Height and subjective body image are associated with suicide ideation among Korean adolescents

Meta-analysis of complications and functional outcomes in cosmetic limb lengthening

Introduction

Short stature, defined as height below the 3rd percentile for age and gender, affects approximately 200 million people worldwide. It can have profound psychological effects, influencing self-esteem, social interactions, and overall life satisfaction, particularly during adolescence. These individuals often face challenges in both professional and romantic lives, increasing their risk of depression and suicidal ideation. Surgical interventions such as limb lengthening can provide life-changing results for individuals facing psychological distress due to short stature. This meta-analysis reviews the literature on cosmetic stature surgery, focusing on Paley outcomes and psychosocial satisfaction, and compares external fixation (EF) and intramedullary nailing (IMN) techniques.

Methods

This study adhered to PRISMA guidelines. Eligibility criteria included studies with more than five patients, the use of the Paley classification for outcome assessment, and a focus on cosmetic limb lengthening with either EF or IMN. Data from PubMed were extracted using standardized forms and analyzed for complication rates, functional outcomes, and psychosocial satisfaction. The Paley complication system categorized problems, obstacles, and complications, and risk of bias was assessed using the STROBE checklist. Data synthesis was performed using JAMOVI software with effect size and confidence interval calculations.

Results

Seven studies were included, with a total of 489 patients undergoing EF or IMN for cosmetic limb lengthening. Procedure-related mortality was zero across all studies. EF was associated with higher rates of Paley problems (56 %), obstacles (48 %), and complications (10 %) compared to IMN, which had 37 % problems and 42 % obstacles, with no significant complications reported. Patient satisfaction was generally high, with EF studies reporting satisfaction rates of up to 95 %.

Conclusion

EF and IMN are both viable options for cosmetic limb lengthening. While EF may present more complications, it maintains high patient satisfaction, whereas IMN offers a safer profile with fewer complications. A collaborative approach, combining surgical options with psychosocial and psychiatric support, can help individuals achieve improved physical and emotional well-being.

Effects of objective and perceived weight on suicidal ideation among adolescents: Findings from the 2015-2021 national Youth Risk Behavior Survey

This study examined the association between perceived weight, actual weight, and suicidal ideation among adolescents. Data for this study were obtained from a nationally representative sample from the Youth Behavior Risk Survey (YRBS) between 2015 and 2021. A total of n= 61,298 adolescents ages 12 to 18 were included in the final analytic sample. A series of logistic regressions was conducted to examine perceived weight, BMI, and suicidal ideation, while adjusting for other demographic and control variables. Approximately one in five adolescents reported suicidal ideation. In the multivariable analyses, adolescents who perceived themselves as overweight and had BMI ≥ 85th percentile had 1.48 times higher odds of reporting suicidal ideation (95 % CI=1.35-1.62) and adolescents who perceived themselves as overweight but had BMI <85th percentile had 1.47 times higher odds of experiencing suicidal ideation than their peers who did not perceive themselves as overweight and had BMI <85th percentile. The findings from this study suggest that both perceived and actual BMI may be associated with suicidal ideation among adolescents. Future research could examine differences in perceived and actual BMI and identify potential interventions to proactively address mental health issues that may stem from stigma related to being overweight or obese.

Development and Validation of a Prediction Model Using Sella Magnetic Resonance Imaging-Based Radiomics and Clinical Parameters for the Diagnosis of Growth Hormone Deficiency and Idiopathic Short Stature: Cross-Sectional, Multicenter Study

BACKGROUND

Growth hormone deficiency (GHD) and idiopathic short stature (ISS) are the major etiologies of short stature in children. For the diagnosis of GHD and ISS, meticulous evaluations are required, including growth hormone provocation tests, which are invasive and burdensome for children. Additionally, sella magnetic resonance imaging (MRI) is necessary for assessing etiologies of GHD, which cannot evaluate hormonal secretion. Recently, radiomics has emerged as a revolutionary technique that uses mathematical algorithms to extract various features for the quantitative analysis of medical images.

