Search Results (41)

Anterior cruciate ligament (ACL) injuries in skeletally immature patients pose unique clinical and surgical challenges due to the presence of open physes and ongoing growth. In recent years, multiple surgical strategies have been developed to restore knee stability while minimizing the risk of growth disturbances. However, clinical decision-making remains complex due to the lack of consensus regarding the optimal timing, technique, and graft selection for this population. This narrative review outlines the current clinical and radiological tools used to assess skeletal maturity and explores how maturity status informs surgical approach, with particular emphasis on physeal-sparing, hybrid, and transphyseal techniques. We summarize postoperative complications—including growth disturbances and graft failure—while highlighting current guideline recommendations and ongoing controversies. Lastly, we propose a multimodal model for skeletal maturity assessment to support individualized treatment strategies and emphasize the need for standardized protocols and high-quality research to improve long-term outcomes in pediatric ACL reconstruction. Full article

Background: Central precocious puberty (CPP), defined as the onset of secondary sexual characteristics before age 8 in girls, is increasingly prevalent worldwide. CPP is often caused by early activation of the HPG axis, leading to accelerated growth and bone maturation. However, the diagnostic accuracy of standard bone age (BA) methods remains uncertain in this context. Objective: To compare the diagnostic accuracy of the Greulich–Pyle atlas (GPA) and Tanner–Whitehouse 3 (TW3) methods in estimating skeletal age in girls with CPP and to assess the predictive value of serum hormone levels for estimating chronological age (CA). Methods: An observational, cross-sectional diagnostic study was conducted, involving n = 109 girls aged 6–12 years with confirmed CPP (Ethics Committee approval: CHUC_2023_86; 13 July 2023). Left posteroanterior hand–wrist (PA–HW) radiographs were assessed using the GPA and TW3 methods. Anthropometric measurements were recorded, and serum concentrations of estradiol, LH, FSH, DHEA-S, cortisol, TSH, and free T4 were obtained. Comparisons between CA and BA estimates were conducted using repeated-measures ANOVA, and ANCOVA was applied to examine the hormonal predictors of CA. Results: Both GPA and TW3 overestimated CA between 7 and 12 years, with the GPA showing larger deviations (up to 4.8 months). The TW3 method provided more accurate estimations, particularly at advanced pubertal stages. Estradiol (η²_p = 0.188–0.197), LH (η²_p = 0.061–0.068), and FSH (η²_p = 0.008–0.023) emerged as the strongest endocrine predictors of CA, significantly enhancing the explanatory power of both radiological methods. Conclusions: The TW3 method demonstrated superior diagnostic accuracy over GPA in girls with CPP, especially between 7 and 12 years. Integrating estradiol, LH, and FSH into BA assessment significantly improved the accuracy, supporting a more individualized and physiologically grounded diagnostic approach. Full article

Weighted belief propagation (WBP) for the decoding of linear block codes is considered. In WBP, the Tanner graph of the code is unrolled with respect to the iterations of the belief propagation decoder. Then, weights are assigned to the edges of the resulting recurrent network and optimized offline using a training dataset. The main contribution of this paper is an adaptive WBP where the weights of the decoder are determined for each received word. Two variants of this decoder are investigated. In the parallel WBP decoders, the weights take values in a discrete set. A number of WBP decoders are run in parallel to search for the best sequence- of weights in real time. In the two-stage decoder, a small neural network is used to dynamically determine the weights of the WBP decoder for each received word. The proposed adaptive decoders demonstrate significant improvements over the static counterparts in two applications. In the first application, Bose–Chaudhuri–Hocquenghem, polar and quasi-cyclic low-density parity-check (QC-LDPC) codes are used over an additive white Gaussian noise channel. The results indicate that the adaptive WBP achieves bit error rates (BERs) up to an order of magnitude less than the BERs of the static WBP at about the same decoding complexity, depending on the code, its rate, and the signal-to-noise ratio. The second application is a concatenated code designed for a long-haul nonlinear optical fiber channel where the inner code is a QC-LDPC code and the outer code is a spatially coupled LDPC code. In this case, the inner code is decoded using an adaptive WBP, while the outer code is decoded using the sliding window decoder and static belief propagation. The results show that the adaptive WBP provides a coding gain of 0.8 dB compared to the neural normalized min-sum decoder, with about the same computational complexity and decoding latency. Full article

