Dental age estimation by assessing the pulp volume of five teeth in a peruvian population using cone beam computed tomography images / Estimación de la edad dental evaluando el volumen pulpar de cinco dientes utilizando imágenes de tomografías computarizadas de haz cónico en una población peruana

Abstract Dental age estimation is very important for individual identification in criminal and civil forensic investigations. One of the methods for age estimation is studying age related changes in pulp volume of teeth. The objective of the current study was to estimate dental age from the pulp volume of five different categories of teeth of a Peruvian sample using cone beam computed tomography (CBCT). Retrospective CBCT records of 231 patients (females (134), males (97), age: 12-60 years) were included in the study, categorized into five different age groups (12-19, 20-29, 30-39, 40-49, 50-59, 60 years and older). Dental pulp volume of five categories of teeth(upper canines, left upper central incisors, left upper first molars, lower left first premolars, first molars) were analyzed using Romexis® 5.3.3.5 software for each patient. There was a reduction in the pulp volume of upper right and left canine with age. The Pulp volume was lowest in people aged 60 years and over. Linear regression analysis of the pulp volume and chronological age showed a coefficient of determination of 30%, suggesting a weak correlation. A weak correlation between dental pulp and age is derived. But, a robust large homogenous sample of teeth in future for different age groups may establish a reliable regression equation.

Resumen La estimación de la edad dental en personas vivas y cadáveres es muy importante para la Odontología Forense, sobre todo en casos de identificación en investigaciones legales y sociales. El objetivo del estudio fue estimación de la edad dental mediante la medición del volumen pulpar de imágenes dentales en tomografía computarizada de haz cónico (TCHC) de pacientes peruanos. Fueron analizadas 231 TCHC de pacientes entre 12 a 60 años a más. (Mujeres (134), hombres (97)) se dividieron en seis grupos de edad (12-19, 20-29, 30-39, 40-49, 50-59, 60 años a más). El análisis volumétrico de la pulpa dental se realizó en un total de 1155 dientes (caninos superiores, incisivos centrales superiores izquierdos, primeros molares superiores izquierdos y primeros premolares inferiores izquierdos), mediante el software Romexis® 5.3.3.5. El análisis de regresión lineal mostró un coeficiente de determinación del 30% que sugiere una correlación débil entre la relación del volumen pulpar de los dientes y la edad. El volumen pulpar de los caninos superiores derecho e izquierdo disminuyó a medida que aumentaba la edad y el volumen pulpar en dientes de personas de 60 años a más fue el más bajo. Sin embargo, se pueden proponer estudios futuros para incluir una gran muestra homogénea de dientes en diferentes categorías y grupos de edad para confirmar la correlación y establecer una ecuación de regresión confiable.

A Importância dos Métodos de Determinação das Idades Esquelética e Dentária na Ortodontia e Odontopediatria ­ uma Revisão de Literatura / The Importance of Methods for Determination of Squeletal and Dental Age in Orthodontics and Pediatric Dentistry ­ a Literature Review

O estágio de desenvolvimento humano é intimamente relacionado à sua maturidade óssea ou dentária, sendo essencial para a escolha do tratamento de alterações dentofaciais em crianças e adolescentes por ortodontistas e odontopediatras. Existem diversos indicadores biológicos para determinar a maturação do indivíduo, como a idade cronológica e as alterações hormonais, porém esses indicadores podem sofrer interferências. Visando uma determinação de desenvolvimento e dos picos de crescimento mais precisa, para um melhor diagnóstico e plano de tratamento, foram desenvolvidos diversos métodos para determinar a idade esquelética e a idade dentária, sendo estes a avaliação da maturação carpal, da morfologia das vértebras cervicais, da fusão óssea da sincondrose esfeno-occipital e da sutura palatina mediana, bem como dos estágios da calcificação dentária. A avaliação das radiografias de mão e punho é o padrão ouro da predição da idade esquelética, e sua correlação com outros métodos já é evidente. Sendo assim, é possível utilizar a avaliação das vértebras cervicais e das idades dentárias de Nolla e Demirjian.

The stage of human development is closely related to bone or dental maturity, being essential for the choice of treatment for dentofacial changes in children and adolescents by orthodontists and pediatric dentists. There are several biological indicators to determine an individual's maturation, such as chronological age and hormonal changes, but these indicators can suffer interference. Aiming at a more accurate determination of development and growth peaks, for a better diagnosis and treatment plan, several methods have been developed to determine skeletal age and dental age, these being the assessment of carpal maturation, the morphology of the cervical vertebrae, bone fusion of the spheno-occipital synchondrosis and the median palatal suture, as well as the stages of dental calcification. The evaluation of hand and wrist radiographs is the gold standard for predicting skeletal age, and its correlation with other methods is already evident. Therefore, it is possible to use the assessment of cervical vertebrae and dental ages by Nolla and Demirjian.

