DOCSLIB.ORG

Bone Age Assessment in the Workup of Children with Endocrine Disorders

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Bone Age Assessment in the Workup of Children with Endocrine Disorders Clinical Practice Committee Publication HORMONE Horm Res Paediatr 2010;73:2–5 Received: March 11, 2009 RESEARCH IN DOI: 10.1159/000271910 Accepted: March 20, 2009 PÆDIATRIC S Published online: January 15, 2010 Bone Age Assessment in the Workup of Children with Endocrine Disorders Gian Luigi Spadoni Stefano Cianfarani ‘Rina Balducci’ Center of Paediatric Endocrinology, Department of Public Health and Cell Biology, Tor Vergata University, Rome , Italy Key Words Introduction Bone age ؒ Growth ؒ Short stature ؒ Puberty ؒ Adult height prediction In most children growth, puberty and related endo- crine changes follow a well-orchestrated pattern but the pace of maturation varies widely so that these events Abstract should be related to physical maturity rather than chron- Bone age is a measure of developmental age, or physiologi- ological age. Skeletal maturation is a surrogate of devel- cal maturity, which represents more truthfully than chrono- opmental age, or physiological maturity, which repre- logical age, how far an individual has progressed towards sents more truthfully than chronological age, how far an full maturity. It is particularly helpful in the clinical workup of individual has progressed towards full maturity and may children with growth and/or puberty disorders as well as in hence be considered a sort of ‘biological age’. treating decisions, such as whether to start replacement Skeletal maturation is marked by an orderly and re- therapy in a patient with hypogonadism. Skeletal maturity producible sequence of recognizable changes in the ap- assessment plays a pivotal role in confirming the diagnosis pearance of the skeleton during childhood. Such changes of normal variants of growth such as familial short stature include the timing and sequence of the appearance of the and constitutional delay of growth, in interpreting hormone centers of ossification, specific alterations in the contours tests during puberty, and in the diagnosis of precocious pu- of the bones, and the timing and sequence of the ultimate berty and hyperandrogenism. On the other hand, it is impor- closure of the growth plates. Radiographically, skeletal tant to recognize that overemphasizing bone age evaluation maturity can be assessed by comparing the radiographic can be misleading if not used in the proper settings. Adult appearance of portions of an individual child’s skeleton height prediction is based on skeletal maturity assessment with the standardized appearance in a comparable popu- and can be used to predict with acceptable accuracy which lation of children at various stages in their progress to- adult height will be achieved by a ‘normal’ child. However, ward maturity. Radiographic assessment of skeletal ma- the predictions do not apply to children with endocrine or turity in the child is most frequently based on the appear- bone pathologies affecting growth. ance of the hand and wrist. Copyright © 2010 S. Karger AG, Basel Bone age assessment is particularly useful in the clin- ical evaluation of early and late maturers. Although bone © 2010 S. Karger AG, Basel Stefano Cianfarani, MD 1663–2818/10/0731–0002$26.00/0 ‘Rina Balducci’ Center of Pediatric Endocrinology, Department of Public Health and Fax +41 61 306 12 34 Cell Biology , Room E-178, Tor Vergata University, Via Montpellier 1 E-Mail [email protected] Accessible online at: IT–00133 Rome (Italy) www.karger.com www.karger.com/hrp Tel. +39 06 7259 6178, Fax +39 06 591 7415, E-Mail [email protected] Table 1. Indications and limitations of bone age assessment With the TW2 method each bone is matched with a set of 8 standard ages and its stage is rated. Each stage of Bone age is necessary each bone has a score attached to it, which is derived In the diagnosis of FSS and CDGP For interpreting hormone levels at pubertal age mathematically so that the sum of the scores for all the For diagnosis of precocious puberty or hyperandrogenism bones represents the best overall estimate of skeletal ma- For deciding whether or not to treat the above-mentioned turity. The Tanner-Whitehouse standards are based on a conditions large-scale random sample of urban and rural children For predicting adult height in normal children taken in the 1950s. Scoring bone by bone makes the TW2 Bone age is useful In evaluating any child with growth and/or puberty disorders method potentially more accurate than the Greulich-Pyle In deciding when to start replacement therapy in atlas method. However, the TW2 method is consistently hypogonadism time consuming and based on a combined score; assign- In monitoring children on GH therapy ing to each of the 20 bones a single score chosen among Bone age may be misleading 8 or 9 maturity stages may eventually lead to a higher risk In evaluating children with bone disorders In predicting