Muscle-bone Relationships in the Lower Leg of Healthy Pre-pubertal Females and Males

Muscle-bone relationships in healthy pre-pubertal children were investigated using four muscle measures as predictors of tibial strength: 66% tibia cross-sectional muscle area (CSMA) by pQCT; leg lean mass (LLM) by DXA; and muscle power (Power) and force (Force) measured during a two-footed jump. Polar strength strain index (pSSI), a calculated surrogate for bone strength at the 20% distal tibia, was obtained on 105 (54 male) self-assessed pre-pubertal children. The amount of muscle (CSMA, LLM) may influence bone strength more than muscle strength (Power, Force) during periods of rapid growth. Correlations and multiple regression partial-R values from models controlling for age, sex, height and weight were obtained for each muscle predictor. CSMA, LLM, Power and Force were positively correlated with pSSI (R=0.84, 0.92, 0.85; 0.66, respectively, all p\u3c 0.01). Partial-R values were highest for LLM (partial-R=0.21), similar for CSMA and Power (0.14, 0.15, respectively) and lowest for Force (0.04) in predicting pSSI. Muscle predictors were associated with total and cortical area (R=0.59 to 0.90; p\u3c 0.01 for all), but not cortical vBMD at the 20% distal tibia site. These data support relationships between muscle predictors and bone parameters measured by pQCT in healthy pre-pubertal children

Effect of Level of Farm Mechanization Early in Life on Bone Later in Life

OBJECTIVE: To determine whether an active rural lifestyle during childhood and adolescence, defined as low farm mechanization, was associated with bone measures later in life.METHODS: DXA bone data from total body, hip and spine, and pQCT data from 4% and 20% distal radius were obtained on 330 individuals (157 women) aged 20-66 years who farmed at least 75% of their lives. Primary bone outcomes included areal bone mineral density (aBMD), aBMD Z-scores, cortical and trabecular volumetric BMD, cortical thickness and periosteal circumference. Relationship between bone and recall of level of farm mechanization as a child was determined after stratifying by sex and controlling for covariates.RESULTS: Controlling for covariates, females from low mechanized farms had higher femoral neck (FN) bone area (p=0.03) than those on high or moderate mechanized farms. No group differences in pQCT ulna measurements or z-scores were found in either gender.CONCLUSION: A low farm mechanization level (high physical activity) prior to 20 years of age is associated with greater FN bone area in females. Future research that includes type and amount of physical activity performed will contribute to growing knowledge of how and when regular physical activity during childhood and adolescence affects adult bone health

Variation in Cortical Density Within the Cortical Shell of Individuals Across a Range in Densities and Ages

OBJECTIVES: The purpose of this study was to determine variability in cortical volumetric bone density (vBMD) from a single slice tibia image over a range of vBMD readings and ages. METHODS: Males and females (N=80; aged 6-80) were randomly selected from a previous study. Cortical vBMD at the anterior, posterior, medial, and lateral regions as well as the endocortical, mid-cortical, and pericortical regions of the cortical shell were determined using pQCT. RESULTS: Mean anterior ROI cortical vBMD (1111±11 mg/cm(3)) was lower than the posterior and lateral ROIs (1169±7 mg/cm(3) and 1151±9 mg/cm(3), respectively), (p CONCLUSIONS: Variability in cortical vBMD was higher among young individuals and those with lower overall cortical vBMD, while lowest in older individuals and men. The anterior ROI had lower mean cortical vBMD than posterior or lateral regions, and endocortical vBMD was lower than the mid- and pericortical regions

South Dakota Pregnancy Survey 2016 Data Report

The South Dakota Department of Health, in conjunction with the EA Martin Program at South Dakota State University, conducted a 2016 Pregnancy Risk Assessment Monitoring System (PRAMS)-like surveillance project. The 2016 South Dakota PRAMS-like survey was a statewide population-based survey based on a stratified random sample of women who gave birth to a live-born infant, thereby allowing rates to be estimated for South Dakota mothers giving birth in 2016. The topics included in this survey were selected to enhance our understanding of maternal attitudes and behaviors around the time of pregnancy and the weighted response rate was 67.6%

Rural vs. Non-rural Differences and Longitudinal Bone Changes by DXA and pQCT in Men Aged 20-66 Years: A Population-Based Study

