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1.
Forensic Sci Int ; 306: 110092, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31816484

RESUMO

Metric assessment of human crania can provide forensic practitioners and anthropological researchers with information on an individual's sex and biogeographical ancestry. However, metric methods rely on the ability of users to remain consistent with themselves and others, with any error in the data rendering conclusions invalid. Digital anthropology is a growing sub-field where human remains are digitised using a growing range of methods and technologies. These models have the potential to boost research collaboration and public engagement. However, not all of these digitisation methods have been examined critically to explore the veracity of their use within a research environment. There has also been limited research into the application of digital anthropology to craniometric analysis. This study examined the intra- and inter- observer variation of seven participants taking physical measurements from a human cranial cast with an associated set of reference values. The same measurements were also taken from three digital models of the cranial cast which were created using digital photogrammetry and laser scanning. This data was then compared to the reference values and the physical measurements taken by the lead author. This study found that there was excellent statistical agreement between the reference values and the measurements taken from the cranial cast, both physical and digital. However, the participants still exhibited variation within a range of -18mm and +30mm from the reference values. MANOVA tests showed between-subject effects on nine measurements across the participant data, and 12 measurements between the digital models. However, there is little consistency between this study and the anthropological literature as to which measurements are most prone to between-subject effects. Despite the excellent agreement shown between the reference values and the digital models this study raises a number of methodological questions regarding inter-observer error and the varying levels of data processing present in different digitisation methods.


Assuntos
Cefalometria/métodos , Simulação por Computador , Imagem Tridimensional , Crânio/anatomia & histologia , Crânio/diagnóstico por imagem , Antropologia Forense , Humanos , Lasers , Masculino , Variações Dependentes do Observador , Fotogrametria , Valores de Referência
3.
Dentomaxillofac Radiol ; 49(1): 20190240, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31530012

RESUMO

OBJECTIVES: To evaluate the impact of movement and motion-artefact correction systems on CBCT image quality and interpretability of simulated diagnostic tasks for aligned and lateral-offset detectors. METHODS: A human skull simulating three diagnostic tasks (implant planning in the anterior maxilla, implant planning in the left-side-mandible and mandibular molar furcation assessment in the right-side-mandible) was mounted on a robot performing six movement types. Four CBCT units were used: Cranex 3Dx (CRA), Ortophos SL (ORT), Promax 3D Mid (PRO), and X1. Protocols were tested with aligned (CRA, ORT, PRO, and X1) and lateral-offset (CRA and PRO) detectors and two motion-artefact correction systems (PRO and X1). Movements were performed at one moment-in-time (t1), for units with an aligned detector, and three moments-in-time (t1-first-half of the acquisition, t2-second-half, t3-both) for the units with a lateral-offset detector. 98 volumes were acquired. Images were scored by three observers, blinded to the unit and presence of movement, for motion-related stripe artefacts, overall unsharpness, and interpretability. Fleiss' κ was used to assess interobserver agreement. RESULTS: Interobserver agreement was substantial for all parameters (0.66-0.68). For aligned detectors, in all diagnostic tasks a motion-artefact correction system influenced image interpretability. For lateral-offset detectors, the interpretability varied according to the unit and moment-in-time, in which the movement was performed. PRO motion-artefact correction system was less effective for the offset detector than its aligned counterpart. CONCLUSION: Motion-artefact correction systems enhanced image quality and interpretability for units with aligned detectors but were less effective for those with lateral-offset detectors.


Assuntos
Movimento , Tomografia Computadorizada de Feixe Cônico Espiral , Artefatos , Humanos , Crânio/diagnóstico por imagem , Tomografia Computadorizada de Feixe Cônico Espiral/normas
4.
Acta Chir Orthop Traumatol Cech ; 86(5): 342-347, 2019.
Artigo em Tcheco | MEDLINE | ID: mdl-31748109

