High-resolution three-dimensional micro-computed tomography assessment of micro-architectural patterns in non-adults with cribra orbitalia: Correlation between macro- and micro-scale bone features.

Skeletal porous lesions such as cribra orbitalia (CO) have long been of interest to bioanthropologists worldwide, mainly due to their high prevalence in osteological material. Previous studies considered CO as an external morphological manifestation, and therefore, research has mainly focused on visible (macroscopic) CO patterns. However, the understanding of CO-induced micro-scale bone changes is still scarce. Therefore, we performed high-resolution micro-computed tomography imaging to investigate three-dimensional CO-induced micro-architectural patterns in non-adults, with a particular focus on the correlation between macroscopic and micro-architectural orbital features. Cortical and trabecular micro-architectural changes in the orbital roof were analyzed in non-adults younger than 15 years, using orbital roof samples with and without macroscopic traces of CO (n = 28). A widely accepted five-grade macroscopic CO scoring system was applied to analyze CO severity. Areas affected with CO (area 1) and areas without macroscopic CO traces (area 2) were analyzed separately. The conducted high-resolution analysis showed that cortical and trabecular micro-architecture varied with CO presence, lesion severity (CO grade), and the analyzed area. Inter-grade comparisons suggested that most of the analyzed micro-architectural parameters were not significantly different between adjacent CO grades. Based on the micro-architectural evaluation of areas 1 and 2, the porous lesions were much more extensive than revealed by gross examination. In addition, micro-architectural differences were particularly pronounced in younger non-adults. In summary, our pilot study suggests that the macroscopic examination of CO reflects only the tip of the iceberg, as the micro-architectural changes seem to be much larger than macroscopically identified. RESEARCH HIGHLIGHTS: Cribra orbitalia (CO) represents orbital porous lesions. A high-resolution microscopic assessment of CO-induced changes in non-adults was done by micro-computed tomography. The microarchitecture was affected by CO presence, CO grade, area, and age.

Testing of Different Scanning Protocols Used for Precise 3D-printing of Mandibular Models.

Multidetector computed tomography (MDCT) is often necessary to manufacture 3D-printed medical models (MMs) required for mandibular restoration due to trauma or malignant tumor. Although cone-beam computed tomography (CBCT) is a preferable method of mandibular imaging, additional scanning is often unjustified. To test whether a single radiologic protocol could be used for mandibular reconstructions, the human mandible was scanned with 6 MDCT and 2 CBCT protocols and later 3D-printed using a fused-deposition modelling technique. Then, we assessed linear measures on the mandible and compared them with MDCT/CBCT digital scans and 3D-printed MMs. Our data revealed that CBCT0.25 was the most precise protocol for manufacturing 3D-printed mandibular MMs, which is expected considering its voxel size. However, we noted that CBCT0.35 and Dental2.0H60s MDCT protocols were of comparable accuracy, indicating that this MDCT protocol could be a single radiologic protocol used to scan both donor and recipient regions required for mandibular reconstruction.

A microarchitectural assessment of the gluteal tuberosity suggests two possible patterns in entheseal changes.

OBJECTIVES: Macroscopic entheseal forms show two main features: predominant signs of bony formation or resorption. To understand the development of these forms, we investigated microarchitectural differences between the macroscopic proliferative and resorptive forms of the gluteus maximus enthesis. MATERIALS AND METHODS: The macromorphological analysis of entheseal changes (EC) was based on the Villotte, visual scoring system for fibrous entheses. Gluteal tuberosity specimens of different stages of Villote's system were harvested from 16 adult males derived from an archaeological context and scanned using microcomputed tomography. RESULTS: The microarchitectural analyzes of cortical bone demonstrated a trend of higher porosity in the resorptive compared to the proliferative phase in Stage B, whereas a 30% porosity reduction was detected in the resorptive compared to proliferative phase of Stage C. In terms of the trabecular bone between the resorptive and proliferative entheseal phases, there was a trend of increased connectivity density, whereas the structural model index decreased in B and increased in C. The assessment of the entire specimen showed an increase in porosity from the proliferative to the resorptive phase in the Stage B, in contrast to a decrease in the Stage C. DISCUSSION: The results suggest that from an initial flat entheses, two directions of EC development are possible: (a) a bony prominence may form and, subsequently, it is subjected to trabecularization of the cortical bone inside the prominence, such cortical trabecularization can lead to visible porosity on the cortical external surface; (b) the cortical bone defect may develop with the regular underlying cortical bone.

