Conserved patterns and locomotor-related evolutionary constraints in the hominoid vertebral column.

The evolution of the hominoid lineage is characterized by pervasive homoplasy, notably in regions such as the vertebral column, which plays a central role in body support and locomotion. Few isolated and fewer associated vertebrae are known for most fossil hominoid taxa, but identified specimens indicate potentially high levels of convergence in terms of both form and number. Homoplasy thus complicates attempts to identify the anatomy of the last common ancestor of hominins and other taxa and stymies reconstructions of evolutionary scenarios. One way to clarify the role of homoplasy is by investigating constraints via phenotypic integration, which assesses covariation among traits, shapes evolutionary pathways, and itself evolves in response to selection. We assessed phenotypic integration and evolvability across the subaxial (cervical, thoracic, lumbar, sacral) vertebral column of macaques (n = 96), gibbons (n = 77), chimpanzees (n = 92), and modern humans (n = 151). We found a mid-cervical cluster that may have shifted cranially in hominoids, a persistent thoracic cluster that is most marked in chimpanzees, and an expanded lumbosacral cluster in hominoids that is most expanded in gibbons. Our results highlight the highly conserved nature of the vertebral column. Taxa appear to exploit existing patterns of integration and ontogenetic processes to shift, expand, or reduce cluster boundaries. Gibbons appear to be the most highly derived taxon in our sample, possibly in response to their highly specialized locomotion.

A social media analysis of patient-perceived complications following periacetabular osteotomy (PAO): a retrospective observational study.

BACKGROUND: Social media is a popular resource for patients seeking medical information and sharing experiences. Periacetabular osteotomy (PAO) is an accepted treatment for symptomatic acetabular dysplasia with a low published complication profile in specialty centers. Little is known regarding patient reporting of complications on social media following PAO. The purpose of this study was to describe the patient-perceived complications of PAO posted on social media and analyze how additional factors (postoperative timeframe, concomitant surgery) correlate with these complication posts. METHODS: Facebook and Instagram were queried from 02/01/18-02/01/23; Twitter was searched over an extended range back to 02/01/11. Facebook posts (1054) were collected from the two most populated interest groups; "Periacetabular Osteotomy" and "PAO Australia." Instagram posts (1003) and Tweets (502) were found using the same five most popular hashtags: #PAOwarrior, #periacetabularosteotomy, #periacetabularosteotomysurgery, #PAOsurgery, and #PAOrecovery. Posts were assessed for demographic data, perspective, timing (early postoperative or late postoperative), additional surgeries, type of complication, and post engagement. RESULTS: Facebook posts (1054), Instagram posts (1003), and Tweets (502) were assessed; 13.6% of posts included a complication. The majority of complications were reported > 6 months postoperatively with excessive pain being the most common complication (57.2%), including chronic pain (41.8%), acute pain (6.7%), and nerve pain (8.8%). Bony complications (6.7%), neurologic/psychiatric complications (3.8%), swelling (1.7%), infection (1.4%), other specified complications (16.2%), and unspecified complications (10.2%) were reported. Complication posts were found to be correlated with postoperative timeframe and concomitant surgery. Post engagement decreased in complication-related posts. CONCLUSIONS: Few patients posted a perceived complication associated with PAO surgery. Of those who did, the majority reported unmanageable pain during the late postoperative period. Posts including a perceived complication were found to be positively correlated with postoperative timeframe and negatively correlated with concomitant surgery. This study found a higher pain complication rate, but a lower overall complication rate compared to prior studies. Considering the social media reported complications of PAO patients in addition to traditional outcome measures reveals which aspects of postoperative recovery are most important to patients themselves.

The Relationship Between Postoperative Patient-Reported Psychological Outcomes and Preoperative Pain Characteristics in Patients Who Underwent Periacetabular Osteotomy.