RESUMO

PURPOSE OF THE STUDY The aim of our study is to show the pitfalls of performing skull X-rays in patients with head injuries and the lack of accuracy of this examination nowadays, and to clarify the current trend in the MTBI investigation algorithm. MATERIAL AND METHODS A retrospective study of 3,950 patients treated for acute head injury at the Department of Trauma Surgery (University Hospital Brno) in the period from 2015 to 2016. Inclusion criteria were the following: mild brain injury (GCS = 15), primary skull X-ray design in head injury diagnosis. Patients with a positive skull X-ray finding underwent a head CT evaluation up to 24-hours from the injury except for the patients with an isolated nose bone fracture. A CT head scan was also performed in patients indicated by the neurologist at the initial examination based on the anamnestic data and an objective finding. RESULTS Inclusion criteria were met by 1,938 patients. In 1806 (93.2%) cases the X-ray was negative, in 132 (6.8%) patients the X-ray was positive, of which in 62% of patients a nasal fracture was detected. A skull fracture reported in 16 cases. Once the CT scan of the head was obtained, all of these cases were classified as false negative. After the CT scan of the head, intracranial bleeding was observed in 12 patients, in 4 cases accompanied by fractures of the skull, not visible on the X-ray images. After the statistical evaluation, the sensitivity and specificity of the X-ray examination compared to the CT scan of the head was determined to be 0.00 and 0.94, respectively. DISCUSSION The aim of MTBI diagnostics is primarily to detect serious intracranial lesions requiring neurosurgical intervention. A simple X-ray of the skull shows fractures only and does not allow to visualize both the brain and any traces of bleeding that would show an intracranial injury. Hofman, in his meta-analysis, points out that a simple X-ray image of the skull has only very little noticeable value when diagnosing MTBI. The prevalence of intracerebral hematoma (ICH) over MTBI is 0.083. The sensitivity of a radiographic finding of skull fracture in the diagnosis of ICH based on the CT verification is only 0.38 with a specificity of 0.95, which is consistent with our study where the sensitivity of the radiographic finding was 0.00 with a specificity of 0.94 relative to CT. Thus, the question is not whether to perform an X-ray of the skull in mild head injuries, but rather when to indicate a CT scan of the brain, when to admit the patient to the hospital for observation, and for how long or when the patient can be safely discharged into home care. The purpose of MTBI diagnostics, however, should not be a rashly decision to perform a brain CT scan, but to put into practice the CT indication criteria in MTBI applying and respecting the validated guidelines known worldwide. CONCLUSIONS Our study, in which no X-ray examination revealed possible intracranial bleeding, clearly shows that nowadays the plain radiograph of the skull does not bring any benefit in the diagnosis of minor traumatic brain injury. Key words:skull X-ray, CT of the head, head injury, minor traumatic brain injury.


Assuntos
Encéfalo/diagnóstico por imagem , Traumatismos Craniocerebrais/diagnóstico por imagem , Fraturas Cranianas/diagnóstico por imagem , Crânio/diagnóstico por imagem , Algoritmos , Lesões Encefálicas/diagnóstico por imagem , Traumatismos Craniocerebrais/complicações , Humanos , Estudos Retrospectivos , Fraturas Cranianas/etiologia , Tomografia Computadorizada por Raios X , Raios X
5.
Forensic Sci Int ; 305: 110013, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31710881

RESUMO

Ancestry estimation of skeletonized remains by forensic anthropologists is conducted through comparative means, and a lack of population-specific data results in possible misclassifications. This is especially germane to individuals of Latin American ancestry. Generally, each country in Latin America can trace their ancestral lineage through three main parental groups: Indigenous, European, and African. However, grouping all Latin American individuals under the broad "Hispanic" category ignores the specific genetic contributions from each parental group, which is variable and dependent on the population histories and sociocultural dynamics of each country. This study analyzes the craniometric ancestry of Hispaniola (the Dominican Republic and Haiti) using 190 cranial Computed Tomography (CT) scans (f=103; m=87), along with the island's history, to explore similarities and differences between the two groups. MANOVA results indicate that 53.6% and 71.4% of the 28 cranial measurements differ between the ancestries and sexes, respectively; and intraobserver error analyses demonstrate that 85.7% of measurements from CT scans are good-excellent in reliability. Further, a total of 12 canonical discriminant function analyses produced cross-validated classification accuracies of 73.7-78.6% for females, 71.8-87.5% for males, and 72.0-77.8% for pooled sex. This study demonstrates that, despite sharing a small island, Dominican and Haitian individuals can be differentiated with a fair amount of statistical certainty, which is possible due to complex socio-cultural, -political, and -demographic factors that have produced and maintained genetic heterogeneity. Moreover, the discriminant functions provided here can be used by the international forensic science community to identify individuals living on Hispaniola.