Background: SET domain-containing 5 (SETD5) is a member of the protein lysine-methyltransferase family. SETD5 gene mutations cause disorders of the epigenetic machinery which determinate phenotypic overlap characterized by several abnormalities. SEDT5 gene variants have been described in patients with KBG and Cornelia de Lange (CdL) syndromes. Case description: A female patient with severe short stature and intellectual disability had been followed since she was 9 years old. Several causes of short stature were ruled out. At the age of 12 years, her height was 114 cm (−5.22 SDS), weight 19 kg (−5.88 SDS), BMI 14.6 kg/m² (−2.26 SDS), and was Tanner stage 1. The target height for the proband was 151.65 cm (−1.80 SDS). The bone age (BA) was delayed by 3 years compared to chronological age. The growth rate was persistently deficient (<<2 SDS). Physical examination revealed dysmorphic features. Genetic analysis documented a de novo SETD5 gene mutation (c.890_891delTT), responsible for phenotypes in the context of an overlap syndrome between the phenotype of MDR23, CdL and KBG syndromes. Recombinant growth hormone therapy (rhGH) was started at the age of 12 years. After both one year (+3.16 SDS) and two years (+2.9 SDS), the growth rate significantly increased compared with the pre-therapy period. Conclusion: This is the first case of a patient with overlap syndrome due to SETD5 mutation treated with rhGH. The review of the scientific literature highlighted the clinical and molecular features of SETD5 gene mutation and the use of rhGH therapy in patients suffering from CdL and KBG syndromes. Full article

Introduction: The monitoring of autonomic nervous balance during childhood remains underexplored. However, heart rate variability (HRV) is widely recognized as a biomarker of health risk across the lifespan. Juvenile idiopathic arthritis (JIA), a group of chronic inflammatory joint disorders, is associated with persistent inflammation and pain, both of which contribute to increased cardiovascular risk, commonly linked to reduced HRV. Among HRV parameters, very-low frequency (VLF) components have been associated with physiological recovery processes. This study aimed to assess HRV during sleep in patients with JIA. Methods: We studied 10 patients with JIA and 10 age-, gender-, and Tanner stage-matched healthy controls. All participants underwent polysomnographic monitoring following an adaptation night in the sleep laboratory. HRV was analyzed using standard time and frequency domain measures over 5 min epochs across all sleep stages. Frequency components were classified into low- and high-frequency bands, and time domain measures included the standard deviation of the beat-to-beat intervals. Group differences in HRV parameters were assessed using nonparametric tests for independent samples, with a significance level set at p < 0.05. Results: JIA exhibited greater sleep disruption than controls, including reduced NREM sleep, longer total sleep time, and increased wake time after sleep onset. HRV analyses in both time and frequency domains revealed significant differences between groups across all stages of sleep. In JIA patients, the standard deviation of the normal-to-normal interval during slow wave sleep (SWS) and total power across all sleep stages (p < 0.05) was reduced. In JIA patients, the standard deviation of the normal-to-normal interval during slow wave sleep and total power across all sleep stages were significantly reduced (p < 0.05). VLF power was also significantly lower in JIA patients across all sleep stages (p = 0.002), with pronounced reductions during N2 and SWS (p = 0.03 and p = 0.02, respectively). A group effect was observed for total power across all stages, mirroring the VLF findings. Additionally, group differences were detected in LF/HF ratio analyses, although values during N2, SWS, and REM sleep did not differ significantly between groups. Notably, the number of affected joints showed a moderate positive correlation with the parasympathetic HRV parameter. Conclusions: Patients with JIA exhibited sleep disruption and alterations in cardiovascular autonomic functioning during sleep. Reduced HRV across all sleep stages in these patients suggests underlying autonomic nervous dysfunction. Addressing sleep disturbances in patients with chronic pain may serve as an effective strategy for managing their cardiovascular risk. Full article

