New Equations for the Estimation of the Age of the Formation of the Harris Lines.

Harris Lines (HLs) are transverse, sclerotic lines that can be visualized by X-ray imaging and that occur in long bones, most commonly in the tibia and femur. HLs are associated with disrupted bone mineralization during endochondral ossification, affecting the normal growth process. The etiology of HLs is debated, with some claims linking their presence to detrimental factors such as inflammation, malnutrition, alcohol abuse, and diseases. The age at which HLs form can be estimated based on their location, which allows for a retrospective assessment of the individual's health status during childhood or youth. The current study is concerned with providing new equations to estimate the age of Harris Line occurrences using a simple calculating tool. Bone growth curves were derived based on a dataset provided by Byers in 1991 using non-linear estimation. The best model was chosen with the Akaike Information Criterion. New and old methods were compared through Bland-Altman plots. As a result, we managed to produce reliable, well-fitted growth curves, concordant with previous methods.

Population Pharmacokinetic-Pharmacodynamic Modeling and Probability of Target Attainment Analysis of Rocuronium and Sugammadex in Children Undergoing Surgery.

BACKGROUND AND OBJECTIVES: Probability of target attainment (PTA) curves are commonly used to support dose recommendations of antibiotics for different patient groups. In this study we propose PTA analysis to optimize sugammadex dosing in children. METHODS: This study involved data from an observational cohort study of 30 American Society of Anesthesiologists (ASA) Physical Status I and II children undergoing surgery requiring muscle relaxation. All patients received 0.6 mg/kg rocuronium, with sugammadex administered at the end of surgery in three different doses (0.5, 1.0, and 2.0 mg/kg) to reverse the neuromuscular blockade. RESULTS: The data were analyzed using a population Bayesian-based approach. The developed model was used to simulate pharmacokinetic-pharmacodynamic profiles for different patient groups and dosing regimens before the PTA analysis was performed to translate these simulations into a clinically useful measure. The target was defined as neuromuscular blockade reversal measured by Train-of-Four (TOF ratio > 90%) at 1.5, 3, and 5 min post sugammadex dose. The sugammadex doses leading to 90% PTA were determined for different patients' body weights, rocuronium doses, and time gaps between rocuronium and sugammadex administration assuming the model, priors, and gathered data. For comparison, PTA curves for a range of clinical scenarios are provided to illustrate the usefulness of PTA analysis in selecting the appropriate dose for a given patient. CONCLUSIONS: The proposed PTA analysis is useful to support the sugammadex dose selection in different clinical scenarios. TRIAL REGISTRATION: The study was registered by ClinicalTrials.gov under number NCT04851574 on 21 April 2021.

Acute colonic flexures: the basis for developing an artificial intelligence-based tool for predicting the course of colonoscopy.

Tortuosity of the colon is an important parameter for predicting the course of colonoscopy. Computed tomography scans of the abdominal cavity were performed in 224 (94 female, 130 male) adult subjects. The number of acute (angle not exceeding 90°) bends between adjacent colonic segments was noted and analyzed. Data were analyzed for correlation with gender, age, height and weight. An artificial intelligence algorithm was proposed to predict the course of colonoscopy. We determined the number of acute flexions in females to be 9.74 ± 2.5 (min-max: 4-15) and in males to be 8.7 ± 2.75 (min-max: 4-20). In addition, more acute flexions were found in women than in men and in older women (after 60 years) and men (after 80 years) than in younger ones. We found the greatest variability in the number of acute flexures in the sigmoid colon (0-9), but no correlation was found between the number of acute flexures and age, gender, height or BMI. In the transverse colon, older and female subjects had more flexures than younger and male subjects, respectively. Older subjects had more acute flexures in the descending colon than younger subjects. There are opportunities to use the number of acute flexures (4-7, 8-12, more than 12 flexures) to classify patients into appropriate risk categories for future incomplete colonoscopy. On this basis, we predicted troublesome colonoscopies in 14.9% female and in 6.1% male subjects.

Morphology of the antegonial notch and its utility in the determination of sex on skeletal materials.

