Long-term secular trend of skeletal maturation of Taiwanese children between agricultural (1960s) and contemporary (after 2000s) generations using the Tanner-Whitehouse 3 (TW3) method.

BACKGROUND: The Tanner-Whitehouse (TW) method is one of the well-known techniques in determining the bone age. OBJECTIVE: According to the objectivity of TW3, the secular trend was investigated to discover whether the skeletal maturation of Taiwanese children between two generations was different. SUBJECTS AND METHODS: The large-scale database of Taiwan was collected. The first group, called mid-1960s, included 265 boys and 295 girls in the agricultural generation (between 1966 and 1967). The second group, called mid-2000s, includes 114 boys and 616 girls in the contemporary generation (after 2000s). The bone age was determined by three radiologists using the carpals-only system of the TW3 method and by two physicians using the Greulich and Pyle method. A comparison of the means (independent-samples t-test) was applied by examining the difference of the children's skeletal maturation between the two generations in the same chronological age. The significant difference was considered while the p-value was 0.05 or less (95% confidence interval). RESULTS: A significant difference of the mean bone age (by, on average, three radiologists using the TW3 method) between the mid-1960s and mid-2000s in the same gender and chronological age was presented by the independent-samples t-test (p<0.001 with 95% confidence interval), and the bone age, determined by the TW3 method, of the mid-2000s group was higher than that of the mid-1960s group. This scenario corresponded with the children's bone age determined by pediatricians. Besides, it deserved to notice that the bone age of boys in the mid-2000s was larger than that of the girls in the mid-1960s. Furthermore, by comparing the environmental condition, we suspect that the difference of bone age of children between the two generations was attributed to the discrepancy in nutrition and socioeconomic variation during the four decades in Taiwan. CONCLUSION: The study presents that the secular trend of skeletal maturation of children in the mid-2000s is faster than that in the mid-1960s.

Simplified radius, ulna, and short bone-age assessment procedure using grouped-Tanner-Whitehouse method.

BACKGROUND: The Tanner-Whitehouse III (TW3) method is popular for assessing children's bone age, but it is time-consuming in clinical settings; to simplify this, a grouped-TW algorithm (GTA) was developed. METHODS: A total of 534 left-hand roentgenograms of subjects aged 2-15 years, including 270 training and 264 testing datasets, were evaluated by a senior pediatrician. Next, GTA was used to choose the appropriate candidate of radius, ulna, and short bones and to classify the bones into three groups by data mining. Group 1 was composed of the maturity pattern of the radius and the middle phalange of the third and fifth digits and three weights were obtained by data mining, yielding a result similar to that of TW3. Subsequently, new bone-age assessment tables were constructed for boys and girls by linear regression and fuzzy logic. In addition, the Bland-Altman plot was utilized to compare accuracy between the GTA, the Greulich-Pyle (GP), and the TW3 method. RESULTS: The relative accuracy between the GTA and the TW3 was 96.2% in boys and 95% in girls, with an error of 1 year, while that between the assessment results of the GP and TW3 was about 87%, with an error of 1 year. However, even if the three weights were not optimally processed, GTA yielded a marginal result with an accuracy of 78.2% in boys and 79.6% in girls. CONCLUSIONS: GTA can efficiently simplify the complexity of the TW3 method, while maintaining almost the same accuracy. The relative accuracy between the assessment results of GTA and GP can also be marginal.

Interrelationship of carpal angle and bone age in children of different generations: a retrospective study.

BACKGROUND: Carpal angle measurement is one of the anthropometrical methods to evaluate the maturation of children. OBJECTIVE: To discuss the relationship between bone age and carpal angle in the maturation of children of two different generations. SUBJECTS AND METHODS: The first group (mid-1960s group) includes 521 Taiwanese children, 196 boys and 325 girls, growing during the agricultural period (between 1966 and 1967). The second group (mid-2000s group) includes 326 children, 74 boys and 252 girls, growing during the mid-2000s. The bone age of both groups was assessed by two leading physicians, and the carpal angle was measured by two senior radiologists. The Mann-Whitney U-test was used to compare the relationship of carpal angle and bone age among eras, sexes, and chronological ages. RESULTS: According to the same chronological age and sexes, the carpal angle of those in the mid-2000s group was larger than that of the mid-1960s group. In addition, in the same chronological age, the results also show that the mean carpal angle of girls in both generations was larger than that of boys. However, it is notable that the carpal angle of boys in the mid-2000s group is larger than that of girls in the mid-1960s group. Furthermore, by comparing the environmental condition, we suspect that the differences between carpal angles of both generation children are caused by the great changes in socioeconomic and nutrition status in Taiwan. CONCLUSION: The study presents a quantitative comparison of carpal angle between two generations of Taiwanese. The preliminary result indicates that the carpal angle for the mid-2000s group is larger than that for the mid-1960s groups.

A fuzzy-based growth model with principle component analysis selection for carpal bone-age assessment.

