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Barash A, Belmaker M, Bastir M, Soudack M, O'Brien HD, Woodward H, Prendergast A, Barzilai O, Been E. The earliest Pleistocene record of a large-bodied hominin from the Levant supports two out-of-Africa dispersal events. Sci Rep 2022; 12:1721. [PMID: 35110601 PMCID: PMC8810791 DOI: 10.1038/s41598-022-05712-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 01/12/2022] [Indexed: 11/09/2022] Open
Abstract
The paucity of early Pleistocene hominin fossils in Eurasia hinders an in-depth discussion on their paleobiology and paleoecology. Here we report on the earliest large-bodied hominin remains from the Levantine corridor: a juvenile vertebra (UB 10749) from the early Pleistocene site of 'Ubeidiya, Israel, discovered during a reanalysis of the faunal remains. UB 10749 is a complete lower lumbar vertebral body, with morphological characteristics consistent with Homo sp. Our analysis indicates that UB-10749 was a 6- to 12-year-old child at death, displaying delayed ossification pattern compared with modern humans. Its predicted adult size is comparable to other early Pleistocene large-bodied hominins from Africa. Paleobiological differences between UB 10749 and other early Eurasian hominins supports at least two distinct out-of-Africa dispersal events. This observation corresponds with variants of lithic traditions (Oldowan; Acheulian) as well as various ecological niches across early Pleistocene sites in Eurasia.
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Affiliation(s)
- Alon Barash
- Azrieli Faculty of Medicine, Bar Ilan University, POB 1589, 1311502, Safed, Israel.
| | - Miriam Belmaker
- The Department of Anthropology, The University of Tulsa, Tulsa, OK, 74104, USA
| | - Markus Bastir
- Paleoanthropology Group, Department of Paleobiology, Museo Nacional de Ciencias Naturales, CSIC, JG Abascal 2, 28006, Madrid, Spain
| | - Michalle Soudack
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Pediatric Imaging, The Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Haley D O'Brien
- Department of Anatomy and Cell Biology, Oklahoma State University Center for Health Science, Tulsa, USA
| | - Holly Woodward
- Department of Anatomy and Cell Biology, Oklahoma State University Center for Health Science, Tulsa, USA
| | - Amy Prendergast
- School of Geography, Earth and Atmospheric Sciences, University of Melbourne, Melbourne, Australia
| | - Omry Barzilai
- Archaeological Research Department, Israel Antiquities Authority, POB 586, 91004, Jerusalem, Israel
| | - Ella Been
- Department of Sports Therapy, Faculty of Health Professions, Ono Academic College, Kiryat Ono, Israel.,Department of Anatomy and Anthropology, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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2
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Li W, Wei C, Xu L, Yu B, Chen Y, Lu D, Zhang L, Song X, Dong L, Zhou S, Xu Z, Zhu J, Chen X, Su C. Schistosome infection promotes osteoclast-mediated bone loss. PLoS Pathog 2021; 17:e1009462. [PMID: 33735306 PMCID: PMC8009420 DOI: 10.1371/journal.ppat.1009462] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 03/30/2021] [Accepted: 03/09/2021] [Indexed: 12/24/2022] Open
Abstract
Infection with schistosome results in immunological changes that might influence the skeletal system by inducing immunological states affecting bone metabolism. We investigated the relationships between chronic schistosome infection and bone metabolism by using a mouse model of chronic schistosomiasis, affecting millions of humans worldwide. Results showed that schistosome infection resulted in aberrant osteoclast-mediated bone loss, which was accompanied with an increased level of receptor activator of nuclear factor-κB (NF-κB) Ligand (RANKL) and decreased level of osteoprotegerin (OPG). The blockade of RANKL by the anti-RANKL antibody could prevent bone loss in the context of schistosome infection. Meanwhile, both B cells and CD4+ T cells, particularly follicular helper T (Tfh) cell subset, were the important cellular sources of RANKL during schistosome infection. These results highlight the risk of bone loss in schistosome-infected patients and the potential benefit of coupling bone therapy with anti-schistosome treatment. Schistosomiasis remains an important public health problem in many countries in tropical and subtropical regions, which affects about 200 million people worldwide, with another 700 million considered at risk of infection. Although the primary cause of pathogenesis of schistosomiasis is the granulomatous inflammatory responses, schistosomiasis patients experience long-term hidden pathologies that remain poorly investigated. Here, we found that schistosome infection resulted in RANKL-associated bone loss. Furthermore, our results indicated that both B cells and CD4+ T cells, particularly Tfh cell subset, in the peripheral lymphoid tissues are likely to be the important contributors to bone loss through releasing soluble RANKL. In addition, Tfh cells played a sufficient but not necessary role in schistosome infection-induced bone loss. Our findings highlight the risk of bone loss in schistosome-infected patients and the potential benefit of coupling bone therapy with anti-schistosome treatment.
