As dimensões ósseas da pelve podem estar relacionadas à gênese dos prolapsos de órgãos pélvicos? Uma revisão sistemática de estudos observacionais para avaliação de risco e prognóstico / Can the bone dimensions of the pelvis be related to the genesis of pelvic organ prolapses? A systematic review of observational studies for risk assessment and prognosis

Objetivo: Averiguar qual o papel desempenhado pelas dimensões ósseas da pelve em relação à gênese do prolapso de órgãos pélvicos por meio de publicações dos últimos quinze anos. Métodos: Trata-se de uma revisão sistemática de estudos ob- servacionais para avaliação de risco e prognóstico por meio de um levantamento bibliográfico virtual de artigos científicos publicados em revistas digitais entre os anos 2007 e 2022, nas bases de dados PubMed, BVS e ScienceDirect. Resultados: Uma área pélvica anterior mais ampla e um maior diâmetro interespinhoso foram caracterizados como possíveis causas para prolapso de órgãos pélvicos. A maior parte dos estudos contou com mensurações ósseas diversificadas, nas quais as demais dimensões não apresentaram significância estatística. Conclusão: Os estu- dos avaliados nesta revisão sugerem uma nova medida do assoalho pélvico rela- cionada a mulheres com prolapso, com apresentação de uma maior área anterior, em grande parte influenciada pelo diâmetro interespinhoso, o qual leva a um au- mento da carga sobre o assoalho pélvico. Porém, ainda assim, urge a necessidade de mais estudos para corroborar nossos achados.

Objective: To investigate the role played by the bone dimensions of the pelvis in relation to the genesis of pelvic organ prolapses through publications from the last fifteen years. Methods: This is a systematic review of obser- vational studies for risk assessment and prognosis through a virtual bibliographic survey of scientific articles published in digital journals between 2007 and 2022, in PubMed, BVS and ScienceDirect databases. Results: A wider anterior pelvic area and a larger interspinous diameter were characterized as possible causes for pelvic organ prolapses. Most of the studies have diversified bone measurements, in which the other dimensions weren't statistically significant. Conclusion: The studies evaluated in this review suggest a new measure- ment of the pelvic floor related to women with prolapse, with a larger anterior area, largely influenced by the interspinous diameter, which leads to an increased load on the pelvic floor. However, even so, there is an urgent need for further studies to corroborate our findings.

A comparative study of visual assessment between dry bone, 2-dimensional photograph, and deep learning methods in sex classification on the auricular area of the os coxae in a Thai population / Un estudio comparativo de la evaluación visual entre el hueso seco, la fotografía bidimensional y los métodos de aprendizaje profundo en la clasificación del sexo en el área auricular del hueso coxal en una población tailandesa

SUMMARY: Sex assessment is an important process in forensic identification. A pelvis is the best skeletal element for identifying sexes due to its sexually dimorphic morphology. This study aimed to compare the accuracy of the visual assessment in dry bones as well as 2D images and to test the accuracy of using a deep convolutional neural network (GoogLeNet) for increasing the performance of a sex determination tool in a Thai population. The total samples consisted of 250 left os coxa that were divided into 200 as a 'training' group (100 females, 100 males) and 50 as a 'test' group. In this study, we observed the auricular area, both hands-on and photographically, for visual assessment and classified the images using GoogLeNet. The intra-inter observer reliabilities were tested for each visual assessment method. Additionally, the validation and test accuracies were 85, 72 percent and 79.5, 60 percent, for dry bone and 2D image methods, respectively. The intra- and inter-observer reliabilities showed moderate agreement (Kappa = 0.54 - 0.67) for both visual assessments. The deep convolutional neural network method showed high accuracy for both validation and test sets (93.33 percent and 88 percent, respectively). Deep learning performed better in classifying sexes from auricular area images than other visual assessment methods. This study suggests that deep learning has advantages in terms of sex classification in Thai samples.

