A growth reference for mid upper arm circumference for age among school age children and adolescents, and validation for mortality: growth curve construction and longitudinal cohort study

Objectives To construct growth curves for mid-upper-arm circumference (MUAC)-for-age z score for 5-19 year olds that accord with the World Health Organization growth standards, and to evaluate their discriminatory performance for subsequent mortality.Design Growth curve construction and longitudinal cohort study.Setting United States and international growth data, and cohorts in Kenya, Uganda, and Zimbabwe.Participants The Health Examination Survey (HES)/National Health and Nutrition Examination Survey (NHANES) US population datasets (age 5-25 years), which were used to construct the 2007 WHO growth reference for body mass index in this age group, were merged with an imputed dataset matching the distribution of the WHO 2006 growth standards age 2-6 years. Validation data were from 685 HIV infected children aged 5-17 years participating in the Antiretroviral Research for Watoto (ARROW) trial in Uganda and Zimbabwe; and 1741 children aged 5-13 years discharged from a rural Kenyan hospital (3.8% HIV infected). Both cohorts were followed-up for survival during one year.Main outcome measures Concordance with WHO 2006 growth standards at age 60 months and survival during one year according to MUAC-for-age and body mass index-for-age z scores.Results The new growth curves transitioned smoothly with WHO growth standards at age 5 years. MUAC-for-age z scores of -2 to -3 and less than-3, compared with -2 or more, was associated with hazard ratios for death within one year of 3.63 (95% confidence interval 0.90 to 14.7; P=0.07) and 11.1 (3.40 to 36.0; P<0.001), respectively, among ARROW trial participants; and 2.22 (1.01 to 4.9; P=0.04) and 5.15 (2.49 to 10.7; P<0.001), respectively, among Kenyan children after discharge from hospital. The AUCs for MUAC-for-age and body mass index-for-age z scores for discriminating subsequent mortality were 0.81 (95% confidence interval 0.70 to 0.92) and 0.75 (0.63 to 0.86) in the ARROW trial (absolute difference 0.06, 95% confidence interval -0.032 to 0.16; P=0.2) and 0.73 (0.65 to 0.80) and 0.58 (0.49 to 0.67), respectively, in Kenya (absolute difference in AUC 0.15, 0.07 to 0.23; P=0.0002).Conclusions The MUAC-for-age z score is at least as effective as the body mass index-for-age z score for assessing mortality risks associated with undernutrition among African school aged children and adolescents. MUAC can provide simplified screening and diagnosis within nutrition and HIV programmes, and in research.

Muscle development in healthy children evaluated by bioelectrical impedance analysis

OBJECTIVES

This study aimed to use bioelectrical impedance analysis (BIA) to generate a new muscle density index (MDI), the MDI_BIA, to evaluate muscle development, and to demonstrate the changes that occur in the BIA-based muscle cross-sectional area index (MCAI_BIA) that accompany growth. We also sought to determine the traceability of chronological changes in the MDI_BIA and MCAI_BIA.

METHODS

Healthy children (n=112) aged 8.68±3.16years (0.33-14.00years) underwent bioelectrical impedance (BI) measurements of their upper arms, thighs, and lower legs. The MDI_BIA and MCAI_BIA were calculated, and cross-sectional investigations were conducted into the changes in these indices that accompanied growth. Data collected after 1.10±0.08years from 45 participants determined the traceability of the chronological changes in the MDI_BIA and MCAI_BIA.

RESULTS

The MDI_BIA and MCAI_BIA were significantly positively correlated with age and height at all locations (P<0.01). The relationships between the locations and the MDI_BIA and MCAI_BIA differed, indicating that these indices evaluated the muscles from different perspectives. Except for the upper arm MDI_BIA, both indices at all locations regardless of age, showed significant chronological increases after an average period of 1.10years.

CONCLUSIONS

The MDI_BIA and MCAI_BIA were significantly correlated with age and height in healthy children, and they showed significant chronological increases. Hence, these indices could be used to represent muscle development and muscle mass increases. BIA is non-invasive, convenient, and economical and it may be useful in evaluating muscle development and muscle cross-sectional areas in children.

Growth in Greenland: development of body proportions and menarcheal age in Greenlandic children

INTRODUCTION

No recent investigations of child growth in Greenland are available. Owing to the secular trend, earlier investigations are of limited clinical value.

OBJECTIVES

For this reason, we studied the most important anthropometric measurements of school children in Maniitsoq, Greenland.

METHODS

We recorded weight, standing height, sitting height, armspan and menarcheal age. After the exclusion of ten children, who were either suffering from conditions known to influence growth, or for whom some of the anthropometric data were lacking, 299 boys and 290 girls remained in the study. The 589 children were between 5-19 years old.

RESULTS

In comparison with a similar study in Maniitsoq undertaken a little more than 30 years ago, 14-year old children in Maniitsoq have increased standing height by 10 cms, or even more. Up to the age of 14, Greenlandic boys followed the Danish curve for standing height, then flattened out to reach a final mean height about 7 cms below the Danish level. The girls' growth curve followed the Danish one only to the age of 11 years, then flattened out to a final height of 5 cms below the Danish level. A somewhat higher sitting height ratio was recorded for both sexes compared to Danish children. The mean menarcheal age was 12.64 years.

CONCLUSION

During the course of 100 years, menarcheal age in Greenland has diminshed by three years, and is now 3 months below that in Denmark.

Practices in child growth monitoring in the countries of the Eastern Mediterranean Region

Growth reference charts are among the most sensitive and valuable tools for assessing the health and development of children. A questionnaire survey was answered by 16 of the 21 ministries of health in the Eastern Mediterranean Region countries (EMR) about their use of growth charts for children under 5 years. Most of the countries (13/16) used the NCHS/WHO charts and weight-for-age was the most commonly used. Charts for height-for-age and head circumference-for-age were less commonly used. Problems in the use of charts were identified. The introduction of the new WHO Child Growth Standards, based on exclusively breastfed babies, is a unique opportunity to support growth monitoring and optimal feeding practices in EMR.

The upper arm muscle and fat area of Santal children: an evaluation of nutritional status

AIMS

The purpose of this study is to determine the growth pattern of upper arm muscle area (UAMA), upper arm fat area (UAFA) and upper arm muscle area by height (UAMAH) and assessment of magnitude of undernutrition on the basis of these parameters in Santal children.

METHODS

UAMA and UAFA of 890 (473 boys and 417 girls) Santal children aged 5-12 years were calculated from mid-upper arm circumference and triceps skinfold.

RESULTS

Growth curves of UAFA-for-age and UAMA by height in Santal boys and girls are placed at lower level of reference curve indicating severe undernutrition. The growth curves of UAMA-for-age in Santal children of both sexes do not indicate severe undernutrition. 17.13% Santal boys and 20.63% girls were truly undernourished on the basis of three Z-scores of height-for-age, weight-for-height and UAMAH of each subject. Santal children have more UAMA and less UAFA compared to similar undernourished children of Sugalis.

