Aromatase inhibitors have been widely used to improve height in the world and China. However, due to their off-label use and relatively short application time, there is a lack of consistent understanding and expert consensus on the indications, efficacy, and side effects of the drugs at home and abroad. Therefore, the Growth and Development and Gonadal Diseases Committee of Chinese Aging Well Association and the Adolescent Medicine and Health Professional Committee of the Chinese Medical Doctor Association organized 28 domestic experts in growth and development, based on the clinical evidence level classification and recommendation level of the Oxford University Evidence-Based Medicine Center to establish some preliminary recommendations on the efficacy, adverse reactions, precautions, dosage, and course of use of aromatase inhibitors in treating children with short stature and improving their year-end height. Combined with the Delphi method evaluation, 14 recommendations were finally formulated to standardized the clinical application of aromatase inhibitors in improving adolescent height.
芳香化酶抑制剂在全球和中国都广泛应用于改善身高，但因属于超适应证用药，且应用时间相对较短，故国内外对用药的适应证、疗效、不良反应缺乏一致的认识和专家共识。因此中国老年保健协会生长发育和性腺疾病分会和中国医师协会青春期医学与健康专业委员会组织国内28位生长发育方面专家，以牛津大学循证医学中心临床证据水平分级和推荐级别为参照，围绕芳香化酶抑制剂治疗儿童矮身材、改善成年终身高的疗效、不良反应、注意事项、使用剂量和用药疗程等问题，筛选出初步推荐意见。再结合德尔菲法评价意见最终确定14条推荐意见，以规范芳香化酶抑制剂改善青少年身高的临床应用。.

UNASSIGNED: The overarching aim of this study was to evaluate the Norwegian guidelines for growth monitoring using routinely collected data from healthy children up to five years of age. We analysed criteria for both status (size for age) and change (centile crossing) in growth.
UNASSIGNED: Longitudinal data were obtained from the electronic health record (EHR) at the well-baby clinic for 2130 children included in the Bergen growth study 1 (BGS1). Measurements of length, weight, weight-for-length, body mass index (BMI) and head circumference were converted to z-scores and compared with the World Health Organization (WHO) growth standards and the national growth reference.
UNASSIGNED: Using the WHO growth standard, the proportion of children above +2SD was generally higher than the expected 2.3% for all traits at birth and for length at all ages. Crossing percentile channels was common during the first two years of life, particularly for length/height. By the age of five years, 37.9% of the children had been identified for follow-up regarding length/height, 33% for head circumference and 13.6% for high weight-for-length/BMI.
UNASSIGNED: The proportion of children beyond the normal limits of the charts is higher than expected, and a surprisingly large number of children were identified for rules concerning length or growth in head circumference. This suggests the need for a revision of the current guidelines for growth monitoring in Norway.

Surgical site infection is a serious complication in orthopedic surgery. The use of antibiotic prophylaxis (AP) combined with other prevention strategies has been shown to reduce this risk to 1% for hip arthroplasty and 2% for knee arthroplasty. The French Society of Anesthesia and Intensive Care Medicine (SFAR) recommends doubling the dose when the patient\'s weight is greater than or equal to 100 kg, and the body mass index (BMI) is greater than or equal to 35 kg/m2. Similarly, patients with a BMIgreater than40 kg/m2 orlesser than18 kg/m2 are ineligible for surgery in our hospital. Self-reported anthropometric measurements are commonly used in clinical practice to calculate BMI, but their validity has not been assessed in the orthopedic literature. Therefore, we conducted a study comparing self-reported with systematically measured values and observed the impact these differences may have on perioperative AP regimens and contra-indications to surgery.
The hypothesis of our study was that self-reported anthropometric values differed from those measured during preoperative orthopedic consultations.
This single-center retrospective study with prospective data collection was conducted between October and November 2018. The patient-reported anthropometric data were first collected and then directly measured by an orthopedic nurse. Weight was measured with a precision of 500 g and height was measured with a precision of 1 cm.
A total of 370 patients (259 women and 111 men) with a median age of 67 years (17-90) were enrolled. The data analysis found significant differences between the self-reported and measured height [166 cm (147-191) vs. 164 cm (141-191) (p<0.0001)], weight [72.9 kg (38-149) vs. 73.1 kg (36-140) (p<0.0005)] and BMI [26.3 (16.2-46.4) vs. 27 (16-48.2) (p<0.0001)]. Of these patients, 119 (32%) reported an accurate height, 137 (37%) an accurate weight, and 54 (15%) an accurate BMI. None of the patients had two accurate measurements. The maximum underestimation was 18 kg for weight, 9 cm for height, and 6.15 kg/m2 for BMI. The maximum overestimation was 28 kg for weight, 10 cm for height, and 7.2 kg/m2 for BMI. The verification of the anthropometric measurements identified another 17 patients who had contra-indications to surgery (12 with a BMI>40 kg/m2 and 5 with a BMI<18 kg/m2) and who would not have been detected based on the self-reported values.
Although patients underestimated their weight and overestimated their height in our study, these had no impact on the perioperative AP regimens. However, this misreporting failed to detect potential contraindications to surgery.
IV; retrospective study with prospective data collection and no control group.