RESUMEN: La evaluación del sexo es un proceso importante en la identificación forense. La pelvis es el mejor elemento esquelético para identificar sexos debido a su morfología sexualmente dimórfica. Este estudio tuvo como objetivo comparar la precisión de la evaluación visual en huesos secos, así como imágenes 2D y probar la precisión del uso de una red neuronal convolucional profunda (GoogLeNet) para aumentar el rendimiento de una herramienta de determinación de sexo en una población tailandesa. Las muestras consistieron en 250 huesos coxales izquierdos, los que fueron dividi- das de la siguiente manera: 200 como un grupo de "entrenamiento" (100 mujeres, 100 hombres) y 50 como un grupo de "prueba". En este estudio, observamos el área auricular, tanto de forma práctica como fotográfica, para una evaluación visual y clasificamos las imágenes utilizando GoogLeNet. Se analizó la confiabilidad intra-interobservador para cada método de evaluación visual. Además, las precisiones de validación y prueba fueron del 85, 72 por ciento y 79,5, 60 por ciento, para los métodos de hueso seco y de imágenes 2D, respectivamente. Las confiabilidades intra e interobservador mostraron un acuerdo moderado (Kappa = 0.54 - 0.67) para ambas evaluaciones visuales. El método de red neuronal convolucional profunda mostró una alta precisión tanto para la validación como para los conjuntos de prueba (93,33 por ciento y 88 por ciento, respectivamente). El aprendizaje se desempeñó mejor en la clasificación de sexos a partir de imágenes del área auricular que otros métodos de evaluación visual. Este estudio sugiere que el aprendizaje profundo tiene ventajas en términos de clasificación por sexo en muestras tailandesas.

The relative efficacy of the cranium and os coxa for taxonomic assessment in macaques.

OBJECTIVES: The cranium is generally considered more reliable than the postcranium for assessing primate taxonomy, although recent research suggests that pelvic shape may be equally reliable. However, little research has focused on intrageneric taxonomic discrimination. Here, we test the relative taxonomic efficacy of the cranium and os coxa for differentiating two macaque species, with and without considering sexual dimorphism. MATERIALS AND METHODS: Geometric morphometric analyses were performed on cranial and os coxa landmarks for 119 adult Macaca fascicularis, M. mulatta, and Chlorocebus pygerythrus. Among-group shape variation was examined using canonical variates analyses. Cross-validated discriminant function analysis provided rates of correct group classification. Additionally, average morphological distances were compared with neutral genetic distances. RESULTS: Macaque species were clearly differentiated, both cranially and pelvically, when sex was not considered. Males were more often correctly classified based on the os coxa, while female classification rates were high for both morphologies. Female crania and male os coxa were differentiated approximately the same as genetic distance, while male crania were more similar (convergent), and female os coxa were more divergent than expected based on genetic distance. DISCUSSION: The hypothesis that cranial and os coxal shape can be used to discriminate among macaque species was supported. The cranium was better at differentiating females, while the os coxa was better at differentiating male macaques. Hence, there is no a priori reason for preferring the cranium when assessing intragenetic taxonomic relationships, but the effects of high levels of sexual dimorphism must be corrected for to accurately assess taxonomic signatures.

A test of four innominate bone age assessment methods in a modern skeletal collection from Medellin, Colombia.

Studying bone collections with known data has proven to be useful in assessing reliability and accuracy of biological profile reconstruction methods used in Forensic Anthropology. Thus, it is necessary to calibrate these methods to clarify issues such as population variability and accuracy of estimations for the elderly. This work considers observations of morphological features examined by four innominate bone age assessment methods: (1) Suchey-Brooks Pubic Symphysis, (2) Lovejoy Iliac Auricular Surface, (3) Buckberry and Chamberlain Iliac Auricular Surface, and (4) Rouge-Maillart Iliac Auricular Surface and Acetabulum. This study conducted a blind test of a sample of 277 individuals from two contemporary skeletal collections from Universal and San Pedro cemeteries in Medellin, for which known pre-mortem data support the statistical analysis of results obtained using the four age assessment methods. Results from every method show tendency to increase bias and inaccuracy in relation to age, but Buckberry-Chamberlain and Rougé-Maillart's methods are the most precise for this particular Colombian population, where Buckberry-Chamberlain's is the best for analysis of older individuals.