CONCLUSION

Growth curves of UAFA-for-age and UAMA by height are good indicators of nutritional status in Santal children. UAMA and UAFA may not be similarly affected in undernourished children of every community. A comprehensive approach to identify the truly undernourished child has been suggested from this study.

Anthropometric measurements of children attending a vaccination clinic in Yaounde, Cameroon

BACKGROUND

Growth faltering is a frequent public health problem in children and anthropometric measurements are useful tools for follow-up and early diagnosis. This problem has not been studied in the Cameroonian setting, that's why we undertook this study.

OBJECTIVES

To have a synopsis of the nutritional status in apparently healthy children attending a vaccination clinic and show the importance of anthropometric measurements in routine child health care.

DESIGN

A retrospective study.

PATIENTS AND PARTICIPANTS

1351 children aged (6-24 months), who attended the vaccination clinic of the Yaounde Gynaeco-Obstetric and Pediatric Hospital over a 6 month period, were enrolled in the study.

METHOD

The registers of the vaccination clinic of the above hospital were retrospectively reviewed from 1st March to 31st August 2005. The following parameters were noted: age, height, weight, mid-upper arm circumference (MUAC), and Z scores calculated for the following indicators: weight for age (WAZ), weight for height (WHZ), and height for age (HAZ).

RESULTS

Our results show that 12 children (1.1 percent) in the 0-6 months age group and 4 (1.6 percent) in the 6-12 months age group had WAZ less than -2 indicating underweight. Also 10 children (0.9 percent) and 2 (0.8 percent) in the 0-6 and 6-12 months age groups respectively had WHZ less than -2, indicating wasting. HAZ was less than -2 in 70 children (6.4 percent) and in 8 (3.2 percent) in the 0-6 and 6-12 months age groups respectively indicating stunting. The MUAC was less than 12.5 cm in 6 children (2.4 percent).

CONCLUSIONS

From our results, we conclude that growth faltering is common in supposedly healthy children attending our vaccination clinic. Anthropometric measurements are thus recommended and should be encouraged in routine child care settings for early diagnosis of growth retardation and to provide useful interventions.

Treatment of congenital upper extremity problems

LEARNING OBJECTIVES

After studying this article, the participant should be able to: 1. Describe the terminology and classification of congenital hand anomalies. 2. Describe the incidence and embryogenesis of some common congenital hand anomalies. 3. Discuss the general principles and goals for treatment of congenital hand anomalies. 4. Describe the management of five of the more common congenital hand anomalies (syndactyly, short digits, thumb duplication, hypoplastic thumb, and radial dysplasia).

SUMMARY

Congenital hand anomalies can cause substantial emotional and functional problems. This article reviews the etiology, classification, and management of some of the more common hand anomalies. A general approach to the patient and the goals of treatment are reviewed, as is the approach to five specific congenital hand anomalies: syndactyly, short digits, thumb duplication, hypoplastic thumb, and radial dysplasia.

[Selected body proportions in girls with Turner's syndrome]

INTRODUCTION

Typical features in Turner s syndrome (TS) are growth deficit and abnormal body proportions resulting from shorter lower extremities in relation to trunk height and larger shoulder girdle, compared with healthy girls.

AIM OF THE STUDY

To compare upper body length to body height (bh) in TS and healthy girls.

MATERIAL AND METHODS

The following variables were recorded: body height (bh), sitting height (sh), upper extremity length, chest and hips girth (cg). In addition, body stature index equal to the ratio bs/bh was computed. Girls with TS aged 7-14 years (n=46) and healthy short-statured girls (below 10th percentile) in the same age ranges (n=46, respectively) were studied.

RESULTS

Compared to healthy short-statured girls, Turner ones did not differ significantly with respect to body height (bh), and upper extremity length,. The index of height proportion (sh/bh) in healthy and TS girls aged 7-14 years amounted to 0.519+/-0.002 and 0.546+/-0.003, The differences were in both cases highly significant (p<0.001). Moreover, Turner girls were significantly heavier, had significantly larger hip and chest girths than healthy short-statured girls.

CONCLUSION

Basic anthropometric measurements or the index of height proportion measured at the early-school age may serve as a simple diagnostic tool in screening abnormal growth proportions, e.g. in Turner s syndrome.

Cartilage oligomeric matrix protein is involved in human limb development and in the pathogenesis of osteoarthritis

As a member of the thrombospondin gene family, cartilage oligomeric protein (COMP) is found mainly in the extracellular matrix often associated with cartilage tissue. COMP exhibits a wide binding repertoire and has been shown to be involved in the regulation of chondrogenesis in vitro. Not much is known about the role of COMP in human cartilage tissue in vivo. With the help of immunohistochemistry, Western blot, in situ hybridization, and real-time reverse transcription-polymerase chain reaction, we aimed to elucidate the role of COMP in human embryonic, adult healthy, and osteoarthritis (OA) cartilage tissue. COMP is present during the earliest stages of human limb maturation and is later found in regions where the joints develop. In healthy and diseased cartilage tissue, COMP is secreted by the chondrocytes and is often associated with the collagen fibers. In late stages of OA, five times the COMP mRNA is produced by chondrocytes found in an area adjacent to the main defect than in an area with macroscopically normal appearance. The results indicate that COMP might be involved in human limb development, is upregulated in OA, and due to its wide binding repertoire, could play a role in the pathogenesis of OA as a factor secreted by chondrocytes to ameliorate the matrix breakdown.

Left-right upper arm length asymmetry associated with apical vertebral rotation in subjects with thoracic scoliosis: anomaly of bilateral symmetry affecting vertebral, costal and upper arm physes?

Left-right skeletal length asymmetries in upper limbs related to curve side and severity have been detected with adolescent idiopathic scoliosis (AIS). This paper reports upper arm length asymmetry in thoracic scoliosis related significantly to apical vertebral rotation in school screening referrals. The reason(s) for the association of upper arm length asymmetry with apical vertebral rotation is unknown and three factors are considered: (1) neuromuscular mechanisms from primary or secondary causes, (2) relative concave neurocentral synchondrosis overgrowth, and (3) relative concave periapical rib length overgrowth, A putative anomaly of growth plates (physes) of ribs, neurocentral synchondroses and upper arms, would account for the findings. A solution to this dilemma may emerge from the results of surgery should concave periapical rib resections become evaluated further for right thoracic AIS in girls.

Familial growth and skeletal features associated with SHOX haploinsufficiency

This study was designed to determine the intrafamilial effect of SHOX haploinsufficiency on stature, by comparing the growth and phenotype of 26 SHOX haploinsufficient individuals with 45 relatives and population standards. It confirmed that SHOX haploinsufficiency leads to growth restriction from birth to final height. Compared to unaffected siblings, the SHOX haploinsufficient cohort was 2.14 SDS (3.8 cm) shorter at birth and 2.1 SDS shorter through childhood. At final height females were 2.4 SDS (14.4 cm) shorter and males 0.8 SDS (5.3 cm) shorter than normal siblings. The family height analysis suggests that the effect of SHOX haploinsufficiency on growth may have been previously underestimated at birth and overestimated in males at final height. SHOX haploinsufficiency leads to short arms in 92%, bilateral Madelung deformity in 73% and short stature in 54%. Females were more severely affected than males. We conclude that SHOX is a major growth gene and that mutations are associated with a broad range of phenotype.