Accuracy of bone age assessment system based on deep learning in children with abnormal growth and development / 中华放射学杂志

Objective:To explore the accuracy of artificial intelligence (AI) system based on deep learning in evaluating bone age of children with abnormal growth and development.Methods:The positive X-ray films of the left wrist of children with abnormal growth and development who were treated at the Affiliated Hospital of Guizhou Medical University from January 2020 to December 2021 were collected retrospectively. A total of 717 children were collected, including 266 males and 451 females, aged 2-18 (11±3) years. Based on Tanner Whitehouse 3 (TW 3)-RUS (radius, ulna, short bone) and TW3-Carpal (carpal bone) method, bone age was measured by 3 senior radiologists, and the mean value was taken as reference standard. The bone ages were independently evaluated by the AI system (Dr.Wise bone age prediction software) and two junior radiologists (physicians 1 and 2). The accuracy within 0.5 year, the accuracy within 1 year, the mean absolute error (MAE) and the root mean square error (RMSE) between the evaluation results and the reference standard were analyzed. Paired sample t-test was used to compare MAE between AI system and junior physicians. Intraclass correlation coefficient (ICC) was used to evaluate the consistency between AI system, junior physician and reference standard. The Bland-Altman diagram was drawn and the 95% consistency limit was calculated between AI system and reference standard. Results:For TW3-RUS bone age, compared with the reference standard, the accuracy within 0.5 year of AI system, physician 1 and physician 2 was 75.3% (540/717), 62.1% (445/717) and 66.2% (475/717), respectively. The accuracy within 1 year was 96.9% (695/717), 86.3% (619/717) and 89.1% (639/717), respectively. MAE was 0.360, 0.565 and 0.496 years, and RMSE was 0.469, 0.634 and 0.572 years, respectively. For TW3-Carpal bone age, compared with the reference standard, the accuracy within 0.5 year of AI system, physician 1 and physician 2 was 80.9% (580/717), 65.1% (467/717) and 71.7% (514/717), respectively. The accuracy within 1 year was 96.0% (688/717), 87.3% (626/717) and 90.4% (648/717), respectively. MAE was 0.330, 0.527 and 0.455 years, and RMSE was 0.458, 0.612, 0.538 years, respectively. Based on TW3-RUS and TW3-Carpal bone age, the MAE of AI system were lower than those of physician 1 and physician 2, and the differences were statistically significant ( P all<0.001). The evaluation results of AI, physician 1 and physician 2 were in good agreement with the reference standard (ICC all>0.950). The Bland-Altman analysis showed that the 95% agreement limits of AI system for assessing TW3-RUS and TW3-Carpal bone age were -0.75-1.02 years and-0.86-0.91 years, respectively. Conclusion:The accuracy of AI system in evaluating the bone age of children with abnormal growth and development is close to that of senior doctors, better than that of junior doctors, and in good agreement with senior doctors.

Clinical application differences between TW3-Carpal and TW3-RUS based artificial intelligence-assisted bone age assessment system: a real-world pilot study / 中华放射学杂志

Objective:To investigate the differences between Tanner-Whitehouse (TW)3-Carpal and TW3-RUS(radius, ulna and short bone)-based artificial intelligence (AI)-assisted bone age assessment system using real world data.Methods:The image data of 262 children who received X-ray examination of left wrist in the Affiliated Children′s Hospital, Capital Institute of Pediatrics from July to September 2021 were retrospectively collected. The AI bone age assistant methods based on TW3-RUS and TW3-Carpal criteria were used to obtain the bone age results, respectively. Two senior pediatric radiologists evaluated the bone age on the basis of TW3-RUS and TW3-Carpal criteria, and the averaged values of two reviewers was calculated and taken as the gold standard reference. The cases were stratified into six age groups at 3-year intervals according to the gold standard reference, including 1-3 ( n=10), 4-6 ( n=35), 7-9 ( n=70), 10-12 ( n=118), 13-15 ( n=27) and 16-18 ( n=2) years old groups. Intraclass correlation coefficient (ICC) was used to evaluate the consistency between AI results and the gold standard bone age results. Pearson correlation method was used to measure the reliability between AI results and the gold standard results. The difference of bone age results between using TW3-RUS and TW3-Carpal criteria in different age groups was compared using paired t-test. Results:As for the whole sample, the results based on TW3-RUS criteria were 8.9±3.1 years old for AI assessment and 8.7±2.9 years old for the golden standard reference, with the ICC of 0.983; and the results based on TW3-Carpal criteria were 8.7±3.0 years old for AI and 8.8±2.8 years old for the golden standard reference, with the ICC of 0.976. Positive correlation were found in both TW3-RUS ( r=0.985, P<0.001) and TW3-Carpal criteria groups ( r=0.978, P<0.001). There were significant differences between TW3-RUS and TW3-Carpal at age groups of 7-9( t=-3.36, P=0.001), 10-12( t=-1.77, P=0.046), and 13-15 years old ( t=1.84, P=0.040). The bone age assessment using TW3-RUS and TW3-Carpal criteria were both in good agreement with the gold standard reference in age group of 4-6 years old (ICC=0.929 and 0.940), as well as in age group of 7-9 years old (ICC=0.882 and 0.927, respectively), with the results using TW3-Carpal criteria were slightly higher. As for the age groups of 10-12 and 13-15 years old, the method using TW3-RUS criteria showed excellent agreement with the gold standard reference (ICC=0.962 and 0.963, respectively), which were better than the performance of method using TW3-Carpal criteria (ICC=0.744 and 0.605, respectively). Conclusions:AI-assisted bone age system based TW3-Carpal and TW3-RUS criteria both show good reliability and accuracy in the bone age measurements. The AI method based TW3-Carpal criteria shows better performance in age group of 4-9 years old, while the method based on TW3-RUS criteria may be better for children of age 10-15 years old.