A number of criteria for the assessment of biological sex, which are applied to living or recently deceased individuals, have been developed, such as genetic, chromosomal, gonadal, hormonal, and phenotypic criteria. Features of a metric and descriptive nature are used to assess the sex of skeletal materials. The diagnostic features of the skull are concentrated in the craniofacial region and around the eye sockets. The mandible is a diagnostically important part of the skull, on which a complex of features is visible. These features develop up to the third decade of life. The goal of the research was to assess the suitability of the parameters of the preangular notch, in other words, the length, height, and surface area for sex prediction applied to skeletal materials. The study included computed tomography images of the masticatory system of 194 patients, consisting of 83 females and 111 males, aged from 16 to 93 years. The three straight lines which correspond to the sides of the triangle representing the notch, in addition to its height, were determined and measured digitally. The receiver operating characteristic method was used to assess the usefulness of the studied features for the purposes of sex prediction. The sensitivity of the test ranged from 51.4% to 67% for the parameters of the preangular notch on the right-hand side, and from 44.4% to 80.2% on the left-hand side. The most reliable predictive models were obtained for two features (shown in the graphical abstract). However, when taking into account, the specificity and sensitivity of the tests presented here, only the length of side AB (a basal length of the notch) can be regarded as a feature that supports the assessment of sex on the basis of other diagnostic features of the mandible. The size and shape of the preangular notch should be treated as auxiliary features in the assessment of sex. For this reason, it is recommended that they should be applied simultaneously to the set of features described in the section on anthropological standards.

Nutritional reconstruction in an early modern population: Searching for a relationship between dental microwear and bone element composition.

BACKGROUND: Observing the microwear patterns of the dental crowns enamel surface can provide information on the ingredients and structure of the food consumed, but also on eating habits and lifestyle. Major role in reconstructing the diet and lifestyle of past populations is played by the analysis of alkaline earth metals, such as strontium, barium, zinc and calcium. Ba and Sr are indicators of the consumption of vegetables, plants (cereals and legumes) and marine organisms. This study aims to assess dietary diversity and identify its components based on microscopic techniques and chemical analyses of material from early modern archaeological sites in Wroclaw, Poland. METHODS: The material consisted of 36 permanent molars and the intrasternal parts of 122 first ribs, collected from 6 Wroclaw early modern cemeteries. Tooth microwear was evaluated on Scanning electron microscopy images, with Microwear 4.02 software. Bone chemical composition (Ca, P, Ba, Sr content) was evaluated with mass spectrometry. RESULTS: Most lines were present on the teeth from St. Mary Magdalene Cemetery, with the lowest average number of lines observed on the teeth from St. Barbara Cemetery. The Ca/P ratios calculated for different sites formed two clusters that allows to distinguish two groups of archaeological sites with different bone preservation status. Number of differences in Ba/Sr, Sr/Ca, Ba/Ca ratios was found between disctinct archaeological sites. A number of correlations were found between the concentration of the chemical elements, but no statistically significant correlation was found between the microwear characteristics and the proportion of the elements studied. Some strong correlations were found between microwear features and the Ca/P ratio. CONCLUSIONS: the different values of Sr/Ca, Ba/Ca and Ba/Sr ratios indicate different diets in the different communities. The data obtained indicate a mixed diet, with a relatively high proportion of animal products throughout Wroclaw. Conclusions should be treated with caution due to secondary diagenesis. The lack of interdependence between microwear and chemical composition characteristics suggests that the two methods should be considered complementary and not overlapping, as they provide different insights into the diets of past populations. The comparison of microwear between different sites should always take into account secondary diagenesis and the burial environment, as these influence the characteristics of microwear.

Descending-sigmoid colon flexure - An important but surprisingly ignored landmark.

BACKGROUND: In invasive examinations of the colon, e.g. colonoscopy, the tortuosity of the colon is a crucial factor for successful completion of the procedure. If adjacent segments of the colon bend at acute angles (under 90°), endoscopy may become difficult and troublesome. METHODS: We retrospectively enroled 227 individuals (96 female, 131 male) who underwent abdominopelvic computed tomography examination. For inclusion, subjects were required to have a negative history for colonic disease and abdominopelvic surgery. We measured the angle between the descending colon and the proximal part of the sigmoid (in degrees). In addition, the position of the descending-sigmoid flexure was assessed in relation to the left anterior superior iliac spine, the median plane, and anterior aspect of the 5th lumbar vertebra (in mm). The study protocol was reviewed and approved by the local ethics committee. RESULTS: We visualised the descending-sigmoid flexure in all 227 subjects. In one third of cases, the flexure formed an angle smaller than/or 90°. In females, this landmark (mean ± standard deviation) was located 30.2 ± 8.4 mm from the left anterior superior iliac spine, 88.6 ± 14.2 mm from the median plane, and 115.4 ± 21.4 mm from the anterior aspect of the 5th lumbar vertebra. In males, the dimensions were: 32.1 ± 12.8 mm, 97.6 ± 15.8 mm, and 123.9 ± 22.9 mm, respectively. This landmark distance remained constant from the left anterior superior iliac spine regardless of subject age, height and weight. The other measured distances were related to age, height, weight or BMI. CONCLUSIONS: The descending-sigmoid flexure is an important landmark in large intestine morphology situated approximately width of two fingers (3 cm) from the left anterior superior iliac spine and one hand width (9-10 cm) from the median plane. In approximately one third of the subjects, the flexure formed an angle of less than/or 90°, which can cause a problem during colonoscopy.