This International Consensus Guideline was developed by experts in the field of small for gestational age (SGA) of 10 pediatric endocrine societies worldwide. A consensus meeting was held and 1300 articles formed the basis for discussions. All experts voted about the strengths of the recommendations. The guideline gives new and clinically relevant insights into the etiology of short stature after SGA birth, including novel knowledge about (epi)genetic causes. Further, it presents long-term consequences of SGA birth and also reviews new treatment options, including treatment with gonadotropin-releasing hormone agonist (GnRHa) in addition to growth hormone (GH) treatment, as well as the metabolic and cardiovascular health of young adults born SGA after cessation of childhood GH treatment in comparison with appropriate control groups. To diagnose SGA, accurate anthropometry and use of national growth charts are recommended. Follow-up in early life is warranted and neurodevelopment evaluation in those at risk. Excessive postnatal weight gain should be avoided, as this is associated with an unfavorable cardiometabolic health profile in adulthood. Children born SGA with persistent short stature < -2.5 SDS at age 2 years or < -2 SDS at 3 to 4 years of age, should be referred for diagnostic workup. In case of dysmorphic features, major malformations, microcephaly, developmental delay, intellectual disability, and/or signs of skeletal dysplasia, genetic testing should be considered. Treatment with 0.033 to 0.067 mg GH/kg/day is recommended in case of persistent short stature at age of 3 to 4 years. Adding GnRHa treatment could be considered when short adult height is expected at pubertal onset. All young adults born SGA require counseling to adopt a healthy lifestyle.

The National Institute for Clinical Excellence (NICE) has just released its latest guidelines to assess and predict health risk, such as type 2 diabetes, hypertension or cardiovascular disease. Their latest advice is \"Keep the size of your waist to less than half of your height\". We believe this advice is flawed and will seriously and unfairly penalize shorter people and lull taller people into a false sense of security. In this short communication, we provide this evidence. We consider this a serious oversight by NICE and feel strongly that this evidence needs to be made available in the public domain.

To develop a guideline for preventive child healthcare professionals in order to improve early detection of pathological disorders associated with short stature (or growth faltering) or tall stature (or accelerated growth).
We updated the previous Dutch guideline for short stature in children aged 0-9 years and extended it to adolescents (10-17 years), and added a guideline for tall stature, based on literature and input from an expert committee. Specificities were calculated in a cohort of healthy Dutch children aged 0-9 years (n = 970). We investigated the impact of a late onset of puberty on height standard deviation score based on the Dutch growth charts.
Growth parameters of the guideline include height, the distance between height and target height and change of height over time. Other parameters include diagnostic clues from medical history and physical examination, for example behavioural problems, precocious or delayed puberty, body disproportion and dysmorphic features.
Preventive child healthcare professionals now have an updated guideline for referring short or tall children to specialist care. Further research is needed on the diagnostic yield after referral and specificity at field level.