Assuntos
Cefalometria , Crânio/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adulto , Idoso , Idoso de 80 Anos ou mais , Análise Discriminante , República Dominicana , Feminino , Antropologia Forense , Haiti , Humanos , Imagem Tridimensional , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Variações Dependentes do Observador , Adulto Jovem
6.
Yonsei Med J ; 60(11): 1067-1073, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31637889

RESUMO

PURPOSE: Bone flap resorption (BFR) after cranioplasty with an autologous bone flap (ABF) is well known. However, the prevalences and degrees of BFR remain unclear. This study aimed to evaluate changes in ABFs following cranioplasty and to investigate factors related with BFR. MATERIALS AND METHODS: We retrospectively reviewed 97 patients who underwent cranioplasty with frozen ABF between January 2007 and December 2016. Brain CT images of these patients were reconstructed to form three-dimensional (3D) images, and 3D images of ABF were separated using medical image editing software. ABF volumes on images were measured using 3D image editing software and were compared between images in the immediate postoperative period and at postoperative 12 months. Risk factors related with BFR were also analyzed. RESULTS: The volumes of bone flaps calculated from CT images immediately after cranioplasty ranged from 55.3 cm³ to 175 cm³. Remnant bone flap volumes at postoperative 12 months ranged from 14.2% to 102.5% of the original volume. Seventy-five patients (77.3%) had a BFR rate exceeding 10% at 12 months after cranioplasty, and 26 patients (26.8%) presented severe BFR over 40%. Ten patients (10.3%) underwent repeated cranioplasty due to severe BFR. The use of a 5-mm burr for central tack-up sutures was significantly associated with BFR (p<0.001). CONCLUSION: Most ABFs after cranioplasty are absorbed. Thus, when using frozen ABF, patients should be adequately informed. To prevent BFR, making holes must be kept to a minimum during ABF grafting.


Assuntos
Transplante Ósseo , Craniotomia , Congelamento , Imagem Tridimensional , Retalhos Cirúrgicos , Adolescente , Adulto , Reabsorção Óssea/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pacientes , Estudos Retrospectivos , Crânio/diagnóstico por imagem , Crânio/cirurgia , Software , Cirurgiões , Transplante Autólogo , Adulto Jovem
7.
J Craniofac Surg ; 30(8): 2362-2367, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31609941

RESUMO

BACKGROUND: Cutaneous squamous cell carcinoma (cSCC) is a common type of malignant skin disorder. An uncommon feature is local bony invasion, as can rarely be seen in lesions on the scalp. The optimal treatment strategy in these rare cases is still under debate. OBJECTIVE: The aim of this case report is to present a 1-stage three-dimensional planned surgical resection and reconstruction of a cSCC with bony invasion into the scalp and to discuss the alternative options and potential pitfalls. MATERIALS AND METHODS: A patient diagnosed with rT4N0M0 cSCC of the scalp underwent a cranial resection and reconstruction in 1 stage. With the use of computer-assisted design and computer-assisted manufacturing a patient-specific implant (PSI) of poly (ether ether ketone) was manufactured. After the PSI was inserted, it was covered with a latissimus dorsi muscle and a split-thickness skin graft. RESULTS: Intraoperatively the resection template generated an accurate resection and accurate and fast placement of the PSI. The reconstruction had a clinical satisfactory esthetic result, but was hampered by the development of a small wound dehiscence was observed over the postoperative course. CONCLUSION: Three-dimensional planned resection and reconstruction for composite defects of the skull after resection of a cSCC of the scalp with bony invasion may lead to an accurate and predictable resection and accurate and fast placement of the PSI. However, patient specific characteristics should be considered to assess potential risks and benefits before opting for this one-stage treatment strategy.