There are two well-known methods to assess bone age, the Greulich-Pyle method and the Tanner-Whitehouse method, which both utilize the hand radiogram to make bone-age assessment to assist medical doctors to identify the growth status of children. Basically, the morphology of bones could be evaluated to quantitatively describe the maturity. The study extracted the morphology of carpal bones and applied the fuzzy theory with principle component analysis to estimate the maturity of skeleton. Five geometric features of the carpals were extracted including the bone area, the area ratio, and the bone contour of the carpals. In order to analyze these features, the principle component analysis and the statistical correlation combined with three different types of procedure were used to construct a growth model of carpals. Eventually, the results of the three types of procedure with fuzzy rules can construct a bone-age assessment system to identify the maturity of children. The study shows that the proposed model based on fuzzy rule has an accuracy rate above 89% in Type-I and II, and above 87% in Type-III within a tolerance of 1.5 years.

Turner syndrome phalangeal screening based on a two-stage linear regression concept.

BACKGROUND: Turner syndrome (TS) is a congenital chromosomal abnormality, resulting in short stature, short fourth metacarpal, and retarded skeletal maturation in children. The existing methods of diagnosis, which include carpal angle, metacarpal sign, and body mass index (BMI), cannot accurately diagnose TS. The authors propose a novel procedure for examining the hand skeleton to distinguish between normal individuals and patients with TS. METHODS: This investigation was divided into two parts. In the first part, existing methods (evaluation of the metacarpal sign, measurement of the carpal angle, and determination of BMI) were used. Examination in the second part was based on the two-stage screening method (TSSM). In the first stage in TSSM, the ratio of the lengths of the distal-middle phalanges of the fifth digit was determined in normal subjects with average range of satisfactory body height and TS patients. A suitable cut-off was found on linear regression and used to divide the plot into TS patients and normal subjects. In the second stage, the normal section was transferred to another group based on bone and chronological ages. A greater number of patients were diagnosed with TS using this method. Finally, four cut-off parameters were determined on linear regression analysis. Results with optimal sensitivity and specificity were automatically obtained. RESULTS: The combination of TSSM with optimal programming (sensitivity = 0.81 and specificity = 0.91) was satisfactory for diagnosing TS patients. CONCLUSION: TSSM can suitably evaluate growth of the hand skeleton to distinguish between normal individuals and patients with TS.

Computer-aided diagnosis of peripheral soft tissue masses based on ultrasound imaging.

Medical ultrasound (US) has been widely used for distinguishing benign from malignant peripheral soft tissue tumors. However, diagnosis by US is subjective and depends on the experience of the radiologists. The rarity of peripheral soft tissue tumors can make them easily neglected and this frequently leads to delayed diagnosis, which results in a much higher death rate than with other tumors. In this paper, we developed a computer-aided diagnosis (CAD) system to diagnose peripheral soft tissue masses on US images. We retrospectively evaluated 49 cases of pathologically proven peripheral soft tissue masses (32 benign, 17 malignant). The proposed CAD system includes three main procedures: image pre-processing and region-of-interest (ROI) segmentation, feature extraction and statistics-based discriminant analysis (DA). We developed a depth-normalization factor (DNF) to compensate for the influence of the depth setting on the apparent size of the ROI. After image pre-processing and normalization, five features, namely area (A), boundary transition ratio (T), circularity (C), high intensity spots (H) and uniformity (U), were extracted from the US images. A DA function was then employed to analyze these features. A CAD algorithm was then devised for differentiating benign from malignant masses. The CAD system achieved an accuracy of 87.8%, a sensitivity of 88.2%, a specificity of 87.5%, a positive predictive value (PPV) 78.9% and a negative predictive value (NPV) 93.3%. These results indicate that the CAD system is valuable as a means of providing a second diagnostic opinion when radiologists carry out peripheral soft tissue mass diagnosis.

Overexpression of neuronal intermediate filament protein alpha-internexin in PC12 cells.

The neuronal intermediate filaments include not only the neurofilament triplet proteins but also peripherin and alpha-internexin. To determine whether neurite outgrowth is enhanced by alpha-internexin, the cDNA of rat alpha-internexin tagged with enhanced green fluorescent protein (EGFP) was transfected into a rat adrenal pheochromocytoma cell line PC12 that responds to nerve growth factor (NGF) by induction of the neuronal phenotype. Selected stable clones were induced by NGF and examined for expression patterns of neuronal intermediate filaments by Western blot and immunocytochemistry. Differentiating neurons were also collected after NGF induction for RT-PCR analysis. Overexpressed alpha-internexin-EGFPs were found mainly in cell bodies and the proximal part of neurites. It was also found that overexpression of alpha-internexin-EGFPs enhanced the neurite outgrowth of PC12 cells at the early stages of NGF induction. Meantime, NF-L and NF-M were upregulated by the overexpression of alpha-internexin-EGFPs. Interestingly, alpha-internexin-EGFP-transfected cells obviously detached from culture plates at the later stages of NGF induction. Massive IF accumulations, swelling mitochondria, and degenerating neurites with numerous electron-dense granules were observed ultrastructurally in the alpha-internexin-EGFP-transfected cells. In addition, neuronal death was also characterized positively by the TUNEL assay. These observations may imply that cell death was occurring in alpha-internexin-EGFP-transfected cells. From this study, it could be suggested that alpha-internexin plays an important role in neurite outgrowth and regulates the expression of other neurofilaments during neuronal development. Apoptosis-like cell death could also be induced by the overexpression of alpha-internexin-EGFP in PC12 cells after NGF induction.