Applicability analysis of bone age assessment standards for children in rural areas of Beijing / 中华放射学杂志

Objective:To evaluate the applicability of bone age (BA) assessment methods and to investigate the difference between BA and chronological age (CA) based on the data of children in rural areas of Beijing.Methods:A total of 412 healthy children (226 boys, 186 girls) with the age 8.6 (6.8, 10.3) years old were included in this study. The data of the prospective study were from a subgroup of the project "National Nutrition and Health Systematic Survey for 0-18 Years Old Children in China", which included children with age of 3-12 years old in Beijing rural areas. The non-dominant hand-wrist radiographs of all participants were obtained in April 2021. The Dr.Wise BA detection and analysis system was used to assess the BA according to the Tanner Whitehouse 3 (TW3) radius-ulna-short bone score (TW3-RUS), TW3 carpal bone score (TW3-Carpal), China-05 TW3-Chinese RUS (TW3-C RUS), China-05 TW3-Chinese carpal (TW3-C Carpal), and Greulich-Pyle (G-P) standards. The cases were stratified by the sex and different CA in the statistical analysis. The estimated BA obtained using different methods were compared with the CA using Wilcoxon signed ranks test.Results:The sex-stratified results showed that no significant difference was found between the estimated BA using G-P standards and CA in boys ( Z=-0.694, P=0.488), while all the other estimated BA results were statistically significantly higher than CA ( P<0.05). Stratified by both sex and CA, the estimated BA using G-P standards in 4-6 years old boy groups, as well as the estimated BA using TW3-Carpal and TW3-C Carpal standards in 11-12 years old girl groups were lower than CA, while in the other groups, the estimated BA were higher than CA. Conclusions:There were varying degrees of deviations in the BA estimations using TW3, China 05, and G-P methods for children in rural areas of Beijing. It is imperative to establish a new standard for the BA evaluation of the contemporary Chinese children.

Sampling study design and radiography protocol of a large-sample investigation on skeletal maturation in 3 to 18-year-old children in China / 中华放射学杂志

Objective:To report the sampling study design and radiography protocol of a large-sample investigation on skeletal maturation of 3 to 18-year-old children in China.Methods:Multi-stage stratified random sampling was employed in this study. Two provinces, municipalities, or autonomous regions were randomly selected from each of the seven regions of China, including Northeast China, Northwest China, North China, Central China, East China, Southwest China, and South China. Then one rural and one urban investigation site were randomly selected from each province, municipality, or autonomous region. In total 28 sites were included. Among those sites, four residential districts were randomly selected from each urban site, and four townships from each rural site. For each residential district or township, 1-4 kindergartens, primary schools, and middle schools were chosen. Random cluster sampling was used to extract 3-<6-year-old children in kindergartens, and 6-18-year-old children in primary schools and middle schools. The investigation on skeletal maturation was sampled proportionate to the sampling of the whole study. The estimated simple size was 780 for each site, and 21 840 for all 28 sites in total. There were six groups of 3-<6-year-old children classified at 0.5-year intervals, and 12 groups of 6-18-year-old children classified at 1-year intervals. Posteroanterior position radiography of the left hand and wrist was achieved for all subjects.Results:The study was performed from August 26, 2019 to October 16, 2021. In total, 20 444 children received posteroanterior position radiography of the left hand and wrist, including 10 196 males and 10 248 females, 9 711 urban and 10 733 rural, respectively. The 3-<6-year-old group included 1 611 (male 819, female 792) subjects, and the 6 to 18-year-old group included 18 833 (male 9 377, female 9 456) subjects.Conclusion:This nationwide investigation on skeletal maturation of 3 to 18-year-old children in seven regions of China was successfully preformed. The results of this study can provide an important reference for establishing the current evaluation criteria of bone age in Chinese children and adolescents.

Comparison of Accuracy Between Pulp/Tooth Ratio and Tooth Coronal Index Methods for Dental Age Estimation Using Digital Panoramic Radiographs

ABSTRACT Objective: To evaluate the reliability and the accuracy of Tooth Coronal Index (TCI) and Pulp/Tooth Ratio (PTR) methods in dental age estimation using digital panoramic radiography. Material and Methods: In this cross-sectional study, 237 dental panoramic images were collected. The two methods (TCI and PTR) were applied to all left mandibular first and second molars based on inclusion and exclusion criteria. In order to analyze the acquired data, statistical methods were used. The estimated ages derived by exclusive formula were compared to the chronological age, and the error ranges for each indicator were measured to determine their accuracy. Results: There were negative correlations between PTR in the first molar (r=-0.89) and in the second molar (r=-0.788), as well as TCI in the first molar (r=-0.587) and in the second molar (r=-.242). In this study, we found that the Pulp/Tooth Ratio (PTR) accuracy rate for mandibular first and second molar teeth was 79.21% and 62.09 %, respectively, although the Tooth Coronal Index (TCI) value for these teeth was 34.45% and 5.85%. Conclusion: Pulp/Tooth Ratio and Tooth Coronal Index are potential age estimation indices. Although PTR was the more accurate one in our study. The results also demonstrated that indices related to the first molar tooth could be used to estimate age with greater accuracy and validity.

