Trend of cerebral aneurysms over the past two centuries: need for early screening.

OBJECTIVE: Cerebral aneurysms (CAs) are linked to variations in the cerebral basal arterial network (CBAN). This study aimed to find the optimal age for screening to detect brain arterial variations and predict aneurysms before rupture. DESIGN: An observational, quantitative and retrospective research. SETTING: The study analysed 1127 cases of CAs published from 1761 to 1938. Additionally, CT angiography images of 173-patients at the Royal Adelaide Hospital (RAH), South Australia between 2011 and 2019 were examined for the presence and the location of aneurysms in CBAN. PARTICIPANTS: The data were collected from patients at RAH and 407 published sources, including males and females across the entire age range, up to 100 years old. OUTCOME MEASURES AND RESULTS: Data, CAs cases, from 1761 to 1938 included (526 males, 573 females and 28 unknown sexes). The age of these patients varied from 18 months to 89 years (mean age=42, SD=18). Approximately 11.5% of the CAs occurred in patients aged <20 years. Among the 1078 aneurysms whose location was reported, 76% were located in the internal carotid (IC), middle cerebral (MC) and anterior communicating artery complex (AcomAC) regions, while the remaining 24% were in the vertebrobasilar region. Among 173 patients from RAH aged between 18 and 100 years (male=83 and female=90, mean age=60, SD=16), 94% of the CAs were found in the IC, MC and AcomAC regions. The pattern of aneurysm occurrence, as indicated by values at the 25th, 50th and 75th percentiles, along with the minimum and maximum patient ages, has remained consistent from 1761 to 2019. CONCLUSION: The distribution pattern of CAs in relation to sex, age and locations in the CBAN, remained steady over the last 260 years resulting in risk of strokes early in life. Therefore, early screening for CBAN segment variations is advised for stroke prevention if possible.

The Oral Health of a Group of 19th Century South Australian Settlers in Relation to Their General Health and Compared with That of Contemporaneous Samples.

The aims of this study are to determine the oral health status of a rare sample of 19th-century migrant settlers to South Australia, how oral conditions may have influenced their general health, and how the oral health of this group compares with contemporaneous samples in Australia, New Zealand, and Britain. Dentitions of 18 adults and 22 subadults were investigated using non-destructive methods (micro-CT, macroscopic, radiographic). Extensive carious lesions were identified in seventeen adults and four subadults, and from this group one subadult and sixteen adults had antemortem tooth loss. Sixteen adults showed evidence of periodontal disease. Enamel hypoplastic (EH) defects were identified in fourteen adults and nine subadults. Many individuals with dental defects also had skeletal signs of comorbidities. South Australian individuals had the same percentage of carious lesions as the British sample (53%), more than other historic Australian samples, but less than a contemporary New Zealand sample. Over 50% of individuals from all the historic cemeteries had EH defects, suggesting systemic health insults during dental development were common during the 19th century. The overall oral health of the South Australian settlers was poor but, in some categories, (tooth wear, periapical abscess, periodontal disease), better than the other historic samples.

Gross anatomy of the gluteal and posterior thigh muscles in koalas based on their innervations.

Morphological and functional comparison of convergently-evolved traits in marsupials and eutherians is an important aspect of studying adaptive divergence in mammals. However, the anatomy of marsupials has been particularly difficult to evaluate for multiple reasons. First, previous studies on marsupial anatomy are often uniformly old and non-exhaustive. Second, muscle identification was historically based on muscle attachment sites, but attachment sites have since been declared insufficient for muscle identification due to extensive interspecific variation. For example, different names have been used for muscles that are now thought to be equivalent among several different species, which causes confusion. Therefore, descriptions of marsupial muscles have been inconsistent among previous studies, and their anatomical knowledge itself needs updating. In this study, the koala was selected as the representative marsupial, in part because koala locomotion may comprise primate (eutherian)-like and marsupial-like mechanics, making it an interesting phylogenetic group for studying adaptive divergence in mammals. Gross dissection of the lower limb muscles (the gluteal and the posterior thigh regions) was performed to permit precise muscle identification. We first resolved discrepancies among previous studies by identifying muscles according to their innervation; this recent, more reliable technique is based on the ontogenetic origin of the muscle, and it allows for comparison with other taxa (i.e., eutherians). We compared our findings with those of other marsupials and arboreal primates and identified traits common to both arboreal primates and marsupials as well as muscle morphological features unique to koalas.

Was it worth migrating to the new British industrial colony of South Australia? Evidence from skeletal pathologies and historic records of a sample of 19th-century settlers.