Assuntos
Carcinoma de Células Escamosas/diagnóstico por imagem , Neoplasias Cutâneas/diagnóstico por imagem , Idoso de 80 Anos ou mais , Carcinoma de Células Escamosas/cirurgia , Estética Dentária , Humanos , Imagem Tridimensional , Masculino , Complicações Pós-Operatórias , Procedimentos Cirúrgicos Reconstrutivos/métodos , Couro Cabeludo/diagnóstico por imagem , Couro Cabeludo/cirurgia , Pele , Neoplasias Cutâneas/cirurgia , Transplante de Pele , Crânio/diagnóstico por imagem , Crânio/cirurgia
8.
Forensic Sci Int ; 304: 109965, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31610333

RESUMO

Facial soft tissue thicknesses (FSTT) form a key component of craniofacial identification methods, but as for any data, embedded measurement errors are highly pertinent. These in part dictate the effective resolution of the measurements. As herein reviewed, measurement methods are highly varied in FSTT studies and associated measurement errors have generally not been paid much attention. Less than half (44%) of 95 FSTT studies comment on measurement error and not all of these provide specific quantification. Where informative error measurement protocols are employed (5% of studies), the mean error magnitudes range from 3% to 45% rTEM and are typically in the order of 10-20%. These values demonstrate that FSTT measurement errors are similar in size to (and likely larger than) the magnitudes of many biological effects being chased. As a result, the attribution of small millimeter or submillimeter differences in FSTT to biological variables must be undertaken with caution, especially where they have not been repeated across different studies/samples. To improve the integrity of FSTT studies and the reporting of FSTT measurement errors, we propose the following standard: (1) calculate the technical error of measurement (TEM or rTEM) in any FSTT research work; (2) assess the error embedded in the full data collection procedure; and (3) conduct validation testing of FSTT means proposed for point estimation prior to publication to ensure newly calculated FSTT means provide improvements. In order to facilitate the latter, a freely available R tool TDValidator that uses the C-Table data for validation testing is provided.


Assuntos
Face/anatomia & histologia , Face/diagnóstico por imagem , Biópsia , Cefalometria , Coleta de Dados , Diagnóstico por Imagem/métodos , Medicina Legal , Humanos , Imagem Tridimensional , Punções , Caracteres Sexuais , Pele/patologia , Crânio/anatomia & histologia , Crânio/diagnóstico por imagem , Decúbito Dorsal
10.
Int J Nanomedicine ; 14: 6313-6324, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31496688

RESUMO

Background: Craniosynostosis is a developmental disorder characterized by the premature fusion of skull sutures, necessitating repetitive, high-risk neurosurgical interventions throughout infancy. This study used protein-releasing Titania nanotubular implant (TNT/Ti) loaded with glypican 3 (GPC3) in the cranial critical-sized defects (CSDs) in Crouzon murine model (Fgfr2c342y/+ knock-in mutation) to address a key challenge of delaying post-operative bone regeneration in craniosynostosis. Materials and methods: A 3 mm wide circular CSD was created in two murine models of Crouzon syndrome: (i) surgical control (CSDs without TNT/Ti or any protein, n=6) and (ii) experimental groups with TNT/Ti loaded with GPC3, further subdivided into the presence or absence of chitosan coating (on nanotubes) (n=12 in each group). The bone volume percentage in CSDs was assessed 90 days post-implantation using micro-computed tomography (micro-CT) and histological analysis. Results: Nano-implants retrieved after 90 days post-operatively depicted well-adhered, hexagonally arranged, and densely packed nanotubes with average diameter of 120±10 nm. The nanotubular architecture was generally well-preserved. Compared with the control bone volume percentage data (without GPC3), GPC3-loaded TNT/Ti without chitosan coating displayed a significantly lower volume percent in cranial CSDs (P<0.001). Histological assessment showed relatively less bone regeneration (healing) in GPC3-loaded CSDs than control CSDs. Conclusion: The finding of inhibition of cranial bone regeneration by GPC3-loaded TNT/Ti in vivo is an important advance in the novel field of minimally-invasive craniosynostosis therapy and holds the prospect of altering the whole paradigm of treatment for affected children. Future animal studies on a larger sample are indicated to refine the dosage and duration of drug delivery across different ages and both sexes with the view to undertake human clinical trials.