Extracting Cross-Sectional Clinical Images Based on Their Principal Axes of Inertia.

Cross-sectional imaging is considered the gold standard in diagnosing a range of diseases. However, despite its widespread use in clinical practice and research, no widely accepted method is available to reliably match cross-sectional planes in several consecutive scans. This deficiency can impede comparison between cross-sectional images and ultimately lead to misdiagnosis. Here, we propose and demonstrate a method for finding the same imaging plane in images obtained during separate scanning sessions. Our method is based on the reconstruction of a "virtual organ" from which arbitrary cross-sectional images can be extracted, independent of the axis orientation in the original scan or cut; the key is to establish unique body coordinates of the organ from its principal axes of inertia. To verify our method a series of tests were performed, and the same cross-sectional plane was successfully extracted. This new approach offers clinicians access, after just a single scanning session, to the morphology and structure of a lesion through cross-sectional images reconstructed along arbitrary axes. It also aids comparable detection of morphological and structural changes in the same imaging plane from scans of the same patient taken at different times-thus potentially reducing the misdiagnosis rate when cross-sectional images are interpreted.

Prognostic factors and outcomes of cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy in patients with advanced ovarian cancer - A single tertiary institution experience.

PURPOSE: Ovarian cancer (OC) ranks fifth in mortality among females cancer patients. Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) have radically changed the treatment of OC. The aim of this study was to evaluate overall survival (OS) and disease-free survival (DFS) in our patient population after the application of combined CRS and HIPEC treatment. METHODS: The study included patients who met defined inclusion and exclusion criteria and had undergone CRS of peritoneal carcinomatosis from 2006 to 2011. Tumor extension was intraoperatively calculated using peritoneal cancer index (PCI). After CRS had been performed, selected patients underwent closed HIPEC. Assessment of successful surgery was estimated with the completeness of cytoreduction score. RESULTS: The study involved 31 patients. The median DFS was 19 months. The DFS for 1 and 2-year period were 69.2 and 35.2%, respectively. The mean OS was 51 months. The 1-, 2- and 5-year OS was 85.4, 63.3 and 56.3%, respectively. PCI ranged from 1 to 24 and the majority (77.4%) of the patients had PCI score below 13. The most frequent carcinomatosis was observed in the omentum (80.6%), followed by adnexae (61.3%), uterus (58.1%), colon (58.1%). spleen (25.8%), diaphragm (25.8%), small intestine (19.4%), bursa omentalis 19.4, liver (9.7%), and pancreas (3.2%). CONCLUSION: The results of the current study are in concordance with the literature which clearly favors combined the CRS and HIPEC treatment. The reported data suggest that this method could be successfully applied in our region and outline the necessity of future multicentric studies that will involve major regional hospitals.

The role of CT analyses of the sternal end of the clavicle and the first costal cartilage in age estimation.

The ossification patterns of medial clavicle and the first costal cartilage represent interesting features of the same anatomical region which are accessible for conventional radiographic and computed tomography (CT) examinations in the same field of view. This study encompassed Serbian population and was carried out to examine whether CT analyses of medial clavicle and the first costal cartilage could be successfully applied, either individually or conjointly, in the age assessment. The study was based on CT examinations of thoracic region of 154 patients, aged between 15 and 35 years. Besides radiodensity and stages of epiphyseal cartilage ossification of medial clavicle, the study detected other features that expressed significant correlation with age, such as calculated anterior to posterior cortical thickness ratio, medullar canal diameter, and clavicular shaft diameter. However, although calculated ossified and calcified linear projections' (OCP) stages correlated to age, the distinction between stages was not satisfying. The interaction between the ossification status of medial clavicle and OCP was not significantly influenced by age. The results of our study outlined interesting new age predictors with mutual relationship: acquired radio density of the sternal epiphyseal-metaphyseal region and radio density of the first costal cartilage. Intersex variability was observed in several age-related features: calculated anterior to posterior cortical thickness ratio, diameter of medullar canal, and diameter of the clavicular shaft. Altogether, our study identified several radiological features of the first costal cartilage and medial clavicle that correlated with age and which could be applied as additional guidance for age estimation in each specific case.