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Affiliation(s)
- Wei Li
- Department of Clinical Laboratory, Nanjing First Hospital, Nanjing Medical University, Nanjing, P. R. China
- State Key Lab of Reproductive Medicine, Jiangsu Key Laboratory of Pathogen Biology, Department of Pathogen Biology and Immunology, Center for Global Health, Nanjing Medical University, Nanjing, P. R. China
| | - Chuan Wei
- State Key Lab of Reproductive Medicine, Jiangsu Key Laboratory of Pathogen Biology, Department of Pathogen Biology and Immunology, Center for Global Health, Nanjing Medical University, Nanjing, P. R. China
| | - Lei Xu
- State Key Lab of Reproductive Medicine, Jiangsu Key Laboratory of Pathogen Biology, Department of Pathogen Biology and Immunology, Center for Global Health, Nanjing Medical University, Nanjing, P. R. China
| | - Beibei Yu
- State Key Lab of Reproductive Medicine, Jiangsu Key Laboratory of Pathogen Biology, Department of Pathogen Biology and Immunology, Center for Global Health, Nanjing Medical University, Nanjing, P. R. China
| | - Ying Chen
- State Key Lab of Reproductive Medicine, Jiangsu Key Laboratory of Pathogen Biology, Department of Pathogen Biology and Immunology, Center for Global Health, Nanjing Medical University, Nanjing, P. R. China
| | - Di Lu
- State Key Lab of Reproductive Medicine, Jiangsu Key Laboratory of Pathogen Biology, Department of Pathogen Biology and Immunology, Center for Global Health, Nanjing Medical University, Nanjing, P. R. China
| | - Lina Zhang
- State Key Lab of Reproductive Medicine, Jiangsu Key Laboratory of Pathogen Biology, Department of Pathogen Biology and Immunology, Center for Global Health, Nanjing Medical University, Nanjing, P. R. China
| | - Xian Song
- State Key Lab of Reproductive Medicine, Jiangsu Key Laboratory of Pathogen Biology, Department of Pathogen Biology and Immunology, Center for Global Health, Nanjing Medical University, Nanjing, P. R. China
| | - Liyang Dong
- State Key Lab of Reproductive Medicine, Jiangsu Key Laboratory of Pathogen Biology, Department of Pathogen Biology and Immunology, Center for Global Health, Nanjing Medical University, Nanjing, P. R. China
| | - Sha Zhou
- State Key Lab of Reproductive Medicine, Jiangsu Key Laboratory of Pathogen Biology, Department of Pathogen Biology and Immunology, Center for Global Health, Nanjing Medical University, Nanjing, P. R. China
| | - Zhipeng Xu
- State Key Lab of Reproductive Medicine, Jiangsu Key Laboratory of Pathogen Biology, Department of Pathogen Biology and Immunology, Center for Global Health, Nanjing Medical University, Nanjing, P. R. China
| | - Jifeng Zhu
- State Key Lab of Reproductive Medicine, Jiangsu Key Laboratory of Pathogen Biology, Department of Pathogen Biology and Immunology, Center for Global Health, Nanjing Medical University, Nanjing, P. R. China
| | - Xiaojun Chen
- State Key Lab of Reproductive Medicine, Jiangsu Key Laboratory of Pathogen Biology, Department of Pathogen Biology and Immunology, Center for Global Health, Nanjing Medical University, Nanjing, P. R. China
- * E-mail: (XC); (CS)
| | - Chuan Su
- State Key Lab of Reproductive Medicine, Jiangsu Key Laboratory of Pathogen Biology, Department of Pathogen Biology and Immunology, Center for Global Health, Nanjing Medical University, Nanjing, P. R. China
- * E-mail: (XC); (CS)
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3
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Alshamrani K, Messina F, Offiah AC. Is the Greulich and Pyle atlas applicable to all ethnicities? A systematic review and meta-analysis. Eur Radiol 2019; 29:2910-2923. [PMID: 30617474 PMCID: PMC6510872 DOI: 10.1007/s00330-018-5792-5] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 09/06/2018] [Accepted: 09/21/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine whether the Greulich and Pyle (G&P) atlas is applicable when applied to populations of different ethnicity. METHODS A systematic review of studies published between 1959 and 15th February 2017 identified from the Embase, MEDLINE and Cochrane databases was undertaken. Quality of the studies was assessed using the National Institute for Health and Care Excellence tool. Meta-analysis used mean differences and standard deviations as summary statistics for the difference between bone age (BA) and chronological age (CA). RESULTS A total of 49 studies were included of which 27 (55%) were related to Caucasian populations. Of the 49 eligible studies, 35 were appropriate for further meta-analysis. In African females, meta-analysis showed a significant mean difference between BA and CA of 0.37 years (95% CI 0.04, 0.69). In Asian males, meta-analysis showed significant differences between BA and CA of -1.08, -1.35, -1.07, -0.80 and 0.50 years for chronological ages of 6, 7, 8, 9 and 17 years, respectively. Meta-analysis showed no significant differences between BA and CA in African males, Asian females, Caucasians and Hispanics. CONCLUSIONS The G&P standard is imprecise and should be used with caution when applied to Asian male and African female populations, particularly when aiming to determine chronological age for forensic/legal purposes. KEY POINTS • In African females, bone age is significantly advanced when compared to the G&P standard. • In Asian males, bone age is significantly delayed between 6 and 9 years old inclusive and significantly advanced at 17 years old when compared to the G&P standard. • The G&P atlas should be used with caution when applied to Asian and African populations, particularly when aiming to determine chronological age for forensic/legal purposes.
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Affiliation(s)
- Khalaf Alshamrani
- Department of Oncology & Metabolism, University of Sheffield, Sheffield, UK.
- College of Applied Medical Sciences, Najran University, Najran, Saudi Arabia.
- Academic Unit of Child Health, Damer Street Building, Sheffield Children's NHS Foundation Trust, Western Bank, Sheffield, S10 2TH, UK.