adult height in pathological conditions of error than the comprehensive analysis method of If considered an absolute diagnostic marker Greulich-Pyle. An automatic measurement of bone age If, during the follow-up of a patient or in comparing groups using computerized image analysis based on TW2 was of patients, different readers are involved or different proposed to facilitate and speed up the reading [6] . methods are employed A d u l t H e i g h t P r e d i c t i o n age assessment may provide precious information, it In normal children, bone age closely correlates with should always be considered ancillary to a more compre- the remaining growth potential and it has been included hensive clinical, auxological and laboratory approach ( ta- in the equations used for predicting adult height. Each ble 1 ). bone age assessment method refers to its specific adult height prediction method: namely the Bayley-Pinneau method for the Greulich-Pyle method of bone age assess- Methods of Bone Age Assessment ment and the TW2 height prediction method for the TW2 bone age method. The predictions, however, do not apply In principle, any part of the skeleton could be used to to children with endocrine or bone pathologies affecting determine skeletal maturity, but in practice the hand and growth and should be restricted to normal children be- wrist represent the most convenient area. They are easily cause a delay in bone age does not necessarily mean a big- X-rayed without fear of any radiation being delivered to ger growth potential. the reproductive organs. The two most widely used methods are the ‘atlas’ method of Greulich-Pyle [1–3] and the bone scoring Conditions in Which Bone Age Assessment Is method of Tanner-Whitehouse (TW2 method) [4, 5] . Necessary They are not always comparable and cannot be consid- ered interchangeable. Therefore, in the follow-up of an Normal Variants of Growth: Familial Short Stature individual or in comparing different groups of patients it and Constitutional Delay of Growth and Puberty is crucial to use the same method. The vast majority of short children referred to the pe- With the Greulich-Pyle atlas method, developed from diatric endocrinologist do not have any pathological con- films taken in the 1930s and 1940s, each bone is matched ditions but their patterns of growth represent normal with a similar-appearing bone in a series of standard ra- variants of the growth process. Classically, normal vari- diographs of bones of increasing age. This is still the most ants of growth comprise familial short stature (FSS) and frequently used method; certainly its easy use and the constitutional delay of growth and puberty (CDGP). To fact that moving quickly from the preceding to the fol- be identified both conditions require the ascertainment lowing standard makes it difficult, at least for the experi- of a normal growth rate. FSS children present a stature enced reader, to have an error greater than the time inter- within the target height range and no bone age delay, val which separates two X-ray standards. whilst CDGP subjects show short stature, bone age delay Bone Age Evaluation Horm Res Paediatr 2010;73:2–5 3 (usually more than 2 years), delayed onset of puberty, and risk of subnormal adult height and deserve specific treat- often familial history of delayed puberty. ment, a subset of children will have a good spontaneous height outcome. The degree of bone age advancement and Interpretation of Endocrine Tests during Puberty the actual height of the child play a key role in selecting Bone age is extremely helpful in the interpretation of children to be treated with either GnRH analogs (preco- the GnRH test carried out to distinguish delayed puberty cious puberty) or hydrocortisone (CAH). Once therapy is from hypogonadism. Subnormal peak gondotropin re- started, skeletal maturation assessment will be helpful to sponses to GnRH test indicate a gonadotropin defect only monitor the effect of therapy on the advancement of bone if the child has a biological age consistent with the physi- age and, ultimately, on the adult height prognosis. ological rise in gonadotropins. In practice a bone age of 13 years may be considered the threshold to expect the Adult Height Prediction (Projection) in Normal pubertal gonadotropin response. Therefore, we should Children not expect pubertal values of LH and FSH in a child with Bone age is essential for predicting adult height ac- a bone age less than 13 years. cording to both Bayley-Pinneau and TW2 methods. Pro- jected height represents a method to roughly predict adult Precocious Puberty and Hyperandrogenism height. It consists of plotting actual height on centile In case of anticipated or premature appearance of the curves according to the bone age rather than the chrono- secondary sex characteristics, bone age should be used in logical age. the differential diagnosis. It often occurs that a girl ex- hibits the symmetrical or asymmetrical growth of mam- mary glands before the age of 8 years.