OBJECTIVES: To examine pathological evidence present in a sample of 19th -century settlers to South Australia in the context of an early industrial society. MATERIALS: Skeletal remains of 20 adults and 45 nonadults from the government funded burial site (free ground) of St Mary's Anglican Church Cemetery, gravestones of privately funded burials and local parish records. METHODS: Investigation of pathological manifestations of skeletal remains, church records and historic literature. Comparison with similar samples from Britain and from New South Wales. RESULTS: Joint disease seen in 35% of adults. Porosity in bone cortices indicative of vitamin C deficiency seen in 32% of the total sample and porous lesions in the orbit (cribra orbitalia) in 7% of nonadults. Traumatic fractures identified in two adult males. Gastrointestinal conditions were the leading cause of death for nonadults, most adults died of pulmonary conditions. Life expectancy of people buried at the expense of the government was 23.8-42.6 years, those in private burials 57.1 years. CONCLUSION: Health of migrant settlers from the St Mary's free ground did not differ much from that of a similar population in Britain nor of settlers in New South Wales. Thus, it is characteristic for lower socioeconomic groups in early industrialised societies. SIGNIFICANCE: St Mary's sample is a rarity due scarcity of similar Australian skeletal samples. LIMITATIONS: Small sample size and lack of similar samples for comparison. SUGGESTIONS FOR FURTHER RESEARCH: Comprehensive investigation of dentitions in St Mary's sample and studies of more skeletal samples of early settlers in other Australian locations.

Health effects of European colonization: An investigation of skeletal remains from 19th to early 20th century migrant settlers in South Australia.

The British colony of South Australia, established in 1836, offered a fresh start to migrants hoping for a better life. A cohort of settlers buried in a section of St Mary's Anglican Church Cemetery (1847-1927) allocated for government funded burials was investigated to determine their health, with a focus on skeletal manifestations associated with metabolic deficiencies. Findings of St Mary's sample were compared with those published for contemporary skeletal samples from two British cemeteries, St Martin's, Birmingham, and St Peter's, Wolverhampton, to explore similarities and differences. To investigate the changing economic background of the St Mary's cohort, which may have influenced the location of their burial within the cemetery, the number and demographic profile of government funded burials and those in privately funded leased plots were compared. The study sample consisted of the skeletal remains of 65 individuals (20 adults, 45 subadults) from St Mary's Cemetery 'free ground' section. The bones and teeth of individuals in this cohort showed evidence of pathological manifestations, including areas of abnormal porosity in bone cortices in 9 adults and 12 subadults and flaring of metaphyses (one subadult) and costochondral junctions of the ribs (one subadult). Porous lesions of orbital roof bones (Types 3 to 4) were seen on three subadults. Macroscopic examination of teeth identified enamel hypoplastic defects and micro-CT scans showed areas of interglobular dentine. Comparison of St Mary's findings with the British samples revealed that prevalences of manifestations associated with vitamin C deficiency were higher at St Mary's and manifestations associated with vitamin D deficiency were lower respectively. The location of burial pattern at St Mary's Cemetery, from the mid-1840s to1860s, showed differences in the economic status of migrants. This pattern changed from the 1870s, which reflected improvements in the local economy and the economic recovery of the colony.

The role of microglia in neuropsychiatric disorders and suicide.

This narrative review examines the possible role of microglial cells, first, in neuroinflammation and, second, in schizophrenia, depression, and suicide. Recent research on the interactions between microglia, astrocytes and neurons and their involvement in pathophysiological processes of neuropsychiatric disorders is presented. This review focuses on results from postmortem, positron emission tomography (PET) imaging studies, and animal models of schizophrenia and depression. Third, the effects of antipsychotic and antidepressant drug therapy, and of electroconvulsive therapy on microglial cells are explored and the upcoming development of therapeutic drugs targeting microglia is described. Finally, there is a discussion on the role of microglia in the evolutionary progression of human lineage. This view may contribute to a new understanding of neuropsychiatric disorders.

Relationship between cerebral aneurysms and variations in cerebral basal arterial network: a morphometric cross-sectional study in Computed Tomography Angiograms from a neurointerventional unit.