This study sought to investigate the relationship between multiple preoperative characteristics of pain (maximum pain severity location, the presence of pain in certain locations, the highest level of pain, and the number of pain locations) and psychological outcome measures as reported by patients. Fifty-four hips (50 patients) that underwent periacetabular osteotomy to treat acetabular dysplasia between February 2017 and July 2020 were reviewed using the Depression, Anxiety, and Stress Scale-21 (DASS21), Hospital Anxiety and Depression Scale (HADS), and Pain Catastrophizing Scale (PCS), radiographic analysis, and questionnaires concerning pain severity/location. Twenty-six hips had their worst pain in the groin, whereas 28 hips had greater or equal levels of pain at another location. There was no significant difference between these two locations on any of the postoperative psychological outcomes (HADS, P=.53; DASS21, P=.85; PCS, P=.97). Additionally, there was not a significant relationship between pain in any location other than the groin and any postoperative psychological outcomes (P≥.08). Finally, the highest level of preoperative pain and the number of locations of pain demonstrated no significant relationship with postoperative psychological outcomes (maximum severity: HADS, P=.28; DASS21, P=.49; PCS, P=.57; number of pain locations: HADS, P=.47; DASS21, P=.60; PCS, P=.35). Variance in preoperative pain location, severity, and number of pain locations seemingly does not result in any significant effect on postoperative psychological outcomes. Thus, a large range of patients with acetabular dysplasia may experience similar, favorable psychological outcomes from treatment with periacetabular osteotomy notwithstanding the characteristics of preoperative pain. [Orthopedics. 2024;47(1):28-33.].

Making meaning from fragmentary fossils: Early Homo in the Early to early Middle Pleistocene.

In celebration of the 50th anniversary of the Journal of Human Evolution, we re-evaluate the fossil record for early Homo (principally Homo erectus, Homo habilis, and Homo rudolfensis) from early diversification and dispersal in the Early Pleistocene to the ultimate demise of H. erectus in the early Middle Pleistocene. The mid-1990s marked an important historical turning point in our understanding of early Homo with the redating of key H. erectus localities, the discovery of small H. erectus in Asia, and the recovery of an even earlier presence of early Homo in Africa. As such, we compare our understanding of early Homo before and after this time and discuss how the order of fossil discovery and a focus on anchor specimens has shaped, and in many ways biased, our interpretations of early Homo species and the fossils allocated to them. Fragmentary specimens may counter conventional wisdom but are often overlooked in broad narratives. We recognize at least three different cranial and two or three pelvic morphotypes of early Homo. Just one postcranial morph aligns with any certainty to a cranial species, highlighting the importance of explicitly identifying how we link specimens together and to species; we offer two ways of visualizing these connections. Chronologically and morphologically H. erectus is a member of early Homo, not a temporally more recent species necessarily evolved from either H. habilis or H. rudolfensis. Nonetheless, an ancestral-descendant notion of their evolution influences expectations around the anatomy of missing elements, especially the foot. Weak support for long-held notions of postcranial modernity in H. erectus raises the possibility of alternative drivers of dispersal. New observations suggest that the dearth of faces in later H. erectus may mask taxonomic diversity in Asia and suggest various later mid-Pleistocene populations could derive from either Asia or Africa. Future advances will rest on the development of nuanced ways to affiliate fossils, greater transparency of implicit assumptions, and attention to detailed life history information for comparative collections; all critical pursuits for future research given the great potential they have to enrich our evolutionary reconstructions for the next fifty years and beyond.

Duration of Symptoms Does Not Significantly Influence Short-term Outcomes for Patients Undergoing Periacetabular Osteotomy.

