Predicting chronological age based on age-related osteophyte development in the superior and inferior vertebral centrum margins of T12-L5.

The purpose of this study was to determine the relationship between vertebral margins at individual vertebral levels between T12-L5 vertebra and chronological age and develop predictive models. Three hundred and nineteen CT scans from a medical imaging database in North America were randomly selected. Three superior and inferior vertebral margin sites were scored based on observable age-related changes. All individual vertebral margin site scores significantly correlated with age at death with Pearson r values ranging from 0.47 to 0.77. Totaling the individual vertebral margin site scores for L1-L5 improved Pearson r to 0.92. All resulting predictive models were significant, and the best models predicted age at death within 10 years 70%-76% of the time for males, females, and combined male and females. In conclusion, this study produced accurate and reliable models to predict age at death using age-related changes in the spine for a North American population.

Design and Validation of a 3D Printed Cranio-Facial Simulator: A Novel Tool for Surgical Education.

OBJECTIVE: To assess the ability of current 3D printing technology to generate a craniofacial bony and soft tissue anatomical model for use in simulating the performance of a fronto-orbital advancement (FOA) osteotomy and then to further assess the value of the model as an educational tool. DESIGN: Anatomic models were designed with a process of serial anatomic segmentation/design, 3D printing, dissection, and device refinement. A validation study was conducted with 5 junior and 5 senior plastic surgery residents. The validation study incorporated a multiple-choice Knowledge Assessment test (KA), an Objective Structured Assessment of Technical skills (OSATs), a Global Rating Scale (GRS) and a Michigan Standard Simulation Experience Scale (MiSSES). We compared the scores of both the junior and senior residents and compared junior resident scores, before and after viewing a lecture/demonstration. RESULTS: MiSSES showed high face validity with a score of 85.1/90, signifying high satisfaction with the simulator learning experience. Simulation and the lecture/demonstration improved the junior resident average KA score from 5.6/10 to 9.6/10 (P = .02), OSATs score from 32.4/66 to 64.4/66 (P < .001) and GRS score from 13.9/35 to 27.5/35 (P < .001). The senior residents OSATs score of 56.3/66 was higher than the pre-lecture juniors (32.4/66) (P < .001), but lower than the post-lecture juniors (64.4/66) (P < .001). CONCLUSION: We have successfully fabricated a 3D printed craniofacial simulator capable of being used as an educational tool alongside traditional surgical training. Next steps would be improving soft tissue realism, inclusion of patient and disease specific anatomy and creation of models for other surgical specialties.

3-Dimensional Printed Alternative to the Standard Synthetic Flocked Nasopharyngeal Swabs Used for Coronavirus Disease 2019 Testing.

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes coronavirus disease 2019 (COVID-19), can be detected in respiratory samples by real-time reverse transcriptase polymerase chain reaction (RT-PCR) or other molecular methods. Accessibility of diagnostic testing for COVID-19 has been limited by intermittent shortages of supplies required for testing, including flocked nasopharyngeal (FLNP) swabs. METHODS: We developed a 3-dimensional printed nasopharyngeal (3DP) swab as a replacement of the FLNP swab. The performance of 3DP and FLNP swabs were compared in a clinical trial of symptomatic patients at 3 clinical sites (n = 291) using 3 SARS-CoV-2 emergency use authorization tests: a modified version of the Centers for Disease Control and Prevention (CDC) RT-PCR Diagnostic Panel and 2 commercial automated formats, Roche Cobas and NeuMoDx. RESULTS: The cycle threshold-C(t)-values from the gene targets and the RNase P gene control in the CDC assay showed no significant differences between swabs for both gene targets (P = .152 and P = .092), with the RNase P target performing significantly better in the 3DP swabs (P < .001). The C(t) values showed no significant differences between swabs for both viral gene targets in the Roche cobas assay (P = .05 and P = .05) as well as the NeuMoDx assay (P = .401 and P = .484). The overall clinical correlation of COVID-19 diagnosis between all methods was 95.88% (Kappa 0.901). CONCLUSIONS: The 3DP swabs were equivalent to standard FLNP in 3 testing platforms for SARS-CoV-2. Given the need for widespread testing, 3DP swabs printed onsite are an alternate to FLNP that can rapidly scale in response to acute needs when supply chain disruptions affect availability of collection kits.

Radiographic Comparison of Superior and Inferior Gluteal Vessels in Jackknife versus Prone Position: A Prospective, Self-Controlled Trial.