Use of the Demirjian method to estimate dental age in panoramic radiographs of patients treated at the Buenos Aires University School of Dentistry / Utilización del Método de Demirjian para estimación de la edad dental en radiografías panorámicas de pacientes atendidos en la Facultad de Odontología de la Universidad de Buenos Aires

ABSTRACT The aim of this study was to determine the difference between real age (RA) and dental age (DA) in boys and girls from the Autonomous City of Buenos Aires (C.A.B.A.) by analyzing digital panoramic radiographs from the database of the Imaging Department at the Buenos Aires University School of Dentistry, using the Demirjian Method (DM). The sample consisted of 508 panoramic radiographs of 6- to 14-year old Argentines (268 female and 240 male). The Demirjian method was used to estimate dental age from each panoramic radiograph, and the Wilcoxon test was applied to perform a comparative analysis with the real age recorded in the image database. Average RA was 9.36 years (SD 2.11), and average DA according to the Demirjian method was 10.45 years (SD 2.31). For females, RA was 9.25 (SD 2.12), and DA according to the DM was 10.40 years (SD 2.41). For males, RA was 9.46 (SD 2.10), and DA according to the DM was 10.50 years (SD 2.22). An inter-class correlation coefficient (ICC) calculated as a correlation measure between dental age and real age was ICC = 1.09%. The ICC was 1.04% for the males and 1.15% for females. Significant differences were found between DA and RA (p <0.01) in general and according to sex. Real age was found to be lower than dental age in the study population from Buenos Aires City.

RESUMEN El objetivo del presente trabajo fue determinar la diferencia entre la edad real (ER) y la edad dental (ED) en niños y niñas de la Ciudad de Buenos Aires analizando radiografías panorámicas digitales de la base de datos de la Cátedra de Diagnóstico por imágenes FOUBA, utilizando el Método Demirjian (MD). La muestra consistió en 508 radiografías panorámicas (268 del sexo femenino y 240 del sexo masculino) en una población argentina de 6 a 14 años de edad. Se realizó el cálculo de la edad dental en cada una de ellas, conforme el método de Demirjian. Se efectuó un análisis comparativo con la ER proveniente de la base de datos, utilizando la prueba de Wilcoxon. En las 508 panorámicas se estimó la ED. Se pudo establecer que la ER en promedio es 9.36 años con un desviación estándar (DS) de 2,11 y que la edad según el método de Demirjian es 10,45 años con una DS de 2,31. Para el sexo femenino se obtuvo una ER de 9,25 y una DS de 2,12 y según MD es de 10,40 años con una DS de 2,41. Para el sexo masculino se obtuvo una ER de 9,46 y una DS de 2,10 y según MD es de 10,50 años con una DS de 2,22. Se obtuvo un coeficiente de correlación inter-clase (CCI), como medida de correlación entre edad dental y real, de (CCI 1,09%). El CCI para el sexo masculino fue de (CCI 1,04 %) y en el caso del sexo femenino fue de (CCI 1,15%). Se hallaron diferencias significativas entre ED y ER (p<0,01) en general y también para ambos sexos. Se pudo evidenciar que la edad real es menor que la edad dental en la población de la Ciudad de Buenos Aires.

Comparación entre edad cronológica y dental según tres métodos de estimación en una población peruana / Comparison between chronological and dental ages according to three estimation methods in a Peruvian population

Resumen Las técnicas de estimación de edad dental tienen gran importancia en la evaluación odontológica, específicamente en el área de ortodoncia, académica y forense. El objetivo de este estudio fue comparar la edad dental según los métodos de Demirjian, Nolla y Cameriere con la edad cronológica en una población peruana. El diseño del estudio es de tipo observacional, descriptivo, de corte transversal y retrospectivo; tuvo una población total de 578 radiografías panorámicas de sujetos de 6 a 14 años, en las cuales se calculó la diferencia de medias de un estudio previo y, finalmente, fueron seleccionadas 193 de forma aleatoria. Se compararon la edad cronológica (EC) y la edad dental (ED) según los métodos de Nolla, Demirjian y Cameriere, utilizando las Pruebas de Rangos de Wilcoxon y Kruskall Wallis. Las medias de la EC fueron de 8,77±2,34 y 8,90±2,04 años para el género femenino y masculino, respectivamente. Las diferencias de medias de la EC y ED, de acuerdo con los métodos Nolla, Demirjian y Cameriere, fue de -0,38, 0,96 y -0,29 años, respectivamente, para la muestra total de estudio. Se encontró una correlación positiva para los tres métodos estudiados; sin embargo, el método de Demirjian mostró una diferencia estadísticamente significativa con una subestimación de -0,91 años en la muestra total. Asimismo, el método de Cameriere fue el que tuvo más cercanía a la edad cronológica.

Abstract Dental age estimation techniques have great importance in dental evaluation, specifically in the orthodontic, academic, and forensic areas. The aim of this study was to compare the dental age according to the Demirjian, Nolla and Cameriere methods with the chronological age in a Peruvian population. This is an observational, descriptive, retrospective and cross-sectional study, which had a total population of 578 panoramic radiographs of subjects aged 6 to 14 years, where the difference in means from a previous study was calculated, and 193 subjects were finally randomly selected. The chronological ages (CA) and dental ages (DA) were compared using the Wilcoxon and Kruskall Wallis Range Tests. The means were 8.77 ± 2.34 and 8.90 ± 2.04 years of the CA for the female and male genders, respectively. The difference in means of the CA and DA according to the Nolla, Demirjian and Cameriere methods were -0.38, 0.96 and -0.21 years, respectively, for the total study sample. A positive correlation was found for the three methods studied; however, the Demirjian method showed a statistically significant difference with an underestimation of -0.91 years in the total sample. Also, the method of Cameriere was the closest to the chronological age.