| | - Fabrizio Messina
- School of Health and Related Research, University of Sheffield, Sheffield, UK
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Amaka C Offiah
- Department of Oncology & Metabolism, University of Sheffield, Sheffield, UK
- Academic Unit of Child Health, Damer Street Building, Sheffield Children's NHS Foundation Trust, Western Bank, Sheffield, S10 2TH, UK
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4
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Tsehay B, Afework M, Mesifin M. Assessment of Reliability of Greulich and Pyle (GP) Method for Determination of Age of Children at Debre Markos Referral Hospital, East Gojjam Zone. Ethiop J Health Sci 2018; 27:631-640. [PMID: 29487472 PMCID: PMC5811942 DOI: 10.4314/ejhs.v27i6.8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Greulich and Pyle standards are the most widely used age estimation standards all over the world. The applicability of the Greulich and Pyle standards to populations which differ from their reference population is often questioned. This study aimed to assess the reliability of Greulich and Pyle (GP) method for determination of age of children at Debre Markos Referral Hospital, East Gojjam Zone, Ethiopia. Subjects and Methods Hospital based cross sectional study design was applied to children who came to Debre Markos Referral Hospital from May to October 2015 and fulfilled the inclusion criteria of the study. The data was analyzed using SPSS version 20 and medcalc version 15 softwares. Significance was set at α = 0.05. Results A total of 108 radiographs were analyzed. Chronological age in most of the children was under estimated. The mean under-estimation was 11.8 months in the female sample and 8.7 months in the male sample. Greulich and Pyle method became inapplicable for the sample at 16 years for females and 16.5 years for males and later. Delay in skeletal maturation was observed in both sexes, but the females in the sample matured earlier than the males. Conclusion The findings of this study suggest against the applicability of GP atlas which were not directly applicable to an East Gojjam Zone population. Large scale studies should be planned and nationwide guideline, and atlas which can easily be used throughout the country should be developed.
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Affiliation(s)
- Binalfew Tsehay
- Department of Biomedical Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Mekbeb Afework
- Department of Anatomy, Addiss Ababa University, Addiss Ababa, Ethiopia
| | - Metasebia Mesifin
- Department of Biomedical Sciences, Debre Markos University, Debre Markos, Ethiopia.,Department of Anatomy, Addiss Ababa University, Addiss Ababa, Ethiopia.,Department of Radiology, Debre Markos Referal Hospital, Debre Markos, Ethiopia
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5
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Govender D, Goodier M. Bone of contention: The applicability of the Greulich-Pyle method for skeletal age assessment in South Africa. SA J Radiol 2018; 22:1348. [PMID: 31754503 PMCID: PMC6837818 DOI: 10.4102/sajr.v22i1.1348] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 05/15/2018] [Indexed: 11/18/2022] Open
Abstract
Background The Greulich–Pyle (GP) method is one of the most commonly used radiographic techniques for skeletal age (SA) determination. The applicability of this method for populations outside of the United States has been questioned and this has been investigated in several recent studies around the world. Only limited data are available on the accuracy of the GP method for a South African population. Objective To determine the accuracy and reliability of the GP method in a population from KwaZulu-Natal, South Africa. Method A retrospective study was performed using a digital database consisting of 102 hand-wrist radiographs. The SA was estimated by two readers with different levels of experience, using the GP method. Differences between estimated SA and chronological age (CA) were analysed. Results Skeletal age determined with the GP method was found to significantly differ from CA. For the population as a whole, the GP method underestimated age. The greatest mean underestimation between SA and CA was 11.5 ± 17 months and 7.4 ± 13.2 months for the 10.1 to 15 year age groups in male and female patients, respectively. The method was found to have excellent inter- and intra-observer reliability. Conclusion The GP method generally significantly underestimates age for both genders. Overestimation is also possible with individuals as young as 16 years old found by the method to be skeletally mature. Until new SA assessment tools are developed for South Africa, use of supplementary means of determination of SA should be considered, especially in medico-legal cases.
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Affiliation(s)
- Dashnee Govender
- Department of Radiology, Grey's Hospital, University of KwaZulu-Natal, South Africa
| | - Matthew Goodier
- Department of Radiology, Grey's Hospital, University of KwaZulu-Natal, South Africa
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Abstract
Systemic inflammation mediated by Plasmodium parasites is central to malaria disease and its complications. Plasmodium parasites reside in erythrocytes and can theoretically reach all host tissues via the circulation. However, actual interactions between parasitized erythrocytes and host tissues, along with the consequent damage and pathological changes, are limited locally to specific tissue sites. Such tissue specificity of the parasite can alter the outcome of malaria disease, determining whether acute or chronic complications occur. Here, we give an overview of the recent progress that has been made in understanding tissue-specific immunopathology during Plasmodium infection. As knowledge on tissue-specific host-parasite interactions accumulates, better treatment modalities and targets may emerge for intervention in malaria disease.
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7
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Lee MSJ, Maruyama K, Fujita Y, Konishi A, Lelliott PM, Itagaki S, Horii T, Lin JW, Khan SM, Kuroda E, Akira S, Ishii KJ, Coban C. Plasmodium products persist in the bone marrow and promote chronic bone loss. Sci Immunol 2017; 2:2/12/eaam8093. [PMID: 28783657 DOI: 10.1126/sciimmunol.aam8093] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 04/28/2017] [Indexed: 12/18/2022]
Abstract
Although malaria is a life-threatening disease with severe complications, most people develop partial immunity and suffer from mild symptoms. However, incomplete recovery from infection causes chronic illness, and little is known of the potential outcomes of this chronicity. We found that malaria causes bone loss and growth retardation as a result of chronic bone inflammation induced by Plasmodium products. Acute malaria infection severely suppresses bone homeostasis, but sustained accumulation of Plasmodium products in the bone marrow niche induces MyD88-dependent inflammatory responses in osteoclast and osteoblast precursors, leading to increased RANKL expression and overstimulation of osteoclastogenesis, favoring bone resorption. Infection with a mutant parasite with impaired hemoglobin digestion that produces little hemozoin, a major Plasmodium by-product, did not cause bone loss. Supplementation of alfacalcidol, a vitamin D3 analog, could prevent the bone loss. These results highlight the risk of bone loss in malaria-infected patients and the potential benefits of coupling bone therapy with antimalarial treatment.