Mortality after gluteal augmentation with fat transfer techniques is extremely high. Placement of fat subcutaneously versus in the gluteal musculature, or both, is considerably debated. The purpose of this study was to radiographically show the anatomical difference in live subjects in different procedural positions: the flexed or "jackknife" versus prone position. A total of 10 women underwent computed tomographic scanning of the pelvis with venous phase run-off in both the jackknife and prone positions. A computed tomography-specialized radiologist then reviewed images and measured distances from the inferior and superior gluteal veins to the skin and muscle. Three-dimensional imaging and analysis were also performed. Measurements were significantly shorter with respect to distance from skin to muscle, skin to vessel, and vessel to muscle observed from inferior and superior gluteal veins in the jackknife versus the prone position. Three-dimensional modeling showed a significant reduction in the volume and inferior and superior gluteal vein diameters when in the jackknife position. When placed in the jackknife position for gluteal augmentation with fat transfer, extreme caution should be taken with the injecting cannula, as the underlying muscle is only 2 to 3 cm deep. Three-dimensional analysis showed narrowed and reduced volume of gluteal vasculature when in the jackknife position; this is a possible indication of torsion or stretch on the vessel around the pelvic rim that could cause vein avulsion injury from the pressurized fat within the piriform space.

Aging of the Adult Bony Orbit.

BACKGROUND: Accurate quantitative data of the adult bony orbital volume and dimension are needed for treatment optimization. In the present study, the authors aim to evaluate adult orbital volume and corresponding linear dimensions according to age, volume, and individual symmetry. METHODS: Seventy computerized tomography facial scans of adults were randomly chosen from an institutional database and 3-dimensionally reconstructed. Studies were excluded for orbital pathology or incomplete radiographic data. Anatomic landmarks were marked. Interval linear distances and orbital volumes were calculated. Data were analyzed using paired T-tests, independent T-tests, linear regression analysis, and 1-way analysis of variance. RESULTS: A total of 140 orbits from 70 patients were analyzed (female = 35, male = 35), ranging from 20 to 88 years of age. Orbital volume was similar between an individual's left and right side; however, a difference was observed in vertical orbital height, orbital width, inferior orbital rim position, orbital roof length, orbital width, and medial orbital wall length (0.45, 0.64, 0.4, 0.77, 0.97, and 5.1 mm, respectively; P < 0.05). In comparison to females, males averaged larger orbital volume by 3.07 cm (29.58 cm versus 26.51 cm, P = 0.0002), medial wall length by 2.66 mm (P < 0.05), and orbital width by 2.66 mm (P < 0.05). Orbital volume did not correlate with patient age, while lateral wall length was correlative. CONCLUSION: This accurate normative data of the adult bony orbit impacts key aspects of patient diagnosis and treatment and also suggest clinical signs of periorbital aging are not due to bony orbital changes.

Three-Dimensional Morphological Analysis of Sex, Age, and Symmetry of Proximal Femurs from Computed Tomography: Application to Total Hip Arthroplasty.

The success of a total hip arthroplasty is directly related to the ability of the implant to match original femoral morphology. Given this critical relationship, we characterized normal proximal femoral morphology as it relates to sex, age, and symmetry. Sixty abdominopelvic computed tomography (CT) scans (30 male and 30 female, ages 20-85 years old) from patients without any osseous pathology or implants were utilized. Three-dimensional models were constructed from the CT scans using Mimics v19 (Materialize). Thirteen landmarks were placed on each femur model and yielded eight morphological measurements for each femur. Medullary cavity measurements were taken superior to, at the center of, and inferior to the lesser trochanter. Morphological measurements were analyzed by sex, age group, and left versus right. A significant difference was identified between males and females for femoral head height, inferior neck length, minimum neck diameter, neck shaft angle, mediolateral medullary cavity measurement superior to the lesser trochanter and the anteroposterior at the lesser trochanter (P < 0.05). Age was found to correlate with medullary cavity measurements. As previously identified in the literature, differences with respect to the right and left femur were not of practical significance. The results show that sex is critical in determining prosthesis fit with the examined morphological measurements of the proximal femur while age is more important with respect to the medullary cavity. It is also evident that the current practice of using one femur to approximate the opposite is a viable clinical assumption. Clin. Anat., 33:731-738, 2020. © 2019 Wiley Periodicals, Inc.

An Analysis of Hounsfield Unit Values and Volumetrics from Computerized Tomography of the Proximal Femur for Sex and Age Estimation.