Relationship between the Height of Alveolar Bone Resorption and Sex and Age in Adolescents / 法医学杂志

OBJECTIVES@#To explore the relationship between the height of alveolar bone resorption and sex and age in the adolescent dentition.@*METHODS@#Multi-slice computed tomography (MSCT) was used to measure the height of alveolar bone resorption at labial, lingual, mesial and distal sites of teeth in 149 adolescents aged from 10 to 20 years. SPSS 25.0 software was used to analyze the relationship between the height of alveolar bone resorption and sex and age.@*RESULTS@#There was no significant difference in the height of alveolar bone resorption between sex (P>0.05). The height of alveolar bone resorption was positively correlated with age in all types of teeth. The model constructed by combining the alveolar bone resorption height data of four sites (y=2.569x1+3.106x2+4.108x3+1.451x4-0.082, R2max=0.756)had a better ability to infer age than that of combining two sites (y=5.942x1+4.489x2+0.612, R2max=0.706) and a single site (R2max=0.638).@*CONCLUSIONS@#The height of alveolar bone resorption is positively correlated with the age of adolescents. The combination of four sites has a stronger ability to infer the relationship between the height of alveolar bone resorption and age in adolescents and has higher accuracy in practical application.

Clinical study on thyroid function in children with congenital hypothyroidism / 中国基层医药

Objective:To investigate thyroid function, physical growth, and psychological and behavioral development in children with congenital hypothyroidism.Methods:Thirty-two children with congenital hypothyroidism who were born in Yuyao People's Hospital from January 2014 to December 2018 were included in the observation group. Thirty healthy neonates who were born in the same period were included in the control group. Thyroid function index changes at the age of 1 year relative to at birth, physical, intellectual, and neuropsychological development and bone age at the age of 1 year were compared between the observation and control groups.Results:Thyroid-stimulating hormone level at birth was significantly higher in the observation group than in the control group [(18.23 ± 2.71) mU/L vs. (2.85 ± 0.34) mU/L, t = 30.84, P < 0.001]. Free thyroxine level at birth was significantly lower in the observation group than in the control group [(6.76 ± 1.54) pmol/L vs. (17.91 ± 2.04) pmol/L, t = 24.39, P < 0.001]. In the observation group, thyroid-stimulating hormone and free thyroxine levels at the age of 1 year were (2.68 ± 0.78) mU/L and (17.26 ± 2.11) pmol/L, respectively, which were not significantly different from those in the control group [(2.77 ± 0.63) mU/L and (17.54 ± 2.20) pmol/L, t = 0.50, 0.51, both P > 0.05]. Body weight, body length, head circumference, and bone age at the age of 1 year were (9.21 ± 1.20) kg, (79.84 ± 3.05) cm, (43.73 ± 1.42) cm, (1.01 ± 0.15) years old, respectively in the observation group, which were significantly lower than those in the control group [(10.12 ± 1.32) kg, (84.54 ± 3.41) cm, (45.85 ± 2.04) cm, (1.14 ± 0.28) years old, t = 2.84, 5.73, 4.77, 2.30, P < 0.05]. The proportion of children patients with bone age lag was significantly higher in the observation group than in the control group [21.88% (7/32) vs. 3.33% (1/30), χ2 = 4.74, P < 0.05]. There was a significant difference in intellectual development at the age of 1 year between the two groups ( χ2 = 7.05, P < 0.05). Gross movement, fine movement, adaptability, language ability, and social ability in the observation group were scored (90.43 ± 6.96) points, (92.03 ± 6.03) points, (88.45 ± 4.85) points, (84.04 ± 5.71) points, and (85.05 ± 6.17) points, respectively, which were significantly lower than those in the control group [(99.47 ± 5.40) points, (104.12 ± 5.71) points, (98.47 ± 5.22) points, (94.16 ± 4.98) points, and (104.34 ± 5.70) points ( t = 5.69, 8.09, 7.84, 7.42, 12.76, all P < 0.001]. Conclusion:Neonate patients with congenital hypothyroidism have obvious physical growth and psychological and behavioral development disorders. Early screening and treatment of neonatal congenital hypothyroidism should be strengthened to improve the prognosis.

Effect of oral acitretin on the height and bone development of children: a retrospective analysis of 106 cases / 中华皮肤科杂志

Objective:To evaluate the effect of oral acitretin on the height and bone development of children.Methods:Clinical and imaging data were collected from 106 children receiving oral acitretin for at least 1 month in Department of Dermatology, Beijing Children′s Hospital from March 2007 to January 2021, and retrospectively analyzed. The main outcome measures were height and near-adult height. Multivariate logistic regression analysis was carried out to investigate relevant factors for short stature in children, and non-inferiority test was used to analyze the proximity of the actual height to target height of children who had reached near-adult height. The secondary outcome measures were bone age and epiphyseal closure. Wilcoxon signed-rank test was used to analyze differences in the value of bone age minus chronological age between the baseline and last follow-up, and the premature closure of epiphysis was also evaluated.Results:Among the 106 children, 62 were males and 44 were females; 84 were diagnosed with pustular psoriasis, 10 with psoriasis vulgaris, 11 with pityriasis rubra pilaris, and 1 with lupus miliaris disseminatus faciei. These children received oral acitretin at doses of <1 mg·kg -1·d -1 for 1 - 90 months. Among the 96 children aged under 18 years, 91 (94.8%) were of normal stature, and 5 (5.2%) were short in stature; among the 83 children receiving acitretin monotherapy, 81 (97.6%) were of normal stature, and 2 (2.4%) of short stature. Binary logistic regression analysis showed that the risk of short stature caused by acitretin combined with glucocorticoid therapy was 76.57 times higher than that of acitretin monotherapy ( OR = 77.57, 95% CI: 2.20 - 2 738.82, P = 0.017) , while the type of disease, gender, age at onset, age at initial treatment with acitretin, course of treatment, and average daily dose of acitretin did not significantly affect the stature of children ( P = 0.988, 0.214, 0.087, 0.078, 0.066, 0.350, respectively) . At the last follow-up visit, 13 children who had reached near-adult height were of normal stature, and the non-inferiority test showed that their near-adult height was not inferior to the target height (Satterthwaite = 0.23, P = 0.030) . Bone age was evaluated in 45 children at baseline and last follow-up visit, there was no significant difference in the value of bone age minus chronological age between the baseline and last follow-up ( Z = -0.85, P = 0.250) , and no patients experienced premature closure of epiphysis before and after the treatment. Conclusion:This study preliminarily revealed that oral acitretin at doses of <1 mg·kg -1·d -1 for less than 90 months might not significantly affect the height and bone development of children.