Load more

Recommended publications
  • Chondrogenesis of Mesenchymal Stem Cells in a Novel Hyaluronate-Collagen-Tricalcium Phosphate Scaffolds for Knee Repair F.G
    EuropeanF Meng et Cells al. and Materials Vol. 31 2016 (pages 79-94) DOI: 10.22203/eCM.v031a06 TCP-COL-HA scaffolds for cartilage ISSN regeneration 1473-2262 CHONDROGENESIS OF MESENCHYMAL STEM CELLS IN A NOVEL HYALURONATE-COLLAGEN-TRICALCIUM PHOSPHATE SCAFFOLDS FOR KNEE REPAIR F.G. Meng§, Z.Q. Zhang§, G.X. Huang, W.S. Chen, Z.J. Zhang, A.S. He and W.M. Liao* Department of Joint Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510080, China §These two authors contributed equally to this work. Abstract Introduction Scaffolds are expected to play a key role in the induction Damaged articular cartilage has poor self-repair capability of chondrogenesis of mesenchymal stem cells (MSCs) owing to the low metabolic rate of chondrocytes (Chen for cartilage tissue regeneration. Here, we report the et al., 2009; Hunziker, 2002; Steadman et al., 2002). development of a novel tricalcium phosphate-collagen- Tissue engineering is considered a potential strategy hyaluronate (TCP-COL-HA) scaffold that can function as for regenerating damaged tissue (Jackson and Simon, a stem cell carrier to induce chondrogenesis and promote 1999). Mesenchymal stem cells (MSCs) are an especially cartilage repair, and the investigation of chondroinductive promising tool since they can be easily isolated from bone properties of scaffolds containing varying amounts of TCP, marrow and expanded in vitro without the loss of their COL and HA. TCP-COL-HA scaffolds, as well as TCP- capacity to differentiate into various cell types, including COL scaffolds at two different TCP/COL ratios (50:50 and chondrocytes and osteoblasts (Caplan, 2005).
    [Show full text]
  • Mesenchymal Stem Cells in Combination with Hyaluronic Acid
    www.nature.com/scientificreports OPEN Mesenchymal Stem Cells in Combination with Hyaluronic Acid for Articular Cartilage Defects Received: 1 August 2017 Lang Li1, Xin Duan1, Zhaoxin Fan2, Long Chen1,3, Fei Xing1, Zhao Xu4, Qiang Chen2,5 & Accepted: 19 April 2018 Zhou Xiang1 Published: xx xx xxxx Mesenchymal stem cells (MSCs) and hyaluronic acid (HA) have been found in previous studies to have great potential for medical use. This study aimed to investigate the therapeutic efects of bone marrow mesenchymal stem cells (BMSCs) combined with HA on articular cartilage repair in canines. Twenty-four healthy canines (48 knee-joints), male or female with weight ranging from 5 to 6 kg, were operated on to induce cartilage defect model and divided into 3 groups randomly which received diferent treatments: BMSCs plus HA (BMSCs-HA), HA alone, and saline. Twenty-eight weeks after treatment, all canines were sacrifced and analyzed by gross appearance, magnetic resonance imaging (MRI), hematoxylin-eosin (HE) staining, Masson staining, toluidine blue staining, type II collagen immunohistochemistry, gross grading scale and histological scores. MSCs plus HA regenerated more cartilage-like tissue than did HA alone or saline. According to the macroscopic evaluation and histological assessment score, treatment with MSCs plus HA also lead to signifcant improvement in cartilage defects compared to those in the other 2 treatment groups (P < 0.05). These fndings suggested that allogeneic BMSCs plus HA rather than HA alone was efective in promoting the formation of cartilage-like tissue for repairing cartilage defect in canines. Articular cartilage is composed of chondrocyte and extracellular matrix and has an important role in joint move- ment including lubrication, shock absorption and conduction.