Effect of 24 months of recombinant growth hormone on height and body proportions in SHOX haploinsufficiency

Leri-Weill syndrome (LWS) is a skeletal dysplasia with mesomelic short stature, bilateral Madelung deformity (BMD) and SHOX (short stature homeobox-containing gene) haploinsufficiency. The effect of 24 months of recombinant human growth hormone (rhGH) therapy on the stature and BMD of two females with SHOX haploinsufficiency (demonstrated by fluorescence in situ hybridisation) and LWS was evaluated. Both patients demonstrated an increase in height standard deviation score (SDS) and height velocity SDS over the 24 months of therapy. Patient 1 demonstrated a relative increase in arm-span and upper segment measurements with rhGH while patient 2 demonstrated a relative increase in lower limb length. There was appropriate advancement of bone age, no adverse events and no significant deterioration in BMD. In this study, 24 months of rhGH was a safe and effective therapy for the disproportionate short stature of SHOX haploinsufficiency, with no clinical deterioration of BMD.

Muscle fiber number in the biceps brachii muscle of young and old men

We have compared the number of muscle fibers in the biceps brachii muscle (BB) of six old men (82.3 +/- 4.3 years) and six young men (21.2 +/- 1.9 years). Muscle fiber number was estimated by dividing the maximal area of the BB, determined with magnetic resonance imaging, by the mean fiber area of the BB determined in a muscle biopsy. The percentage of type II fibers in the BB ( approximately 60%) and the type I fiber area were not different between the groups. The BB area (-26%), type II fiber area (-24%), mean fiber area (-20%), and maximal voluntary contraction strength (MVC) of the elbow flexor muscles (-27%) were lower in the old than young group. However, the estimated number of muscle fibers was not significantly different between the young (253000) and old (234000) men. Consequently, the smaller BB area of the old men could be explained primarily by a smaller type II fiber size. These findings suggest that old age is not associated with a reduced number of muscle fibers in the BB. The relative contribution of a reduction in fiber number to age-related muscle atrophy may be muscle-dependent.

Body proportions before and during growth hormone therapy in children with chronic renal failure

Growth retardation is a common problem in children with chronic renal failure (CRF). Few published data are available on whether the normalization of height in these children during growth hormone (GH) treatment is accompanied by proportional growth of the other parts of the body. In this study, body proportions before and during GH therapy were assessed in children with severe growth retardation due to CRF. Various body segments, such as sitting height, arm span, tibia, hand and foot length, biacromial and biiliacal diameter were measured in 15 children participating in a double-blind placebo-controlled cross-over trial and in 22 children participating in a double-blind dose-response trial. Twelve children continued GH therapy after having participated in one of the two former trials and received GH therapy for 4 years. All results were adjusted for age and sex, and expressed as SD scores using reference values for healthy Dutch children. To assess body proportions, the various body segments were related to height and expressed as shape values (SV). At baseline all body segments SD scores were significantly lower than zero, indicating that the stunted growth of children with CRF included all body segments. Since height was not significantly more or less affected than the other body segments, all children had normal SV, indicating normal body proportions. The placebo-controlled study showed a significant increase of the SD scores of height and several body segments during 6 months of GH [28 IU/m(2) per week (or 1.3 mg/m(2) per day)] versus placebo. The dose-response study demonstrated that height SDS as well as all other body segments SD scores increased significantly during 2 years of GH therapy with 28 IU/m(2) per week, compared with treatment with 14 IU/m(2) per week. Also during 4 years of GH therapy with 28 IU/m(2) per week, body segment SD scores increased to the same extent as height SDS, showing that GH did not significantly change SV i.e., body proportions. Both before and during GH therapy, children on dialysis had normal body proportions, comparable with children on conservative renal treatment. In conclusion, children with severe growth retardation due to CRF maintain normal body proportions in spite of their chronic disease. GH therapy with 28 IU/m(2) per week induces and maintains catch-up growth of height and all body segments without signs of disproportionate growth. Thus GH therapy does not negatively influence body proportions in children with severe growth retardation secondary to CRF.

Exclusive breastfeeding and infant growth studies: reference standards for head circumference, length and mid-arm circumference/head circumference ratio for the first 6 months of life

This paper presents the development of reference standards for head circumference (HC), length and mid-arm circumference/head circumference (MAC/HC) ratio for the evaluation of exclusively breastfed infants. A total of 219 exclusively breastfed term appropriate-for-gestational age (AGA) infants were studied and analysed from 1 June 1995 to 31 May 1997 at the Neonatal Follow-up Clinic, University Teaching Hospital, Benin City, Nigeria. Head circumference and length measurements were recorded for the infants at each postnatal completed month. MAC/HC ratios were also computed for each infant at each completed postnatal month. There was a progressive increase in the mean measurements at the completed months with increasing postnatal age and the differences between the mean measurements of length and head circumference at the 4th and 6th completed months were significant (p < 0.001). The head circumference, length and MAC/HC ratio had significant correlations with postnatal age. The standards represent the regression lines of the anthropometric measurements and MAC/HC ratio on postnatal age with the corresponding 95 per cent confidence limits. The standards identified 95 per cent (for head circumference), 93 per cent (for length) and 94 per cent (for MAC/HC ratio) of exclusively breastfed healthy infants as having normal infant growth for age.

[Upper arm circumference reference values for children aged 1 to 36 months in Lome (Togo)]

BACKGROUND

Mid-upper-arm circumference (MUAC) is widely used as a nutritional status index for children. The aim of our study was to construct MUAC-for-age curves for well-fed 1-36-month-old children of a developing country and to compare them with the WHO reference charts based on samples of American children.

POPULATION AND METHODS

Five thousand thirty-eight boys and 4,972 girls aged 1-36 months were recruited cross-sectionally from 1994 to 1997. Their MUAC were measured as recommended by the WHO. To develop the curves, estimations were first obtained for the mean and standard deviation (SD) of MUAC for each month of age using a 7-month segmental regression equation; the Count model and 2nd degree polynomial in age were then used to describe the mean and SD respectively.

RESULTS

These curves showed important differences for age and sex and were lower than the reference curves, particularly for the older children. The mean curve was -0.44 to -0.75 SD for boys and 0 to -0.8 SD for girls, far from the WHO's reference.

CONCLUSIONS

The authors proposed to take into account the WHO's nutritional recommendations and developing country features in the construction of the reference charts.

Growth of early and late maturers

BACKGROUND

This is a study on the growth of subgroups of normal children, maturing early or late, in the variables height, leg and sitting height, arm length, biiliac and bihumeral width. While a longer growth period affects adult height only marginally, less is known about the other variables. It is also of interest to see in what way a shorter growth period is compensated by a higher velocity.