Transphyseal anterior cruciate ligament reconstruction in skeletally immature pubescent adolescents / 中华骨科杂志

Objective:To evaluate the safety and clinical efficacy of transphyseal anterior cruciate ligament (ACL) reconstruction with hamstring autograft in skeletally immature pubescent adolescents.Methods:Retrospectively reviewed 10 skeletally immature pubescent patients (10 knees) who underwent transphyseal ACL reconstruction with hamstring autograft between May 2015 and May 2020 in our center. Out of the 10 patients, 6 were males aged 14.2±1.4 years (range, 13-15 years) with bone age 13-15 years, 4 were females aged 12.4±1.2 years (range, 11-13 years) with bone age 11-13 years. The average duration from injury to surgery was 8.3±5.3 months (range, 3-48 months). Before operation, left hand and wrist plain film were done to assess bone age. Before operation and at follow up, physical examination, KT-1000 measurements and functional outcome instruments (the Lysholm score, and the Tegner score) were done. Radiographs were performed for angular deformity and leg-length measurements. The surgery was conducted via arthroscopically assisted transphyseal reconstruction of the ACL with use of an autogenous quadrupled hamstring tendon graft and fixation devices that did not cross the physes. A protective knee brace was used for 1 month postoperatively. Comparison of Lysholm score and Tegner score before and after surgery was performed using t test. Results:Arthroscopy confirmed ACL rupture in 10 knees. Concurrent meniscal surgery was performed in 3 knees. The follow-up duration was 3.2±2.3 years (range 2-5 years), one of 10 patients had ligament reinjury 1 year after surgery with positive anterior drawer test and Lachman test. As for the remaining 9 patients, the mean Lysholm knee score improved from preoperative 76.1±8.2 to 95.8 ±3.5, and the mean Tegner score improved from preoperative 4.3±0.9 to 8.3±0.6, both of the two outcomes had statistically significant difference ( t=6.43, P=0.024; t=4.41, P=0.033). One patients was weakly positive for anterior drawer test and Lachman test, with KT-1000 side difference >3 mm, the remaining eight were negative for anterior drawer test and Lachman test, and KT-1000 side difference was mean 1.7±0.7 mm. All patients had no more than 5° restriction in knee range of motion compared with the healthy side. The full-length X-ray of the standing lower limbs showed no length and angle deformity in both lower limbs. Conclusion:Transphyseal ACL reconstruction with autogenous quadrupled hamstring graft in treating skeletally immature pubescent patients (bone age over 13 years in male and 11 years in female) yields satisfied functional outcomes without growth disturbance.

Avaliação da idade dentária em crianças e adolescentes com epidermólise bolhosa ­ série de casos / Dental age estimation in children and adolescents with epidermolysis bullosa ­ case series

Introdução: a epidermólise bolhosa compreende um grupo de doenças genéticas e raras da pele, onde há uma fragilidade estrutural da pele e das mucosas. A gravidade das manifestações clínicas varia de acordo com o subtipo envolvido, no qual a citada enfermidade distrófica recessiva é a mais severa. Há várias implicações sistêmicas, como a anemia, a desidratação e a desnutrição. O envolvimento bucal acompanha e torna mais severo o comprometimento sistêmico. As alterações em tecidos moles e duros dessa região variam consideravelmente. São relatados atrasos no crescimento e desenvolvimento dentoesquelético. Objetivo: considerando as possíveis alterações de desenvolvimento, este estudo tem o objetivo de mensurar a idade dentária em pacientes com epidermólise bolhosa distrófica recessiva, verificando a acurácia de dois métodos em relação à idade cronológica. Metodologia: foi realizado um estudo descritivo analítico transversal do tipo série de casos, que avaliou a idade dentária de 10 pacientes pelos métodos de Demirjian e Willems. Resultados: não houve divergência significativa entre as idades dentária e cronológica, com superestimação comum aos métodos utilizados. Conclusão: sugere-se que o tempo de maturação dentária pode ser um parâmetro estável frente a fatores adversos ao desenvolvimento, que são comuns a esse grupo. São necessários estudos que avaliem também outras variáveis para melhor compreender a relação da epidermólise bolhosa com o desenvolvimento dentoesquelético.