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Affiliation(s)
- Michelle S J Lee
- Laboratory of Malaria Immunology, Immunology Frontier Research Center (IFReC), Osaka University, 3-1 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Kenta Maruyama
- Laboratory of Host Defense, IFReC, Osaka University, Suita, Osaka 565-0871, Japan
| | - Yukiko Fujita
- Laboratory of Malaria Immunology, Immunology Frontier Research Center (IFReC), Osaka University, 3-1 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Aki Konishi
- Laboratory of Malaria Immunology, Immunology Frontier Research Center (IFReC), Osaka University, 3-1 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Patrick M Lelliott
- Laboratory of Malaria Immunology, Immunology Frontier Research Center (IFReC), Osaka University, 3-1 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Sawako Itagaki
- Department of Molecular Protozoology, Research Institute for Microbial Diseases, Osaka University, Suita, Osaka 565-0871, Japan
| | - Toshihiro Horii
- Department of Molecular Protozoology, Research Institute for Microbial Diseases, Osaka University, Suita, Osaka 565-0871, Japan
| | - Jing-Wen Lin
- Leiden Malaria Research Group, Department of Parasitology, Leiden University Medical Centre, 2333 ZA Leiden, Netherlands.,Division of Pediatric Infectious Diseases, State Key Laboratory of Biotherapy, West China Second Hospital, Sichuan University and Collaboration Innovation Centre, Chengdu 610041, China
| | - Shahid M Khan
- Leiden Malaria Research Group, Department of Parasitology, Leiden University Medical Centre, 2333 ZA Leiden, Netherlands
| | - Etsushi Kuroda
- Laboratory of Vaccine Science, IFReC, Osaka University, Suita, Osaka 565-0871, Japan.,Laboratory of Adjuvant Innovation, National Institutes of Biomedical Innovation, Health and Nutrition, 7-6-8 Saito-Asagi, Ibaraki, Osaka 567-0085, Japan
| | - Shizuo Akira
- Laboratory of Host Defense, IFReC, Osaka University, Suita, Osaka 565-0871, Japan
| | - Ken J Ishii
- Laboratory of Vaccine Science, IFReC, Osaka University, Suita, Osaka 565-0871, Japan.,Laboratory of Adjuvant Innovation, National Institutes of Biomedical Innovation, Health and Nutrition, 7-6-8 Saito-Asagi, Ibaraki, Osaka 567-0085, Japan
| | - Cevayir Coban
- Laboratory of Malaria Immunology, Immunology Frontier Research Center (IFReC), Osaka University, 3-1 Yamadaoka, Suita, Osaka 565-0871, Japan.
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8
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Elamin F, Abdelazeem N, Elamin A, Saif D, Liversidge HM. Skeletal maturity of the hand in an East African group from Sudan. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2017; 163:816-823. [DOI: 10.1002/ajpa.23247] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 04/01/2017] [Accepted: 04/29/2017] [Indexed: 11/09/2022]
Affiliation(s)
- Fadil Elamin
- Bart's and The London School of Medicine and Dentistry; Queen Mary University of London, Institute of Dentistry; London E1 2AT United Kingdom
- Khartoum Centre for Research and Medical Training; Qasr Street Khartoum Sudan
- El Razi Dental School; Elazhari 2 Khartoum Sudan
| | - Nihal Abdelazeem
- Khartoum Centre for Research and Medical Training; Qasr Street Khartoum Sudan
- El Razi Dental School; Elazhari 2 Khartoum Sudan
| | - Ahmed Elamin
- El Razi Dental School; Elazhari 2 Khartoum Sudan
| | - Duaa Saif
- Khartoum Centre for Research and Medical Training; Qasr Street Khartoum Sudan
| | - Helen M. Liversidge
- Bart's and The London School of Medicine and Dentistry; Queen Mary University of London, Institute of Dentistry; London E1 2AT United Kingdom
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9
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Forensic use of the Greulich and Pyle atlas: prediction intervals and relevance. Eur Radiol 2016; 27:1032-1043. [DOI: 10.1007/s00330-016-4466-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 04/05/2016] [Accepted: 06/07/2016] [Indexed: 10/21/2022]
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10
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Tisè M, Ferrante L, Mora S, Tagliabracci A. A biochemical approach for assessing cutoffs at the age thresholds of 14 and 18 years: a pilot study on the applicability of bone specific alkaline phosphatase on an Italian sample. Int J Legal Med 2016; 130:1149-1158. [PMID: 27169674 DOI: 10.1007/s00414-016-1382-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 05/02/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND The majority of age estimation methods analyze morphological changes of specific skeletal (or dental) structures reflecting global bone development (biological parameter) in order to estimate a chronological value. This morphological and structural development is the consequence of a very active tissue metabolism and intensive modeling process which involve both bone formation and bone resorption. Several biochemical markers of bone formation and bone resorption are available, and specific biochemical tests can be performed on blood or urine samples, but such markers of bone turnover have never been employed for age estimation in living individuals for forensic purposes. The aim of this study was to ascertain the applicability of serum bone alkaline phosphatase (BALP) concentration in the age estimation for forensic purposes. We focused on the legal age thresholds of 14 and 18 years (LAT) because, in Italy, the former is considered the minimum age for criminal responsibility and the latter defines adult age and the possibility of applying general criminal laws. MATERIALS AND METHODS This study analyzed, from a forensic point of view, BALP and Tanner stages of 202 healthy white individuals (116 females and 86 males) between the ages of 10 and 30 years. We derived a linear logistic model to estimate the probability that an individual was older or younger than LAT using two variables: BALP concentration and Tanner stages. The predictive accuracy of the test was assessed by the determination of the receiver-operating characteristic curve (ROC curve). The test was performed to identify a threshold (cutoff) that could be used to assign an individual to the population of those younger or older than LAT. RESULTS ROC curve showed that the use of both serum BALP concentration and Tanner stages has a very good level of reliability in age assessment (the area under the ROC curve, AUC, ranged from 0.918 to 0.962). Best results were obtained in the assessment of male over 18 years of age (sensibility and specificity respectively of 0.90 and 0.93 with an accuracy of 0.92). Worst results were obtained in the assessment of female over 18 years of age (sensibility and specificity respectively of 0.87 and 0.82 with an accuracy of 0.84). We also calculated the probability of the correctness in the age estimation. CONCLUSION The results showed that the use of serum BALP concentration in the age assessment could be a promising and integrative method to established ones, but more research has to be done to validate the value of the proposed method in the forensic practice.