METHODS

Out of 120 boys and 112 girls followed from 4 weeks until adulthood, subgroups of 40 boys and 37 girls were formed with respect to the average timing (across variables) of the pubertal spurt as an indicator of maturity.

RESULTS

Only leg height shows a smaller adult size for early maturers. The shorter growth period is compensated by a higher prepubertal velocity and a higher level in pubertal years. The pubertal peak is a little larger for early maturing boys but not for girls.

CONCLUSIONS

There is an inherent pacemaker for growth that leads to the same adult size for a shorter growth period via a higher basic intensity. Legs are an exception since late maturers have, on average, longer legs as adults.

Euro-Growth references on increments in length, weight, and head and arm circumferences during the first 3 years of life. Euro-Growth Study Group

BACKGROUND

Reliable assessment of growth performance of infants and young children requires reference data increments. Available increment references are based on data fitted to mathematical models, a process that diminishes variation in increment values.

METHODS

Fully longitudinal data from the multicenter Euro-Growth Study (21 study sites: n = 2145 children) were used to develop sex-specific percentiles for increments in length, weight, and head and mid-upper arm circumferences for selected intervals during the first 36 months of life. Increments (per unit of time) were calculated for 2-, 3- and 6-month intervals from birth to 12 months of age and for 6-month intervals from 12 to 36 months of age. Weight increments were also calculated for 1-month intervals from birth to 6 months of age. The influence of sex, mid-parental height, and study site was determined using analysis of covariance. Comparison with other references was accomplished using percentile values.

RESULTS

Mean and standard deviation values as well as selected percentiles (P; P3, P5, P10, P25, P50, P75, P90, P95, and P97) of increments are presented. Length increments of boys were higher than those of girls until 5 months of age but tended to be lower thereafter. Weight increments of boys were higher until 9 months of age. Sex, mid-parental height, and study site explained only between 2% and 13% of the variances of increments. Mean increments were comparable but P10 and P90 substantially differed from published data.

CONCLUSIONS

The new Euro-Growth references for increments in length, weight, and head and mid-upper arm circumferences provide tools for health workers that should be useful in screening for adequacy of growth during the first 3 years of life.

An implantable upper extremity neuroprosthesis in a growing child with a C5 spinal cord injury

OBJECTIVES

To implement a functional electrical stimulation (FES) hand neuroprosthesis called the Freehand System in a growing child with spinal cord injury (SCI) using extra lead wire to accommodate limb growth, and to evaluate the performance of the Freehand System during the subject's maturation.

SETTING

Pediatric orthopedic hospital specializing in SCI rehabilitation.

SUBJECT

Ten-year-old female patient with a C5 level SCI.

METHOD

The Freehand System was implanted. Eight electrodes were implanted to targeted forearm and hand muscles to provide grasp and release function. The lead wire associated with each electrode was pathed subcutaneously up the arm with 4 cm of extra lead distributed throughout the path to accommodate expected limb growth. All leads were attached to a stimulator placed in the upper chest. Measures of lead unwinding, limb growth, stimulated muscle strength, and hand function were made at 6 and 16 months after implant.

RESULTS

By 16 months post implant, the upper limb growth plates were closed and humeral and radial bone growth combined was 2.7 cm from the time of surgery. For all eight leads, lead unwinding in the upper arm was approximately 1.2 cm and was comparable to humeral bone growth (1.4 cm). Lead unwinding in the lower arm was also measurable for the two electrodes in hand muscles. Six of eight electrodes maintained grade 3 or better stimulated muscle strength throughout the growth period according to a manual muscle test. Of the two other electrodes, one appeared to have lost function due to depletion of excess lead. However, hand function with FES was comparable at 6 and 16 months post implant suggesting that growth did not negatively impact performance with the FES system. Hand function with FES was improved over voluntary hand function as well. Using the Freehand System, a pinch force of approximately 15 N was achieved compared to 1.3 N of voluntary tenodesis pinch force. Scores on the Functional Independence Measure (FIM) increased by 9 points when FES was used as compared to voluntary function. Improvements occurred primarily in eating and grooming. Independence in writing was achieved only with FES.

CONCLUSIONS

For this child, hand function with the Freehand System was sustained over the growth period and was a significant functional improvement over voluntary hand function. By using excess lead wire, the Freehand System was successfully implemented before skeletal maturity, affording the child improved hand function earlier than would be otherwise indicated.

Replantation of large segments in children

If one looks at the final results obtained in children, one should conclude that replantation of large segments is more often indicated in children than in adult patients. Nevertheless, the more common components of crush or avulsion and the frequent severe associated lesions must restrain the surgeon's enthusiasm when indicating replantation of a large segment in children. The possible dramatic consequences of a late revascularization syndrome can be easily foreseen as an outcome of replantation of a large segment in children. Moreover, the problem of growth must be faced from the start, programming secondary surgery either for soft tissue assessment (skin retraction treatments, tendon lengthening, muscle sliding) or for bone lengthening. The final outcome being a functional arm, special care has to be taken in nerve repair integrated with possible secondary tendon transfers to compensate the functional deficit. With all these limitations in indications, care in emergency, and correct timing and planning for secondary surgery, the final functional results of macroreplantations in children will certainly be improved.

Attempted limb lengthenings beyond twenty percent of the initial bone length: results and complications

In response to historic guidelines suggesting limits to the amount of limb lengthening, we report the results and complications of those patients in whom the initial goal of lengthening exceeded 20% of the initial segment length. Thirty-one patients underwent a total of 35 attempted lengthenings with a mean follow-up of 38.6 months. Limb-length discrepancy was the primary indication in all but one case. With an average goal of 35% of the original bone length, we achieved a mean gain of 33%. Lengthening to within 2.5 cm was achieved in 31 (89%) of 35 cases, and significantly more successful with goals extending < or =55% of the initial bone length (p<0.05). Treatment times extended a mean of 8.7 months with a healing index of 37 days/cm. By Paley's classification scheme, all had problems, in addition to an average of 1.3 obstacles and 0.9 complications per segment lengthened. In 23 patients with extended follow-up, good to excellent results were achieved in 78%, and were significantly more successful with goals < or =55% (< or =0.05).

Age changes in some somatometric characters of the Assamese Muslims of Kamrup district, Assam

Growth in weight, stature, sitting height, lower extremity length, head circumference and girth of biceps, chest and calf were studied in a cross-sectional sample of Assamese Muslims in Kamrup district, Assam, India. The sample comprised 835 boys and 894 girls, aged 3-20 years. The average growth pattern for the linear body dimensions was analysed by fitting Preece Baines model I to the mean values. The other dimensions were analysed in terms of simple line charts. Average final size and age at peak velocity of the linear dimensions were derived from the fitted curves. The data for height and weight were compared with other samples of the same district, with national urban and rural growth data for India, and with the NCHS growth standards. Mean height and weight of Assamese Muslim children fluctuates between the 5th and 10th centile of the NCHS standards up to approximately 15 years in boys and 13 years in girls. Thereafter, average length and weight lags behind the American standards, ending up below the 5th centile. The differences between the growth of Assamese Muslims and other populations are discussed.