Background and Clinical Significance: Pituitary apoplexy is an extremely rare condition in children and adolescents with a rapid onset due to acute hemorrhage, infarction, or both in the pituitary gland. Most frequently, pituitary apoplexy is an asymptomatic or subclinical entity. Few cases of pituitary apoplexy with concurrent SARS-CoV-2 infection or COVID-19 vaccination have been reported. Case Presentation: We present the case of a 13-year-8-month-old boy who presented in our pediatric endocrinology department for the evaluation of short stature. He was previously diagnosed with secondary hypothyroidism and was treated with levothyroxine. At admission, clinical examination revealed a height of 141 cm (−2.68 SD/−2.4 SD corrected for mid-parental height), normal weight (60th centile), Tanner-stage G2P1, and delayed bone age. Basal IGF1 was normal, but the tests performed to assess the GH reserve confirmed the GH deficiency (peak GH value 3.11 ng/mL after clonidine/0.95 ng/mL after insulin). The brain MRI revealed a subacute pituitary hemorrhage. Thrombophilia and coagulopathies were excluded by further testing. Anti-SARS-CoV-2 (anti-S-protein IgG) antibodies (>200 BAU/mL) were compatible with COVID-19 infection, indicating a possible association between these two entities. At 3-month follow-up, physical examination showed a 3 cm height gain and advancing pubertal development (G4P2). Newer MRI found changes consistent with resolving hemorrhage. The patient was provided immediately with recombinant human GH and aromatase inhibitor therapy to maximize GH treatment response. During follow-up, the rGH dose was adjusted based on IGF1 values, and after 3 years and 10 months, rGH treatment was stopped, reaching a height of 172.3 cm (−0.51 SD) and surpassing the initial prediction of 164.5 cm. Conclusions: Pituitary apoplexy, an even rarer complication in the pediatric population, may be associated with SARS-CoV-2 infection. Further studies are necessary to better understand the intertwining of those conditions. Full article

Background: The increasing prevalence of overweight and obesity among young people poses a significant public health challenge. Childhood and adolescence are critical periods for establishing long-term health habits. Diet plays a central role in maintaining a healthy weight, and adherence to the Mediterranean diet has been consistently linked to numerous health benefits, including improved weight management and overall well-being. Understanding the factors that influence Mediterranean diet adherence in adolescents can help design effective interventions to promote healthier eating behaviors. Objectives: This study sought to explore the association between following the Mediterranean diet and key physiological factors, including age, sex, body mass index, and pubertal status. Additionally, it explored how Mediterranean diet adherence relates to lifestyle behaviors such as sleep quality and physical activity levels, using data from a sample of 668 Spanish adolescents. Method: Participants completed validated questionnaires assessing dietary habits, physical activity, sleep quality, and pubertal status (Tanner scale). Results: The findings revealed significant associations between Mediterranean diet adherence and body mass index, pubertal status, and physical activity level, while sex, age, and sleep quality showed no significant influence. Adolescents with lower body mass index tended to adhere more to the Mediterranean diet, reinforcing its role in weight management. Additionally, greater adherence was observed in later pubertal stages, suggesting increased nutritional awareness. Conclusions: Healthy eating patterns are associated with a strong promotion of physical activity, highlighting the link between an active lifestyle and adherence to the Mediterranean diet. This positive multifactorial synergy requires further research to better understand its mechanisms and to design effective strategies for promoting healthy habits among adolescents. Full article

Background: Early-maturing players tend to have physical advantages during formative stages, but it remains unclear whether these advantages translate into long-term professional success. This study examines how biological maturation influences participation and career trajectories in youth football. Methods: Anthropometric and competitive data were collected from 47 players (13.53 ± 1.08 years) in a top-tier academy during the 2010–2011 season. The maturation status was assessed using the Tanner–Whitehouse II RUS method, and the career outcomes were tracked in 2024–2025. Results: Early-maturing players showed higher anthropometric values and greater participation. However, late maturers were more likely to reach professional football (p = 0.003), with all players competing in the top five European leagues belonging to the late-maturing group. Conclusions: Early maturation does not guarantee professional success. Strategies such as bio-banding and personalized training can reduce biases and support talent development, highlighting the need for a more holistic approach to player evaluation. Full article

Background: This study aims to explore the association between sleep patterns in children and their exposure to phthalates to assess potential health implications. Methods: Participants (n = 60) completed the Pittsburgh Sleep Quality Index (PSQI) questionnaire. Consumer behavior scores (CBS) were calculated. The Tanner scale was used to monitor the stages of puberty. First-morning urine samples were analyzed by high-performance liquid chromatography–tandem mass spectrometry. Results: The average sleep duration was 8 h and 44 min, with boys sleeping significantly longer (p = 0.01). Notably, 51.7% of participants reported sleeping less than 9 h. The nonlinear effects of phthalate metabolite in association with PSQI were observed for hydroxy-mono-isononyl phthalate (OH-MiNP, p = 0.003) and MnOP (p < 0.001), indicating that the relationship does not follow a simple linear pattern. Simple linear regression revealed a significant positive association between the Mono-n-octyl phthalate (MnOP) and PSQI scores (p = 0.016). After adjustment for place of residence, BMI, CBS, sex, and age, the significance of associations between phthalate metabolites and sleep quality diminished, necessitating cautious interpretation. No statistically significant associations between pubertal changes and the value of PSQI as well as phthalates were observed. Conclusion: Our results provide preliminary evidence of potential nonlinear associations that require validation in a larger cohort. The findings highlight the importance of monitoring phthalate exposure in children, as it may influence sleep patterns and overall health. Full article

