-up period of more than 10 years.Results: We reviewed the literature and found that a number of immunosuppressive agents have stopped inflammation, stabilised the podocyte cytoskeleton and reduce proteinuria. However, prolonged treatment has frequently been associated with a high risk of renal and non-renal complications in patients with a complicated disease course, defined as frequent relapses or steroid dependency. Non-renal complications may include impaired longitudinal growth and pubertal development, undesirable fertility outcomes, ocular complications, bone mineral diseases and potential malignancies.Conclusion: This review discusses and summarises the non-renal outcomes of idiopathic childhood NS. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to explore whether computed tomography (CT) images of cranial sutures can contribute to adult age estimation in Chinese Han individuals. Materials and methods: This study was based on cranial CT scans of 230 Chinese Han males aged 23.33–76.93 years. A total of 160 images from 16 suture segments were scored after volume reformation and multiplanar reconstruction in each individual. Decision tree regression, linear support vector regression, Bayesian ridge regression, and gradient boosting regression were developed for adult age estimation by a training set using leave‐one‐out cross‐validation and further evaluated by the test set. The inaccuracy and bias were calculated to evaluate the four models and the previously used models from the literature. Results: The degree of suture closure was associated with adult age. The minimum inaccuracy of the test set was 7.73 years obtained by linear support vector regression, while the inaccuracy of previous simple linear regression models was 13.09 and 10.97 years. The accuracy was higher in the age group from 40.00 to 59.99 years compared to the other age groups. Discussion: The accuracy of our models for adult age estimation was superior to those in previous studies based on cranial sutures. Hence, the application of novel statistical data mining tools helps to improve aging issues. Nevertheless, age estimation of adults should be combined with other methods, since the accuracy level is still not satisfactory. [ABSTRACT FROM AUTHOR]

Infants and children undergoing craniofacial surgery may present with a wide range of diseases and conditions posing an array of challenges to the anesthesiologist. Optimal perioperative care requires an understanding of these diseases and their impact on airway and anesthetic management. For those children with anomalies affecting airway anatomy, soft tissues of the head and neck, or skeletal mobility, advanced airway management techniques (ie, modalities other than direct laryngoscopy) may be required to secure the airway. Additionally, some craniofacial surgical procedures have direct implications on airway management, such as with Le Fort III midface advancement involving halo distractor application, where the distractor device precludes facemask ventilation. For all of these patients, the anesthetic and airway management plans must be tailored to the surgery being performed, the patient's specific conditions, and take into consideration all phases of perioperative care. In this review, we present some of the more commonly encountered craniofacial abnormalities affecting airway management. [ABSTRACT FROM AUTHOR]

Aim: To refine a FTIR protocol for detection of NaOCl‐induced dentinal collagen changes using an ex vivo irrigation model, and to apply it to determine the collagen change within 0.5 mm of canal or root surfaces, with or without mature roots or periodontal involvement. Methodology: The root canals of extracted human roots were irrigated with control saline (n = 3) or 5% NaOCl (n = 3) and sectioned into transverse disks for FTIR analyses, 0.5 mm from both the canal lumen and root surface, before and after surface treatment with 17% EDTA. Amide I/phosphate and amide II/phosphate absorbance ratios were compared using the Wilcoxon sign rank test. Mature roots without periodontal involvement were irrigated with: saline (n = 7), 5% NaOCl (n = 7) or 5% NaOCl + 17% EDTA (n = 7); those with periodontal involvement (n = 7) or immature roots (n = 7) were irrigated with 5% NaOCl. Dentine disks were then prepared for FTIR analyses. The effects of irrigant/root maturity/periodontal involvement were analysed using linear mixed models. Results: FTIR analyses of the irrigated samples revealed a significant (P < 0.05) reduction in collagen bands near the canal lumen after NaOCl irrigation using surface EDTA‐treated samples. Irrigation with the test solutions resulted in significant (P < 0.0001) dentinal collagen changes in the mature roots, whilst those in the immature roots were significantly (P < 0.05) greater compared with the mature roots with or without periodontal involvement; but there was no difference between the latter groups. Conclusion: EDTA surface treatment of polished dentine surfaces enhanced FTIR detection of NaOCl‐induced collagen changes. Both root maturity and irrigation protocol influenced the ability of NaOCl to alter dentinal collagen up to 0.5 mm from the canal lumen. [ABSTRACT FROM AUTHOR]