One-year treatment with recombinant human growth hormone of children with meningomyelocele and growth hormone deficiency: a comparison of supine length and arm span

Growth retardation and precocious puberty are frequently found in children with meningomyelocele (MMC). Lower limb contractions, spasticity and kyphoscoliosis may lead to disproportionate short stature. Most of these patients have structural brain defects or hydrocephalus which can cause growth hormone deficiency. In this study, 19 children aged between 3.5 and 12.8 years with MMC and growth hormone (GH) deficiency were treated with recombinant human GH for a period of 12 months. Supine length, arm span and growth velocity were compared before, and after 6 and 12 months of treatment with rhGH (daily dose 2.0 IU/m2 BSA s.c.). Mean supine length standard deviation score (SDS) increased by +0.8 SDS after 6 months and +1.2 SDS after 12 months of therapy. Mean arm span standard deviation score increased by +0.9 SDS and +1.3 SDS. Growth velocity increased in supine length from 3.3 cm/yr (-2.1 SDS) to 8.4 cm/yr (+2.4 SDS) and in arm span from 4.8 cm/yr (-1.3 SDS) to 8.6 cm/yr (+3.1 SDS) in the first 6 months and was 8.1 cm/yr (+2.4 SDS) and 8.3 cm/yr (+2.6 SDS) after 12 months of therapy. Linear correlation between SDS growth velocity supine length and SDS growth velocity arm span during one year of treatment was excellent (r = 0.65, p < 0.0025). We surmise that body proportions do not deteriorate when growth velocity is stimulated in MMC patients. Both supine length and arm span measurements are necessary to document growth in children with spinal dysraphism.

Longitudinal growth of arm circumference in Punjabi infants

OBJECTIVE

To study distance and velocity growth pattern of mid-upper-arm-circumference in Punjabi infants.

DESIGN

Longitudinal, monthly follow up.

SETTING

Growth clinic and homes of subjects.

SAMPLE

One hundred and fifty four (Male 86, Female 68) Punjabi infants weighing more than 2.5 kg at birth with gestation over 37 weeks.

METHODS

Every subject was measured for mid-upper-arm circumference between 1 to 12 months of age at one monthly intervals by the same investigator with a time tolerance of 3 days on the day of measurement.

RESULTS

Mid upper arm circumference showed rapid increase between 1 to 6 months whereafter, gain became slower during second half of infancy. It had grown by 34.9% in male and 40.2% in female infants between 1 to 12 months. Sex differences favoring male infants were statistically significant between 1 to 4 months. Monthly growth rates for arm-circumference depicted vascillatory pattern.

CONCLUSION

The values presented for arm circumference may be used as reference base to monitor growth of children during infancy.

Resting energy expenditure and body composition in children with HIV infection

The purpose of this study was to determine whether alterations in body composition, resting energy expenditure (REE), and dietary energy intake are associated with growth retardation in HIV-positive children. Body composition (deuterium oxide dilution, skinfold measurements), REE (indirect calorimetry), and energy intake (24-hour weighed food intake) were evaluated in three groups: HIV-positive with growth retardation (HIV+Gr), HIV-positive with normal growth (HIV+); and HIV-uninfected with normal growth (HIV-). Children were between 2 and 11 years of age, afebrile, and free from acute infection. Forty-two children (13 HIV+Gr, 19 HIV+, 10 HIV-) were studied. Lean body mass was significantly reduced in HIV+Gr compared with HIV- (p < .05), and fat mass was significantly reduced in HIV+Gr and HIV+ compared with HIV- (p < .05). The percentages of lean and fat mass were not significantly different between groups, suggesting that differences in lean and fat mass were proportional to differences in body size. Consistent with reduced lean body mass, mean REE was significantly lower in HIV+Gr compared with HIV- (p < .05). Differences in mean REE/kg of body weight or lean body mass between groups were not statistically significant. A significant negative correlation was found between REE (kcal/kg/day) and weight-for-age (p = .04), and a trend with height-for-age Z-score (p = .07). Mean energy intake was not significantly different between groups. This study suggests that lean and fat mass are proportionately reduced in HIV-positive children with growth retardation. Further studies are necessary to delineate the relationship between energy balance and growth in children with HIV infection.

Evaluation of increases in stature, upper extremity length and hand length in children from school age to the cessation of growth in Ogi County, Japan: a longitudinal study

Stature, upper extremity length (UEL) and hand length (HL) were measured once yearly in children (171 males and 180 females) in Ogi County, Saga, Japan, from the 1 st grade of primary school (6.5 years of age) for 12 years. Based on the age of growth cessation, the order of growth cessation of stature, UEL and HL was investigated, in addition to the relationship between this order and the measurements obtained at 6.5 years of age. With regard to the order of growth cessation of stature and UEL, growth cessation of UEL occurred earlier than that of stature in 73.68% of males and 71.67% of females, growth cessation occurred simultaneously in 23.98% of males and 25.56% of females, and growth cessation of UEL occurred later than that of stature in 2.34% of males and 2.78% of females. According, growth cessation of UEL occurred earlier than that of stature in most subjects. In males, no significant differences were observed between subjects in whom growth cessation of UEL and HL occurred simultaneously and those in whom growth cessation of UEL occurred later than that of HL. However, in females, significant differences were noted, since the latter case was observed 1.69 times more frequently than the former. Nevertheless, growth cessation of stature, UEL and HL occurred at almost the same age in both males and females when cross-sectional data was used for processing, in agreement with data reported by other researchers. We also investigated whether there was any relationship between stature and UEL at initial examination and the order of growth cessation. No significant relationship was observed. Each measured value at initial examination tended to be large in subjects in whom growth cessation of stature and UEL occurred earlier. In addition, final stature was significantly taller in both males and females in whom growth cessation of stature occurred later compared to those in whom growth cessation occurred earlier.

Linear features of Polish population in the years 1962-1992. Tendencies in changes

Cross-sectional material gathered in the years 1962-1992 in a group of 7001 men and 3852 women served as a basis for some measurements of body height (V-B), trunk length (sst-sy), lower limb length (sy-B), upper limb length (a-da), and length of the head together with the neck (V-sst). On the basis of results of mean values obtained from an annual series of examinations--altogether 31 observations were carried out--some statistical methods of analysis were applied with reference to each feature, among others the method of a simple moving average and linear regression of smoothed trend curves. The obtained results allow an evaluation of the dimorphic differences in the size of changes of particular linear features and a determination of the direction of these changes. A greater dynamism of the growth of body height and trunk length as well as tendencies of decreasing the length of lower limbs were observed in men, whereas the dynamism of changes with reference to the length of the head together with the neck was smaller than in women. The pace of changes of the analyzed linear features indicates clearly the process of deepening the differences in the proportions of body build.