Sex and age are two elements in the establishment of a biological profile for forensic identification. While the pelvic bones are the most ideal structures for sex estimation, the condition of a body is not always ideal due to the nature of death, such as in mass disasters, or postmortem processes. This study utilized CT scans and resultant 3D models of 100 male and 100 female adults of known ages ranging from 18 to 98 years old to collect volumetric and Hounsfield unit measurements of the proximal femur. Equations were created to establish logistic regression models for sex estimation and linear regression models for age estimation. The resultant sex estimation method had an accuracy of 93.5% and utilized the volume of the proximal femur. This study provides three linear regression models for age with an accuracy range of 86%-92% ±12 years. As imaging technologies are increasingly adopted for forensic purposes, the power of 3D data will provide the opportunity for more quantitative and reproducible analyses. The proposed method for sex and age estimation provides a reliable tool that can be utilized in both day-to-day casework and disaster victim identification.

Adding Depth to Cephalometric Analysis: Comparing Two- and Three-Dimensional Angular Cephalometric Measurements.

INTRODUCTION: Lateral cephalometric radiographs (LCR) have been the standard tool used for cephalometric analysis in craniofacial surgery. Over the past decade, a three-dimensional (3D) revolution in cephalometric analysis and surgical planning has been underway. To date, research has not validated whether cephalometric measurements taken from two-dimensional (2D) and 3D data sources are equivalent and interchangeable. The authors sought to compare angular cephalometric measurements taken with 2D and 3D modalities. METHODS: Sixty-two head CT scans (36 females, 26 males) with an average age of 63 ±â€Š20 years were studied. Twelve cephalometric angular measurements were taken from 3D reconstructed skulls using the software package Mimics 19.0 (Materialize; Leuven, Belgium). These same facial angles were measured from 2D lateral cephalograms reconstructed from the original CT scans using Dolphin 11.9. Measurements taken with both techniques were compared for agreement using a paired t test. Intra-class correlation coefficient assessment was used to determine inter-rater reliability. Statistical significance was set at P < 0.05. RESULTS: Five of the 12 angular measurements (SNA, SNB, MP-FH, U1-SN, and U1-L1) demonstrated statistically significant differences (P < 0.05) between the 2D and 3D analyses. All of these differences were less than the standard deviations for the respective measure. CONCLUSION: The differences between angular cephalometric values obtained from 2D LCRs and 3D CT reconstructions are small. This supports the practices of using 2D and 3D cephalometric data interchangeably in most applications. Clinicians must be selective in which measures they employ to maximize accuracy and care must be taken when measuring dental inclination with lateral cephalograms.

3D analysis of computed tomography (CT)-derived lumbar spine models for the estimation of sex.

When skeletal remains are found scattered or in fragmentary conditions, the establishment of a biological profile of unknown individuals can be proven difficult. Consequently, multiple methods to ascertain the sex of the individual must be developed. The purpose of this study was to demonstrate that computed tomographic (CT)-derived 3D models of lumbar vertebrae could capture the unique morphologies of all five lumbar vertebrae to create equations for sex identification. The models were selected from a modern population consisting of 154 males and females that measured 30 standard linear measurements, the vertebral body wedging angle, and five aspect ratios. These measurements were then used to develop discriminant function equations for sex identification. Each lumbar level was analyzed individually as well as part of the entire lumbar spinal column. The results of this study showed that L1-L5 vertebrae can be used in sex determination with an 81.2-85.1% accuracy. When all five vertebrae are used in conjunction, the accuracy is 92.2%. The accuracy of the sex estimation found in this study for all lumbar vertebrae reinforces the distinct dimorphism between sexes while also providing forensic practitioners with more options or tools for their analyses.

Forensic personal identification utilizing part-to-part comparison of CT-derived 3D lumbar models.

The objective of this project was to document the efficacy of part-to-part comparison of computed tomography (CT)-derived three-dimensional (3D) models of the lumbar spine in forensic personal identification. By testing the methodology, this study aimed to provide a new technique of quantifiable (through a percent match) positive identification that meets the explicit requirements of the Daubert ruling and the challenges set forth in the 2009 NAS report. Ante-mortem (AM) and simulated post-mortem (PM) models of the lumbar vertebrae (L1-L5) for 30 unique individuals were compared via part comparison analyses. The threshold of ±0.5mm with at least a 90% match was considered a positive identification. Using this threshold, the part comparison results had a perfect identification rate with no false positives and no false negative matches. A ROC curve was generated with a score of 1, signifying a "perfect" sensitivity and specificity, at a cut-off value of 65.5%. On average positive IDs had a 94.7% percent match within the established threshold, while negative IDs had an average of 21.4%. In looking at the impact of different components of the biological profile, age and sex of the unknown individual played a minimal role in the percent match for both a positive and a negative ID. Lumbar level also played a minor role in in both the positive and negative percent match. The real-world application of 3D part-to-part comparison on AM and simulated PM scans demonstrate the potential usefulness of this technology in forensic identification.

Nano-Pulsed Laser Therapy Is Neuroprotective in a Rat Model of Blast-Induced Neurotrauma.