Factors influencing the clinical outcomes after periacetabular osteotomy (PAO) have not been well explored. This study evaluated the influence of symptom duration in developmental dysplasia of the hip on short-term patient-reported outcomes after PAO. A retrospective review of prospectively collected data identified PAOs performed on 139 patients. Sixty-five patients were then stratified into two groups based on preoperative symptom duration: 2 years or less (n=22) vs more than 2 years (n=43). We compared the results of hip-specific patient-reported outcome surveys collected preoperatively and postoperatively. When comparing the two groups, we found no significant differences in clinical outcome scores except for the UCLA Activity Scale. The shorter duration group achieved improvement 6 months postoperatively on the visual analog scale average pain score (from 4.5 to 2.167; P=.0017), International Hip Outcome Tool-12 (from 42.95 to 59.19; P=.0176), and Harris Hip Score (from 53.88 to 69.88; P=.049). The longer duration group also achieved postoperative improvement across multiple surveys. Nevertheless, a multivariate analysis controlling for age, sex, and body mass index and found that symptom duration did not independently affect the change in clinical outcomes. Although PAO leads to improvements in functional status and pain, preoperative symptom duration does not significantly affect these clinical outcomes. [Orthopedics. 2023;46(6):365-372.].

Does surgery change pelvic tilt? : an investigation in patients with osteoarthritis of the hip, dysplasia, and femoroacetabular impingement.

AIMS: Pelvic tilt is believed to affect the symptomology of osteoarthritis (OA) of the hip by alterations in joint movement, dysplasia of the hip by modification of acetabular cover, and femoroacetabular impingement by influencing the impingement-free range of motion. While the apparent role of pelvic tilt in hip pathology has been reported, the exact effects of many forms of treatment on pelvic tilt are unknown. The primary aim of this study was to investigate the effects of surgery on pelvic tilt in these three groups of patients. METHODS: The demographic, radiological, and outcome data for all patients operated on by the senior author between October 2016 and January 2020 were identified from a prospective registry, and all those who underwent surgery with a primary diagnosis of OA, dysplasia, or femoroacetabular impingement were considered for inclusion. Pelvic tilt was assessed on anteroposterior (AP) standing radiographs using the pre- and postoperative pubic symphysis to sacroiliac joint (PS-SI) distance, and the outcomes were assessed with the Hip Outcome Score (HOS), International Hip Outcome Tool (iHOT-12), and Harris Hip Score (HHS). RESULTS: The linear regression model revealed a significant negative predictive association between the standing pre- and postoperative PS-SI distances for all three groups of patients (all p < 0.001). There was a significant improvement in all three outcome measures between the pre- and postoperative values (p < 0.05). CONCLUSION: There is a statistically significant decrease in pelvic tilt after surgery in patients with OA of the hip, dysplasia, and femoroacetabular impingement. These results confirm that surgery significantly alters the pelvic orientation. Pelvic tilt significantly decreased after total hip arthroplasty, periacetabular osteotomy, and arthroscopy/surgical hip dislocation. The impact of surgery on pelvic tilt should be considered within the therapeutic plan in order to optimize pelvic orientation in these patients.Cite this article: Bone Joint J 2022;104-B(9):1025-1031.

IMPLEMENTING A STANDARDIZED INTERVENTIONAL EXERCISE REGIMEN TO IMPROVE FUNCTIONAL MOVEMENTS IN FEMALE COLLEGIATE ATHLETES.