A developmental transition in prehension modeled as a cusp catastrophe

The purpose of the study was to show that the change from reaching without grasping to reaching with grasping during the first 6 months of life carried the characteristics of a discontinuous phase transition (catastrophe). A cross-sectional study was carried out with 58 infants between 60 and 408 days old. The infants were seated in a specially designed seat, and presented with nine detachable balls on a black curved board within reaching distance at shoulder height. The number of reaches without and with grasping were scored from video. A cusp catastrophe model was fitted to the data. A Likelihood-Ratio test indicated that the likelihood of the cusp model was significantly higher, p < .001, than a linear regression model. The cusp model was also compared with a logistic model. Akaike's Information criterion for the cusp catastrophe exceeded the logistic model, thus indicating a general better fit. Based on prior research, the following potential control parameters were chosen: crown-heel length, total body weight, arm length, arm circumference, ponderal index, arm volume, arm weight, and body position relative to the horizontal. The cusp model predicted that arm weight and arm circumference significantly contributed to the control parameters. It was found that these two variables had their largest contribution to the asymmetry control parameters.

The development toward stereotypic arm kinematics during reaching in the first 3 years of life

We recorded reaching movements from nine infants longitudinally from the onset of reaching (5th postnatal month) up to the age of 3 years. Here we analyze hand and proximal joint trajectories and examine the emerging temporal coordination between arm segments. The present investigation seeks (a) to determine when infants acquire consistent, adult-like patterns of multijoint coordination within that 3-year period, and (b) to relate their hand trajectory formation to underlying patterns of proximal joint motion (shoulder, elbow). Our results show: First, most kinematic parameters do not assume adult-like levels before the age of 2 years. At this time, 75% of the trials reveal a single peaked velocity profile of the hand. Between the 2nd and 3rd year of life, "improvements" of hand- or joint-related movement units are only marginal. Second, infant motor systems strive to obtain velocity patterns with as few force reversals as possible (uni- or bimodal) at all three limb segments. Third, the formation of a consistent interjoint synergy between shoulder and elbow motion is not achieved within the 1st year of life. Stable patterns of temporal coordination across arm segments begin to emerge at 12-15 months of age and continue to develop up to the 3rd year. In summary, the development toward adult forms of multijoint coordination in goal-directed reaching requires more time than previously assumed. Although infants reliably grasp for objects within their workspace 3-4 months after the onset of reaching, stereotypic kinematic motor patterns are not expressed before the 2nd year of life.

Brachymetacarpia V in familial short stature

This study was planned to search for the presence of possible tubular bone abnormalities in familial short stature (FSS) as has been previously noted in some reports. Twenty-five (17 male, 8 female) children with FSS aged 10.0 SD 3.6 years were taken as the study group, and 23 (14 male, 9 female) children of normal stature aged 10.6 SD 2.7 years comprised the control group. FSS was defined as height of the child and mean parental height below 3rd centile line, normal growth velocity and bone age within 2 years of chronological age. Other causes of short stature were ruled out. Height, weight, sitting height and arm, forearm and upper arm length measurements were taken by standard methods. A left hand and wrist X-ray was taken to evaluate the length of the 5th metacarpal. Children with FSS had a significantly higher prevalence of brachymetacarpia V (64%) than the children with normal stature (21.7%) (p < 0.001). Other tubular bone parameters, however, were normal. Sitting height/height ratios were in normal ranges and comparable in FSS and the control group. Similarly arm to height and upper arm to forearm ratios were comparable in the two groups excluding disproportionate shortening of the limbs. The finding of increased incidence of brachymetacarpia V in FSS may suggest an underlying tubular bone abnormality, which may explain the short stature in FSS.

A cross-sectional growth study of trunk and limb segments of the Bengali boys of Calcutta

This report deals with cross-sectional growth of sitting height (SH), subischial length (SL, estimated as height minus sitting height), height of the anterior superior iliac spine (HIS), and total arm length (TAL) of Bengali school boys (Calcutta), aged 7.0-16.0 years. Preece-Baines model 1 (PB1) fits to the cross-sectional means of the four traits estimate the average ages at maximum increment at 12.41 years for SL, at 12.43 years for HIS, at 12.97 for TAL, and at 13.74 years for SH. Maximum increment of the upper and lower segment of the body are reached at an earlier age in the present study than in a longitudinal analysis of semi-urban Bengali boys from the suburban area of Calcutta. Socioeconomic differences and secular trend might explain this shift towards earlier maturation.

Development of fat tissue and body mass index from infancy to adulthood

This paper gives a short overview of our recent research on changes in the body mass index (BMI) or in body fat for children studied longitudinally from birth to adulthood. The BMI shows characteristic changes in childhood and adolescence which are different from those known for skeletal growth. A period of loss of BMI from 1 to 6 years is followed by a pubertal spurt which is larger in females than in males. Fat shows a dramatic increase in the 1st year, and velocity is higher for girls than for boys after 3 years of age. At puberty there is a pre-pubertal and a post-pubertal spurt in total body fat or in arm fat and a dip in between. Those heavy or fat as adults have a qualitatively similar pattern of developmental changes, but much more accentuated fluctuations. The analysis relies on new statistical techniques.

Increased limb lengths in patients with shortened spines due to tuberculosis in early childhood

STUDY DESIGN

The spine and limb lengths of 26 patients who had a severe spinal deformity due to tuberculosis in childhood were measured and compared with similar data from 79 normal adult volunteers.

OBJECTIVES

The aim of the study was to assess whether there are any compensatory growth mechanisms present in patients who had stunted spinal growth in childhood.

SUMMARY OF BACKGROUND DATA

Previous studies have documented increased leg lengths in patients with adolescent idiopathic scoliosis who have had spinal fusions done. The aim of this study was to ascertain if this response was unique to scoliosis or was a more general response to the interruption of normal spine growth.

METHODS

The standing height, spine height, leg length, and upper limb length were measured in 26 adults with stunted spinal growth due to tuberculosis of the spine contracted in early childhood, and compared with similar measurements in 79 normal volunteers.

RESULTS

The patients with spinal deformity due to tuberculosis had significantly shorter mean standing and spine heights compared to the volunteers. However, the mean leg length of these patients was 19.4 mm longer than the volunteers and their mean upper limb length was 18.9 mm longer than the volunteers. These differences were statistically significant.

CONCLUSION

Patients whose spinal growth was stunted due to disease in childhood have longer legs and upper limbs than healthy people. A compensatory stimulatory growth mechanism may be responsible for this. This has implications for the whole gamut of childhood spinal disorders that result in stunted spinal growth.

Appearance of ossification centers of the lower arm, wrist, lower leg, and ankle in immature orangutans and chimpanzees with an assessment of the relationship of ossification to dental development

This study examines the appearance of the secondary ossification centers in the lower arms, wrists, lower legs, and ankles of a cross-sectional sample of 20 infant orangutans and chimpanzees (15 of known age). The number of tarsal and carpal centers is analyzed relative to the degree of M1 development and the weight of individual animals. Variation in the appearance of these ossification centers is discussed relative to these variables and others. In addition, a sequence of appearance is established for the carpal and tarsal ossification centers in the orangutan and data is presented on the status of these centers in a fetal and newborn gorilla. Study results indicate that 1) there is variation in the number of secondary epiphyses present in animals of similar ages; 2) tarsal ossification is completed prior to carpal ossification in the orangutan; 3) there are indications of a relationship between weight and the number of ossification centers present in animals of similar age; and 4) there appears to be no evidence of specific relationships between carpal and tarsal development and M1 development.