BACKGROUND: The diagnostic criteria for hypertension have recently been redefined by the American College of Cardiology/ American Heart Association (ACC/AHA). Data on the new prevalence of hypertension in different countries are emerging, but none, to date, from Saudi Arabia.
OBJECTIVE: This study aimed to determine the impact of the 2017 ACC/AHA hypertension guideline on the prevalence and determinants of hypertension in young Saudi women.
METHODS: 518 female college students, 17-29 years of age were prospectively enrolled in a survey during the period from January 1, 2016, to April 15, 2016 at Princess Nourah University. The participants completed a previously validated questionnaire, that assessed their risk factors for hypertension, and their blood pressure, weight and height were measured.
RESULTS: Application of the 2017 ACC/AHA diagnostic criteria resulted in approximately 7-fold increase in the prevalence of hypertension, from 4.1% to 27.1% (P < 0.001). At a cut-off value of ≥140/90, hypertension was significantly associated with increased age, increased body mass index (BMI), increased heart rate, history of chronic illnesses, prior diagnosis with diabetes mellitus and family history of hypertension. Whereas, with the ≥130/80 cut-off value, only increased BMI and heart rate were significant predictors (P < 0.001).
CONCLUSIONS: The prevalence of hypertension markedly increased among young adult Saudi women with the 2017 ACC/AHA classification for hypertension, and the main predictors were increased BMI and heart rate. Further studies on the new prevalence and predictors of hypertension in the Saudi population are warranted. This information is important for healthcare authorities to plan cost effective screening, prevention and control programmes.
الأثر الناجم عن المبدأ التوجيهي المعني بارتفاع ضغط الدم الصادر عام 2017 عن الكلية الأمريكية لأمراض القلب/الجمعية الأمريكية للقلب على معدل انتشار ارتفاع ضغط الدم في صفوف الشابات السعوديات.
مها المحيسن، قماشة العبيد، وفاء الغامدي، حنين العلياني، شيماء دهمان، نورا الوهابي، نورا العوجي، تيري لي.
UNASSIGNED: قامت الكلية الأمريكية لأمراض القلب/الجمعية الأمريكية للقلب مؤخرا بإعادة تعريف معايير تشخيص ارتفاع ضغط الدم. وأخذت البيانات تظهر حول معدلات الانتشار الجديدة لارتفاع ضغط الدم في بُلدان متفرقة، غير أنها لم تتضمن حتى الآن بيانات من المملكة العربية السعودية.
UNASSIGNED: هدفت هذه الدراسة إلى تحديد الأثر الناجم عن المبدأ التوجيهي المعني بارتفاع ضغط الدم الصادر عام 2017 عن الكلية الأمريكية لأمراض القلب/الجمعية الأمريكية للقلب على معدل انتشار ومحددات ارتفاع ضغط الدم في صفوف الشابات السعوديات.
UNASSIGNED: استبق الدراسة تسجيل 518 طالبة جامعية تتراوح أعمارهن بين 17 و 29 سنة في مسح أُجري في الفترة من 1 يناير/كانون الثاني 2016 وحتى 15 أبريل/نيسان 2016 في جامعة الأميرة نورة بنت عبد الرحمن. واستكملت المشاركات استبيانا مجاز مسبقا هدف إلى تحديد عوامل خطر إصابتهن بارتفاع ضغط الدم، وقياس ضغط الدم لديهن، وكذلك قياس أوزانهن وأطوالهن.
UNASSIGNED: أسفر استخدام معايير تشخيص الكلية الأمريكية لأمراض القلب/الجمعية الأمريكية للقلب عن وجود زيادة في معدل انتشار ارتفاع ضغط الدم بمقدار 7 أضعاف تقريبا، إذ ارتفعت النسبة من %4.1 إلى %27.1 (0.001 > P). وعند وصول القيمة الحدية إلى 140/90 أو أعلى، بدا الارتباط واضحا بين ارتفاع ضغط الدم وتقدُّم العمر، وزيادة منسب كتلة الجسم، وزيادة سرعة القلب، وتاريخ الإصابة بأمراض مزمنة، والتشخيص المسبق بالسكريّ، وتاريخ الإصابة بارتفاع ضغط الدم في الأسرة. وعندما بلغت القيمة الحدية 130/80 أو أعلى، كانت زيادة منسب كتلة الجسم وزيادة سرعة القلب العاملين المُنبئيْ الوحيديْن المرتبطيْ بارتفاع ضغط الدم (0.001 > P).