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Affiliation(s)
- Marco Tisè
- Section of Legal Medicine, Department of Biomedical Sciences and Public Health, Polytechnic University of Marche, 60020, Torrette di Ancona, Italy
| | - Luigi Ferrante
- Center of Epidemiology, Biostatistics, and Medical Information Technology, Department of Biomedical Sciences and Public Health, Polytechnic University of Marche, 60020, Torrette di Ancona, Italy
| | - Stefano Mora
- Laboratory of Pediatric Endocrinology, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Adriano Tagliabracci
- Section of Legal Medicine, Department of Biomedical Sciences and Public Health, Polytechnic University of Marche, 60020, Torrette di Ancona, Italy.
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11
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Öztürk F, Karataş OH, Mutaf HI, Babacan H. Bone age assessment: comparison of children from two different regions with the Greulich–Pyle method In Turkey. AUST J FORENSIC SCI 2015. [DOI: 10.1080/00450618.2015.1119311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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12
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Stevenson AJ, Jones HW, Chokotho LC, Beckles VLL, Harrison WJ. The Beit CURE Classification of Childhood Chronic Haematogenous Osteomyelitis--a guide to treatment. J Orthop Surg Res 2015; 10:144. [PMID: 26384208 PMCID: PMC4573297 DOI: 10.1186/s13018-015-0282-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 08/27/2015] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND The Beit CURE (BC) classification is a radiographic classification used in childhood chronic haematogenous osteomyelitis. The aim of this study is to assess correlation between this classification and the type and extent of treatment required. METHODS We present a retrospective series of 145 cases of childhood chronic haematogenous osteomyelitis classified using the BC classification. Variables measured include age, sex, bone involved, number of admissions, length of stay, type/number of operations and microbiology. RESULTS The most commonly affected bone was the tibia (46%), followed by femur (26%) and humerus (10%). Bone defects were most common in the tibia. Staphylococcus aureus was the most commonly isolated organism. Type B, sequestrum type, was the most common (88%), followed by type C, sclerotic type, (7%) and type A, Brodie's abscess (5%). Types A and B1 had the shortest length of hospitalisation (11 days), type B4 had the longest (87 days). Types A and B1 had the fewest infection control operations. Type B4 had the greatest total number of operations. CONCLUSIONS This study shows that the BC classification can guide surgical strategy and help predict length of inpatient treatment and number and type of procedures required.
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Affiliation(s)
- Andrew J Stevenson
- FRCS (T&O), North Bristol NHS Trust, 8 Mervyn Road, Bristol, BS7 9EL, UK.
| | - Henry Wynn Jones
- FRCS (T&O), Wrightington, Wigan & Leigh NHS Foundation Trust, Wigan, UK.
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Mohammed RB, Rao DS, Goud AS, Sailaja S, Thetay AAR, Gopalakrishnan M. Is Greulich and Pyle standards of skeletal maturation applicable for age estimation in South Indian Andhra children? J Pharm Bioallied Sci 2015; 7:218-25. [PMID: 26229357 PMCID: PMC4517325 DOI: 10.4103/0975-7406.160031] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Revised: 01/20/2015] [Accepted: 02/05/2015] [Indexed: 11/12/2022] Open
Abstract
Introduction: Now-a-day age determination has gained importance for various forensic and legal reasons. Skeletal age (SA) of a test population can be estimated by comparing with established standards of Greulich and Pyle (G-P). As this atlas has been prepared using data from upper-class children born between 1917 and 1942 in the USA and the applicability of these standards to contemporary populations has yet to be tested on Andhra children living in India. Hence, this study was aimed to assess the reliability of bone age calculated by G-P atlas in estimation of age in selected population. Materials and Methods: A total of 660 children (330 girls, 330 boys) between ages 9 and 20 years were randomly selected from outpatient Department of Oral Medicine in GITAM Dental College, Andhra Pradesh. Digital hand-wrist radiographs were obtained and assessed for SA using G-P atlas and the difference between estimated SA and chronological age (CA) were compared with paired t-test and Wilcoxon signed rank test. Results: G-P method underestimated the SA by 0.23 ± 1.53 years for boys and overestimated SA by 0.02 ± 2 years in girls and mild underestimation was noted in the total sample of about 0.1 ± 1.78 years. Spearman rank test showed significant correlation between SA and CA (r = 0.86; P < 0.001). Conclusion: This study concluded that G-P standards were reliable in assessing age in South Indian Andhra children of age 9–20 years with unknown CA.