Exponential model for weight using 'RJ index'

We screened a sample of 204 children between the age of 3 months to 5 years and 3 months were during a general health survey conducted by the Department of Community Medicine, Kasturba Medical College, Mangalore from March 1992 to December 1993 at Kumpala village under PHC Ullal about 10 kms from Mangalore City. We developed a new index RJ as RJ = Mid upper Arm Circumference x (Height)2 x 10(-4) and tested the correlation of RJ index and weight for age. We found the correlation coefficient (r = 0.8) to be very significant (P < 0.001). Thus we propose the model as Weight = A x exp (RJ x B). We found that the available data fit in this model. We hope that this study will be a new step in looking at arm circumference as a tool in estimating weight of pre-school children.

[Body proportions of Danish children. Curves for sitting height ratio, subischial length and arm span]

No previous Danish growth charts have been published for sitting height, subischial leg length, armspan or the ratio of sitting height to stature. These growth charts are useful in the evaluation of dysproportional growth retardation. Foreign standards have previously been used. However, due to population-specific differences and "the secular trend", the construction of Danish growth charts was found to be appropriate. We examined 1977 children (927 boys and 1050 girls) from the Copenhagen area, aged six to 20 years. Height, sitting height and armspan were measured. Growth charts were constructed using local linear regression and smoothing of residuals. We found sitting height values in Danish children to be comparable to English and Norwegian children. Sitting height values were lower than values of Dutch children, but higher than values of Swiss and Swedish children. The extremities of Danish children were 3-4 cm longer than the extremities of English children, but Dutch children had 2-3 cm longer armspan than the Danish boys and girls. Growth charts for sitting height, sitting height ratio, subischial leg length and armspan are presented. These charts should be useful when evaluating dysproportionality in growth retarded children and when assessing the effect of growth modulating therapy in children.

Correlations among height, leg length and arm span in growing Korean children

A cross-sectional study was performed to find out if any specific correlations exist among height, leg length and arm span in growing Korean children. Height, leg length and arm span were measured in 10,322 healthy children (4740 males and 5582 females). Computed ratios of leg length to height, leg length to arm span and arm span to height for the 3rd, 25th, 50th, 75th and 97th percentiles were made. It was found that the ratios of leg length to height, leg length to arm span, and arm span to height were bigger in taller children in the same age group than the shorter ones in both sexes. All the ratios were bigger in older children in the same percentile than the younger ones in both sexes, showing that the growth rates of leg length and arm span were bigger than that of height in general. However, growth of leg length is faster in shorter children than in taller children until the onset of puberty, after which growth of leg length in taller children is faster than in shorter children. The first and most rapid growth of leg length is seen from birth to 2 years, the second growth spurt is seen during the pubertal period. An exceptional increment in leg length between ages from 10 to 15 is also noted in taller children. After puberty, arm span grows faster than height until 17 years of age in the tallest male child, and taller children have longer arm span than height, while arm span in the shortest children never exceeds height.

Bone growth after replantation in children

Bone growth and the development of epiphyseal plates are disturbed after the replantation of amputated extremities in children, but the potential for continued skeletal growth is almost always maintained in the replanted part. In this reported series of 12 children, all younger than 15 years old, 13 amputated parts of the upper limb have been successfully replanted. After long-term follow-up (from 21 to 216 months), bone growth of the replanted parts was clinically and radiologically evaluated. Two different growing segments were distinguished: the proximal bone segment, directly injured from the initial trauma, and the distal replanted part. Average longitudinal growth recorded was 94.5 percent and 92.7 percent, respectively. Two young patients demonstrated overgrowth of the proximal bone segment, which attained 110 percent and 118 percent of expected growth. Although it is difficult to determine all the parameters affecting the prognosis of post-traumatic reactions in growing cartilaginous plates, the level of amputation is considered to be a significant prognostic factor for the epiphyseal growth of the replanted part.

Cross-sectional areas of fat and muscle in limbs during growth and middle age

Age changes in the cross-sectional areas (CSAs) of fat and muscle tissues of limbs were investigated by using a B-mode ultrasonic technique for 245 males and 275 females aged 6 to 60 years. Four measurement sites were selected in the right limbs: the forearm, upper arm, lower leg and thigh. In an age span from 13 to 15 years, fat CSA for males decreased, while that for females increased at every site. Fat CSAs for both sexes increased in their thirties, but from then there was no more increase with aging. During early childhood, females had similar growth curves in muscle CSAs to those of males. An apparent sex separation in muscle CSAs took place at 13 years of age and after, the relative gender differences in muscle CSAs became larger with growth in the upper extremity than in the lower one. For both sexes, muscle CSA in every site remained almost constant during middle age. This age change in fat and muscle CSAs of limbs during the period of growth generally resembles that reported previously for total fat and fat free mass, respectively. However, age trend in fat CSAs during middle age, a lack of increase on reaching and after the forties differs from that described by prior studies for fat mass.

Relative growth of the limbs and trunk in sifakas: heterochronic, ecological, and functional considerations

Limb, trunk, and body weight measurements were obtained for growth series of Milne-Edwards's diademed sifaka, Propithecus diadema edwardsi, and the golden-crowned sifaka, Propithecus tattersalli. Similar measures were obtained also for primarily adults of two subspecies of the western sifaka: Propithecus verreauxi coquereli, Coquerel's sifaka, and Propithecus verreauxi verreauxi, Verreaux's sifaka. Ontogenetic series for the larger-bodied P. d. edwardsi and the smaller-bodied P. tattersalli were compared to evaluate whether species-level differences in body proportions result from the differential extension of common patterns of relative growth. In bivariate plots, both subspecies of P. verreauxi were included to examine whether these taxa also lie along a growth trajectory common to all sifakas. Analyses of the data indicate that postcranial proportions for sifakas are ontogenetically scaled, much as demonstrated previously with cranial dimensions for all three species (Ravosa, 1992). As such, P. d. edwardsi apparently develops larger overall size primarily by growing at a faster rate, but not for a longer duration of time, than P. tattersalli and P. verreauxi; this is similar to results based on cranial data. A consideration of Malagasy lemur ecology suggests that regional differences in forage quality and resource availability have strongly influenced the evolutionary development of body-size variation in sifakas. On one hand, the rainforest environment of P. d. edwardsi imposes greater selective pressures for larger body size than the dry-forest environment of P. tattersalli and P. v. coquereli, or the semi-arid climate of P. v. verreauxi. On the other hand, as progressively smaller-bodied adult sifakas are located in the east, west, and northwest, this apparently supports suggestions that adult body size is set by dry-season constraints on food quality and distribution (i.e., smaller taxa are located in more seasonal habitats such as the west and northeast). Moreover, the fact that body-size differentiation occurs primarily via differences in growth rate is also due apparently to differences in resource seasonality (and juvenile mortality risk in turn) between the eastern rainforest and the more temperate northeast and west. Most scaling coefficients for both arm and leg growth range from slight negative allometry to slight positive allometry. Given the low intermembral index for sifakas, which is also an adaptation for propulsive hindlimb-dominated jumping, this suggests that differences in adult limb proportions are largely set prenatally rather than being achieved via higher rates of postnatal hindlimb growth.(ABSTRACT TRUNCATED AT 400 WORDS)