Population-specificity of sexual dimorphism in cranial and pelvic traits: evaluation of existing and proposal of new functions for sex assessment in a Greek assemblage.

The current paper examines the accuracy of existing binary logistic regression equations for sex prediction based on pelvic and cranial traits in a modern Greek assemblage and proposes new equations with the aim of improving correct classification rates for Balkan material. Our results suggest that existing equations based on pelvic traits perform very well on the Greek material, which can be attributed to the fact that sexual dimorphism in the pelvis results from common evolutionary forces across populations. In contrast, equations based on cranial traits are highly dependent upon the populations based on which they were developed, stressing the need to produce more population-specific functions. Our proposed equations achieve correct sex classification in 92.59% of the females and 95.79% of the males for pelvic traits, while these percentages rise to 97.53% for females and 98.95% for males when the vertical femoral head diameter is included in the models. Our functions based on cranial traits produced correct classifications in up to 92.59% of females and 88.42% of males, and when the cranial scores where combined with the vertical femoral head diameter, the correct classification rates increased to 93.83% for females and 94.73% for males. Prior to the generalization of the use of these functions, further research examining their accuracy in other groups is required, but our results appear promising.

The cohort study for the determination of reference values for spinopelvic parameters (T1 pelvic angle and global tilt) in elderly volunteers.

PURPOSE: T1 pelvic angle (TPA) and global tilt (GT) are spinopelvic parameters that account for trunk anteversion and pelvic retroversion. To investigate spinopelvic parameters, especially TPA and GT, in Japanese adults and determine norms for each parameter related to health-related quality of life (HRQOL). MATERIALS AND METHODS: Six hundred and fifty-six volunteers (262 men and 394 women) aged 50-92 years (mean, 72.8 years) were enrolled in this study. The incidence of vertebral fracture, spondylolisthesis and coronal malalignment were measured. Five spinopelvic parameters (TPA, GT, sagittal vertical axis [SVA], pelvic tilt [PT], and pelvic incidence-lumbar lordosis [PI-LL]) were measured using whole spine standing radiographs. The mean values for each parameter were estimated by sex and decade of life. HRQOL measures, including the Oswestry Disability Index (ODI) and EuroQuol-5D (EQ-5D), were also obtained. Pearson's correlation coefficients were determined between each parameter and HRQOL measure. Moreover, the factors contributing to the QOL score were calculated using logistic regression with age, sex, the existence of vertebral fracture and spondylolisthesis, coronal malalignment (coronal curve >30°) and sagittal malalignment (SVA >95 mm) as explanatory variables and the presence of disability (ODI >40) as a free variable. RESULTS: The mean values for the spinopelvic parameters were as follows: TPA, 17.9°; GT, 23.2°; SVA, 50.2 mm; PT, 18.6°; and PI-LL, 7.5°. TPA and GT strongly correlated with each other (r = 0.990) and with the other spinopelvic parameters. TPA and GT correlated with ODI (r = 0.339, r = 0.348, respectively) and EQ-5D (r = -0.285, r = -0.288, respectively), similar to those for SVA. TPA, GT, PT, and PI-LL were significantly higher in women than in men. PT and PI-LL gradually increased with age, while TPA, GT, and SVA tended to deteriorate after the 7th decade. Based on a logistic regression analysis, the deterioration of ODI was mostly affected by the sagittal malalignment. The TPA and GT cut-off values for severe disability (ODI >40) based on linear regression modeling were 26.0° and 33.7°, respectively. CONCLUSIONS: We determined reference values for spinopelvic parameters in elderly volunteers. Similar to SVA, TPA and GT correlated with HRQOL. TPA, GT, PT, and PI-LL were worse in women and progressed with age.

The Use of Entheseal Changes in the Femur and Os Coxa for Age Assessment.