BACKGROUND: Interventional exercises have been developed to help athletes improve scores on the Functional Movement Screen™ (FMS™). However, there is a paucity of research on the effects of a similar program in female athletes, as well as the effects of a standardized corrective exercise regimen. The purpose of this study was to assess whether an in-season, standardized interventional exercise program improves FMS™ score asymmetry and the composite score of female collegiate athletes. STUDY DESIGN: Prospective, quasi-experimental, cohort study. METHODS: Forty-one (mean age 19.5 ± 1.2 years; body mass, 70.6 ± 11.5 kg ; height, 1.70 ± 0.083 m) NCAA Division III female soccer (n=10), softball (n=17), and basketball (n=14) players participated in this study. The athletes completed the FMS™ screens prior to their season, regularly participated in four in-season standardized corrective exercises throughout three to four month athletic seasons, and completed the FMS™ screens in the postseason. RESULTS: The average score of all athletes before the season was 15.52 ± 0.63 and 16.04 ± 0.72 after the season. While the mean score of soccer players increased from 14.80 ± 0.92 to 16.1 ± 1.52 and the mean score of softball players increased from 15.83 ± 1.89 to 16.72 ± 1.41 at the end of the season, the mean score of basketball players dropped from 15.93 ± 1.49 to 15.29 ± 1.59. Women's basketball players experienced a decrease in their composite FMS™ score ( x ¯ = -0.571, p<0.01), while women's soccer players ( x ¯ =+1.30, p<0.05) and softball players ( x ¯ =+1.12, p<0.05) experienced an increase in mean score 2.28 times and 1.96 times greater in magnitude than the decrease in basketball players' composite FMS™, respectively. Fewer total athletes demonstrated asymmetries at postseason testing, decreasing from 24 at preseason testing to 15 at postseason testing (p<0.01). Significant differences were not noted between athlete age and FMS™ scores (p>0.05). CONCLUSIONS: Standardized interventional programs during athletic teams' seasons may be used to help increase FMS™ scores and reduce asymmetry. Though more studies are warranted to address the negative effects of this standardized program in women's basketball players, this study demonstrated that the number of asymmetries significantly decreased from pre- to postseason among soccer and softball players, which may have implications for a higher resistance to injury. LEVELS OF EVIDENCE: 3.

Three-dimensional anatomy of the anthropoid bony pelvis.

OBJECTIVES: Pelvic form is hypothesized to reflect locomotor adaptation in anthropoids. Most observed variation is found in the ilium, which traditionally is thought to reflect thoracic and shoulder morphology. This article examines the articulated bony pelvis of anthropoids in three dimensions (3D) to test hypothesized variation in pelvic anatomy related to overall torso form. MATERIALS AND METHODS: Sixty landmarks were collected on articulated pelves from 240 anthropoid individuals. Landmark data were subjected to a Generalized Procrustes Analysis. Principal Components Analysis was used to identify trends among taxa. Linear metrics were extracted, and bivariate allometric analysis was used to compare intergroup differences and scaling trends of specific dimensions. RESULTS: The combination of 3D and bivariate allometric analysis demonstrates a complex pattern of locomotor/phylogenetic and allometric influences on pelvic morphology. Apes have relatively narrower dorsal interiliac spacing than do most monkeys, with relatively smaller spinal muscle attachment areas but only minimally wider ventral bi-iliac breadths. Hylobatids and atelids have a relatively more cranial position of their sacra than do other taxa, and hylobatids and cercopithecids relatively more retroflexed ischia. Within groups, the three pelvic joints (lumbosacral, sacroiliac, and hip) become relatively closer together with increasing body size. CONCLUSIONS: A three-dimensional consideration of the articulated pelvis in anthropoids reveals determinants of pelvic variation not previously appreciated by studies of isolated hipbones. This study provides no support for the hypothesis that the ape pelvis is mediolaterally broader than that of monkeys in relative terms, as would be expected if iliac shape is related to hypothesized differences in thoracic breadth and shoulder orientation. Instead, apes, especially great apes, have relatively narrow sacra and longer lower pelves, related to their shorter, stiffer lumbar spines and torsos. This difference, coupled with strong positive allometry of iliac breadth and negative allometry of key pelvic lengths, along with some variation in ischial morphology in certain taxa, explains much of the variation in pelvic form among anthropoid primates.

Participation, representation, and shared experiences of women scholars in biological anthropology.