Assuntos
Regeneração Óssea , Disostose Craniofacial/terapia , Sistemas de Liberação de Medicamentos , Glipicanas/administração & dosagem , Glipicanas/uso terapêutico , Nanotubos/química , Crânio/patologia , Titânio/química , Animais , Disostose Craniofacial/diagnóstico por imagem , Modelos Animais de Doenças , Feminino , Masculino , Camundongos Endogâmicos C57BL , Nanotubos/ultraestrutura , Crânio/diagnóstico por imagem , Microtomografia por Raio-X
11.
Endocrinol. diabetes nutr. (Ed. impr.) ; 66(7): 410-416, ago.-sept. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-182860

RESUMO

Introducción: Existen diversas controversias respecto a las pruebas diagnósticas y tratamiento de la pubertad precoz central (PPC). El objetivo de este estudio es exponer las experiencias adquiridas en un grupo de niñas con PPC tratadas con triptorelina, analizándose las características auxológicas y pruebas diagnósticas. Materiales y métodos: Estudio observacional retrospectivo en un grupo de 60 niñas con PPC atendidas entre 2010 y 2017. Al diagnóstico se registraron datos sociodemográficos, auxológicos y hormonales, realizándose ecografía pélvica y resonancia craneal. Fueron tratadas con triptorelina, y tras su retirada fueron seguidas hasta la menarquia. Resultados: Al iniciar el tratamiento, la edad cronológica y edad ósea eran de 7,7±0,7 y 9,7±0,8 años, respectivamente (media±DE), con una velocidad de crecimiento de 8,3±1,6cm/año. La talla diana era de 161,1±5,8cm. El pico de LH tras estimulación era de 16,6±12,1 UI/l. El volumen ovárico era superior a 3 cc en el 35% de los casos. La resonancia magnética craneal fue patológica en 7 casos (11,7%). Al final del tratamiento, la edad cronológica y la edad ósea eran de 10,3±1,1 y 11,2±0,8 años, respectivamente, con una velocidad de crecimiento de 4,7±1,4cm/año. A la edad de la menarquia (11,9±0,9 años), la talla era de 157,5±5,7cm. Conclusiones: El tratamiento de la PPC con triptorelina parece resultar beneficioso. La posibilidad de bloquear el desarrollo puberal y ralentizar la maduración ósea permiten que las pacientes alcancen su talla diana. No obstante, sería preceptiva una monitorización auxológica personalizada


Introduction: There are several controversies regarding the diagnostic tests and management of central precocious puberty (CPP). The aim of this study is to present the experience acquired in a group of girls with CPP treated with triptorelin, and to analyze the auxological characteristics and diagnostic tests. Material and methods: An observational, retrospective study in a group of 60 girls with CPP was conducted between January 2010 and December 2017. Sociodemographic, auxological and hormonal data were recorded at diagnosis, and pelvic ultrasound and magnetic resonance imaging of the head were performed. Girls were treated with triptorelin and monitored after treatment discontinuation until menarche. Results: At treatment start, chronological age and bone age were 7.7±0.7 and 9.7±0.8 years respectively, and growth velocity was 8.3±1.6cm/year. Target height was 161.1±5.8cm. Peak LH level after stimulation was 16.6±12.1 IU/l. Ovarian volumes were greater than 3mL in 35% of cases. MRI of the head was pathological in seven girls (11.7%). At treatment completion, chronological age and bone age were 10.3±1.1 and 11.2±0.8 years respectively, and growth velocity was 4.7±1.4cm/year. At the age of menarche (11.9±0.9 years), height was 157.5±5.7cm. Conclusions: Treatment of CPP with triptorelin appears to be beneficial. The possibility to block pubertal development and slow skeletal maturation allows patients to reach their target height. However, individualized auxological monitoring would be mandatory