This study examined the relationship between age and entheseal modifications in the femur and os coxa for estimating age at death. Five areas on the os coxa and four on the femur were scored in 200 white individuals over 40 years of age. Statistical analyses assessed the relationship between age and entheseal modification using both raw scores and scores adjusted for body size, for each sex, and for sexes combined. Results indicate that significant relationships exist between age and entheseal modification at three sites on the femur and four on the os coxae, but the relationships are not strong enough to generate age predictions. Conversely, the most severe entheseal modifications show promise as an indicator of age in older adults. Although further research is needed using larger samples for robust statistical analyses, current data indicate these modifications can suggest an age >60, or in some cases 70, years.

Metric Sex Determination of the Human Coxal Bone on a Virtual Sample using Decision Trees.

Decision trees provide an alternative to multivariate discriminant analysis, which is still the most commonly used in anthropometric studies. Our study analyzed the metric characterization of a recent virtual sample of 113 coxal bones using decision trees for sex determination. From 17 osteometric type I landmarks, a dataset was built with five classic distances traditionally reported in the literature and six new distances selected using the two-step ratio method. A ten-fold cross-validation was performed, and a decision tree was established on two subsamples (training and test sets). The decision tree established on the training set included three nodes and its application to the test set correctly classified 92% of individuals. This percentage was similar to the data of the literature. The usefulness of decision trees has been demonstrated in numerous fields. They have been already used in sex determination, body mass prediction, and ancestry estimation. This study shows another use of decision trees enabling simple and accurate sex determination.

La Ferrassie 8 Neandertal child reloaded: New remains and re-assessment of the original collection.

The first evidence of the partial infant Neandertal skeleton La Ferrassie 8 (LF8) was discovered in 1970, although most of the remains were found in 1973 as part of the 1968-1973 work at the site by H. Delporte. This individual and the other Neandertal children from La Ferrassie were published in the early 1980s by J.-L. Heim, and since then LF8 has been regarded as coming from a poorly documented excavation. The recent rediscovery of the box that contained the hominin bones given by Delporte to Heim in the Muséum national d'Histoire naturelle (MNHN) collection provided new fossils and helped to locate LF8 in the site: level M2 in square 1. Two visits to the Musée d'Archéologie nationale et Domaine national de Saint-Germain-en-Laye (MAN) yielded additional fossil remains from both the 1970 and 1973 excavations and resulted in the discovery of all of the notes from the excavation of H. Delporte between 1968 and 1973. Here the new fossil remains (47 after performing all possible refits), representing significant portions of the cranium, mandible, and vertebral column together with fragmentary hand and costal remains, are described. Unsurprisingly, the morphology of the bony labyrinth and of a complete stapes from the nearly complete left temporal show clear Neandertal affinities. Additionally, a complete reassessment of the original LF8 collection has resulted in the identification of several errors in the anatomical determination. Despite the significant increase in the anatomical representation of LF8, the skeletal remains are still limited to the head, thorax, pelvis, and four hand phalanges, with some very fragile elements relatively well preserved. Different hypotheses are proposed to explain this anatomical representation, which can be tested during future fieldwork.

A quantitative assessment of the insertional footprints of the hip joint capsular ligaments and their spanning fibers for reconstruction.

Quantitative descriptions of the hip joint capsular ligament insertional footprints have been reported. Using a three-dimensional digitizing system, and computer modeling, the area, and dimensions of the three main hip capsular ligaments and their insertional footprints were quantified in eight cadaveric hips. The iliofemoral ligament (ILFL) attaches proximally to the anterolateral supra-acetabular region (mean area = 4.2 cm(2)). The mean areas of the ILFL lateral and medial arm insertional footprints are 4.8 and 3.1 cm(2), respectively. The pubofemoral ligament (proximal footprint mean area = 1.4 cm(2)) blends with the medial ILFL anteriorly and the proximal ischiofemoral ligament (ISFL) distally without a distal bony insertion. The proximal and distal ISFL footprint mean areas are 6.4 and 1.2 cm(2), respectively. The hip joint capsular ligaments have consistent anatomic and insertional patterns. Quantification of the ligaments and their attachment sites may aid in improving anatomic repairs and reconstructions of the hip joint capsule using open and/or arthroscopic techniques.

An assessment of the repeatability of pubic and ischial measurements.