American Association of Physical Anthropologists (AAPA) membership surveys from 1996 and 1998 revealed significant gender disparities in academic status. A 2014 follow-up survey showed that gender equality had improved, particularly with respect to the number of women in tenure-stream positions. However, although women comprised 70% of AAPA membership at that time, the percentage of women full professors remained low. Here, we continue to consider the status of women in biological anthropology by examining the representation of women through a quantitative analysis of their participation in annual meetings of the AAPA during the past 20 years. We also review the programmatic goals of the AAPA Committee on Diversity Women's Initiative (COD-WIN) and provide survey results of women who participated in COD-WIN professional development workshops. Finally, we examine the diversity of women's career paths through the personal narratives of 14 women biological anthropologists spanning all ranks from graduate student to Professor Emeritus. We find that over the past 20 years, the percentage of women first authors of invited symposia talks has increased, particularly in the sub-disciplines of bioarchaeology, genetics, and paleoanthropology. The percentage of women first authors on contributed talks and posters has also increased. However, these observed increases are still lower than expected given the percentage of graduate student women and women at the rank of assistant and associate professor. The personal narratives highlight first-hand the impact of mentoring on career trajectory, the challenges of achieving work-life satisfaction, and resilience in the face of the unexpected. We end with some suggestions for how to continue to improve equality and equity for women in biological anthropology.

Determinants of Iliac Blade Orientation in Anthropoid Primates.

Orientation of the iliac blades is a key feature that appears to distinguish extant apes from monkeys. Iliac morphology is hypothesized to reflect variation in thoracic shape that, in turn, reflects adaptations for shoulder and forearm function in anthropoids. Iliac orientation is traditionally measured relative to the acetabulum, whereas functional explanations pertain to its orientation relative to the cardinal anatomical planes. We investigated iliac orientation relative to a median plane using digital models of hipbones registered to landmark data from articulated pelves. We fit planes to the iliac surfaces, midline, and acetabulum, and investigated linear metrics that characterize geometric relationships of the iliac margins. Our results demonstrate that extant hominoid ilia are not rotated into a coronal plane from a more sagittal position in basal apes and monkeys but that the apparent rotation is the result of geometric changes within the ilia. The whole ilium and its gluteal surface are more coronally oriented in apes, but apes and monkeys do not differ in orientation of the iliac fossa. The angular differences in the whole blade and gluteal surface primarily reflect a narrower iliac tuberosity set closer to the midline in extant apes, reflecting a decrease in erector spinae muscle mass associated with stiffening of the lumbar spine. Mediolateral breadth across the ventral dorsal iliac spines is only slightly greater in extant apes than in monkeys. These results demonstrate that spinal musculature and mobility have a more significant effect on pelvic morphology than does shoulder orientation, as had been previously hypothesized. Anat Rec, 300:810-827, 2017. © 2017 Wiley Periodicals, Inc.

Morphological variation in Homo erectus and the origins of developmental plasticity.

Homo erectus was the first hominin to exhibit extensive range expansion. This extraordinary departure from Africa, especially into more temperate climates of Eurasia, has been variously related to technological, energetic and foraging shifts. The temporal and regional anatomical variation in H. erectus suggests that a high level of developmental plasticity, a key factor in the ability of H. sapiens to occupy a variety of habitats, may also have been present in H. erectus. Developmental plasticity, the ability to modify development in response to environmental conditions, results in differences in size, shape and dimorphism across populations that relate in part to levels of resource sufficiency and extrinsic mortality. These differences predict not only regional variations but also overall smaller adult sizes and lower levels of dimorphism in instances of resource scarcity and high predator load. We consider the metric variation in 35 human and non-human primate 'populations' from known environmental contexts and 14 time- and space-restricted paleodemes of H. erectus and other fossil Homo Human and non-human primates exhibit more similar patterns of variation than expected, with plasticity evident, but in differing patterns by sex across populations. The fossil samples show less evidence of variation than expected, although H. erectus varies more than Neandertals.This article is part of the themed issue 'Major transitions in human evolution'.

Vertebral numbers and human evolution.