Background/Objectives: Bone age assessments are essential for evaluating the growth and skeletal development of children and adolescents, influenced by factors such as genetics, ethnicity, culture, and nutrition. Clinical standards for these assessments must be adapted to the specific populations under study. This study validates the use of the Tanner–Whitehouse 3 method for determining bone age in pediatric and adolescent populations in the Canary Islands. Methods: This cross-sectional study analyzed 214 posteroanterior radiographs of the left hand and wrist from 80 females and 134 males, aged between 5 and 18 years. The radiographs were independently evaluated by three raters: a Radiologist Specialist (Rater 1), a General Practitioner (Rater 2), and a Medical Student (Rater 3). Intra- and inter-rater reliability were assessed using intraclass correlation coefficients (ICCs). Accuracy was evaluated by comparing estimated bone age with chronological age, stratified by sex and developmental stage. Results: Strong intra-rater reliability was observed across all raters. Raters 1 and 2 demonstrated excellent consistency (ICCs: 0.990–0.996), while Rater 3 exhibited slightly lower yet robust reliability (ICCs: 0.921–0.976). Inter-rater agreement was high between Raters 1 and 2 but decreased with Rater 3, reflecting the influence of experience (ICCs: 0.812–0.912). Bone age was underestimated in preschool children (mean difference: 3.712 mos.; 95% CI: 1.290–6.130; p = 0.199) and school-age males (mean difference: 3.978 mos.; 95% CI: −12.550 to 4.590; p = 0.926), with minimal discrepancies in females. In teenagers, the Tanner–Whitehouse 3 method slightly overestimated bone age (mean difference: −0.360 mos.; 95% CI: −0.770 to −0.954; p = 0.299). Conclusions: In conclusion, the Tanner–Whitehouse 3 method demonstrates overall precision and reliability but requires caution, as it underestimates bone age in preschool children and school-age males, while slightly overestimating it in adolescents. Full article

Background: Cardiovascular diseases increasingly impact youth, with early development of risk factors such as obesity, hypertension, and inadequate nutrient intake. Proper nutrient intake and physical fitness are vital for reducing these risks, especially in pediatric populations. This study explores the connection between physical fitness, metabolic risk, and nutrient status among 1656 Chilean schoolchildren from diverse socio-economic backgrounds. Methods: Anthropometric measures included weight, height, skinfold thickness, waist circumference, and blood pressure. Physical fitness was assessed via handgrip strength, standing long jump, and a six-minute walk test. Nutrient intake was also evaluated, and a composite metabolic risk score was calculated based on waist circumference, skinfolds, and blood pressure. Results: Boys consistently outperformed girls in physical fitness tests, including grip strength and horizontal jump, with differences becoming more pronounced in higher grades and Tanner stages. Girls exhibited higher subcutaneous fat levels and obesity prevalence during later grades, highlighting gender-specific patterns in body composition. Better physical fitness was associated with lower waist circumference, skinfold thickness, and metabolic risk scores. A moderate correlation between aerobic fitness (distance/height) and blood pressure (r = 0.27, p = 0.01) was observed. Z-Score MR analysis revealed that students in the lowest fitness tertile exhibited significantly higher cardiovascular risk profiles compared to their fitter peers. Conclusions: Physical fitness plays a critical role in reducing cardiovascular risk in children. The findings underscore the importance of promoting gender- and age-specific interventions that include both aerobic and strength-based physical activities. Comprehensive school programs focusing on nutrition and physical activity are essential to mitigating cardiovascular risk and promoting long-term health outcomes. Future longitudinal studies are recommended to establish causal relationships and evaluate the impact of targeted interventions. Full article

Background: Previous infection with Adenovirus-36 (HAdv-D36) has been associated with adipogenesis and glycemic regulation in cell culture and animal models. In humans, HAdv-D36 antibodies correlate with increased obesity risk yet paradoxically enhance glycemic control across various demographics. This study assesses the association of HAdv-D36 seropositivity with obesity, lipid, and glycemic profiles among school-aged children. Methods: We evaluated 208 children aged 9–13, categorized by BMI z-scores into normal weight (−1 to +1), overweight (+1 to +2), and obese (>+3). Assessments included anthropometry, Tanner stage for pubertal development, and biochemical tests (relating to lipids, glucose, and insulin), alongside HAdv-D36 seropositivity checked via ELISA. Insulin resistance was gauged using Chilean pediatric criteria. Results: The cohort displayed a high prevalence of overweight/obesity. HAdv-D36 seropositivity was 5.4%, showing no correlation with nutritional status. Additionally, no link between HAdv-D36 seropositivity and lipid levels was observed. Notably, insulin levels and HOMA-RI were significantly lower in HAdv-D36 positive children (p < 0.001). No cases of insulin resistance were reported in the HAdv-D36 (+) group in our population. Conclusions: HAdv-D36 seropositivity appears to decrease insulin secretion and resistance, aligning with earlier findings. However, no association with obesity development was found in the child population of southern Chile. Full article