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Affiliation(s)
- Rezwana Begum Mohammed
- Department of Oral Medicine and Radiology, GITAM Dental College and Hospital, Visakhapatnam, Andhra Pradesh, India
| | - Dola Srinivasa Rao
- Department of Periodontics, GITAM Dental College and Hospital, Visakhapatnam, Andhra Pradesh, India
| | - Alampur Srinivas Goud
- Department of Periodontics, Bhabha College of Dental Sciences, Bhopal, Madhya Pradesh, India
| | - S Sailaja
- Department of Oral Medicine and Radiology, Government Dental College, Hyderabad, Telangana, India
| | - Anshuj Ajay Rao Thetay
- Department of Orthodontics and Dentofacial Orthopaedics, RKDF Dental College and Research Centre, Bhopal, Madhya Pradesh, India
| | - Meera Gopalakrishnan
- Department of Endodontics and Conservative Dentistry, Indira Gandhi Institute of Dental Sciences, Ernakulam, Kerala, India
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Paxton ML, Lamont AC, Stillwell AP. The reliability of the Greulich-Pyle method in bone age determination among Australian children. J Med Imaging Radiat Oncol 2012; 57:21-4. [PMID: 23374549 DOI: 10.1111/j.1754-9485.2012.02462.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2012] [Accepted: 06/21/2012] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Bone age (BA) determination in skeletally immature children has been used as a measurement of growth for many years. The Greulich-Pyle (G&P) method of estimating BA is most commonly used. The standards used within this atlas were compiled from research conducted on normal white children in the United States, during the 1930s. The applicability of G&P beyond populations similar to its own can be variable. The aim of this study was to determine the accuracy of G&P in BA determination among Australian children. METHODS AND MATERIALS Hand X-rays of children under the age of 18, investigated for trauma, were recruited. Mean differences between BA, according to the standards of G&P, and chronological age (CA) were compared among all patients and subgroups according to age, gender and left versus right hand. RESULTS Between January and December 2010, 654 children underwent hand X-rays, 406 of these were included (276 males and 130 females). Overall BA was 2.2 months less than CA (P-value = 0.005). BA of males and females was estimated to be 1.5 months (P-value = 0.142) and 3.7 months (P-value = 0.002) less than their CA respectively. No statistically significant difference was identified with intra-observer (P-value = 0.846) and inter-observer interpretations (P-value = 0.102). CONCLUSIONS Our results show that the standards of G&P are an accurate means of BA determination in Australian children.
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Affiliation(s)
- Mark L Paxton
- Department of Medical Imaging, The Townsville Hospital, Townsville, Queensland, Australia.
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Hackman L, Black S. The reliability of the Greulich and Pyle atlas when applied to a modern Scottish population. J Forensic Sci 2012; 58:114-9. [PMID: 23061975 PMCID: PMC3781705 DOI: 10.1111/j.1556-4029.2012.02294.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2011] [Revised: 11/17/2011] [Accepted: 12/04/2011] [Indexed: 11/27/2022]
Abstract
This study examines the reliability of age estimation utilizing the Greulich and Pyle atlas in relation to a modern Scottish population. A total of 406 left-hand/wrist radiographs (157 females and 249 males) were age-assessed using the Greulich and Pyle atlas. Analysis showed that there was a strong correlation between chronological age and estimated age (females R(2) = 0.939, males R(2) = 0.940). When age groups were broken down into year cohorts, the atlas over-aged females from birth until 13 years of age. The pattern for males showed that the atlas under-estimated age until 13 years of age after which point it consistently over-aged boys between 13 and 17 years of age. This study showed that the Greulich and Pyle atlas can be applied to a modern population but would recommend that any analysis takes into account the potential for over- and under-aging shown in this study.
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Affiliation(s)
- Lucina Hackman
- Centre for Anatomy and Human Identification, University of Dundee, Dundee, UK.
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Dembetembe KA, Morris AG. Is Greulich–Pyle age estimation applicable for determining maturation in male Africans? S AFR J SCI 2012. [DOI: 10.4102/sajs.v108i9/10.1036] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Hawley NL, Rousham EK, Johnson W, Norris SA, Pettifor JM, Cameron N. Determinants of relative skeletal maturity in South African children. Bone 2012; 50:259-64. [PMID: 22075209 DOI: 10.1016/j.bone.2011.10.029] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2011] [Revised: 10/20/2011] [Accepted: 10/25/2011] [Indexed: 12/17/2022]
Abstract
The variation of skeletal maturity about chronological age is a sensitive indicator of population health. Age appropriate or advanced skeletal maturity is a reflection of adequate environmental and social conditions, whereas delayed maturation suggests inadequate conditions for optimal development. There remains a paucity of data, however, to indicate which specific biological and environmental factors are associated with advancement or delay in skeletal maturity. The present study utilises longitudinal data from the South African Birth to Twenty (Bt20) study to indentify predictors of relative skeletal maturity (RSM) in early adolescence. A total of 244 black South African children (n=131 male) were included in this analysis. Skeletal maturity at age 9/10 years was assessed using the Tanner and Whitehouse III RUS technique. Longitudinal data on growth, socio-economic position and pubertal development were entered into sex-specific multivariable general linear regression models with relative skeletal maturity (skeletal age-chronological age) as the outcome. At 9/10 years of age males showed an average of 0.66 years delay in skeletal maturation relative to chronological age. Females showed an average of 1.00 year delay relative to chronological age. In males, being taller at 2 years (p<0.01) and heavier at 2 years (p<0.01) predicted less delay in RSM at age 9/10 years, independent of current size and body composition. In females, both height at 2 years and conditional weight at 2 years predicted less delay in RSM at 9/10 years (p<0.05) but this effect was mediated by current body composition. Having greater lean mass at 9/10 years was associated with less delayed RSM in females (p<0.01) as was pubertal status at the time of skeletal maturity assessment (p<0.01). This study identifies several predictors of skeletal maturation at 9/10 years, indicating a role for early life exposures in determining the rate of skeletal maturation during childhood independently of current stature.
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Affiliation(s)
- Nicola L Hawley
- International Health Institute, Department of Community Health, Brown University, Providence, RI 02912, USA.