    [Show full text]
  • Association Between Dietary Habits and Parental Health with Obesity Among Children with Precocious Puberty
    children Article Association between Dietary Habits and Parental Health with Obesity among Children with Precocious Puberty 1, 1, 2 1 3, Yong Hee Hong y , Yeon Ju Woo y, Jong Hyun Lee , Young-Lim Shin and Hee-Sook Lim * 1 Department of Pediatrics, Soonchunhyang University Bucheon Hospital, Soonchunhyang University School of Medicine, Bucheon 14584, Korea; [email protected] (Y.H.H.); [email protected] (Y.J.W.); [email protected] (Y.-L.S.) 2 Department of Pediatrics, Soonchunhyang University Gumi Hospital, Soonchunhyang University School of Medicine, Gumi 39371, Korea; [email protected] 3 Department of Food Sciences and Nutrition, Yeonsung University, Anyang 14011, Korea * Correspondence: [email protected] These authors contributed equally to this work as first author. y Received: 25 September 2020; Accepted: 5 November 2020; Published: 8 November 2020 Abstract: Precocious puberty, resulting in various physical, mental, and social changes, may have negative consequences for children and their families. In this study, we investigated whether there were differences between parental obesity, children’s and parent’s awareness of body shape, and dietary habits according to obesity levels in children with precocious puberty. A total of 193 children (93.3% girls) diagnosed with precocious puberty were classified into three groups according to their obesity levels. Negative body shape awareness and dissatisfaction were significantly higher in the obese group than in the normal-weight group, and parents were more likely to perceive their children as fat than the children themselves. In addition, the obesity rate of parents in the obese group was higher, and the body mass indexes of children and parents were significantly correlated.
    [Show full text]
  • Effectiveness of Antibacterial Surfaces in Osseointegration of Titanium Dental Implants: a Systematic Review
    antibiotics Review Effectiveness of Antibacterial Surfaces in Osseointegration of Titanium Dental Implants: A Systematic Review Nansi López-Valverde 1 , Bruno Macedo-de-Sousa 2 , Antonio López-Valverde 1,* and Juan Manuel Ramírez 3 1 Department of Surgery, Instituto de Investigación Biomédica de Salamanca (IBSAL), University of Salamanca, 37007 Salamanca, Spain; [email protected] 2 Institute for Occlusion and Orofacial Pain, Faculty of Medicine, University of Coimbra, Polo I-Edifício Central Rua Larga, 3004-504 Coimbra, Portugal; [email protected] 3 Department of Morphological Sciences, University of Cordoba, Avenida Menéndez Pidal S/N, 14071 Cordoba, Spain; [email protected] * Correspondence: [email protected] Abstract: Titanium (Ti) dental implant failure as a result of infection has been established at 40%, being regarded as one of the most habitual and untreatable problems. Current research is focused on the design of new surfaces that can generate long-lasting, infection-free osseointegration. The purpose of our study was to assess studies on Ti implants coated with different antibacterial surfaces, assessing their osseointegration. The PubMed, Web of Science and Scopus databases were electronically searched for in vivo studies up to December 2020, selecting six studies that met the inclusion criteria. The quality of the selected studies was assessed using the ARRIVE (Animal Research: Reporting of In Vivo Experiments) criteria and Systematic Review Center for Laboratory animal Experimentation’s (SYRCLE’s) risk of bias tool. Although all the included studies, proved greater osseointegration Citation: López-Valverde, N.; capacity of the different antibacterial surfaces studied, the methodological quality and experimental Macedo-de-Sousa, B.; models used in some of them make it difficult to draw predictable conclusions.
    [Show full text]
  • Meyer Dysplasia in the Differential Diagnosis of Hip Disease in Young Children
    ARTICLE Meyer Dysplasia in the Differential Diagnosis of Hip Disease in Young Children Liora Harel, MD; Liora Kornreich, MD; Shai Ashkenazi, MD, MSc; Avinoam Rachmel, MD; Boaz Karmazyn, MD; Jacob Amir, MD Objectives: To describe a rare developmental disorder Results: Two of the 5 patients were initially diagnosed of the femoral capital epiphysis in infants and children as having osteomyelitis and 3 as having Perthes disease. that is often misdiagnosed and to suggest an evaluation The diagnosis of Meyer dysplasia was confirmed by plain protocol to differentiate it from other hip problems. film of the pelvis, a negative bone scan, or normal bone marrow findings on magnetic resonance imaging. The Design: Case series. limping resolved without treatment in all patients within 1 to 3 weeks. Setting: Tertiary care center. Conclusions: Meyer dysplasia is a benign condition that Subjects: Five consecutive patients referred for evalu- should be included in the differential diagnosis of hip dis- ation of acute onset of limping between January 1990 and ease in infants and children. Awareness of this condi- December 1997. tion may prevent unnecessary hospitalization and treat- ment. Intervention: All clinical and imaging data were col- lected. Arch Pediatr Adolesc Med. 1999;153:942-945 5 patients. The 5 children included 4 males Editor’s Note: Keep this in mind next time you see a limping and 1 female aged 9 to 48 months. All pre- toddler or preschooler. sented with acute onset of limping of 2 to Catherine D. DeAngelis, MD 30 days’ duration. Patient 3 was being ob- served by a pediatric endocrinologist for short stature, and patient 4 had a family EYER dysplasia is a history of congenital dislocation of the hip symptomless develop- and Perthes disease.