Forensic anthropologists frequently use measurements of the human skeleton to determine sex and ancestry. Since the establishment of the Daubert criteria of admissibility of scientific evidence to court, methodologies used by anthropologists came under severe scrutiny. It is therefore important to ensure that the osteometric standards that are used in skeletal analyses are clearly explained, repeatable and reliable. Adams and Byrd (2002) found that measurements of the pelvis that originated from a point inside the acetabulum could not be repeated accurately. The purpose of this paper was to use three different sets of pubic and ischial measurements to establish whether they can be repeated with high precision between four different observers, and also by the observers themselves. Generally, high levels of repeatability were obtained, with intra-class correlations (ICC) above 0.8. Pubic and ischial measurements using a point in the acetabulum as origin performed the worst (ICC values of 0.82 and 0.79 respectively for inter-observer repeatability), whereas other methods performed better with ICC values above 0.9. It is advised that pubic and ischial measurements should be taken using the origin of the iliac blade as landmark.

Discriminant function analysis for sex assessment in pelvic girdle bones: sample from the contemporary Mexican population.

Sex assessment of skeletal remains plays an important role in forensic anthropology. The pelvic bones are the most studied part of the postcranial skeleton for the assessment of sex. It is evident that a population-specific approach improves rates of accuracy within the group. The present study proposes a discriminant function method for the sex assessment of skeletal remains from a contemporary Mexican population. A total of 146 adult human pelvic bones (61 females and 85 males) from the skeletal series pertaining to the National Autonomous University of Mexico were evaluated. Twenty-four direct metrical parameters of coxal and sacral bones were measured and subsequently, sides and sex differences were evaluated, applying a stepwise discriminant function analysis. Coxal and sacra functions achieved accuracies of 99% and 87%, respectively. These analyses follow a population-specific approach; nevertheless, we consider that our results are applicable to any other Hispanic samples for purposes of forensic human identification.

The impact of racial metric variation in the os coxae on the morphological assessment of sex.

This study examines whether sex determination based on morphological traits in the os coxae is impacted by racial quantitative variation. Nineteen traits were evaluated independently by two observers in 876 os coxae. Chi-square test was used on a random sample of 400 individuals to assess whether the distribution of correct sex assessment varied for white and black individuals based on each trait individually and all 19 traits collectively, as well as on inter-observer agreement in correct sex assessment. Results indicate that accuracy of sex assessment varied between white and black individuals in certain individual traits; however, accuracy was not impacted when all traits were considered together. Furthermore, traits that showed significant variation in correct sex assessment between races generally were not related to size, but instead were "discrete." Finally, analyses of inter-observer variation suggest that disparities in sex assessment for some traits may be related to differences in trait interpretation between observers rather than morphological dissimilarities between races.

Urinary incontinence in the childbearing woman.

Urinary Incontinence (UI) is an often under-reported and untreated medical condition that affects the lives of women of all ages and backgrounds. Although there are six major types of UI, stress urinary incontinence (SUI) is the type most often associated with women of childbearing age. Development of SUI has also been linked to the childbirth process itself. This article will discuss the types, characteristics, and diagnosis of UI, with a focus on SUI. Precipitating factors for SUI, including the influence of pregnancy, childbirth, and aging on its development, will be reviewed.

MRI assessment of the bony pelvis may help predict resectability of rectal cancer.

OBJECTIVE: The outcome after surgical treatment of rectal cancer may be influenced by the technical difficulty of the operation, which is thought to be affected by pelvic size. The aim of this study was to examine the association between bony pelvic dimensions and CRM involvement. PATIENTS AND METHODS: All patients with primary rectal cancer between December 1999 and January 2002 were studied. Staging was performed by pelvic MRI. Nine pelvic dimensions were measured from the MR images on a workstation. Pathology reports were obtained for all patients and the mesorectal specimen was examined. Technical difficulty was assessed by circumferential resection margin (CRM) involvement. RESULTS: Of 126 patients with primary rectal cancer, 88 had staging MRI and rectal excision; there were significant differences between the sexes in all 9 pelvic dimensions (P < 0.05). In females, the interspinous diameter was significantly shorter in patients with CRM involvement compared with patients with a negative CRM. In female patients predicted to have a negative CRM, the anteroposterior diameter of the inlet, the anteroposterior diameter of the midplane and the transverse diameter of the midplane (interspinous distance) were significantly shorter in patients who actually had a positive CRM compared with those in whom the CRM was negative. In male patients, there was no correlation between pelvic dimensions and CRM status. CONCLUSIONS: In certain patients with rectal cancer, CRM positivity may be predicted from pre-operative MRI pelvic measurements. This may influence the choice of adjuvant therapy.