OBJECTIVE

This study aimed to develop a machine learning-based model using sella MRI-based radiomics and clinical parameters to diagnose GHD and ISS.

METHODS

A total of 293 children with short stature who underwent sella MRI and growth hormone provocation tests were included in the training set, and 47 children who met the same inclusion criteria were enrolled in the test set from different hospitals for this study. A total of 186 radiomic features were extracted from the pituitary glands using a semiautomatic segmentation process for both the T2-weighted and contrast-enhanced T1-weighted image. The clinical parameters included auxological data, insulin-like growth factor-I, and bone age. The extreme gradient boosting algorithm was used to train the prediction models. Internal validation was conducted using 5-fold cross-validation on the training set, and external validation was conducted on the test set. Model performance was assessed by plotting the area under the receiver operating characteristic curve. The mean absolute Shapley values were computed to quantify the impact of each parameter.

RESULTS

The area under the receiver operating characteristic curves (95% CIs) of the clinical, radiomics, and combined models were 0.684 (0.590-0.778), 0.691 (0.620-0.762), and 0.830 (0.741-0.919), respectively, in the external validation. Among the clinical parameters, the major contributing factors to prediction were BMI SD score (SDS), chronological age-bone age, weight SDS, growth velocity, and insulin-like growth factor-I SDS in the clinical model. In the combined model, radiomic features including maximum probability from a T2-weighted image and run length nonuniformity normalized from a T2-weighted image added incremental value to the prediction (combined model vs clinical model, P=.03; combined model vs radiomics model, P=.02). The code for our model is available in a public repository on GitHub.

CONCLUSIONS

Our model combining both radiomics and clinical parameters can accurately predict GHD from ISS, which was also proven in the external validation. These findings highlight the potential of machine learning-based models using radiomics and clinical parameters for diagnosing GHD and ISS.

Suicide Attempts After a Diagnosis of Polycystic Ovary Syndrome : A Cohort Study

BACKGROUND

Limited evidence exists about suicide risk in persons with polycystic ovary syndrome (PCOS).

OBJECTIVE

To assess suicide risk in persons with PCOS, accounting for psychiatric comorbid conditions and age group.

DESIGN

Cohort study.

SETTING

Data from the Taiwanese nationwide database from 1997 to 2012.

PATIENTS

A cohort of 18 960 patients diagnosed with PCOS, each matched with control participants in a 1:10 ratio on the basis of age, psychiatric comorbid conditions, urbanization level, and income. Suicide attempts were evaluated using Cox regression models.

MEASUREMENTS

Suicide risk with hazard ratios (HRs).

RESULTS

Participants with PCOS had a notable 8.47-fold increase in risk for suicide attempt compared with the control group (HR, 8.47 [95% CI, 7.54 to 9.51]), after adjustment for demographic characteristics, psychiatric comorbid conditions, Charlson Comorbidity Index scores, and frequency of all-cause clinical visits. The elevated risk was evident across the adolescent (HR, 5.38 [CI, 3.93 to 7.37]), young adult (<40 years; HR, 9.15 [CI, 8.03 to 10.42]), and older adult (HR, 3.75 [CI, 2.23 to 6.28]) groups. Sensitivity analyses involving the exclusion of data from the first year or the first 3 years of observation yielded consistent results.

LIMITATION

Potential underestimation of PCOS and mental disorder prevalence due to use of administrative claims data; lack of clinical data, such as body mass index and depressive symptoms; and no assessment of a confounding effect of valproic acid exposure.

CONCLUSION

This study underscores the heightened risk for suicide attempt that persons with PCOS face, even after adjustment for demographics, psychiatric comorbid conditions, physical conditions, and all-cause clinical visits. This suggests the importance of routine monitoring of mental health and suicide risk in persons diagnosed with PCOS.

PRIMARY FUNDING SOURCE

Taipei Veterans General Hospital, Yen Tjing Ling Medical Foundation, and Ministry of Science and Technology of Taiwan.