Bone mineral density (BMD) is not the sole predictor of fracture development. Qualitative markers including bone collagen maturity contribute to bone fragility. Bone and related type I collagen containing connective tissues degenerate in parallel fashion. With aging, changes in skin collagen content and quality have been observed that can be detected on ultrasound (US) as a decrease in dermal thickness and an increase in reticular layer echogenicity. We hypothesized that US dermal thickness and echogenicity correlate with bone collagen maturity. Data of 43 prospectively enrolled patients (mean age 61 years, 24 females), who underwent instrumented, posterior lumbar fusion was analyzed. Besides preoperative quantitative computed tomography (QCT) and skin US measurements, intraoperative bone biopsies were obtained and analyzed with Fourier‐transform infrared spectroscopy. Among men, there was no correlation between US measurements and collagen maturity. Among women, dermal layer thickness correlated negatively with collagen maturity in trabecular bone of the iliac crest (r = −0.51, p = 0.01) and vertebra (r = −0.59, p = 0.01) as well as in cortical bone of the iliac crest (r = −0.50, p = 0.02) and vertebra (r = −0.50, p = 0.04). In addition, echogenicity correlated positively with collagen maturity in trabecular vertebral bone (r = 0.59, p = 0.01). In both genders, US measurements showed no correlation with QCT BMD. In summary, ultrasound skin parameters are associated with bone quality factors such as collagen maturity, rather than bone quantity (BMD). Ultrasound of the skin may thereby be an easy and accessible take off point for diagnosis of bone collagen maturity and connective tissue degeneration in the future. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:2508–2515, 2019 [ABSTRACT FROM AUTHOR]

Background: Although skeletal-related events (SREs) are linked with a reduced quality of life and worse outcomes, to the authors' knowledge the factors that predict SREs are minimally understood. The objective of the current study was to identify predictors of SREs and all-cause mortality among men with metastatic castration-resistant prostate cancer (mCRPC).Methods: Data were collected on 837 men with bone mCRPC at 8 Veterans Affairs medical centers within the Shared Equal Access Regional Cancer Hospital (SEARCH) database from 2000 through 2017. Patients were followed to assess development of SREs (pathological fracture, radiotherapy to bone, spinal cord compression, or surgery to bone). Cox proportional hazards models were used to evaluate predictors of SREs and mortality.Results: Of the 837 men with bone mCRPC, 287 developed a SRE and 740 men died (median follow-up, 26 months). Bone pain was found to be the strongest predictor of SREs (hazard ratio [HR], 2.96; 95% CI, 2.25-3.89). A shorter time from CRPC to the development of metastasis (HR, 0.92; 95% CI, 0.85-0.99), shorter progression to CRPC (HR, 0.94; 95% CI, 0.91-0.98), and visceral metastasis at the time of diagnosis of bone metastasis (HR, 1.91; 95% CI, 1.18-3.09) were associated with an increased risk of SREs. Ten or more bone metastases (HR, 2.17; 95% CI, 1.72-2.74), undergoing radical prostatectomy (HR, 0.73; 95% CI, 0.61-0.89), shorter progression to CRPC (HR, 0.97; 95% CI, 0.94-0.99), older age (HR, 1.03; 95% CI, 1.02-1.04), higher prostate-specific antigen level at the time of diagnosis of metastasis (HR, 1.21; 95% CI, 1.14-1.28), bone pain (HR, 1.44; 95% CI, 1.23-1.70), and visceral metastasis (HR, 1.72; 95% CI, 1.23-2.39) were associated with an increased mortality risk.Conclusions: Among men with bone mCRPC, bone pain was found to be the strongest predictor of SREs and the number of bone metastases was a strong predictor of mortality. If validated, these factors potentially may be used for risk stratification and for SRE prevention strategies. [ABSTRACT FROM AUTHOR]

