INTRODUCTIONDual energy X-ray absorptiometry (DEXA) is currently the gold standard for the assessment of bone mineral density. Quantitative ultrasound (QUS), on the other hand, is a radiation-free alternative for the assessment of bone strength in the paediatric population. Establishing normative data for bone strength specific to the population would allow identification of children at risk of osteoporosis as a consequence of disease and its treatment. This cross-sectional study aims to establish the normal reference range for calcaneal broadband ultrasound attenuation (BUA) measurements in normal Singaporean children aged 6 to 12 years.

MATERIALS AND METHODSHealthy Singaporean children were randomly selected from 11 primary schools for the assessment of calcaneal BUA, using the paediatric Contact Ultrasonic Bone Analyzer (CUBA, McCue Plc, Compton, Winchester, England). The height, weight, body mass index and BUA measurements for each age group and gender were expressed as the mean ± SD. One-way ANOVA was used to compare the mean calcaneal BUA by age and gender of Singaporean children with that of children from the United Kingdom, Turkey and Taiwan.

RESULTSA total of 750 healthy Singaporean children (417 males and 333 females) aged 6 to 12 years from 11 primary schools were enrolled. The calcaneal BUA values of Turkish and white British children were not statistically different from this Singaporean cohort. However, the Singaporean calcaneal BUA measurements were significantly higher compared to the Taiwanese children.

CONCLUSIONThis study provides the first normal reference data to evaluate bone strength in Singaporean children using the paediatric Contact Ultrasonic Bone Analyzer.

Absorptiometry, Photon ; Age Factors ; Analysis of Variance ; Body Mass Index ; Bone Density ; Bone and Bones ; diagnostic imaging ; Child ; Child Welfare ; Cross-Sectional Studies ; Female ; Humans ; Male ; Reference Values ; Risk Assessment ; methods ; Schools ; Sex Factors ; Singapore ; Taiwan ; Turkey ; Ultrasonography ; United Kingdom

Humans ; Infant ; Infant, Newborn ; Male ; Mutation ; Thyroid Hormone Receptors beta ; genetics ; Thyroid Hormone Resistance Syndrome ; genetics

Biological Products ; Compliance ; Ice ; Incubators ; Methods ; Polyethylene ; Polypropylenes ; Polystyrenes ; Product Packaging ; Refrigeration ; Transportation ; Vaccines

INTRODUCTION: Fluorescence imaging (FI) with indocyanine green (ICG) is increasingly implemented as an intraoperative navigation tool in hepatobiliary surgery to identify hepatic tumours. This is useful in minimally invasive hepatectomy, where gross inspection and palpation are limited. This study aimed to evaluate the feasibility, safety and optimal timing of using ICG for tumour localisation in patients undergoing hepatic resection. METHODS: From 2015 to 2018, a prospective multicentre study was conducted to evaluate feasibility and safety of ICG in tumour localisation following preoperative administration of ICG either on Day 0-3 or Day 4-7. RESULTS: Among 32 patients, a total of 46 lesions were resected: 23 were hepatocellular carcinomas (HCCs), 12 were colorectal liver metastases (CRLM) and 11 were benign lesions. ICG FI identified 38 (82.6%) lesions prior to resection. The majority of HCCs were homogeneous fluorescing lesions (56.6%), while CLRM were homogeneous (41.7%) or rim-enhancing (33.3%). The majority (75.0%) of the lesions not detected by ICG FI were in cirrhotic livers. Most (84.1%) of ICG-positive lesions detected were < 1 cm deep, and half of the lesions ≥ 1 cm in depth were not detected. In cirrhotic patients with malignant lesions, those given ICG on preoperative Day 0-3 and Day 4-7 had detection rates of 66.7% and 91.7%, respectively. There were no adverse events. CONCLUSION ICG FI is a safe and feasible method to assist tumour localisation in liver surgery. Different tumours appear to display characteristic fluorescent patterns. There may be no disadvantage of administering ICG closer to the operative date if it is more convenient, except in patients with liver cirrhosis.