OBJECTIVE: Segments of cerebral basal arterial network (CBAN) dampen the peak pressure in blood flowing through these arteries, thus minimising the chances of development of cerebral aneurysms. The objective of this research was to find the relationship of occurrence of intracranial aneurysms to variations of the components of the CBAN. DESIGN AND SETTING: This is an observational, quantitative and retrospective research, which used cerebral CT angiography (CCTA) images. PARTICIPANTS: Cerebral CTA of 145 adult patients of both sexes were studied. MAIN OUTCOME MEASURES: Diameters of segments of CBAN were measured in CCTA images and the relative size of each vessel was calculated to standardise for differences in overall arterial sizes among patients. Relationships among sizes of CBAN components were analysed. Presence of aneurysms in different parts of the CBAN was recorded. RESULTS: Forty-six aneurysms in right internal carotid artery (ICA) and middle cerebral artery (MCA) and 32 aneurysms in left ICA and MCA segments were noted in 42 and 30 patients, respectively. Aneurysms in anterior communicating artery complex and vertebral-basilar arterial segments were seen in 27 and 8 patients, respectively, while they were not detected in parts of posterior cerebral artery (PCA). The significant (p<0.001) inverse relationships between sizes of posterior communicating artery and the first segment of PCA on both sides indicated that blood inputs to the second part of PCA were similar. Difference in means of the index of arterial size variation for people with aneurysms (mean 0.96, SD 0.23) and without aneurysms (mean 0.86, SD 0.22) was significant (p=0.015). CONCLUSION: Variation in segments of CBAN was quantified. The peak pressure dampening mechanism in such arterial segments reduces the chances of development of aneurysms.

Recently increased prevalence of the human median artery of the forearm: A microevolutionary change.

The median artery has been considered as an embryonic structure, which normally regresses around the 8th week of gestation. However, various prevalences have been reported in adults since the 18th century. Furthermore, in a study by Henneberg and George (1995; Am J Phys Anthropol 96, 329-334), has suggested that increasing prevalence of the median artery during the 20th century was a 'possible secular trend'. The present study, conducted nearly a quarter of a century later, is a continuation of that study. A total of 26 median arteries were found in 78 upper limbs obtained from Australians aged 51 to 101 years, who died in the period 2015-2016, a prevalence rate of 33.3%. Analysis of the literature showed that the presence of the median artery has been significantly increasing (p = .001) over time, from approximately 10% in people born in the mid-1880s to approximately 30% by the end of the 20th century. The significance of the prevalence increased to a p value <.0001, when the results of the present study and other studies conducted by our research team were combined. After removal of the studies that were possibly biased, because of their specific focus on the evolutionary aspects of the median artery, the significance remained at p = .018. The present study provides an example of microevolutionary changes in the internal anatomy of the human body. Second-order polynomial regression of the median artery's prevalence on dates of birth shows that it is now present in 35% of people and predicts that people born 80 years from now will all carry a median artery if the trend continues. When the median artery prevalence reaches 50% or more, it should not be considered as a variant, but as a 'normal' human structure.

Quantifying asymmetry of anterior cerebral arteries as a predictor of anterior communicating artery complex aneurysm.

OBJECTIVES: The aim of this study was to establish an anatomical index for early prediction of the risk of development of aneurysms in anterior communicating arterial complex (AcomAC). The asymmetric diameter of one anterior cerebral artery (ACA) to other could alter haemodynamics and may contribute to formation of aneurysms in AcomAC and be a reliable predictor of the risk of development of aneurysms. DESIGN AND SETTING: This is a retrospective, observational and quantitative study, which used cerebral computed tomography angiography (CCTA) scans in South Australia. PARTICIPANTS: CCTA scans of 166 adult patients of both sexes were studied. MAIN OUTCOME MEASURES: The internal diameters of the proximal segments of ACAs (A1s) were measured. Position and presence or absence of aneurysms in AcomAC were determined. The ratio of A1 diameters was taken as a measure of A1 asymmetry. RESULTS: The ratio of diameters of A1s correlated with the occurrence of AcomAC aneurysms. The risk of development of aneurysms in AcomAC was much greater (80%, OR=47.3) when one A1 segment's radius was at least 50% larger (ie, 2.25 times cross-sectional area) than the other. CONCLUSION: The general information on asymmetric A1 has been published previously. The present findings have significant contribution since the A1s asymmetry ratios have been categorised in ascending order and matched with the presence of AcomAC aneurysms. The asymmetry ratio of the A1 is a good predictor for the development of AcomAC aneurysms. Reconstruction of the asymmetric A1 could be done if the technology gets advanced.

Asymmetries of total arterial supply of cerebral hemispheres do not exist.