Objectives: Osteoarthritis (OA) generally increases with age, but it is a complex, multifactorial disease. This study investigated whether obesity, physical activity, and antemortem trauma preclude the use of OA for skeletal age estimation. Materials and Methods: The temporomandibular joint (TMJ) and all appendicular joints were scored for skeletal indicators of OA in 408 modern European‐Americans (Bass Collection, TN). Binomial generalized linear models (GLMs) assessed the contributions of self‐reported demographic data to OA, including: age; body mass index (BMI); and metabolic values for physical activities. Repeated resampling tested whether observed mean OA scores for joints with trauma consistently exceeded mean scores for unaffected joints. Single‐variable GLM probit models were generated for OA presence/absence data in relevant joints. Results: Age was the only statistically significant predictor of OA in most multivariable GLMs. Occupation and age were both significant predictors of male hand OA; BMI was the only significant predictor of female ankle OA. Trauma significantly affected OA in most joints. Age cut‐offs calculated from the single‐variable probit models (representing ages of transition to "OA present") ranged from 29.7 to 77.3 years (90%) and 32.7 to 96.6 years (95%), but were problematic for the male TMJ. Discussion: Ankle OA should not be used to age females; TMJ OA should not be used to age males. For other joints, using OA to inform age estimates appears valid (in absence of antemortem trauma). While skeletal evidence of OA is not a primary age indicator, its presence can refine age ranges and provide essential age data in fragmentary cases. [ABSTRACT FROM AUTHOR]

The Roche, Wainer, and Thissen (RWT) knee method was designed to assess maturity in living individuals, but is infrequently cited in studies of skeletal measures for legal age thresholds or estimation of age‐at‐death for forensic cases. We implement the RWT method using R scripts and analyze its utility in establishing an age threshold of 18 years. We fit the RWT model and verify its accuracy in estimating skeletal age against results and known age data provided by RWT. We also found the transition distribution for full skeletal maturity. Agreement between the RWT method and our implementation was good, with a maximum deviation of 0.03 years. The modes of transition to full skeletal maturity are 18.37 and 17.16 years for males and females. The corresponding Bayes factors are 5.73 and 1.77, indicating that complete skeletal maturity of the knee does not provide conclusive evidence of attainment of 18 years of age. [ABSTRACT FROM AUTHOR]

Objective: Limb salvage in pediatric patients remains a challenge. We describe a staged strategy. The procedure includes: (i) tumor removal and non‐hinged static endoprosthesis reconstruction; (ii) leg length discrepancy (LLD) correction by shoe lift or distraction osteogenesis; and (iii) maturity reconstruction by regular endoprosthesis. The aim of the study was to investigate the results of non‐hinged static megaprosthesis reconstruction and staged LLD correction in the treatment of malignant tumors in the distal femur in children. Methods: Non‐hinged megaprostheses were implanted in 12 pediatric patients with osteosarcoma in the distal femur. The prosthesis consists of a femoral component with constrained condylar knee (CCK) design, and a tibial component with a small‐diameter press‐fit stem and derotation fins. A posterior stabilizing polyethylene component is fixed on the tibial component. The cases were prospectively followed up with focus on the growth rate of adjacent uninvolved bone in the salvaged limb, joint stability, knee stability, function outcome, length discrepancy, and surgery‐related complications. Results: There were five girls and seven boys included in the study, with an average age at the time of primary surgery of 10.0 years (range, 8–12 years). All the tumors were located in the distal femur. The average follow up was 76.3 months (range, 24–139 months). The Ligament Augmentation and Reconstruction System (LARS) ligament was used in two patients to enhance the soft tissue reattachment and reconstruct medial collateral ligament (MCL). Ten patients were alive at the final follow‐up and two had died of lung metastases. Expected LLD was 6.7 cm (range, 3.0–13.2 cm) at initial surgery. At the final follow‐up, nine patients reached skeletal maturity and the actual LLD at the femur was 5.3 cm (range, 3.0–10.1 cm), excluding 1 cm correction at initial surgery by endoprosthesis. The proximal tibia physis showed an average of 86.7% (range, 56.5%–100%) growth of the contralateral side. The mean reduction in tibial length was 1.2 cm (range, 0.5–4.7 cm). Six patients received distraction osteogenesis at a mean length of 5.4 cm (range, 3.0–9.1 cm). Range of knee movement was between 85° and 125°, with an average of 102.5°. The Musculoskeletal Tumor Society 93 score of patients alive was 80.6 (range, 60–90). Conclusion: Non‐hinged static megaprosthesis followed by LLD correction with shoe lift or staged distraction osteogenesis appears to be an alternative option to treat children with malignant bone tumors around the knee. [ABSTRACT FROM AUTHOR]