UNASSIGNED: زاد معدل انتشار ارتفاع ضغط الدم بصورة ملحوظة في صفوف الشابات السعوديات البالغات وفق تصنيف الكلية الأمريكية لأمراض القلب/الجمعية الأمريكية للقلب الصادر عام 2017 بشأن ارتفاع ضغط الدم، وتمثلت العوامل الرئيسية المنبِئة في زيادة منسب كتلة الجسم وزيادة سرعة القلب. ويوصى بإجراء مزيد من الدراسات حول معدلات الانتشار الجديدة والعوامل المنبِئة بارتفاع ضغط الدم في صفوف السكان السعوديين. وتنطوي تلك المعلومات على أهمية بالنسبة للسلطات الصحية من أجل التخطيط الفعّال من حيث التكلفة لبرامج التحري، والوقاية، والمكافحة.
Impact des lignes directrices 2017 sur l’hypertension de l’American College of Cardiology/American Heart Association sur la prévalence de l’hypertension chez les jeunes femmes saoudiennes.
BACKGROUND: Les critères de diagnostic de l’hypertension ont récemment été redéfinis par l’American College of Cardiology/American Heart Association (ACC/AHA). Des données sur la nouvelle prévalence de l’hypertension dans différents pays commence à voir le jour, mais il n’y a, pour l’heure, aucune donnée pour l’Arabie saoudite.
OBJECTIVE: La présente étude avait pour objectif de déterminer l’impact des lignes directrices 2017 sur l’hypertension de l’ACC/AHA sur la prévalence et les déterminants de l’hypertension chez les jeunes femmes saoudiennes.
UNASSIGNED: 518 étudiantes de l’Université Princesse Nourah, âgées de 17 à 29 ans ont été recrutées de manière prospective pour participer à une enquête entre le 1er janvier et le 15 avril 2016. Les participantes ont rempli un questionnaire préalablement validé, qui évaluait les facteurs de risque de l’hypertension et indiquait leur tension artérielle, leur poids et leur taille.
UNASSIGNED: L’application des critères de diagnostic définis par les lignes directrices 2017 sur l’hypertension de l’ACC/AHA s’est traduite par une multiplication approximative par 7 de la prévalence de l’hypertension, qui est passée de 4,1 % à 27,1 % (p < 0,001). À une valeur seuil supérieure ou égale à 140/90, l’hypertension était significativement associée à l’âge, à un indice de masse corporelle (IMC) plus élevé, à une fréquence cardiaque accrue, à des antécédents de maladies chroniques, à un diagnostic antérieur de diabète sucré et à des antécédents familiaux d’hypertension. En revanche, avec une valeur seuil supérieure ou égale à 130/80, seule l’augmentation de l’IMC et de la fréquence cardiaque constituait des facteurs prédictifs significatifs (p < 0,001).
CONCLUSIONS: La prévalence de l’hypertension a nettement augmenté chez les jeunes femmes adultes saoudiennes suite à l’application des lignes directrices 2017 de l’ACC/AHA sur l’hypertension. Les principaux facteurs prédictifs étaient l’augmentation de l’IMC et de la fréquence cardiaque. Des études supplémentaires sur les nouvelles données concernant la prévalence et les facteurs prédictifs de l’hypertension dans la population saoudienne sont nécessaires. Ces informations sont importantes pour les autorités sanitaires afin de prévoir la mise en place de programmes de dépistage, de prévention de l’hypertension et de lutte contre cette affection ayant un bon rapport coût-efficacité.