Influence of Holes Manufacture Technology on Perforated Plate Aerodynamics.

Transpiration flow is a very important and still open subject in many technical applications. Perforated walls are useful for the purpose of "flow control", as well as for the cooling of walls and blades (effusive cooling) in gas turbines. We are still not able to include large numbers of holes in the numerical calculations and therefore we need physical models. Problems are related also to the quality of the holes in perforated plates. The present transpiration analysis concerns with experimental investigations of the air flow through perforated plates with microholes of 125 and 300 µm diameters. A good accordance of the results with other experiments, simulations and theory was obtained. The received results very clearly show that technology manufacturing of plate holes influences on their aerodynamic characteristics. It turned out that the quality of the plate microholes using laser technology and, consequently, the shape of the hole, can affect the flow losses. Therefore, this effect was investigated and the flow characteristics in both directions were measured, i.e., for two plate settings.

Estimation of age at onset of linear enamel hypoplasia. New calculation tool, description and comparison of current methods.

Enamel Hypoplasia (EH) is known to be a useful indicator for wide range of detrimental factors in early childhood in past populations, such as nutritional disturbances, mechanical trauma, disease, metabolic, and/or genetic disorders. EH may be divided into three categories: pits, grooves, and lines, where the last two are referred to as "Linear Enamel Hypoplasia" (LEH). The regularity of enamel formation allows retrospective determination of the age of LEH formation. The current article reviews and compares the best-known methods used to estimate age at LEH formation and provides a new computational tool. Growth curves for canines and incisors were developed based on tooth growth tables by previous authors. Optimal models were selected using the Akaike Information Criterion. A Microsoft Excel spreadsheet was created to calculate age at LEH formation using the most common methods. All method results were compared with an archaeological sample (44 teeth of 18 individuals from an early modern cemetery from Wroclaw, Poland) and a theoretical model. The results of the methods were compared pairwise with Bland-Altman plots. The current article provides a quick and easy-to-use tool for analyzing LEH chronology and comparing the results of different methods. As shown by the Bland-Altman plots, most methods provide approximately consistent results for LEHs formed at around 2-3 years of age. However, LEHs formed particularly early or late are more prone to discrepancies between different methods. Comparison of the age at LEH formation obtained by different methods should be done carefully - and the new LEH calculation tool with optimized equations provided in this publication can facilitate this process.

Ultrasound evaluation of the radial artery in young adults - A pilot study.

The radial artery is a vessel frequently used in various medical procedures which carry a risk of complications. One such method used to minimize the number of complications is a profound knowledge of the artery's diameter, which allows for appropriate selection of an instrument to use for puncture. The purpose of this study is to determine the diameter of the radial artery and its depth from the skin surface in young adults. MATERIAL AND METHODS: 96 volunteers participated in the study. The average age of the volunteers was 20.43 years. All participants underwent a B-mode ultrasonography to measure the distal radial artery's diameter. Certified anthropometric instruments were used to determine the relation between the artery diameter and the selected basic anthropometric parameters. RESULTS: The mean right arterial diameter for the entire examined population at the level of the styloid process was mean 1.42 (SD 0.26) mm and its distance to the skin was mean 4.00 (SD1.20) mm. Statistical analysis revealed the presence of moderate positive relationship between the diameter of the radial artery and body weight and between the diameter of the radial artery and BMI. A weak correlation between the artery diameter and the width of the wrist was also present. CONCLUSION: In the present work, we aimed to determine the dimensions of the distal section of the radial artery in young people free from symptoms of cardiovascular diseases. The obtained initial study results advise selecting instruments for vascular puncture individually, with special attention paid to slender people with slim wrists.

Topography of muscular branches of the superficial fibular nerve based on anatomical preparation of human foetuses.