Introduction: Epidermolysis Bullosa (EB) describes a group of rare genetic skin diseases where there is structural fragility within the skin and mucosa. Severity of clinical manifestations varies according to the specific EB type, and the most severe EB type is recessive dystrophic EB. There are several systemic implications, such as anemia, dehydration and malnutrition. There are also oral manifestations, so systemic manifestations may be more severe. Changes in soft and hard oral tissues vary considerably. Dentofacial growth and development retardation is reported. Aim: considering developmental changes, this study aims to measure the dental age of patients with recessive dystrophic EB by verifying the accuracy of two methods in relation to chronological age. Methods: a descriptive cross-sectional and analytical study of case series was carried out, which assessed the dental age of 10 patients using Demirjian and Willems methods. Results: there was not significant divergence between dental and chronological ages, but there was mutual overestimation related to both methods. Conclusion: it is suggested that dental maturation period may be a stable parameter against adverse developmental factors that are common to this group. Studies that also assess other variables are necessary to better understand the relation between EB and dentofacial growth.

Retraso de la erupción dental en el síndrome de Down: evaluación crítica de la evidencia / Delayed tooth eruption in Down syndrome: critical appraisal of evidence

El síndrome de Down en niños se asocia con múltiples alteraciones orofaciales, dentro de ellas se ha mencionado el retraso en la erupción dental, cuya comprensión no es aún del todo conocida. Se realizó una revisión para analizar los conceptos de erupción dental y acerca de la evidencia disponible respecto al retraso en la erupción dental de los niños con síndrome de Down y su relación con la maduración de los dientes o con otros factores sistémicos y locales. Se observó escasez de estudios sobre el tema, sin embargo, con la literatura encontrada se pudo concluir que el retraso de erupción de las piezas dentales parece no tener relación con la maduración de la pieza dental, sino a otros procesos que tienen lugar durante la erupción dental o que puede ser parte del retraso general del crecimiento y del desarrollo que caracteriza al síndrome de Down.

Down syndrome in children is associated with multiple orofacial alterations, among them delayed tooth eruption has been mentioned, the understanding of which is not yet fully known. A review was carried out to analyze the concepts of tooth eruption and the available evidence regarding delayed tooth eruption in children with Down syndrome, and its relationship with tooth maturation or with other systemic and local factors. Few studies were observed on the subject, however, with the found literature it was possible to conclude that the delay in tooth eruption seems not to be related to the maturation of the tooth, but it is related to other processes that take place during tooth eruption or it may be part of the general delay in growth and development that characterizes Down syndrome.

Tooth Coronal Index: A Novel Tool For Age Estimation on Cone-Beam Computed Tomography

ABSTRACT Objective: To evaluate dental age assessment reliability through Tooth Coronal Index (TCI) method. Material and Methods: The cone-beam computed tomography (CBCT) scans of 160 individuals aged between 20-70 years were analyzed in the present study. The height of the crown, i.e., coronal height, and the height of the coronal pulp cavity, i.e., coronal pulp cavity height, of mandibular second premolars and first molars were calculated and then TCI was measured. The actual age of a subject was compared with TCI of tooth and the acquired data were subjected to Pearson's correlation and unpaired t-tests. Results: Negative correlation was observed between the real age and TCI of mandibular first molar (r = -0.094, p=0.382) and second premolar (r = -0.176, p=0.0961. Statistically significant difference was observed between actual age and TCI for mandibular second premolar and first molar (p<0.001). Conclusion: Tooth coronal index has the potential to estimate age of an individual on CBCT scans. It is simple, cost-effective than histological methods and can be applied to both living and unknown dead.

Age estimation by pulp/tooth area and width ratios in panoramic images of upper and lower canines among the Iranian population / Estimativa da idade por área de polpa/dente e relações de largura em imagens panorâmicas de caninos superiores e inferiores entre a população iraniana

Objective: One of the techniques of estimating age in forensic medicine, which is associated with the least trauma in both living individuals and corpses, is to use teeth. Accordingly, the present study aims to determine the relationship between chronological age and pulp-to-tooth area ratio and pulp-to-root width ratio in maxillary and mandibular canines on panoramic radiographs among the Iranian population. Material and Methods: A total of 162 panoramic radiographs were evaluated in the present study. Selected patients were of verified age with the age range of 15-45 years. The pulp-to-tooth area ratio (PTR) and the pulp-to-root width ratio were calculated with AutoCAD 2016 software program in maxillary and mandibular canines at two points of the root. The two points include cemento-enamel Junction (CEJ) and pulp/root width at the quarter of a distance between CEJ and end point of root-canal, which was named WA, WB respectively. The patients' age was also estimated with the use of linear regression equation. Then each patient's chronological age and the age estimated using this technique was compared. Results: The relationship between PTR in both canines and WB variable in maxilla with chronological age was inverse and significant (P < 0.05); However, there was no strong correlation coefficient (r≤- o.37). Gender had no effect on the results of the study. The mean difference between predicted age and actual age with combined PTR and WB formula was lower than 1 year. When the mean of PTR or WB variables was considered as a predictor, significant results were obtained (P < 0.05), showing a decrease in Standard error of estimation (SEE). The results were not significant when variables of upper PTR and lower PTR and the interaction between them were included in the linear regression model (p > 0.05). Same results were obtained with the variable of WB. Conclusion: Combining the variables of PTR and WB gives better results than using variables alone. Estimation of age with the mean of each variable shows less error than their combination. (AU)

