Value of Magnetic Resonance Imaging for Skeletal Bone Age Assessment in Healthy Male Children

BACKGROUND

Skeletal bone age assessment for medical reasons is usually performed by conventional x-ray with use of ionizing radiation. Few pilot studies have shown the possible use of magnetic resonance imaging (MRI).

PURPOSE

To comprehensively evaluate feasibility and value of MRI for skeletal bone age (SBA) assessment in healthy male children.

MATERIALS AND METHODS

In this prospective cross-sectional study, 63 male soccer athletes with mean age of 12.35 ± 1.1 years were examined. All participants underwent 3.0 Tesla MRI with coronal T1-weighted turbo spin echo (TSE), coronal proton density (PD)-weighted turbo spin echo (TSE), and T1-weighted three-dimensional (3D) volume interpolated breath-hold examination (VIBE) sequence. Subsequently, SBA was assessed by 3 independent blinded radiologists with different levels of experience using the common Greulich-Pyle (GP) atlas and the Tanner-Whitehouse (TW2) method.

RESULTS

In a mean total acquisition time of 5:04 ± 0:47 min, MR image quality was sufficient in all cases. MRI appraisal was significantly faster ( P < 0.0001) by GP with mean duration of 1:22 ± 0:08 min vs. 7:39 ± 0:28 min by TW. SBA assessment by GP resulted in mean age of 12.8 ± 1.2 years, by TW 13.0 ± 1.4 years. Interrater reliabilities were excellent for both GP (ICC = 0.912 (95% confidence interval [CI] = 0.868-0.944) and TW (ICC = 0.988 (95% CI = 0.980-0.992) and showed statistical significance ( P < 0.001). Subdivided, for GP, ICCs were 0.822 (95% CI = 0.680-0.907) and 0.843 (95% CI = 0.713-0.919) in Under 12 and Under 14 group. For TW, ICCs were 0.978 (95% CI = 0.958-0.989) in Under 12 and 0.979 (95% CI = 0.961-0.989) in Under 14 group.

CONCLUSION

MRI is a clinically feasible, rapidly evaluable method to assess skeletal bone age of healthy male children. Using the Greulich-Pyle (GP) atlas or the Tanner-Whitehouse (TW2) method, reliable results are obtained independent of the radiologist's experience level.

Nationwide Subjective and Objective Assessments of Potential Talent Predictors in Elite Youth Soccer: An Investigation of Prognostic Validity in a Prospective Study

Recent studies have provided empirical evidence on the prognostic relevance of objective performance diagnostics in the soccer talent identification and development process. However, little is known about the prognostic validity of coaches' subjective evaluations of performance. This study evaluated objective and subjective assessments within a nationwide talent development program and addressed motor, perceptual skill, and personality-related performance factors. Male players (N = 13,869; M_age = 12.59 ± 1.07 years) from the age groups U12 to U15 of the German soccer talent development program participated in this study. Participants completed an objective motor diagnostic (sprint, agility, dribbling, ball control, juggling) and were subjectively rated by their coaches (kicking skills, endurance, individual tactical skills, psychosocial skills). All nine predictors were assessed with sufficient psychometric properties (α ≥ 0.72; except dribbling and ball control: α ≥ 0.53). Players' success three seasons later was operationalized by achieving professional youth academy level or not (success rate, 9%). Independent-samples t-tests analyzed univariate mean group comparisons between future selected and non-selected players. Logistic regression models examined the multivariate prognostic validity of all assessments by predicting success with subjective (model 1), objective (model 2), and both groups of predictors (model 3). Confirming the univariate prognostic validity, future selected outperformed non-selected players regarding all predictors (each p < 0.001, except for agility in U15: p < 0.01). Tactical skills, kicking skills, and sprint were of highest predictive value (d ≥ 0.61 in each age group). Multivariate results provided empirical evidence for the subjective (7% ≤ Nagelkerke's R² ≤ 11%; each p < 0.001) and objective (8% ≤ Nagelkerke's R² ≤ 13%; each p < 0.001) assessments' prognostic validity. However, model 3 revealed the best statistical explanatory power in each age group (0.15 ≤ Nagelkerke's R² ≤ 0.20; p < 0.001). In this combined assessment model, sprint, tactical skills, and dribbling were found to be the most predictive variables. In conclusion, this study reinforces the call for multidimensional diagnostics integrating objective and subjective assessments. Future research is needed to address the demands for longitudinal analyses of subjective ratings, the integration of biological maturation, and empirical evidence for female soccer.