    [Show full text]
  • Identification of Teeth, Wrist and Femur Bone Features for Age and Gender Identifiction
    Vidyashree H S et al. / International Journal of Computer Science Engineering (IJCSE) IDENTIFICATION OF TEETH, WRIST AND FEMUR BONE FEATURES FOR AGE AND GENDER IDENTIFICTION Vidyashree H S Department of Computer Science and Engineering, Bapuji Institute of Engineering and Technology, Davanagere, India. Email: [email protected] Pradeep N Department of Computer Science and Engineering, Bapuji Institute of Engineering and Technology, Davanagere, India. Email: [email protected] Abstract: Personal identification is defined as establishing the identity of an individual. The need for personal identification arises in natural mass disasters like earth quakes, tsunamis, landslides, floods etc., and in man-made disasters such as terrorist attacks, bomb blasts, mass murders, and in cases when the body is highly decomposed or dismembered to deliberately conceal the identity of the individual. Computers have been widely used in the field of medical research over the past few decades. Machine Learning and Biomedical Image Processing Techniques have enormously contributed in the field of Medical Image Analysis, classification and recognition. But fewer contributions have been made in the area of forensics by researchers. There is a scope for researches, where they can make their contributions especially in medical image analysis where they can estimate age and identify gender using digital X-ray images. In this paper, we are identifying features of Femur, Teeth and Wrist features that are helpful for age and gender identification. Keywords- Forensic Science, Femur Bone Age, Gender Estimation, teeth, wrist bone age and gender comparison. I.INTRODUCTION The age of an individual is often a fundamental piece of data in connection with forensic identification of unidentified bodies.
    [Show full text]
  • Original Article Clinical Characteristics and Mutation Analysis of Two Chinese Children with 17A-Hydroxylase/17,20-Lyase Deficiency
    Int J Clin Exp Med 2015;8(10):19132-19137 www.ijcem.com /ISSN:1940-5901/IJCEM0013391 Original Article Clinical characteristics and mutation analysis of two Chinese children with 17a-hydroxylase/17,20-lyase deficiency Ziyang Zhu, Shining Ni, Wei Gu Department of Endocrinology, Nanjing Children’s Hospital Affiliated to Nanjing Medical University, Nanjing 210008, China Received July 25, 2015; Accepted September 10, 2015; Epub October 15, 2015; Published October 30, 2015 Abstract: Combined with the literature, recognize the clinical features and molecular genetic mechanism of the disease. 17a-hydroxylase/17,20-lyase deficiency, a rare form of congenital adrenal hyperplasia, is caused by muta- tions in the cytochrome P450c17 gene (CYP17A1), and characterized by hypertension, hypokalemia, female sexual infantilism or male pseudohermaphroditism. We presented the clinical and biochemical characterization in two patients (a 13 year-old girl (46, XX) with hypokalemia and lack of pubertal development, a 11 year-old girl (46, XY) with female external genitalia and severe hypertension). CYP17A1 mutations were detected by PCR and direct DNA sequencing in patients and their parents. A homozygous mutation c.985_987delTACinsAA (p.Y329KfsX418) in Exon 6 was found in patient 1, and a homozygous deletion mutation c.1459_1467delGACTCTTTC (p.Asp487_Phe489del) in exon 8 in patient 2. The patients manifested with hypertension, hypokalemia, sexual infantilism should be sus- pected of having 17a-hydroxylase/17,20-lyase deficiency. Definite diagnosis is depended on mutation analysis. Hydrocortisone treatment in time is crucial to prevent severe hypertension and hypokalemia. Keywords: 17a-hydroxylase/17,20-lyase deficiency Introduction patients with 17a-hydroxylase/17,20-lyase defi- ciency, and made a confirmative diagnosis by Deficiency in cytochrome p450c17 (MIM mutation analysis of CYP17A1.