Children are defined as hypertensive when their blood pressure values equal or exceed the 95th percentile of the blood pressure value distribution in a pediatric population, according to gender, age and height. The population on which reference tables are based is of fundamental importance to establish the threshold values for the diagnosis of hypertension in pediatric age. Before 2017, both American and European guidelines used nomograms created in the same reference population which included children of all weight classes. Given the close and well-known association between hypertension and excess weight in childhood, the 2017 American guidelines proposed new reference nomograms excluding subjects with overweight and obesity from the \"historical\" reference population. Furthermore, the new American guidelines suggested a fixed cut-off of 130/80 mmHg, starting from 13 years and regardless of gender and height, to make the diagnosis of hypertension. In this document, the Italian Hypertension Society (SIIA) and the Italian Pediatric Society (SIP) jointly discuss a number of issues raised by the new American guidelines that involve the entire medical community, and also address the definition of arterial hypertension in the transition phase between childhood and adulthood.

Data are lacking to provide cutoffs for hypotension in children based on outcome studies and Pediatric Advanced Life Support (PALS), and Advanced Trauma Life Support (ATLS) definitions are based on normal populations. The goal of this study was to compare different normal population based cutoffs including fifth percentile of systolic blood pressure (P5-SBP) in children and adolescents from the German Health Examination Survey for Children and Adolescents (KiGGS), US population data (Fourth Report), and cutoffs from PALS and ATLS guidelines.
Fifth percentile of systolic blood pressure according to age, sex, and height was modeled based on standardized resting oscillometric BP measurements (12,199 children aged 3-17 years) from KiGGS 2003-2006. In addition, we applied the age-adjusted pediatric shock index in the KiGGS study.
The KiGGS P5-SBP was on average 7 mm Hg higher than Fourth Report P5-SBP (5-10 mm Hg depending on age-sex group). For children aged 3 to 9 years, KIGGS P5-SBP at median height follows the formula 82 mm Hg + age; for age 10 to 17 years, the increase was not linear and is presented in a simplified table. Pediatric Advanced Life Support/ATLS thresholds were between KiGGS and Fourth Report until age of 11 years. The adult threshold of 90 mm Hg was reached by KiGGS P5-SBP median height at 8 years, PALS/ATLS at age of 10 years, and Fourth Report P5-SBP at 12 years. The pediatric shock index, which is supposed to identify severely injured children, was exceeded by 2.3% nonacutely ill KiGGS participants.
Our study shows that percentile cutoffs vary by reference population. The 90 mm Hg cutoff for adolescents targets only those in the less than 1% of the low SBP range and represents an undertriage compared with P5 at younger ages according to both KiGGS and Fourth Report. Finally, current pediatric shock index cutoffs when applied to a healthy cohort lead to a relevant percentage of false positives.
Epidemiologic/prognostic, level III.

The goal is to establish dialogue and determine the needs and skill levels of adolescence. This concerns sexuality, the prevention of STIs, the informed choice of contraception to avoid an unplanned pregnancy. MéTHODES: A systematic review based on literature about contraception AND teenagers was performed using Pubmed, Cochrane, national and international recommendations.
The surveillance of the teenager contraception must integrate more specifically: global health with a stability of weight and corpulence, a sufficient calcium intake, the prevention of the sexually transmitted infections (STIs) and the vaccination against HPV. The 1st consultations with adolescent girls are an essential moment for dialogue in order to develop sexuality education. Main themes are: prevention of STIs with the use of condoms, detection of situations of precariousness or sexual abuse, and finally adherence to treatment to avoid unplanned pregnancy. Use of condoms associated with regular contraception is essential to assure a barrier against sexually transmitted infections (STIs) (NP1). To preserve the patient confidentiality, the patient is received alone (Grade B). She must be reassured about respect of anonymity and availability of free treatment. Clinical examination collects weight, height, BMI and blood pressure (Grade C). It is important to give them the choice of contraceptive method and provide objective information on the different contraceptive methods (NP2). If there are any contraindications, when the first prescription is a pill, it must be a 1st or 2nd generation pill with levonorgestrel. For some experts, it would be important to prescribe a pill at 30μg EE for better efficacy in case of forgetfulness in very young patients and for the good maintenance of bone mineralization (NP4). Information on long-acting reversible contraceptives, or LARCs, is essential. These contraceptive methods have proved their efficacy and their place in the first intention. (NP1).
Prescribing contraception to a teenage girl requires the adaptation of the best treatment to her needs to prevent an unwanted pregnancy. This requires good information on prevention of STIs and on different methods of contraception in a confidence climate.