This study aimed to investigate the impact of hypogonadism on bone mineral density (BMD) in children and adolescents with chronic diseases to determine the relationship between sex hormones and BMD. This retrospective study included 672 children and adolescents with chronic diseases such as hemato-oncologic, rheumatoid, gastrointestinal, and endocrinologic diseases. The relationship between the sex- and Tanner-stage-matched Z-scores for sex hormones and the sex- and age-matched lumbar spine BMD (LSBMD) Z-scores was evaluated. Adjustments were made for confounders such as underlying diseases, age at diagnosis, and age- and sex-matched body mass index Z-scores. Patients had a mean LSBMD Z-score of −0.55 ± 1.31. In the multivariate regression analysis, male testosterone showed a positive association with the LSBMD Z-score (p < 0.001), whereas female estradiol, luteinizing hormone, and follicular-stimulating hormone showed no significant association with the LSBMD Z-scores. In the male group, the testosterone level was associated with LSBMD Z-scores > −1.0 (p < 0.001), > −2.0 (p < 0.001), and > −3.0 (p = 0.002), while the estradiol level was associated with LSBMD Z-scores > −2.0 (p = 0.001) and > −3.0 (p = 0.002) in the female group. In conclusion, sex hormones are associated with BMD in children and adolescents with chronic diseases. Therefore, various measures may be necessary to predict future skeletal problems and improve bone health in these patients. Full article

Epidemiological studies have linked obesity to the onset of puberty, while its causality and the potential metabolite mediators remain unclear. We employed a two-sample Mendelian randomization (MR) design to evaluate the causal effects of obesity on puberty onset and its associated diseases including type 2 diabetes (T2D) and cardiovascular diseases (CVDs). The potential mediators in this pathway were further explored using a two-step MR design. The robustness of our findings was evaluated using sensitivity analyses. Our MR results revealed that childhood obesity/BMI were causally associated with an increased Tanner stage in girls, younger age at menarche, and increased risk of adulthood T2D and CVD. However, neither childhood BMI nor obesity had a causal effect on the Tanner stage in boys. Mediation analysis further indicated that increased creatine served as a mediator for the causal pathway from childhood obesity/BMI to the Tanner stage of girls, while early puberty onset in girls played a mediating role in the pathway linking childhood obesity to increased risk of adulthood T2D and CVD. This study indicated that the risk of early puberty onset in girls and its associated health issues can be potentially reduced by preventing childhood obesity. The involvement of creatine in this process needs to be further validated and explored. Full article

Background: The performance of young swimmers is the result of a multifactorial process that is influenced by anthropometric characteristics and biological maturation. The purpose of our study was to investigate the effect of stages of biological maturation and body surface area on cardiopulmonary fitness indicators in preadolescent female swimmers, for whom menstruation has not started. Methods: Thirty female preadolescent swimmers (age 13.4 ± 1.0 years) participated in this study. We recorded anthropometric and morphological characteristics, stages of biological maturation, and pulmonary function parameters, and the swimmers underwent cardiopulmonary exercise testing. Results: The cut-off was set for body surface area (BSA) at 1.6 m² and for biological maturation stages at score 3. The BSA results showed differences in variabilities in maximal effort oxygen pulse (p < 0.001), oxygen uptake (p < 0.001), ventilation (p = 0.041), tidal volume (p < 0.001), and oxygen breath (p < 0.001). Tanner stage score results showed differences in variabilities in maximal effort breath frequency (p < 0.001), tidal volume (p = 0.013), and oxygen breath (p = 0.045). Biological maturation stages and BSA were correlated during maximal effort with oxygen breath (p < 0.001; p < 0.001), oxygen uptake (p = 0.002; p < 0.001), and oxygen pulse (p < 0.001; p < 0.001). Conclusions: In conclusion, the findings of our study showed that the girls who had a smaller body surface area and biological maturation stage presented lower values in maximal oxygen uptake and greater respiratory work. Full article