The study of skeletochronology and bone tissue as a record of information on ontogenetic stages and events is widely used for improving the knowledge about life histories (LHs) of extinct and extant vertebrates. Compared with dinosaurs and extant reptiles, mammalian bone histology has received little attention. Here, we calibrate for the first time bone and dental age with histological bone characteristics and LH stages in ontogenetic series of red deer. We rely on known LHs of different aged individuals of captive Cervus elaphus hippelaphus from Austria to correlate epiphyseal closure, dental eruption pattern, bone growth marks and bone tissue patterns in femora and tibiae, and of wild Cervus elaphus hispanicus from Spain. Our data show that females (of both subspecies) attain skeletal maturity earlier than males. At this moment, epiphyseal closure (in femora and tibiae) and dental eruption are complete and long bones start to deposit an external fundamental system. The results also show that the attainment of reproductive maturity in red deer occurs slightly before skeletal maturity. [ABSTRACT FROM AUTHOR]

Keywords: adolescent; general anesthesia; quality improvement EN adolescent general anesthesia quality improvement 242 244 3 02/06/21 20210201 NES 210201 INTRODUCTION Children and adolescents are required to fast prior to undergoing anesthesia to minimize the risk of pulmonary aspiration of gastric contents. When an adolescent has fasted within the normal range of NPO guidelines, dysglycemia is unlikely; if NPO time is excessively prolonged, providers should consider checking a blood glucose at induction and adding dextrose-containing fluids if necessary. [Extracted from the article]

Summary: Background: The occurrence of osteoarthritis (OA) of the temporomandibular joint (TMJ) in juveniles could be associated with fluctuating levels of oestrogen and growth hormone (GH) during adolescence. Objective: To investigate extent of skeletal maturation and predicted adult height in adolescents with TMJ OA. Method: In total, 155 adolescents (54 males, 101 females; mean age, 14.1 ± 2.0 years) were enrolled. Among them, 19 adolescents (CON) showed no sign of TMD, 50 adolescents exhibited signs of disc displacement but did not have TMJ OA (TMDnoOA), 23 adolescents exhibited the initial stage of TMJ OA (TMJOAini) and 63 adolescents exhibited the severe stage of TMJ OA (TMJOApro). TMJ OA was diagnosed based on the Research Diagnostic Criteria axis I and bone age was estimated using the Greulich‐Pyle method. The height, weight and body mass index of participated adolescents were measured and statistically converted to z‐scores. The predicted adult height and age of peak height velocity (APHV) were calculated using the BoneXpert® software. Results: In female adolescents, the differences between the chronological and bone ages were significantly higher and the z‐score for height was significantly lower in the TMJOApro. Female adolescents with TMJOA exhibited a significantly shorter predicted adult height and earlier APHV than those in the CON and TMDnoOA. Conclusion: The adolescents with TMJ OA exhibited premature skeletal maturations and short predicted adult stature, particularly the female adolescents. [ABSTRACT FROM AUTHOR]

Introduction: Patients with Duchenne muscular dystrophy (DMD) exhibit low bone mineral density and increased fracture risk. Because glucocorticoid therapy results in delayed puberty and short stature, it is important to account for delayed skeletal development when interpreting patients' bone mineral density.Methods: Twelve glucocorticoid-treated patients with DMD were evaluated by dual x-ray absorptiometry scans and wrist x-rays to estimate bone density and bone age, respectively. Z-scores were determined on the basis of chronological age. Each patient was assigned a "corrected" birth date that was calculated according to bone age, and a bone-age-corrected z-score was determined.Results: Z-scores adjusted for chronological age were lower than those adjusted for bone age.Discussion: We suggest the use of bone age as an alternative to chronological age for analysis of bone mineral density in glucocorticoid-treated patients with DMD. Additional research is required to determine the optimal method to predict fracture risk in this patient group. Muscle Nerve 59:422-425, 2019. [ABSTRACT FROM AUTHOR]