    [Show full text]
  • Alan E. Oestreich Growth of the Pediatric Skeleton a Primer for Radiologists Alan E
    Alan E. Oestreich Growth of the Pediatric Skeleton A Primer for Radiologists Alan E. Oestreich Growth of the Pediatric Skeleton A Primer for Radiologists With illustrations by Tamar Kahane Oestreich 123 Alan E. Oestreich, MD, FACR Radiology 5031 Cincinnati Children’s Hospital Medical Center 3333 Burnett Ave. Cincinnati OH 45229-3039 USA Library of Congress Control Number: 2007933312 ISBN 978-3-540-37688-0 Springer Berlin Heidelberg New York This work is subject to copyright. All rights are reserved, whether the whole or part of the material is con- cerned, specifi cally the rights of translation, reprinting, reuse of illustrations, recitations, broadcasting, reproduction on microfi lm or in any other way, and storage in data banks. Duplication of this publica- tion or parts thereof is permitted only under the provisions of the German Copyright Law of September 9, 1965, in its current version, and permission for use must always be obtained from Springer-Verlag. Violations are liable for prosecution under the German Copyright Law. Springer is part of Springer Science+Business Media http//www.springer.com Springer-Verlag Berlin Heidelberg 2008 Printed in Germany The use of general descriptive names, trademarks, etc. in this publication does not imply, even in the absence of a specifi c statement, that such names are exempt from the relevant protective laws and regula- tions and therefore free for general use. Product liability: The publishers cannot guarantee the accuracy of any information about dosage and application contained in this book. In every case the user must check such information by consulting the relevant literature. Medical Editor: Dr.
    [Show full text]
  • REVIEW ARTICLE Interactions Between GH, IGF-I, Glucocorticoids
    0031-3998/02/5202-0137 PEDIATRIC RESEARCH Vol. 52, No. 2, 2002 Copyright © 2002 International Pediatric Research Foundation, Inc. Printed in U.S.A. REVIEW ARTICLE Interactions between GH, IGF-I, Glucocorticoids, and Thyroid Hormones during Skeletal Growth HELEN ROBSON, THOMAS SIEBLER, STEPHEN M. SHALET, AND GRAHAM R. WILLIAMS Department of Clinical Research [H.R.], Department of Endocrinology [S.M.S.], Christie Hospital National Health Service Trust, Manchester, U.K.; University Children’s Hospital, University of Leipzig, Leipzig, Germany [T.S.]; IC Molecular Endocrinology Group, Division of Medicine and MRC Clinical Sciences Centre, Faculty of Medicine, Imperial College School of Science Technology and Medicine, Hammersmith Hospital, London, U.K. [G.R.W.] ABSTRACT Linear growth occurs during development and the childhood Abbreviations years until epiphyseal fusion occurs. This process results from 5'-DI, 5'-iodothyronine deiodinase endochondral ossification in the growth plates of long bones and FGF, fibroblast growth factor is regulated by systemic hormones and paracrine or autocrine FGFR, fibroblast growth factor receptor factors. The major regulators of developmental and childhood GC, glucocorticoid growth are GH, IGF-I, glucocorticoids, and thyroid hormone. GHR, GH receptor Sex steroids are responsible for the pubertal growth spurt and GR, glucocorticoid receptor epiphyseal fusion. This review will consider interactions between HSPG, heparan sulfate proteoglycan GH, IGF-I, glucocorticoids, and thyroid hormone during linear 11␤HSD, 11␤-hydroxysteroid dehydrogenase growth. It is well known from physiologic and clinical studies IGF-IR, IGF-I receptor that these hormones interact at the level of the hypothalamus and IGFBP, IGF binding protein pituitary. Interacting effects on peripheral tissues such as liver are Ihh, Indian hedgehog also well understood, but we concentrate here on the epiphyseal JAK-2, Janus-activated kinase-2 growth plate as an important and newly appreciated target organ PTHrP, PTH-related peptide for convergent hormone action.
