Timing of menarche in girls adopted from China: a cohort study.

BACKGROUND: Girls adopted internationally from some states have been found to have high rates of early puberty, including early menarche. Explanations for the link between international adoption and early puberty include post-adoption catch-up growth triggering puberty, and under-recorded age. METHODS: We compared menarcheal age in a cohort of 814 girls adopted from China into North America against menarcheal ages in girls in China. Adoptive parents provided survey data on their daughters' weight in 2005 and on menarcheal status and age at menarche in 2011. RESULTS: Estimated median age at menarche for adopted Chinese girls is 12.37 years (95% CI: 11.84-13.00 years). Estimated prevalence of menarcheal age ≤10.00 years for adopted girls is 3%. These findings are similar to published findings on non-adopted Chinese girls. The distribution of menarche of adopted girls and non-adopted girls at the estimated incidence rates P3-P97 are also similar. Among the 609 girls whose parents reported on their weight shortly after adoption, 148 (24.3%) were -2SD or more below the median weight in the WHO weight-for-age tables. The proportion of these girls who had attained menarche was not statistically different from other girls. CONCLUSIONS: For girls adopted from China, the age of menarche, the percentage of girls attaining menarche <10 years and the distribution of menarcheal age are all similar to Chinese girls growing up in China.

Mutations in isocitrate dehydrogenase 1 and 2 occur frequently in intrahepatic cholangiocarcinomas and share hypermethylation targets with glioblastomas.

Mutations in the genes encoding isocitrate dehydrogenase, IDH1 and IDH2, have been reported in gliomas, myeloid leukemias, chondrosarcomas and thyroid cancer. We discovered IDH1 and IDH2 mutations in 34 of 326 (10%) intrahepatic cholangiocarcinomas. Tumor with mutations in IDH1 or IDH2 had lower 5-hydroxymethylcytosine and higher 5-methylcytosine levels, as well as increased dimethylation of histone H3 lysine 79 (H3K79). Mutations in IDH1 or IDH2 were associated with longer overall survival (P=0.028) and were independently associated with a longer time to tumor recurrence after intrahepatic cholangiocarcinoma resection in multivariate analysis (P=0.021). IDH1 and IDH2 mutations were significantly associated with increased levels of p53 in intrahepatic cholangiocarcinomas, but no mutations in the p53 gene were found, suggesting that mutations in IDH1 and IDH2 may cause a stress that leads to p53 activation. We identified 2309 genes that were significantly hypermethylated in 19 cholangiocarcinomas with mutations in IDH1 or IDH2, compared with cholangiocarcinomas without these mutations. Hypermethylated CpG sites were significantly enriched in CpG shores and upstream of transcription start sites, suggesting a global regulation of transcriptional potential. Half of the hypermethylated genes overlapped with DNA hypermethylation in IDH1-mutant gliobastomas, suggesting the existence of a common set of genes whose expression may be affected by mutations in IDH1 or IDH2 in different types of tumors.

Atypical findings of discordant bone scan and radiographs in transient osteoporosis of the hip: case report and review of the literature.

The authors report atypical findings of discordant bone scans and radiography seen in a patient with transient osteoporosis of the hip (TOH). Presented in the case of a 60-year-old man who had spontaneous onset of left hip pain which worsened for 2 months with weight-bearing on the affected side. Initial and follow-up radiographs of the let hip were normal. Bone scan demonstrated intense uptake of Tc-99m MDP in the affected femoral head and neck, corresponding to characteristics of abnormal signal intensity of TOH or transient bone marrow edema syndrome on MRI. This discordant pattern of bone scan and radiographs has rarely been reported in the literature. Its possible mechanism of causation and clinical implication in TOH, together with a review of the literature, are discussed in this report.

Ga-67 scintigraphy in pediatric patients. Comparison of extended SPECT of the chest and abdomen with planar imaging.

Ga-67 SPECT has been shown to be more sensitive than planar imaging in several pediatric and adult studies. With multidetector SPECT cameras, SPECT imaging of multiple sites and volumes rendered images are possible. This study was performed to determine if SPECT of the chest, abdomen, and pelvis can be substituted for planar imaging of the same body regions. Fifty-one Ga-67 studies in 36 patients with lymphoma (29 patients) and inflammation (7 patients) were reviewed. Ga-67 SPECT of the chest, abdomen, and pelvis was compared with planar images of the same body regions. There were 52 abnormal sites on SPECT and 42 on planar imaging. Ten sites were positive only on SPECT; five of these sites were seen on SPECT because of improved three-dimensional separation of sites of gallium uptake. In the limited number of cases in this study, duplicate planar and SPECT imaging of the same volume was unnecessary.

Effects of myocardial viability assessment with positron emission tomography on clinical management and patient outcomes.

OBJECTIVE: To evaluate the effects of myocardial viability assessment with positron emission tomography on cardiac revascularization decision-making and consequential outcomes of patients with multivessel coronary artery disease. METHODS: Thirty-three patients with multivessel coronary disease and heart failure were studied in this series, using 13NH for myocardial perfusion and F-18-deoxy-glucose for myocardial metabolism. Viable myocardium (mis-matched perfusion-metabolism) was visually and quantitatively analyzed in anterior, apical, septal, inferior, and lateral segments of the left ventricle. Left ventricular ejection fraction (LVEF) was also measured with first-pass radionuclide angiocardiography. RESULTS: Based on the assessment of myocardial viability, 19 patients (group A) with sufficient viable myocardium underwent revascularization (coronary bypass graft and/or angioplasty), and 14 patients (group B) without sufficient viable myocardium received conservative medical treatment. During an average of 17-month follow-up, there were 2 (10.5%) deaths in group A and 2 in group B (14.3%) deaths (P > 0.5). Patients with revascularization showed significantly improved average LVEFs post-revascularization, without revascularization procedure-related mortality; patients with medical treatment had an initial average LVEF of 25% and class II-III (NYHA) average cardiac function with a survival rate of 86% in average, which was better than that reported in literature. CONCLUSION: Positron emission tomography is useful in myocardial viability assessment for cardiac revascularization decision-making through precisely selecting suitable patients for revascularization and avoiding operations on those who will not benefit, which results in promising effects on outcomes of patients with multivessel coronary disease and severe left ventricular dysfunction.