Dynamic assessment of pelvic floor and bony pelvis morphologic condition with the use of magnetic resonance imaging in a multiethnic, nulliparous, and healthy female population.

OBJECTIVE: The purpose of this study was to determine dynamic pelvic floor and bony pelvis morphologic condition in asymptomatic multiethnic women. STUDY DESIGN: Pelvic floor anthropometry, at rest and after the Valsalva maneuver, and pelvimetry were compared with the use of magnetic resonance imaging in nulliparous young volunteers from 5 ethnic groups (n=11 x 5 volunteers: Emirati, other Arab, Filipino, Indian/Pakistani, and European/white volunteers), with the white volunteers as the reference group. RESULTS: The white volunteers were significantly taller (P <.0001) than the other women. Their levator hiatus was significantly longer than the Emirati women (P=.03) and wider than the Filipino women (P=.04). The bladder neck descent on straining was also significantly greater than the other groups (P <.00001). The white women also had the longest transverse diameter of the pelvic inlet (P=.002). Their sagittal outlet diameter was significantly longer than the Emirati and Arab women (P=.02), and their interspinous diameter was significantly longer than the Arab women (P=.002). CONCLUSION: Nulliparous, healthy white women have larger levator hiatus and bony pelvis with greater bladder neck descent on straining than non-white women.

Metric assessment of race from the pelvis in South Africans.

It is well known that there are measurable differences between whites and blacks in the size and proportions of skeletal components. There are also metric differences among populations within these racial phenotypes. The population specific quantification of this variation can be used to aid in the identification of racial affinity in the absence of a more racially definitive skeletal element like the skull. Therefore, the purpose of this research is to quantify these differences in the pelvis of South African whites and blacks. A sample of 400, ostensibly healthy known sex/race os coxae was examined. Skeletal material was obtained from the Pretoria and Dart collections. A series of 13 measurements were taken Data were subjected to SPSS stepwise and direct discriminant function analysis. Pubic length was chosen as best for discriminating between races for males and iliac breadth as best in females. Highest average accuracies (Function 1) were 88% for males (pubic length, greater sciatic notch posterior width, acetabulum diameter, total height) and 85% for females (pubic length, greater sciatic notch posterior width, acetabulum diameter, iliac breath). In conclusion, this research resulted in the development of standards of identification tailored to this population and unquestionably demonstrates that race differences in the skeleton are highly significant and must be considered in all skeletal analyses.

Assessment and management of pelvic fracture in the hemodynamically unstable patient.

Hypotensive patients with pelvic ring injuries present a diagnostic and therapeutic challenge. This article reviews pelvic anatomy, the classification of pelvic injuries, and how to rapidly identify patients' unstable pelvic injuries. Current recommendations for the evaluation and treatment of these patients are reviewed.

Evaluation of CT scans and 3-D reformatted images for quantitative assessment of the hip.

Hip measurements using three-dimensional (3-D) images and computed tomography (CT) scans were evaluated. The 3-D measurements proved more accurate than CT measurements of femoral and acetabular anteversion. Additionally, accurate 3-D measurements (> 99%) of the femoral neck-shaft angle were provided. Acetabular anteversion determinations by CT scans were systematically decreased as pelvic flexion increased, whereas accuracy was > 96% with 3-D images. The 3-D software allows image rotation in all three reference planes, which minimizes positional errors. A case study is provided to exemplify the shortcomings of conventional imaging techniques and the utility of the quantitative 3-D protocol.