Straight-line graphs for the prediction of growth of the upper extremities

A simple graphic method was used for the prediction of growth and the determination of when a corrective procedure should be performed to equalize the lengths of the upper extremities. Straight-line graphs, similar to those described by Moseley for the lower extremities, were constructed for the radius, ulna, and humerus. The data for the current study were derived from a multidisciplinary, longitudinal study of growth in 244 healthy children (123 boys and 121 girls)--from infancy to skeletal maturity--and from previously constructed graphs depicting remaining growth. The use of this method can simplify the planning of an equalization procedure for an upper extremity.

The relationship between electrophysiological findings, upper limb growth and histological features of median and ulnar nerves in man

In 19 median and 10 ulnar nerves of 28 healthy young volunteers, the maximum orthodromic sensory conduction velocity was studied along one or two fingers (the third and/or the fifth), the palm, and the forearm. In five 20 to 32-yr-old males and in a newborn male, post-mortem samples of either the median or the ulnar nerve were obtained from the finger (either the third or the fifth), the palm, the wrist and the forearm in order to study the size distribution of external fibre and axon diameters, and the fibre internodal length. In 2374 infants, children and adolescents, the height, length of both the third and the fifth finger, length of the palm, and length of the forearm were measured. The results showed (i) a significantly slower conduction velocity along the fingers; (ii) a significantly shorter internodal length without remarkable fibre diameter changes in the same nerve segments; (iii) a significantly smaller elongation of these body parts; (iv) a significant correlation between these data. In conclusion, internodal length seems to play an important role in governing conduction velocity of myelinated peripheral nerve fibres.

The effects of resistance training on muscle area and strength in prepubescent age

The purpose of this study was to determine the effect of strength training in prepubescent boys and girls on muscle strength and cross-sectional area of upper arm. Subjects were ninety-nine healthy elementary school children who belonged to 1st, 3rd and 5th grades and they were assigned to two groups of training (N = 52) and control (N = 47). Training group participated in strength training program for 12 weeks which consisted of maximum sustained isometric contraction of elbow flexion for ten sec, whereas control group did not participate in special training program in this period. In orger to determine the changes due to training, cross-sectional areas of the tissues in upper arm, such as muscle, fat and bone, were measured by the ultrasonic method. Maximum isometric and isokinetic muscle strength of elbow flexion and extension were measured by means of isokinetic cybex dynamometer. In order to assess the development of physiological maturity, TW2 method was used to estimate the skeletal age in each subject by taking the hand-wrist X-ray photograph. After 12-week training period, the whole cross-sectional areas increased in both training and control groups. This increment was due to significant increases in muscle and bone area in the training group and, on the other hand, due to the increase in fat area in the control. The increment of muscle area of training group was about 50% of that derived from the study on adults (Fukunaga, T., 1978). The increment in cross-sectional area of muscle with training was significantly correlated with the skeletal age.(ABSTRACT TRUNCATED AT 250 WORDS)

Comparative evaluation of calf, thigh and arm circumferences in detecting low birth weight infants--Part II

In an earlier study usefulness and validity of calf circumference in the identification of low birth weight (LBW) infants was reported. To evolve a simple indicator in identifying LBW in community, comparative evaluation of three simple measurements, i.e., circumferences of calf (CC), thigh (TC) and arm (AC) was done with respect to their sensitivity and specificity. Though all the three measurements showed a high degree of correlation with the birth weight, calf circumference tended to be most sensitive in identifying almost 95% of LBW infants. Having established the superiority of CC, a two color tape demarcating LBW zone from normal birth weight using 10 cm CC as cut off point was tested by two independent investigators and two ANMs. It was observed that only 5% of cases were misclassified either as LBW or normal weight by the tape with hardly any inter individual variation. Measurement of calf circumference being simple and easy even in the hands of paramedics, it would be used as indicator of LBW and neonatal mortality in the community.

Usefulness of calf circumference as a measure for screening low birth weight infants

Usefulness of calf circumference (CC) for screening low birth weight (LBW) was assessed in comparison with other anthropometric measurements, crown heel and crown rump lengths (CHL, CRL), Chest (Ch C), head (HC) and arm (AC) circumferences in 256 infants within 24 hours of birth. Calf circumference showed highest degree of correlation (r = 0.83) with birth weight followed by arm and chest circumference and crown heel length. Step down multiple linear regression analysis of birth weight showed highest R2 value with combination of calf, arm and crown heel length (82.1%). Addition of other measurements did not improve the predictive value of the model. Sensitivity of these parameters in screening LBW infants (less than 2500 g) showed 95.7% critical limit for calf followed by 82.6% with arm circumference and 72.5% with crown heel length. False positive responses were similar (18-20%) with all the three parameters. Calf circumference being highly sensitive and easy to measure, is useful in screening most of the low birth weight infants in the communities where weighing scales are not available or cannot be used by peripheral workers.

Disproportionate body growth in girls with adolescent idiopathic scoliosis. A longitudinal study

Two thousand, one hundred and eighty-nine southern Chinese women, aged 8-21 years, were studied: 541 with adolescent idiopathic scoliosis (176 treated with posterior spinal fusion and Harrington instrumentation, 150 with brace, and 215 who did not require any treatment), and 1,648 age-matched normal controls from schools and colleges. Scoliotic girls treated at Duchess of Kent Children's Hospital were examined clinically, radiologically, and anthropometrically, including a roentgenogram of the left hand for bone age, at yearly intervals from their first visit to hospital until maturity. Leg:spine and leg:arm ratios were calculated to study the proportionate body growth. The data obtained at first visit and at maturity for each treatment group were compared within treatment groups, and also with normal controls (all age-matched comparisons). The results are summarized as follows: The comparison of leg:spine ratio between fusion, brace, and untreated groups at first visit using uncorrected spinal length showed inconsistent results, but when these ratios were calculated using spinal length corrected for scoliosis, the results were all consistent, showing no significant difference between these groups at first visit. At maturity, leg:spine ratios, using either uncorrected spinal length or corrected spinal length, were highly significantly greater for the fusion group compared to the brace and untreated groups. The leg:spine ratio comparisons of scoliosis groups against normals showed that brace and fusion groups had highly significantly greater ratios at first visit and at maturity, using uncorrected spinal length. Similar comparison using corrected spinal length showed minimum or no difference at first visit, but at maturity, only the fusion group had a significantly greater ratio than normals.(ABSTRACT TRUNCATED AT 250 WORDS)