BACKGROUND: Total blood supply to an organ, or its part, is proportional to its function. The aim of this project was to investigate whether there is a lateralisation of total functions of cerebral hemispheres by determining differences in the arterial blood supply to left and right cerebral hemispheres. METHODS: Diameters of right and left anterior, middle and posterior cerebral arteries were measured at specific sites and cross-sectional areas calculated in 203 adult brains (51 donated and dissected brain specimens and 152 cerebral arterial Computed Tomography Angiography and Magnetic Resonance Angiography images). FINDINGS: The sample size was large enough to provide a power of detecting as significant differences of 4%, but neither of the average cross-sectional areas of right anterior, middle and posterior cerebral arteries were significantly different from those of the anterior, middle and posterior cerebral arteries of the left side. Furthermore, combined areas of the three right cerebral arteries were not significantly different from combined areas of the left three arteries. This clearly indicates that the blood supply into the right cerebral hemisphere is not different from that of the left cerebral hemisphere. Therefore, there is no total functional lateralisation between the two cerebral hemispheres. CONCLUSION: Brain lateralisation, frequently discussed in the literature, does not deferentially influence the total activity levels of cerebral hemispheres.

Neuro-hormonal Regulation Is a Better Indicator of Human Cognitive Abilities Than Brain Anatomy: The Need for a New Paradigm.

Human intelligence has been theorized since the ancient Greeks. Plato and Aristotle incorporated theories of human intelligence into their metaphysical and cosmological theories which informed the social and medical sciences for centuries. With the advent of the 20th century, human intelligence became increasingly standardized based on Intelligence Quotients (IQ). Moreover, multiple theories of human intelligence were posited on morphological features of the human brain, focusing on cranial volume and size of the pre-frontal cortex which was suggestive of superior human cognitive abilities. This article argues that fixation with anatomical features of the brain was tended to ignore the importance of neuro-hormonal regulation which is a more appropriate indicator of human cognitive abilities. The article challenges the correlation between brain size and human cognitive abilities while offering an alternate theory of human cognitive abilities which emphasizes the roles of neurotransmitters, neurotrophins, and enteric gut microbiome (EGM) regulation.

Comparison of porcine organs and commonly used ballistic simulants when subjected to impact from steel spheres fired at supersonic velocities.

Firearm injuries are common in the world today, in both military and civilian settings. Research into the effects different ammunition has on the human body has been conducted using tissue simulants such as Ballistics Ordnance Gelatine. Previous research has found that with low velocity projectiles, the tissue simulants only represent a selected few organs, as the human body and its organs/tissues are not homogeneous. The aim of this research was to determine which ballistic simulants best represent the abdomen and thorax, for the purposes of anatomical modelling. A mounted firearm was used to fire specially made ammunition containing a sabot and steel spherical projectile at medium (∼500m/s) and high (∼900m/s) velocities. Test specimens of 50mm cube porcine tissues (lung, liver, kidney and heart) and ballistics simulants (20% and 10% Ballistics Gelatine and Clear Gel) were shot at and the energy loss determined using Doppler radar, optical infra-red sighting screens and high speed video. This study determined that the conclusions drawn from studies in these tissue simulants may not be an accurate representation of what occurs in human tissues and that different impact velocities produce differing results. New simulants are required to better represent the energy loss of a projectile through the organs of the abdomen and thorax and the results of this study may guide this development. Further experiments will be required to determine different concentrations of gelatine and their accuracy at representing the heterogeneous nature organs of the human body.

Variability of characteristics of cranial projectile trauma in skeletal material.

ABSTRACT: In cranial firearm trauma, where soft tissues have decomposed, determining the manner of death can pose difficultly for a forensic anthropologist. Detailed analysis of skeletal wounds may lead to reconstruction of the events surrounding death, however considerable research has been conducted on soft tissue details and less has focused on skeletal wounds alone. Macroscopic descriptive observations were carried out on thirteen skulls from the Hamman-Todd Human Osteological Collection at the Cleveland Museum of Natural History, Ohio which had documented cranial projectile trauma to analyse wound location, shape, size, beveling and projectile paths. This sample of skeletons provides a non-arbitrary selection of individuals which were unclaimed bodies from a disturbed social environment. Nine entry wounds were located on the right side of the skull, 3 located on left side of skull and one had entry under the right side of the skull. Entry wounds were often oval or round in shape. Exit wounds were not present in all cases; however, when present they were of irregular shape. Radiating fractures occurred in 8 entry wounds and 8 exit wounds. Concentric fractures accompanied 3 exit wounds. Three entry wounds had clear internal beveling. Three cases had exit wounds with external beveling. One showed signs of combination beveling on the entry wound. Beveling, if present, can lead to identifying the entry/exit wound. Radiating fractures form when the intracranial pressure is too great and if the pressure is not relieved, concentric fractures form secondarily. Based on the characteristics of the cranial projectile trauma one can suggest manner of death, however, it is not possible to reach a firm decision.