    [Show full text]
  • Knee MACI Procedure Rehabilitation Protocol
    REHABILITATION MANUAL Guidelines for the functional recovery of patients following MACI for the treatment of cartilage defects of the knee Written by: Jay Ebert, PhD, AEP ESSAM Hollywood Functional Rehabilitation Clinic School of Sport Science, Exercise and Health University of Western Australia Please see Important Safety Information on page 21 and accompanying full Prescribing Information 2 INTRODUCTION The purpose of this manual is to provide guidance for the development of a KEY POINTS OF CONSIDERATION physician-prescribed rehabilitation program to foster early mobilization and load • Patient adherence to the prescribed rehabilitation protection, promote graft maturation, and reduce the risk of graft delamination, program is critical. postoperative thromboembolic events, and joint stiffness. • Consider lesion size, location and patient characteristics when determining a The MACI® (autologous cultured chondrocytes on porcine collagen membrane) rehabilitation program. Rehabilitation Manual is based on clinical experience* that supports the use of a controlled rehabilitation program to promote a progressive return to full range • Emphasis should be placed on reaching the goals of a given phase over rigid adherence to time schedule. of motion (ROM) and weight bearing (WB), as well as muscle strengthening and conditioning. The rehabilitation program was designed using the knowledge of • It is important to avoid excessive load/WB on the graft site to allow proper healing. basic science, anatomy, and the biomechanics of articular cartilage, as well as the natural course of healing following implantation. It is not intended as a • Pain and swelling must be carefully monitored throughout the rehabilitation process. Ignoring substitute for individual clinical judgment, and a patient-specific rehabilitation these symptoms may compromise the success of program should be implemented.
    [Show full text]
  • Guidelines for Best Practice Imaging for Age Estimation in the Living
    Journal of Forensic Radiology and Imaging 16 (2019) 38–49 Contents lists available at ScienceDirect Journal of Forensic Radiology and Imaging journal homepage: www.elsevier.com/locate/jofri Guidelines for best practice: Imaging for age estimation in the living T ⁎ Edel Doylea, , Nicholas Márquez-Grantb, Lisa Fieldc, Trish Holmesa, Owen J Arthursd,e,f, Rick R. van Rijng,h, Lucina Hackmani, Kathleen Kasperj, Jim Lewisk,l, Peter Loomism, Denise Elliotta, Jeroen Krolla,n, Mark Vinera,b,o, Soren Blaup, Alison Broughq,r, Stella Martín de las Herass, Pedro Manuel Garamendit,u,v a International Association of Forensic Radiographers, UK b Cranfield Forensic Institute, Cranfield University, Defence Academy of the United Kingdom,UK c International Society of Radiographers & Radiologic Technologists, UK d Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK e UCL Great Ormond Street Institute of Child Health, London, UK f ISFRI Paediatric Working Group, Switzerland g Department of Radiology, Emma Children's Hospital – Academic Medical Center Amsterdam, the Netherlands h Department of Forensic Medicine, Netherlands Forensic Institute, The Hague, the Netherlands i Leverhulme Centre for Forensic Science, Ewing Building, University of Dundee, Dundee, UK j Tarrant County Medical Examiner's District, Ft. Worth, Texas; Forensic Odontologist, Collin County Medical Examiner, McKinney, TX, USA k The University of Tennessee, Graduate School of Medicine, Department of General Dentistry, Division of Forensic Odontology,
    [Show full text]
  • Evaluation of Functional Dynamics During Osseointegration And
    Review Po-Chun Chang Evaluation of functional dynamics Niklaus P. Lang William V. Giannobile during osseointegration and regeneration associated with oral implants Authors’ affiliations: Key words: bone–implant interactions, finite element analysis, growth factor Po-Chun Chang, William V. Giannobile, Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Abstract Ann Arbor, MI, USA Objectives: The aim of this paper is to review current investigations on functional Po-Chun Chang, William V. Giannobile, assessments of osseointegration and assess correlations to the peri-implant structure. Department of Biomedical Engineering, College of Engineering, University of Michigan, Ann Arbor, Material and methods: The literature was electronically searched for studies of promoting MI, USA dental implant osseointegration, functional assessments of implant stability, and finite Po-Chun Chang, Department of Preventive Dentistry, Division of Periodontology, Faculty of element (FE) analyses in the field of implant dentistry, and any references regarding Dentistry, National University of Singapore, biological events during osseointegration were also cited as background information. Singapore Niklaus P. Lang, Faculty of Dentistry, The Results: Osseointegration involves a cascade of protein and cell apposition, vascular University of Hong Kong, Hong Kong, China SAR invasion, de novo bone formation and maturation to achieve the primary and secondary William V. Giannobile, Michigan Center for Oral dental implant stability.
    [Show full text]