Modeling of liver metastatic disease with applied drug therapy.

Colorectal carcinoma is acknowledged as the second leading cause of total cancer-related death in the European Region. The majority of deaths related to colorectal carcinoma are connected with liver metastatic disease. Approximately, in 25% of all patients, liver metastatic disease is diagnosed at the same time as the primary diagnosis, while up to a quarter of others would develop liver metastases in the course of the illness. In this study, we developed reaction-diffusion model and analyzed the effect of drug therapy on liver metastatic disease for a specific patient. Tumor volumes in specific time points were obtained using CT scan images. The nonlinear function for cell proliferation rate as well as data about clinically applied drug therapy was included in the model. Fitting procedure was used for parameter estimation. Good agreement of numerical and experimental results shows the feasibility and efficacy of the proposed system.

Dental age assessment validity of radiographic methods on Serbian children population.

In order to establish reliable age estimation method based on dental development, various correlations between chronological age and real growth were tested. Demirjian's scheme was mostly used, but lately the Willems' method has been found to be more reliable. The aim of this study was to evaluate the accuracy of Demirjian's and Willems' methods for dental age estimation in Serbian children population. The study sample encompassed panoramic radiographs of 686 children (322 boys and 364 girls) with age range from 4 to 15 years. The dental age was assed using Demirjian's and Willems' maturity scores. Statistical analysis was performed to test the accuracy of investigated methods by comparing the mean chronological and mean estimated age in total sample, as well as in each group comprising individuals within one-year-age-interval. Both methods showed discrepancy between obtained and chronological age. The Demirjian's method overestimated age with a mean accuracy of 0.45 in boys and 0.42 in girls, while Willems' method showed lower discrepancy (0.12 and 0.16 in boys and girls, respectively). Overall, both methods were unsatisfactory in some age groups, however, Willems' method provided more accurate age estimation in majority of categories. In summary, our results suggest that Willem's method was more accurate for estimating dental age in contemporary Serbian children population.

Skeletal age estimation based on medial clavicle--a test of the method reliability.

In order to establish a reliable age indicator in the period when all other epiphyseal age indicators have already been inactivated, medial clavicle as the bone with the longest period of growth became the object of various investigations. However, the lack of population-specific method often made it unreliable in some regions. The current study involved a Balkan population and it was designed in order to examine whether morphological, radiological, and histological analyses of medial clavicles could be applied with success in age assessment of individuals beyond their twenties in anthropological and forensic practice. The medial clavicular specimens were collected from contemporary Serbian population, autopsied in the period from 1998 to 2001, encompassing 67 individuals (42 males and 25 females) with the age range from 20 to 90 years. The conducted analyses of morphological features identified the epiphyseal union timing, signs of lipping in the region of the notch for the first rib as well as exostoses and bone overgrowths of the articular surface margin as age-dependent attributes. Trabecular bone volume fraction and minimum trabecular width were also highlighted as age-distinctive microscopic features. Sex difference was ascertainable in epiphyseal union timing, morphology of the notch for the first rib, margin of the articular surface, and basic morphology of articular surface as well as in two microscopic characteristics: trabecular bone volume fraction and minimum trabecular width. The study managed to identify several age- and sex-related features that could be applied as additional guidance for age estimation in Serbian population.

Dental status of victims from Batajnica's mass graves.

The aim of this paper is to present the post mortem dental evidence and dental health of the victims interred during 1999 in five grave pits at Batajnica near Belgrade. The investigated sample comprised 32 individuals with only maxillae preserved, 80 with mandible, and 260 individuals with both jaws. We have found high degree of enamel hypoplasia (25.89%), frequent signs of the severe forms of periodontal disease (18.55%), very high percent of antemortem tooth loss (31.48%), and evidence of edentate jaws in an early age of individuals. Amalgam was predominant material for tooth fillings; implants and non-metal ceramic crowns were not found, and three quarters of edentate individuals were found with full prostetic dentures. Despite the detailed postmortem dental analysis, antemortem dental charts were not collected. These individuals were identified by other forensic methods.