Objetivo: Uma das técnicas de estimativa da idade na medicina legal, que está associada ao menor trauma em indivíduos vivos e cadáveres, é usar os dentes. Nesse sentido, o presente estudo tem como objetivo determinar a relação entre a idade cronológica e a relação área polpa-dente e relação largura-polpa-raiz em caninos superiores e inferiores em radiografias panorâmicas na população iraniana. Material e Métodos: Um total de 162 radiografias panorâmicas são avaliadas no presente estudo. Os pacientes selecionados são da idade verificada com a faixa etária de 15-45 anos. A relação de área polpa-dente (PTR) e a relação largura-polpa-raiz são calculadas com o programa de software AutoCAD 2016 em caninos superiores e inferiores em dois pontos da raiz. Os dois pontos incluem a junção cemento-esmalte (CEJ) e a largura da polpa / raiz no quarto de distância entre a CEJ e o ponto final do canal radicular, que é denominado WA, WB. A idade dos pacientes também é estimada com o uso da equação de regressão linear. Em seguida, a idade cronológica de cada paciente e a idade estimada usando esta técnica são comparadas. Resultados: A relação entre a PTR em ambos os caninos e a variável WB na maxila com a idade cronológica é inversa e significativa (P <0,05); No entanto, não existe um coeficiente de correlação forte (r≤- o.37). O gênero não tem efeito nos resultados do estudo. A diferença média entre a idade prevista e a idade real com a combinação de PTR e fórmula WB é inferior a 1 ano. Quando a média das variáveis PTR ou WB é considerada como preditora, resultados significativos são obtidos (P <0,05), mostrando uma diminuição no SEE. Os resultados não são significativos quando as variáveis de PTR superior e PTR inferior e a interação entre elas são incluídas no modelo de regressão linear p> 0,05). Os mesmos resultados são obtidos com a variável de WB. Conclusão: Combinar as variáveis de PTR e WB dá melhores resultados do que usar variáveis sozinhas. A estimativa da idade com a média de cada variável apresenta menos erros do que sua combinação. (AU)

Age Estimation by Modified Demirjian's Method in a Hospital-Based Population: A Radiographic Study

ABSTRACT Objective: To test the modified Demirjian's method of dental age estimation on the South Indian population and correlate it with the patient's chronological age. Material and Methods: This retrospective radiographic study was performed on digital panoramic radiographs taken during a one-year duration. Radiographs of patients in the age range from 8 to 18 years were included in the study. The radiographs were examined and according to the stage of the crown and root status of the left side mandibular teeth. The stage of calcification was observed for eight teeth in the mandibular arch and was recorded in a specially designed proforma. Each rated tooth with stage was converted into a score using a conversion table specified for girls and boys. Results: 224 digital panoramic radiographs were retrieved from the radiologic database. Out of total study sample, 49.5% (n=111) were boys and 50.5% (n=113). The mean chronological and estimated dental age using dental maturity scores resulted in an overestimation of 3 years and eight months. Also, it was noted that there was a strong positive association between chronological (real) and dental age. Conclusion: It was observed that there was a strong correlation between chronological and dental age. A new formula for determining the chronological age from the estimated dental age was derived. Further studies on a larger population may prove the reliability of this age estimation method.

Relationship between Wound Age and Serum Marker Metabolites of Rats Skin Incised Wound / 法医学杂志

Objective To observe the metabolomics changes of serum after skin incision of rats and to determine the wound age of skin incision. Methods A rat skin incision model was established, 21 SD rats were divided into 1 h, 2 h, 4 h, 8 h, 16 h, 24 h after skin incision groups and the control group, then blood was taken from rats in the experimental groups at the corresponding time points after injury, and taken from the control group directly. Gas chromatography-mass spectrometry （GC-MS） technology was used to detect serum metabolites and screen marker metabolites, then orthogonal partial least square-discriminant analysis （OPLS-DA） model was used to establish a regression model for the relationship between marker metabolite content and wound age to determine wound age of skin. Results GC-MS was used to detect the serum collected, and 21 marker metabolites were obtained through initial screening, and 4 marker metabolites were further analyzed and screened using multivariate statistical analysis methods. There was no correspondence between the change rule of the serum content and wound age, therefore it cannot be used directly to determine wound age. OPLS model could be used to obtain regression models of the content and wound age of 21 marker metabolites and 4 marker metabolites, both of which can determine wound age, but the prediction accuracy of the regression model of 21 marker metabolites was significantly higher. Conclusion Using metabolomics to establish a regression model of the metabolite content and wound age has the potential to be applied to skin incision wound age determination.

Adult Age Estimation of CT Image Reconstruction of the Laryngeal Cartilages and Hyoid Bone Based on Data Mining / 法医学杂志

Objective To explore the feasibility of the CT image reconstruction of laryngeal cartilage and hyoid bone in adult age estimation using data mining methods. Methods The neck thin slice CT scans of 413 individuals aged 18 to <80 years were collected and divided into test set and train set, randomly. According to grading methods such as TURK et al., all samples were graded comprehensively. The process of thyroid cartilage ossification was divided into 6 stages, the process of cricoid cartilage ossification was divided into 5 stages, and the synosteosis between the greater horn of hyoid and hyoid body was divided into 3 stages. Multiple linear regression model, support vector regression model, and Bayesian ridge regression model were developed for adult age estimation by scikit-learn 0.17 machine learning kit （Python language）. Leave-one-out cross-validation and the test set were used to further evaluate performance of the models. Results All indicators were moderately or poorly associated with age. The model with the highest accuracy in male age estimation was the support vector regression model, with a mean absolute error of 8.67 years, much higher than the other two models. The model with the highest accuracy in female adult age estimation was the support vector regression model, with a mean absolute error of 12.69 years, but its accuracy differences with the other two models had no statistical significance. Conclusion Data mining technology can improve the accuracy of adult age estimation, but the accuracy of adult age estimation based on laryngeal cartilage and hyoid bone is still not satisfactory, so it should be combined with other indicators in practice.