BACKGROUND: The progress of pediatric surgery and increasingly better diagnosis of fetal defects require detailed knowledge of human developmental anatomy. Precise knowledge of the anatomy of innervation of the lower extremities corresponds to this subject and is not only cognitive but also clinically important. The aim of this study was to analyse the anatomy of the topography of the muscular branches of the superficial fibular nerve (NPS) in the prenatal period, which will fill a gap in the literature. METHODS: The analysis was carried out on 207 human foetuses aged from the 113th day to 222nd day of foetal life. The study material is a part of the collection of the Division of Normal Anatomy of Wroclaw Medical University. The study incorporated the following methods: anthropological, preparational and image acquisition which was acquired with the use of high-resolution digital camera. Statistical analysis was carried out with the use of STATISTICA package. RESULTS: Based on the research results the number of muscle branches of the examined nerve was determined. It was shown that in more than half of the cases the two nerve branches are responsible for Peroneus Longus innervation and in about 90% of cases one branch is responsible for Peroneus Brevis innervation. Based on the obtained data a unique, new typology of distribution of these branches was created. It has been shown that the bipinnate type is the most common in the examined fetal population. The presence of statistically significant differences in the frequency of occurrence of individual innervation patterns depending on sex and body side were excluded (p > 0.05). There were also no statistically significant changes in the frequency of occurrence of individual types of NPS branch distribution according to fetal age (p > 0.05). CONCLUSIONS: The created unique typology of NPS branch distribution based on extensive preparation material is an important supplement to the anatomical knowledge and at the same time, due to the peripheral and superficial location of the described structures, it has a relevant clinical significance.

Assessing weaning stress - Relations between enamel hypoplasia, δ18O and δ13C values in human teeth obtained from early modern cemeteries in Wroclaw, Poland.

OBJECTIVES: The aim of this paper is to assess linear enamel hypoplasia (LEH) on canines of adults from early modern Wroclaw cemeteries to compare δ13C and δ18O values in enamel formed before, during and after LEH formation, and to attempt to find a link between the selected indicators of the weaning process. MATERIAL AND METHODS: 15 permanent canines with visible LEH were selected for analysis. Age at LEH formation was estimated using the Reid and Dean method. The perikymata count was used to estimate the duration of LEH formation. Incremental stable oxygen and carbon isotopes analysis was performed on tooth enamel to infer stress related to weaning and dietary patterns. Kruskal-Wallis ANOVA, Mann-Whitney U test and Spearman correlation were used in statistical inference. RESULTS: The average age of LEH formation was 3.14 years, with an average duration of 111 days. Stable carbon isotope values consistently increase in 73% of the individuals sampled. The values of δ18O do not show a dominant pattern. The average value of δ13C increases over the time of enamel formation. The δ13C values collected below LEH were negatively correlated with δ18O values and the duration of LEH termination. CONCLUSIONS: Marking of carbon and oxygen isotopes indicates different stages of weaning. Advancements in diet change (determined by higher δ13C) corresponds with faster recovery after physiological stress episode. There is no evidence for different breastfeeding models between distinct parishes in early modern Wroclaw.

Anatomy-related ratios predict colonoscopy incompleteness in similar examination conditions.

BACKGROUND: Screening colonoscopy is one of the most popular modalities for screening and surveillance of colorectal cancer and other colon disorders. OBJECTIVES: To introduce new ratios to predict the colonoscopy course in patients with similar characteristics. MATERIAL AND METHODS: Five hundred screening colonoscopies (252 females and 248 males) were performed by an experienced endoscopist. Incomplete colonoscopies (without pathologic findings, i.e., disease-unrelated) were included in the study. Collected data was used to determine new ratios. RESULTS: An examination was completed in 231 (91.7%) females (F) and 239 (96.4%) males (M). The majority of incomplete colonoscopies were discontinued in the sigmoid colon: 8 F (38.1%) and 4 M (44.4%) or in the descendosigmoid flexure: 4 F (19%) and 2 M (22.2%). We found statistically significant higher risk of incompleteness in females (p = 0.03), patients after 2 or more surgical treatments (p = 0.007) and in males with lower body mass index (BMI) (p = 0.01) (χ2 tests). Moreover, we discovered a statistically significant correlation with 2 or more previous surgical treatments in the female group (p = 0.02) (χ2 test). We calculated the incomplete colonoscopy anatomy-related (ICAR) and modified ICAR (MICAR) ratios. The range of ICAR and MICAR was 0-0.17; the number of incomplete examinations ranged from 0 to 1 failed out of 6 attempts (calculation: 100:17 = 5.88). CONCLUSIONS: The ICAR and MICAR ratios reflect the various risk of colonoscopy incompleteness (i.e., disease-unrelated) and highlight the differences between patients in similar examination condition.