Biological Maturity Status in Elite Youth Soccer Players: A Comparison of Pragmatic Diagnostics With Magnetic Resonance Imaging

The influence of biological maturity status (BMS) on talent identification and development within elite youth soccer is critically debated. During adolescence, maturity-related performance differences within the same age group may cause greater chances of being selected for early maturing players. Therefore, coaches need to consider players' BMS. While standard methods for assessing BMS in adolescents are expensive and time-consuming imaging techniques (i.e., X-ray and MRI), there also exist more pragmatic procedures. This study aimed to evaluate commonly used methods to assess BMS within a highly selected sample of youth soccer players. A total of N = 63 elite male soccer players (U12 and U14) within the German Soccer Association's talent promotion program completed a test battery assessing BMS outcomes. Utilizing MRI diagnostics, players' skeletal age (SA_MRI) was determined by radiologists and served as the reference method. Further commonly used methods included skeletal age measured by an ultrasound device (SA_US), the maturity offset (MO_MIR), and the percentage of adult height (PAH_KR). The relation of these alternative BMS outcomes to SA_MRI was examined using different perspectives: performing bivariate correlation analyses (1), modeling BMS as a latent variable (BMS_lat) based on the multiple alternative diagnostics (2), and investigating individual differences in agreement (3). (1) Correlations of SA_MRI and the further BMS variables ranked from r = 0.80 to r = 0.84 for the total sample and were lower for U12 (0.56 ≤ r ≤ 0.66), and U14 (0.61 ≤ r ≤ 0.74) (2). The latent structural equation modeling (SEM) (R² = 51%) revealed a significant influence on BMS_lat for MO_MIR (β = 0.51, p <0.05). The additional contribution of PAH_KR (β = 0.27, p = 0.06) and SA_US (β = −0.03, p = 0.90) was rather small (3). The investigation of individual differences between the reference method and alternative diagnostics indicated a significant bias for MO_MIR (p <0.01). The results support the use of economical and time-efficient methods for assessing BMS within elite youth soccer. Bivariate correlation analyses as well as the multivariate latent variable approach highlight the measures' usefulness. However, the observed individual level differences for some of the utilized procedures led to the recommendation for practitioners to use at least two alternative assessment methods in order to receive more reliable information about players' BMS within the talent promotion process.

[Adverse cutaneous reaction to celecoxib: 6 cases]

INTRODUCTION

Our objective was to characterize adverse cutaneous reactions to celecoxib, a new non steroidal anti-inflammatory drug.

PATIENTS AND METHODS

A retrospective study of 6 consecutive patients.

RESULTS

The average delay before the onset of the reaction was 10.2 days for patients taking the medication for the first time and 48 hours for one patient taking the drug for the second time. Two patients had fever. Patients presented with an exanthema and in most cases an edema of the face. Buccal mucosa was involved in two patients, and one patient had minimal blister lesions. In five of the six patients, minor and transitory biological abnormalities were found. The intrinsic imputability of the celecoxib was I3 (C3S2) in all the cases.

DISCUSSION

Our cases are similar to those reported by the French drug regulatory agency (Pharmacovigilance). Usually the adverse cutaneous reactions were not too severe, with maculo-papulo exanthema and edema of the face. The reactions due to celecoxib are more frequent than those due to other non steroidal anti-inflammatory drugs (7.5% versus 4.1%), but severe cases are rarely reported. Besides, an allergic history to sulphonamide contraindicates celecoxib. However celecoxib does not have the aromatic amine common to antibacterial sulphonamides, and there is no proof of cross reactions between these two families. Furthermore, this amine is usually associated with drug reaction severity, which could explain why severe cases due to celecoxib are rare.

[Medical activity in a emergency outpatient department dermatology]

BACKGROUND

The aim of this study was to characterize the medical activity of a dermatology emergency room and to compare it with 1) outpatients, scheduled visits to the same department and 2) visits to community dermatologists in private practice.

METHODS

All the 500 patients who attended the emergency room in one month and all the 411 patients with scheduled appointments during one week within the same period were included prospectively. The clinical diagnoses were recorded and compared between the two groups using chi square and linear correlation tests. Data on the diagnoses made by community dermatologists in private practice were obtained from another study.

RESULTS

In the emergency room, 4 diagnoses accounted for 71.4 of all visits: infections (29 p. 100), dermatitis (23.8 p. 100), rashes (11 p. 100) and urticaria (7.6 p. 100). In scheduled visits the 4 leading diagnosis were cancer and precancerous lesions (28.7 p. 100), dermatitis (11.7 p. 100), fungal infections (8.3 p. 100) and acne (7.1 p. 100). There was no correlation (r=0.14; p=0.6) between the 16 more prevalent diagnoses in the emergency room and the prevalence of the same diagnoses in scheduled visits in the hospital department. The emergency diagnosis were also not correlated with those seen in private practice (r=0.21; p=0.4). Seven percent of emergency room consultants were hospitalized.

COMMENTS

Skin disorders encountered in the dermatology emergency room differ from those seen both in the outpatient hospital department and in community private practice.

[Mammary staphylococcal cellulitis of the newborn]

BACKGROUND

Neonatal cellulitis is usually caused by staphylococcal infection of the mammary gland which has generally reached the stage of abscess formation at the time of diagnosis. The circumstances of onset and possible complications remain poorly known. We report a recent case.

CASE REPORT

A female neonate developed major bilateral mammary hypertrophy. Her mother had tried to express the breasts, fearing "congestion". Three days later, the right breast showed signs of inflammation with a fluctuant central zone suggestive of a cellulitic infectious abscess confirmed at ultrasound. Recovery was achieved with incision and antistaphylococci antibiotic therapy.

DISCUSSION

Mammary cellulitis of the newborn appears to generally occur following an attempt to manipulate a pre-existing physiological hypertrophy of the breast. Staphylococcus aureus is the most commonly found agent. Early surgical care is generally required as there is a real risk of progression to necrotizing faciitis.