Ever since Tyson (1699), anatomists have noted and compared differences in the regional numbers of vertebrae among humans and other hominoids. Subsequent workers interpreted these differences in phylogenetic, functional, and behavioral frameworks and speculated on the history of vertebral numbers during human evolution. Even in a modern phylogenetic framework and with greatly expanded sample sizes of hominoid species, researchers' conclusions vary drastically, positing that hominins evolved from either a "long-backed" (numerically long lumbar column) or a "short-backed" (numerically short lumbar column) ancestor. We show that these disparate interpretations are due in part to the use of different criteria for what defines a lumbar vertebra, but argue that, regardless of which lumbar definition is used, hominins are similar to their great ape relatives in possessing a short trunk, a rare occurrence in mammals and one that defines the clade Hominoidea. Furthermore, we address the recent claim that the early hominin thoracolumbar configuration is not distinct from that of modern humans and conclude that early hominins show evidence of "cranial shifting," which might explain the anomalous morphology of several early hominin fossils. Finally, we evaluate the competing hypotheses on numbers of vertebrae and argue that the current data support a hominin ancestor with an African ape-like short trunk and lower back.

Evaluation and management of greater trochanter pain syndrome.

Greater trochanteric pain syndrome is an enigmatic but common cause of lateral hip symptoms in middle-aged active women. The most common manifestation of this syndrome is a degenerative tendinopathy of the hip abductors similar to the intrinsic changes seen with rotator cuff pathology in the shoulder. There are no definitive tests to isolate the underlying pathology and palpation is a non-specific means by which to differentiate the source of the pain generator. The physical examination must comprehensively evaluate for a cluster of potential impairments and contributing factors that will need to be addressed to effectively manage the likely functional limitations and activity challenges the syndrome presents to the patient. Compressive forces through increased tension in the iliotibial band should be avoided. Intervention strategies should include education regarding postural avoidance, activity modifications, improvement of lumbopelvic control, and a patient approach to resolving hip joint restrictions and restoring the tensile capabilities of the deep rotators and abductors of the hip. A number of reliable and validated hip-specific self-report outcome tools are available to baseline a patient's status and monitor their progress. Further investigations to identify the epidemiological risk factors, establish effective treatment strategies, and predict prognosis are warranted.

Factors that impact rehabilitation strategies after rotator cuff repair.

Multiple factors influence rehabilitation strategies after rotator cuff repair. These variables may also impact the overall success of the surgical intervention. Physicians and rehabilitation specialists should be aware of prognostic indicators that can provide therapeutic guidance and offer insights into eventual clinical outcomes. The success of surgical and rehabilitative interventions is often evaluated in terms of patient-reported outcome measures, return to activity, and pain. Although these factors are somewhat interdependent, each of them independently influences the final result. This article presents a comprehensive overview of the recent literature in this area to provide insight as to the short- and long-term outcomes that patients should expect based on their unique presentations. This article examines both intrinsic and extrinsic patient factors to help therapists develop customized rehabilitation programs that optimize surgical outcomes.

Post-traumatic stress disorder (PTSD) treatment experience in Bedford East - audit and reaudit.

Post-traumatic stress disorder (PTSD) can develop following exposure to a stressful event of an exceptionally threatening or catastrophic nature. Symptoms experienced by PTSD suffers can include re-experiencing the trauma through intrusive 'flashbacks' and recurrent dreams or nightmares, avoidance of stimuli associated with the stressor, hyperarousal, emotional blunting and an inability to remember aspects of the period of exposure to the stressor. We performed an audit of the treatment of PTSD in patients under the care of the Bedford East Mental Health Team to examine the psychological and pharmacological treatments currently being used and compared these with data collected in 2008. In summary, in the last 2 years there has been an increase in the identification of PTSD patients in Bedford East. These patients are a group with high levels of comorbidities and risk factors, and are challenging to treat. As a result of this, a wide range of agents including antidepressants with augementation, mood stabilizers and antipsychotic agents are used in their treatment, many of which are outside of NICE guidelines. There appears to be less availability of psychological therapy in these patients than we would expect. We discuss reasons for this and suggest possible solutions.