Anatomical and Clinical Implications in Neocondyle Stability After a Condylectomy.

: A condylectomy of the mandibular condyle is considered to be the treatment of choice in most cases of condylar head hyperactivity. The aim of the procedure is to remove the growth center of the mandible which is responsible for the mandibular enlargement and asymmetry. This surgical procedure has an impact on the condyle shape and position, but the restoration of mandibular movement and a stable joint position (namely, the proper alignment of the newly shaped condylar head within the condyle fossa) should also be considered important surgical outcomes. In this article, the authors present their own experience in performing condylectomies with an arthroplasty procedure and a special forced suturing technique (FST) in terms of achieving early, accurate mandibular movement and maintaining a stable condyle position in early and late outcomes. MATERIALS AND METHODS: A modified high condylectomy with arthroplasty and FST results had been studied in anatomical, radiological, and clinical model. RESULTS: Early findings after FST are promising. A slight improvement in lateral jaw movement was noted after condylectomy with arthroplasty (P < 0.05) both in early and late follow-up. Incisal opening, mandibular protrusion, and lateral movement were sustained. A stable condyle position within the fossa was achieved in each case of condylectomy with arthroplasty (P < 0.05). CONCLUSIONS: The FST condylectomy and reattachment of the lateral pterygoid muscle in a new, wider position provided an improvement in lateral jaw movement as well as in incisal opening and mandibular protrusion in early follow-up examination compared to the presurgical values. It seems that the FST enabled a better new condylar head position in the glenoid fossa and improved early functional mandibular movement.

Diagnodent and VistaCam may be unsuitable for the evaluation of dental caries in archeological teeth.

OBJECTIVES: The aim of the study was to compare the usefulness of fluorescence-based caries detection systems (Diagnodent and VistaCam) for the assessment of carious lesions on archeological molars. MATERIALS AND METHODS: The study material consisted of teeth from the Cemetery of St. Mary Magdalene (Cmentarz sw. Marii Magdaleny) in Wroclaw, Poland. A sample of 178 permanent molars from 38 skulls were examined. Five surfaces of teeth (occlusal, mesial, distal, buccal, and lingual) were assessed on either basically cleaned or sandblasted teeth. Six diagnostic methods were used to detect carious lesions: the visual classification of the International Caries Detection and Assessment System (ICDAS II), fluorescent methods (Diagnodent and VistaCam), X-ray, cone beam computed tomography and histological sections. The sensitivity and specificity of the methods were determined using receiver operating characteristic (ROC) curves and the correlation between the severity of dental caries and the readouts obtained with each method. RESULTS: In most cases, Diagnodent and VistaCam yielded unsatisfactory specificity and sensitivity values. The area under curve (AUC) values in ROC curves for Diagnodent and Vistacam were lower than the AUC values obtained for the ICDAS II visual classification. CONCLUSIONS: According to our results, in the case of archeological teeth, neither Diagnodent nor VistaCam can be regarded as a better diagnostic method than the ICDAS II visual classification of caries.

Comparison of short-term head and body growth in an infant, preschool children, and adolescent girls

SUMMARY: Introduction: The aim of the present longitudinal study was to compare short-term growth in height, the circumference of the head, chest, and hips, biacromial width, as well as bi-iliac breadth in one infant, two preschool children, and seven adolescent girls. Methods: The studied characteristics were measured four times a week. Stature was observed during 83-130 days and the other measures during 60 days. Intra-observer technical error was calculated (TEM), and smoothing techniques using combined repeated median/median hybrid filter (CRMMH) were applied. One-way analysis of variance (ANOVA) was used to estimate statistical significance of differences between mean values of length, as well as the number of stasis periods and steep changes. Results: Steep changes, continuous growth, and stasis periods were found in the studied individuals. The highest number of steep changes and the largest steep changes were noted for stature (0.85 cm). The longest period of stasis was 48 days for head circumference. There were no statistically significant differences between period length and number of stasis periods or steep changes in any of the measures of children. Conclusion: Growth curves for stature and head circumference were similar, which may suggest a common pattern of growth, different from that for thoracic bones. Steep changes in body width measures were observed in the absence of increments in both stature and head circumference.