Should we consider the sex when estimating bone age from hand bone biometrics?

BACKGROUND: Recently, it was proposed to estimate age from the biometric information of hand bones. We observed that these estimations became less precise as children get older, especially from the age of 13-15 years. OBJECTIVE: This study aimed to evaluate the influence of considering sex for age estimation based on hand bones biometrics. MATERIALS AND METHODS: The study sample consisted of metacarpals and proximal phalanges measurements collected on 1003 medical images performed at Nancy and Marseille Hospitals of individuals aged under 21 years. This sample was divided into two subgroups delineated by the age of 13, as it is a relevant legal threshold for most European countries. First, the influence of sex on the hand bones biometrics and on the estimated age was evaluated. Then, based on these results, new sex-specific age estimation formulas were constructed from linear models and their precision was assessed using residual analysis, in comparison with previous global formulas. RESULTS: An influence of sex was only highlighted from the age of 13 and for the total study sample. Thus, new sex-specific age estimation formulas were built for the [1-21] global sample and the [13-21] subsample. Even though the differences with the previous formulas were minor, age was more accurately estimated when sex was considered. CONCLUSION: Considering sex in age estimation is relevant when relying on hand bone biometrics. A new tool was proposed to select the most appropriate age estimation formula, based on the discriminant analysis result and the a priori knowledge of the sex.

HoSAGE: Sarcopenia in Older Patients before and after Treatment with Androgen Deprivation Therapy and Radiotherapy for Prostate Cancer.

BACKGROUND: Sarcopenia is a muscle disease defined by a loss of muscle strength associated to a decrease in skeletal muscle mass. In addition to aging, many factors may contribute to sarcopenia as cancer and/or androgen deprivation therapy (ADT). OBJECTIVES: The aims of this study are to describe the prevalence of sarcopenia in older prostate cancer patients before initiation of treatment with ADT and radiotherapy, and to evaluate the impact of ADT on the occurrence or aggravation of sarcopenia in this population. DESIGN: longitudinal study. PARTICIPANTS AND SETTING: Sarcopenia was prospectively evaluated in 31 consecutive patients aged 70 to 88 years, referred in one hospital unit of south eastern France, for a comprehensive geriatric assessment (CGA) before cancer treatment initiation. MEASUREMENTS AND RESULTS: CGA, measures of muscle strength and physical performances were performed at baseline (T0) and at the end of cancer treatment (T1). Appendicular skeletal muscle mass was measured by Dual-energy X-ray absorptiometry (DXA) at the end of treatment. At T0, 8 patients (among 31) had a probable sarcopenia according to European consensus, and 18 had altered physical performance. At T1, 15 patients (among 19) had abnormal one leg balance test. Finally, only one patient had a sarcopenia confirmed by DXA. CONCLUSION: This preliminary study showed a high prevalence of muscle disorders before initiation of ADT in a population of elderly cancer prostate patients with intermediate frailty status, and an increased risk of falls at the end of ADT. This highlighted the importance of screening for sarcopenia before treatment initiation, to prevent the occurrence or aggravation of sarcopenia by possible adjustment of treatment, and implementation of appropriate exercise and nutrition interventions.

[Estimation of small and large fetal weight at delivery from ultrasound data]. / Estimation du poids de naissance de fœtus de petit poids (≤2500g) et de gros poids (≥4000g) à partir des données échographiques.