The purpose of this research was to determine whether there were differences in estimated means and rates of change in BMC, bone area, BMD and measures of bone geometry among men (n=544) from three distinct populations (Hutterite [rural], rural non-Hutterite, non-rural), and whether activity levels or calcium intake explain these population differences. Men were enrolled in the South Dakota Rural Bone Health Study and followed for 7.5 years to estimate means and rates of change in bone mass, density, size and geometry. Femoral neck (FN) and spine measurements were obtained every 18 months by DXA and distal radius (4% and 20%) measurements by pQCT. Activity measurements and calcium intake were obtained quarterly for the first 3 years and at 54, 72, and 90 months. Rural men had greater percent time in moderate plus vigorous activity (mean ± SD: 22 ± 10 vs. 15 ± 8%,

Fat Mass Gain is Lower in Calcium-supplemented than in Unsupplemented Preschool Children with Low Dietary Calcium Intakes

BACKGROUND: Dietary calcium may play a role in the stimulation of lipolysis and the inhibition of lipogenesis, thereby reducing body fat.OBJECTIVE: The aim was to determine whether an association existed between change in percentage body fat (%BF) or fat mass and calcium intake in children aged 3-5 y.DESIGN: A secondary analysis of a 1-y randomized calcium and activity trial in 178 children was conducted. Three-day diet records and 48-h accelerometer readings were obtained at 0, 6, and 12 mo. Body composition was measured by dual-energy X-ray absorptiometry at 0 and 12 mo.RESULTS: The decrease in %BF was less in girls (-0.6 +/- 2.8%) than in boys (-1.5 +/- 2.6%; P = 0.03) and correlated with age (r = 0.19, P = 0.01) and maternal body mass index (r = 0.19, P = 0.02). Changes in fat mass were not significantly different by activity group or between children randomly assigned to receive calcium or placebo (0.5 +/- 0.9 and 0.6 +/- 0.8 kg, respectively; P = 0.32). Similar findings were observed for the change in %BF. No correlations between %BF and fat mass changes and dietary calcium (r = -0.01, P = 0.9 and r = -0.05, P = 0.5) or total (dietary + supplement) calcium intake (r = -0.02, P = 0.8 and r = -0.06, P = 0.4) were observed. Among children in the lowest tertile of dietary calcium (/d), fat mass gain was lower in the calcium group (0.3 +/- 0.5 kg) than in the placebo group (0.8 +/- 1.1 kg) (P = 0.04) but was not correlated with mean total calcium intake (r = -0.20).CONCLUSION: These findings support a weak relation between changes in fat mass gain and calcium intake in preschool children, who typically consume below recommended amounts of dietary calcium

Higher BMC and areal BMD in Children and Grandchildren of Individuals with Hip or Knee Replacement

The relationship between aBMD and osteoarthritis (OA) remains unclear. We compared aBMD, BMC and bone size among children and grandchildren of Hutterites with hip or knee replacement (n=23 each) to children and grandchildren of age- and sex-matched controls (178 children and 267 grandchildren). There were no differences in anthropometric measures or activity levels between case and control probands, but femoral neck (FN) and spine (LS) aBMD and Z-scores were greater in cases than controls (0.89 vs. 0.80 g/cm2; 1.15 vs. 1.03 g/cm2; 1.5 vs. 0.8; 2.4 vs. 1.2: all por =2 years post-menarcheal or males\u3e or =18 years): 33 were not classified. Post-menarcheal, but not premenarcheal, granddaughters of cases had greater hip, FN and LS aBMD Z-scores (0.7 vs. -0.1; 0.6 vs. -0.1; 0.8 vs. -0.3); greater hip and spine aBMD (1.03 vs. 0.95, 1.10 vs. 0.98 g/cm2); greater femoral neck and spine BMC (4.77 vs. 4.21, 66.7 vs. 55.4 g); and greater spine bone area (60.7 vs. 56.6 cm2) compared to granddaughters of controls (all,

HAE international home therapy consensus document

Hereditary angioedema (C1 inhibitor deficiency, HAE) is associated with intermittent swellings which are disabling and may be fatal. Effective treatments are available and these are most useful when given early in the course of the swelling. The requirement to attend a medical facility for parenteral treatment results in delays. Home therapy offers the possibility of earlier treatment and better symptom control, enabling patients to live more healthy, productive lives. This paper examines the evidence for patient-controlled home treatment of acute attacks ('self or assisted administration') and suggests a framework for patients and physicians interested in participating in home or self-administration programmes. It represents the opinion of the authors who have a wide range of expert experience in the management of HAE

The global retinoblastoma outcome study : a prospective, cluster-based analysis of 4064 patients from 149 countries