We have developed a novel, non-invasive nano-pulsed laser therapy (NPLT) system that combines the benefits of near-infrared laser light (808 nm) and ultrasound (optoacoustic) waves, which are generated with each short laser pulse within the tissue. We tested NPLT in a rat model of blast-induced neurotrauma (BINT) to determine whether transcranial application of NPLT provides neuroprotective effects. The laser pulses were applied on the intact rat head 1 h after injury using a specially developed fiber-optic system. Vestibulomotor function was assessed on post-injury days (PIDs) 1-3 on the beam balance and beam walking tasks. Cognitive function was assessed on PIDs 6-10 using a working memory Morris water maze (MWM) test. BDNF and caspase-3 messenger RNA (mRNA) expression was measured by quantitative real-time PCR (qRT-PCR) in laser-captured cortical neurons. Microglia activation and neuronal injury were assessed in brain sections by immunofluorescence using specific antibodies against CD68 and active caspase-3, respectively. In the vestibulomotor and cognitive (MWM) tests, NPLT-treated animals performed significantly better than the untreated blast group and similarly to sham animals. NPLT upregulated mRNA encoding BDNF and downregulated the pro-apoptotic protein caspase-3 in cortical neurons. Immunofluorescence demonstrated that NPLT inhibited microglia activation and reduced the number of cortical neurons expressing activated caspase-3. NPLT also increased expression of BDNF in the hippocampus and the number of proliferating progenitor cells in the dentate gyrus. Our data demonstrate a neuroprotective effect of NPLT and prompt further studies aimed to develop NPLT as a therapeutic intervention after traumatic brain injury (TBI).

Role of nutraceuticals in dementia care.

With an increase in the number of patients diagnosed with Alzheimer's disease, it is not surprising that there is a consistent increase in use of nutraceuticals and other over-the-counter medications to combat memory complaints and ideally treat dementia. Throughout this review article, the authors highlight recent literature updates on B vitamins, vitamin D, vitamin E, omega-3 fatty acids, and gingko biloba. Similar to any other medication, it is imperative to evaluate the risks and benefits in older patients, especially in light of comorbidities and existing medications.

Sepsis in obstetrics: cause, prevention, and treatment.

PURPOSE OF REVIEW: The aim of the study was to provide a summary of recent guidance on sepsis in obstetrics. RECENT FINDINGS: Morbidity and mortality from sepsis is increasing in the UK and other developed countries. In many cases, care has been found to be substandard. Common themes are a failure to recognize and respond to the sick woman and inadequate antibiotic and fluid management in the septic parturient. SUMMARY: Increased awareness of obstetric sepsis is required. Women and their families need to be informed about it and staff must have the skills and competencies to recognize this early. The management of severe sepsis in obstetrics is multidisciplinary. Implementation of the goals of the Surviving Sepsis Campaign into obstetric practice is important to improve outcomes. More research is needed to validate the parameters used in this and early warning scores for the obstetric population.

A simple method of nose tip shape validation for facial approximation.

Despite numerous papers relating to the prediction of nose projection for the purposes of facial approximation, there is little guidance for nose tip shape that has been evaluated on a known data set. This study presents a novel, simple technique for validation of the reconstructed nose tip shape based on methods used in actual approximation practice. The data set was comprised of 25 full-head computed tomography (CT) patient scans. In 22 of the 25 patients across all age and sex groups, when the head is tilted so that soft tissue pronasale is superimposed on hard tissue rhinion, the curvature of the nose tip was found to mimic the curvature of the superior portion of the nasal aperture. This occurs when the head is tilted dorsally by approximately 60° (55.87±5.91). Individuals with snub noses presented a much wider tip curvature. The method was highly repeatable and was evaluated through inter- and intra-observer studies (error=3.15%).

Virtual determination of sex: metric and nonmetric traits of the adult pelvis from 3D computed tomography models.

Examination of the adult os coxae and sacrum is one of the most common methods of sex estimation from bone. Medical imaging, such as computed tomography (CT), provides the opportunity for three-dimensional (3D) imaging of the skeleton from clinical scans of known individuals in situ. In this study, a randomly selected subset of abdominopelvic CT-derived models were used to evaluate simple, repeatable metric methods of sex estimation based on a combination of obstetric measurements and the traditionally nonmetric Phenice-derived traits. A four-variable discriminant function for sex estimation was developed based on statistical analyses. Overall, the cross-validated accuracy of this method was 100%, with inter-observer error showing an average of only 2.2%. Comparative analysis was run on the data set using FORDISC 3.0. This study shows that current sex determination standards from the pelvis should be updated to include more in vivo data to increase the accuracy of identification.