OBJECTIVE: Birth weight (BW) prediction is crucial to assess the risk of fetal and neonatal morbidity and mortality related to growth restriction or macrosomia. Our objective here was to devise an accurate BW prediction method for small fetuses (BW ≤ 2500 g) and large fetuses (BW ≥ 4000 g), based on ultrasound data collected starting at 20 weeks' gestational age. These new models were tested on a new sample of validation consisted of 397 small fetuses and 135 large fetuses. METHODS: We included 3486 fetuses whose age and weight at birth were known and for whom standard data were available from ultrasound scans. Extrapolation to full-term of the estimated fetal weight computed using Hadlock's equation identified 212 small and 291 large fetuses. We built a new regression model for predicting the BWs of small fetuses and large fetuses. The results obtained using these models were compared to those provided by Hadlock's equation. RESULTS: Predicted BWs of small and large fetuses obtained using the regression models showed significantly less systematic bias (1.0 versus 4.9) and (-3.4 versus -7.0, respectively) and random error (10.1 versus 11.6 and 7.5 versus 8.9, respectively) than Hadlock's estimate. These results are confirmed on the sample of validation. CONCLUSIONS: Our results support the accuracy and reliability of our BW prediction models for small and large fetuses. In addition, our models provide BW estimates as early as 5 ± 1 weeks before birth.

[A look into the past: improves in obstetrical and neonatal outcome in maternity since the 19th century]. / Un regard dans le passé : évolution du devenir materno-fœtal en maternité depuis le xixe siècle.

OBJECTIVE: Evaluate changes in obstetrical and neonatal outcome of women who delivered in maternity hospital since the 19(th) century. MATERIALS AND METHODS: Data from a historic cohort of 1022 women who delivered between 1871 and 1874 in the hôtel Dieu hospital of Marseille were compared to those from 1159 women who delivered from 2005 to 2006 in the level 3 maternity of Nord hospital of Marseille (contemporary cohort). Deliveries that had occured before 22 weeks and/or with a foetal birth weight of less than 500 g were excluded. RESULTS: A total of 2131 pregnancies were included: 1011 and 1120 in historic and contemporary cohort, respectively. Despite comparable mean term of delivery, mean birth weight of neonates from historic cohort were significantly lower: 2971 g (550-4900 g) vs 3250 g (500-5375 g), respectively (p<0.001). Stillbirths were reported in 72 (7.1%) cases in historic cohort compared to nine (0.8%) in contemporary cohort (p<0.001). Neonatal mortality was 3.7% in historic cohort and 1.9% in contemporary cohort (p=0.012). A total of 99 (9.8%) maternal deaths were reported in historic cohort, while none in contemporary cohort (p<0.001). A wide majority of maternal deaths were caused by maternal infection (72.9%); 5.2% were caused by postpartum haemorrhage. CONCLUSION: Our results illustrate the tremendous impact on maternal and neonatal outcome of advances in obstetrical management. The significant increase in the median foetal birth weight is likely to be related to wide changes in environmental conditions and behaviour.

Small and large foetuses: Identification and estimation of foetal weight at delivery from third-trimester ultrasound data.

BACKGROUND: The estimation of foetal weight (EFW) at delivery is crucial to assess the risk of foetal and neonatal morbidity and mortality, most notably when the foetus is small or large. AIM: To accurately predict the EFW at delivery of small foetuses (birth weight [BW]≤2500g) and large foetuses (BW≥4000g) identified with third-trimester ultrasound data. METHODS: We included 1309 foetuses whose age and weight at birth were known and for whom standard data were available from third-trimester ultrasound scans. Small and large foetuses were identified by extrapolation to full term of the estimated foetal weight obtained using Hadlock's equation. We built two regression models for predicting the birth weights of small and large foetuses, respectively. The results obtained with these models were compared to those obtained with Hadlock's equation. RESULTS: Third-trimester sonograms were obtained at 33.6±1.3 weeks gestational age [WGA] and birth occurred at 38.7±1.2WGA. EFW of small foetuses predicted using the regression model showed significantly less systematic bias than the Hadlock estimate (2.3% vs. 7.2%, respectively), whereas random errors were similar. EFW of large foetuses predicted using the regression model showed significantly less random error than the Hadlock estimate (6.2% vs. 10.1%, respectively), whereas systematic bias was similar. Data from an independent validation sample indicate that our regression models are accurate. CONCLUSIONS: To apply distinct models for accurately predicting the EFWs at delivery of small and large foetuses should prevent adverse events related to newborn size.