DATA SHARING : The study data will become available online once all analyses are complete.BACKGROUND : Retinoblastoma is the most common intraocular cancer worldwide. There is some evidence to suggest that major differences exist in treatment outcomes for children with retinoblastoma from different regions, but these differences have not been assessed on a global scale. We aimed to report 3-year outcomes for children with retinoblastoma globally and to investigate factors associated with survival. METHODS : We did a prospective cluster-based analysis of treatment-naive patients with retinoblastoma who were diagnosed between Jan 1, 2017, and Dec 31, 2017, then treated and followed up for 3 years. Patients were recruited from 260 specialised treatment centres worldwide. Data were obtained from participating centres on primary and additional treatments, duration of follow-up, metastasis, eye globe salvage, and survival outcome. We analysed time to death and time to enucleation with Cox regression models. FINDINGS : The cohort included 4064 children from 149 countries. The median age at diagnosis was 23·2 months (IQR 11·0–36·5). Extraocular tumour spread (cT4 of the cTNMH classification) at diagnosis was reported in five (0·8%) of 636 children from high-income countries, 55 (5·4%) of 1027 children from upper-middle-income countries, 342 (19·7%) of 1738 children from lower-middle-income countries, and 196 (42·9%) of 457 children from low-income countries. Enucleation surgery was available for all children and intravenous chemotherapy was available for 4014 (98·8%) of 4064 children. The 3-year survival rate was 99·5% (95% CI 98·8–100·0) for children from high-income countries, 91·2% (89·5–93·0) for children from upper-middle-income countries, 80·3% (78·3–82·3) for children from lower-middle-income countries, and 57·3% (52·1-63·0) for children from low-income countries. On analysis, independent factors for worse survival were residence in low-income countries compared to high-income countries (hazard ratio 16·67; 95% CI 4·76–50·00), cT4 advanced tumour compared to cT1 (8·98; 4·44–18·18), and older age at diagnosis in children up to 3 years (1·38 per year; 1·23–1·56). For children aged 3–7 years, the mortality risk decreased slightly (p=0·0104 for the change in slope). INTERPRETATION : This study, estimated to include approximately half of all new retinoblastoma cases worldwide in 2017, shows profound inequity in survival of children depending on the national income level of their country of residence. In high-income countries, death from retinoblastoma is rare, whereas in low-income countries estimated 3-year survival is just over 50%. Although essential treatments are available in nearly all countries, early diagnosis and treatment in low-income countries are key to improving survival outcomes.The Queen Elizabeth Diamond Jubilee Trust and the Wellcome Trust.https://www.thelancet.com/journals/langlo/homeam2023Paediatrics and Child Healt

Increased Periosteal Circumference Remains Present 12 Months After an Exercise Intervention in Preschool Children

We previously reported that calcium intake enhanced the leg bone response to physical activity of preschool children in a 12-month randomized trial of calcium supplementation and physical activity. To determine whether the intervention-induced changes in leg bone mineral content and size were maintained through the subsequent 12-month follow-up period, total body bone measurements by DXA and 20% distal tibia pQCT bone measurements were obtained at 24 months (12 months post-intervention). Children also were measured for height and weight, and accelerometer readings were obtained in a subset of children at 18 and 24 months (6 and 12 months post-intervention). Regression analyses were performed controlling for covariates and indicated that increases from 12 to 24 months were greater in the gross motor (GM) activity group (bone loading, large muscle exercises) vs. fine motor (FM) activity group (arts and crafts program) for arm bone area (BA) (P \u3c 0.01), total body (P = 0.04) and arm (P \u3c 0.01) bone mineral content (BMC). There were no differences in BA or BMC changes from 12 to 24 months by calcium supplementation. Differences in tibia periosteal circumference by pQCT persisted at 24 months (GM 51.4 ± 0.4 mm vs. FM 50.2 ± 0.4 mm, P = 0.03) with a trend for greater endosteal circumferences in the children in the GM vs. FM groups at both 12 and 24 months (both, P = 0.08). There were no significant differences in cortical area or thickness by activity or supplement group at 24 months. Children in the GM group had greater accelerometer counts/day (P = 0.04) and more time in vigorous activity (P = 0.05) at 18 months compared to FM group. No differences in accelerometer readings were noted at 24 months. In conclusion, we found higher activity levels in children randomized to gross motor vs. fine motor activities 6 months after the intervention program ceased. Whether the greater periosteal circumference that was observed 12 months post-intervention was a persistent biological bone effect or due to persistently higher activity levels is not known