A Histological Analysis of Visceral Organs to Evaluate the Effect of Duration of Heating From Refrigeration to Core Body Temperature for Ballistics Investigations.

Animal organs have been used in ballistics research to investigate the effects on human organs. Such organs are refrigerated until the investigation to minimize autolytic degradation and at times have been reheated to the human core body temperature to simulate the in situ environment. The aim of this investigation was to study the microstructural changes that may occur in fresh chilled visceral organs of the thorax and abdomen (ie, heart, lung, liver, and kidney) during the period of reheating to 37°C. Fifty-millimeter cubes of porcine heart, lung, liver, and kidney were taken rapidly after slaughter, chilled overnight, and the next morning were reheated to core body temperature (37°C). Histological changes occurring in the tissues during the reheating phase were investigated. The findings indicated that no cytoplasmic or nuclear changes occurred in any of the tissues during the period of reheating. Therefore, reheating of animal organs to the human core body temperature is not necessary, if the organs are refrigerated.

The cerebral basal arterial network: morphometry of inflow and outflow components.

The aim of this project was to study how the morphology of the incoming and outgoing arterial components of the cerebral basal arterial network influence the blood flow to the brain. The cerebral basal arterial network consists of the circulus arteriosus cerebri anteriorly and the basilar artery posteriorly. Diameters of inflow vessels (bilateral vertebral and internal carotid arteries), connecting vessels (anterior communicating, basilar and bilateral posterior communicating arteries) and outflow vessels (anterior, middle and posterior cerebral arteries) were measured and cross-sectional areas calculated in 51 cadaveric brain specimens. The individual and the average cross-sectional areas of inflow arteries (51.43 mm2 ) were significantly bigger than the major outflow arteries (37.76 mm2 ) but smaller than the combined cross-sectional areas of outflow (37.76 mm2 ) and connecting (25.33 mm2 ) arteries. The difference in the size of arterial cross-sectional area and the presence of the connecting arteries in the cerebral basal arterial network provides a mechanism for lowering peaks in pressure, and demonstrates a function of the cerebral basal arterial network.

Effects of Re-heating Tissue Samples to Core Body Temperature on High-Velocity Ballistic Projectile-tissue Interactions.

Damage produced by high-speed projectiles on organic tissue will depend on the physical properties of the tissues. Conditioning organic tissue samples to human core body temperature (37°C) prior to conducting ballistic experiments enables their behavior to closely mimic that of living tissues. To minimize autolytic changes after death, the tissues are refrigerated soon after their removal from the body and re-heated to 37°C prior to testing. This research investigates whether heating 50-mm-cube samples of porcine liver, kidney, and heart to 37°C for varying durations (maximum 7 h) can affect the penetration response of a high-speed, steel sphere projectile. Longer conditioning times for heart and liver resulted in a slight loss of velocity/energy of the projectile, but the reverse effect occurred for the kidney. Possible reasons for these trends include autolytic changes causing softening (heart and liver) and dehydration causing an increase in density (kidney).

Characteristics of Bone Injuries Resulting from Knife Wounds Incised with Different Forces.

The aim of this research was to experimentally determine the characteristics of incised bone wounds, which are commonly found in defense injuries. A specially constructed pivoting arm device was used to inflict wounds with controlled forces and direction. Five knives were selected to inflict the wounds on porcine forelimbs. Eight incised wounds were made per knife per force. A larger knife and a greater force caused longer and wider bone wounds. Comparisons of individual knives at the two forces produced varying results in the bone wounds. A correlation was seen between the force and the length (r = 0.69), width (r = 0.63), and depth (r = 0.57) of bone wounds. Serrated-edge and nonserrated knives can be distinguished from the appearance of the wound. The outcomes may be applicable in forensic investigations to ascertain the forces associated with incised wounds and identify the specific knife used.

Ballistics and anatomical modelling - A review.

Ballistics is the study of a projectiles motion and can be broken down into four stages: internal, intermediate, external and terminal ballistics. The study of the effects a projectile has on a living tissue is referred to as wound ballistics and falls within terminal ballistics. To understand the effects a projectile has on living tissues the mechanisms of wounding need to be understood. These include the permanent and temporary cavities, energy, yawing, tumbling and fragmenting. Much ballistics research has been conducted including using cadavers, animal models and simulants such as ballistics ordnance gelatine. Further research is being conducted into developing anatomical, 3D, experimental and computational models. However, these models need to accurately represent the human body and its heterogeneous nature which involves understanding the biomechanical properties of the different tissues and organs. Further research is needed to accurately represent the human tissues with simulants and is slowly being conducted.