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Tisè M, Mazzarini L, Fabrizzi G, Ferrante L, Giorgetti R, Tagliabracci A. Applicability of Greulich and Pyle method for age assessment in forensic practice on an Italian sample. Int J Legal Med 2011; 125:411-6. [PMID: 21221985 DOI: 10.1007/s00414-010-0541-6] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2010] [Accepted: 12/15/2010] [Indexed: 11/29/2022]
Abstract
BACKGROUND The main importance in age estimation lies in the assessment of criminal liability and protection of unaccompanied minor immigrants, when their age is unknown. Under Italian law, persons are not criminally responsible before they reach the age of 14. The age of 18 is important when deciding whether juvenile or adult law must be applied. In the case of unaccompanied minors, it is important to assess age in order to establish special protective measures, and correct age estimation may prevent a person over 18 from benefiting from measures reserved for minors. OBJECTIVE Since the Greulich and Pyle method is one of the most frequently used in age estimation, the aim of this study was to assess the reproducibility and accuracy of the method on a large Italian sample of teenagers, to ascertain the applicability of the Atlas at the critical age thresholds of 14 and 18 years. MATERIALS AND METHODS This retrospective study examined posteroanterior X-ray projections of hand and wrist from 484 Italian-Caucasian young people (125 females, 359 males) between 11 and 19 years old. All radiographic images were taken from trauma patients hospitalized in the Azienda Ospedaliero Universitaria Ospedali Riuniti of Ancona (Italy) between 2006 and 2007. Two physicians analyzed all radiographic images separately. The blind method was used. RESULTS In the case of an estimated age of 14 years old, the true age ranged from 12.2 to 15.9 years (median, 14.3 years, interquartile range, 1.0 years) for males, and 12.6 to 15.7 years (median, 14.2 years, interquartile range, 1.7 years) for females. In the case of an estimated age of 18 years, the true age ranged from 15.6 to 19.7 years (median, 17.7 years, interquartile range, 1.4 years) for males, and from 16.2 to 20.0 years (median, 18.7 years, interquartile range, 1.8 years) for females. CONCLUSION Our study shows that although the GPM is a reproducible and repeatable method, there is a wide margin of error in the estimation of chronological age, mainly in the critical estimated ages of 14 and 18 years old in both males and females.
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Affiliation(s)
- Marco Tisè
- Institute of Legal Medicine, Università Politecnica delle Marche, Via Conca 71, 60126, Ancona, Italy
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The problem of aging human remains and living individuals: A review. Forensic Sci Int 2009; 193:1-13. [DOI: 10.1016/j.forsciint.2009.09.008] [Citation(s) in RCA: 384] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2009] [Revised: 09/08/2009] [Accepted: 09/14/2009] [Indexed: 11/17/2022]
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Büken B, Erzengin OU, Büken E, Safak AA, Yazici B, Erkol Z. Comparison of the three age estimation methods: which is more reliable for Turkish children? Forensic Sci Int 2008; 183:103.e1-7. [PMID: 19054636 DOI: 10.1016/j.forsciint.2008.10.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2008] [Revised: 09/10/2008] [Accepted: 10/02/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Three atlases-the GOK, the Greulich-Pyle (GP), and the Tanner-Whitehouse (TW3)-are used frequently for age determination in Turkey. The purpose of this study was to evaluate the applicability of these three methods related to the skeletal age assessment for Turkish adolescents. MATERIALS AND METHODS The conventional roentgenograms of the left hands and wrists, elbows, shoulders, and pelvises of 333 healthy Caucasian children (164 females, 169 males) who fit the study and the criteria of each atlas were obtained. The mean differences (+/- standard deviation [S.D.] in years) between the chronologic age (CA) and the skeletal age (BA), which were obtained by using each age estimation method, were calculated and tested using t-test. RESULTS For girls, the most accurate method was the TW3 (mean differences (d): -0.21 (p<0.05)), following by the GP (d: 0.66 (p<0.001), and the GOK (d: 2.99 (p<0.001)). For boys, the most accurate method was the GP (d: -0.02 (p>0.05)), followed by the TW3 (d: -0.18 (p<0.05)) and GOK (d: 1.05 (p<0.001)). DISCUSSION AND CONCLUSIONS Results show that the TW3 (for girls) and the GP (for boys) methods are more appropriate than the GOK atlas for estimating the BA. GOK could be used for boys aged 11-14 years but it should not be used for girls.
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Affiliation(s)
- Bora Büken
- Düzce University, Faculty of Medicine, Forensic Medicine Department, Konuralp, 81620 Düzce, Turkey.
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Adamsbaum C, Chaumoitre K, Panuel M. [Bone age determination in a medicolegal setting]. JOURNAL DE RADIOLOGIE 2008; 89:455-456. [PMID: 18477950 DOI: 10.1016/s0221-0363(08)71447-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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Büken B, Safak AA, Yazici B, Büken E, Mayda AS. Is the assessment of bone age by the Greulich-Pyle method reliable at forensic age estimation for Turkish children? Forensic Sci Int 2007; 173:146-53. [PMID: 17391883 DOI: 10.1016/j.forsciint.2007.02.023] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2005] [Revised: 12/01/2006] [Accepted: 02/22/2007] [Indexed: 10/23/2022]
Abstract
BACKGROUND Estimation of age is an important task for forensic experts especially in developing countries where birth records are often not well maintained. In this study, we investigated whether or not the Greulich-Pyle (G-P) method is sufficient at forensic age estimation for Turkish children. METHODS Plain radiographies of left hands and wrists of 492 (241 (49.0%) female, 251 (51.0%) male) healthy children between 11 and 18 years of age for girls and 11 and 19 years of age for boys were taken. Mean chronological ages (CA) were compared with mean skeletal ages according to G-P atlas for each gender and in the second step the differences those for each age group were determined. The children were Caucasian and had a low-middle socioeconomic status in this study population. The paired sample t test was used to indicate the difference between G-P (mean skeletal age according to G-P atlas) and CA (mean chronological age). In order to indicate the relation Pearson correlation coefficient was used. Modeling the relationship between G-P and CA linear regression was used. The analyses were done under SPSS 11.5. RESULTS The G-P compared to their CA. The CA was 14.52+/-2.18 S.D. years, S.E.: 0.14 (median: 14.47, range: 11.07-18.92 years) whereas G-P was 15.06+/-2.31 S.D. years, S.E.: 0.15 (median: 15.00, range: 10-18 years) for girls. The difference between the two parameters was statistically significant (p<0.001). The CA was 15.28+/-2.41 S.D. years, S.E.: 0.15 (median: 15.09, S.E. range 11.13-19.94 years) and G-P was 15.41+/-2.92 S.D. years, S.E.: 0.18 (median: 15.60, range 9-19 years) for boys. The difference was not statistically significant (p>0.05). There was a high correlation (Pearson r=0.882, p<0.001) for girls and (Pearson r=0.900, p<0.001) for boys. The determination coefficient (R2) is equal to 0.778 for girls and 0.81 for boys. The regression model also tested by ANOVA and it is found significant (p<0.01) for both genders. According to age groups G-P was advanced (0.17-1.1 year) almost for all ages and differences were significant at 11, 12, 14, 16 ages for girls. G-P was delayed at 11-14 ages (0.01-0.58 year) but not significant except for 13 years and G-P were significantly advanced in 15-17 ages (0.88-0.98 years) but then delayed in 18-19 years of age (0.02-0.48) for boys. The difference's standard deviation at 12, 13, 15, 16 years of ages for girls and between 12 and 16 and 18 years of ages for boys were more than 1 year. CONCLUSION When the results of the previous study and this study are compared, the test method could be used technically by pediatricians and other clinicians, but it is even more important for ethically unacceptable errors to disappear, especially in cases involving the possible criminal liability of the supposed minor. So standard deviation at 12, 15 years of ages for girls and 12, 15, 18 years of ages for boys were more than 1 year. But it is not known that the other methods whether more useful or not than this method. For the time being unless any other methods will be proved more useful, we have to use this method cautiously for possible criminal liability cases in forensic age diagnosis.
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Affiliation(s)
- Bora Büken
- Düzce University, Düzce Medical Faculty, Forensics Medicine Department, Turkey.
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Dvorak J, George J, Junge A, Hodler J. Age determination by magnetic resonance imaging of the wrist in adolescent male football players. Br J Sports Med 2006; 41:45-52. [PMID: 17021001 PMCID: PMC2465138 DOI: 10.1136/bjsm.2006.031021] [Citation(s) in RCA: 136] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND In football there are established age-related tournaments for males and females to guarantee equal chances within the game for all the different age groups. To prevent participation in the incorrect age group, and owing to the fact that in some Asian and African countries registration at birth is not compulsory, other methods of age determination need to be available. Standard radiographs of the left wrist have been used for assessment of skeletal age for many years. This is, however, not ethical in the sporting environment. AIM To study the possible use of magnetic resonance imaging (MRI), which has no radiation risk, in estimating the age of healthy adolescent football players. METHODS The examination protocol was applied in four countries using, their respective MRI equipment using a 1-T or 1.5-T magnet and a wrist coil. 496 healthy male adolescent football players between the ages of 14 and 19 years from Switzerland, Malaysia, Algeria and Argentina were selected for the study. The degree of fusion of the left distal radial physis was determined by three independent raters by a newly developed grading system which can be used in future MRI epiphysial fusion grading studies. RESULTS The inter-rater reliability for grading was high (r = 0.91 and 0.92); all correlations were highly significant (p<0.001). The average age increased with a higher grading of fusion, and the correlation between age and grade of fusion was highly significant (r = 0.69, p<0.001). Only one player (0.8%) in the 16-year-old age group was graded as completely fused. CONCLUSION MRI of the wrist offers an alternative as a non-invasive method of age determination in 14-19-year-old male adolescents. The grading system presented here clearly identifies the skeletal maturity by complete fusion in all MRI slices, which eliminates any risk associated with standard radiographic rating as determined by the International Atomic Energy Agency.
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Affiliation(s)
- Jiri Dvorak
- Department of Neurology, Schulthess Clinic, Lengghalde 2, 8008 Zurich, Switzerland.
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Abstract
BACKGROUND Cyclooxygenase (COX)-2-specific inhibitors demonstrate analgesic efficacy comparable with that of conventional nonsteroidal anti-inflammatory drugs but are associated with reduced gastrointestinal side effects and an absence of antiplatelet activity. Thus, they can be administered to patients undergoing spinal fusion surgery without an added risk of bleeding. However, concerns regarding a possible deleterious effect on bone-healing have limited their routine use. Celecoxib, a COX-2 inhibitor, recently was approved for the treatment of acute pain. The goals of the present study were to examine the analgesic efficacy of celecoxib and to determine the incidence of nonunion at one year following spinal fusion surgery. METHODS Eighty patients who were scheduled to undergo spinal fusion received either celecoxib or placebo one hour before the induction of anesthesia and every twelve hours after surgery for the first five postoperative days. Pain scores and morphine use were recorded one hour after arrival in the post-anesthesia care unit and at four, eight, twelve, sixteen, twenty, and twenty-four hours later. Intraoperative blood loss was recorded. The status of the fusion was determined radiographically at the time of the one-year follow-up. RESULTS There were no differences in demographic data or blood loss between the two groups. Pain scores were lower in the celecoxib group at one, four, eight, sixteen, and twenty hours postoperatively. There were no differences between the two groups with regard to the pain scores at twelve and twenty-four hours postoperatively. Morphine use was lower in the celecoxib group at all postoperative time-intervals. There was no difference between the celecoxib group and the placebo group with regard to the incidence of nonunion at the time of the one-year follow-up (7.5% [three of forty] compared with 10% [four of forty]). CONCLUSIONS The perioperative administration of celecoxib resulted in a significant reduction in postoperative pain and opioid use following spinal fusion surgery. In addition, the short-term administration of this COX-2-specific non-steroidal anti-inflammatory drug had no apparent effect on the rate of nonunion at the time of the one-year follow-up.
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Affiliation(s)
- Scott S Reuben
- Baystate Medical Center and Tufts University School of Medicine, 759 Chestnut Street, Springfield, MA 01199, USA.
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