Assuntos
Humanos , Feminino , Criança , Puberdade Precoce/diagnóstico , Puberdade Precoce/tratamento farmacológico , Pamoato de Triptorrelina/administração & dosagem , Pamoato de Triptorrelina/uso terapêutico , Pelve/diagnóstico por imagem , Crânio/diagnóstico por imagem , Espectroscopia de Ressonância Magnética , Menarca/efeitos dos fármacos , Estudos Longitudinais
12.
BMC Oral Health ; 19(1): 180, 2019 08 08.
Artigo em Inglês | MEDLINE | ID: mdl-31395055

RESUMO

BACKGROUND: McCune-Albright syndrome (MAS) is a rare multisystem disorder that classically was defined by the triad of polyostotic fibrous dysplasia of bone, café-au-lait skin pigmentation, and precocious puberty. It is a condition that has a gradual onset, slow growth rate and remain painless throughout. The clinical phenotype of MAS is highly variable and no definite treatment is available. CASE PRESENTATION: This article describes two cases, a 10-year-old girl and an 11-year-old boy, both with MAS comprising deforming craniofacial FD. Challenges related to diagnosis and management included late reporting with big lesions, involvement of multiple craniofacial bones, mutilating surgeries and ultimately high degree of morbidity. CONCLUSION: Delayed diagnosis and management of MAS results in devastating physical disabilities and severe morbidity after treatment.


Assuntos
Displasia Fibrosa Craniofacial/diagnóstico , Displasia Fibrosa Poliostótica/diagnóstico , Criança , Displasia Fibrosa Craniofacial/cirurgia , Diagnóstico Tardio , Ossos Faciais/diagnóstico por imagem , Feminino , Displasia Fibrosa Poliostótica/cirurgia , Humanos , Masculino , Puberdade Precoce , Radiografia , Crânio/diagnóstico por imagem , Tanzânia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
13.
Forensic Sci Int ; 302: 109916, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31426020

RESUMO

Several studies have shown variability in osteometric measurements of the skull between populations. Therefore, each population should have specific standards to optimize the accuracy of identification. The aim of this study was to evaluate the sexual dimorphism in metric relations between anatomical points of the skull using CT scans in a Jordanian population by means of discriminant function analysis, to determine which continuous variables discriminate between sexes, and to examine the craniofacial changes according to age. 500 CT scans (240 males and 260 females) were used and a total of 11 craniofacial parameters were studied. The data were analyzed using distriminant function analysis. Sexual dimorphism was found mainly in the young adult group. Significant age related changes were noticed in minimum frontal breadth, orbital height and orbital index. In all subjects, the analysis of multivariate (dimorphic variables) and stepwise functions gave an accuracy of 58.8% and 57.0% respectively. Using stepwise analysis, the most dimorphic variables to estimate sex were maximum frontal breadth, bimaxillary breadth and orbital index. The multivariate analysis of all variables gave an accuracy of 58.8%. The percentages of correct sexing in Jordanian population were high using the single variable analysis in females only. In females, classification accuracies of 70.4% using bimaxillary breadth, 70.0% using the orbital index, and 68.1% using maximum frontal breadth were obtained. Additionally, discriminant analysis was conducted separately for each age group. Higher percentages of correct sexing were obtained only in young adults. The results of the discriminant function analysis did not appear to be significant. The results of discriminant function were insignificant in middle aged and elderly groups. Being female and young increases the percentages of correct sexing. Generally, low levels of accuracy of sexual dimorphism were obtained in our study, suggesting that population estimates of dimorphism are highly variable and the equations derived from the discriminant function analysis are not reliable in sex estimation in Jordanians.


Assuntos
Determinação do Sexo pelo Esqueleto/métodos , Crânio/anatomia & histologia , Crânio/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Pontos de Referência Anatômicos , Análise Discriminante , Feminino , Antropologia Forense , Humanos , Processamento de Imagem Assistida por Computador , Jordânia , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Adulto Jovem
14.
Nat Commun ; 10(1): 3523, 2019 08 06.
Artigo em Inglês | MEDLINE | ID: mdl-31388014

RESUMO

Injectable hydrogels can fill irregular defects and promote in situ tissue regrowth and regeneration. The ability of directing stem cell differentiation in a three-dimensional microenvironment for bone regeneration remains a challenge. In this study, we successfully nanoengineer an interconnected microporous networked photocrosslinkable chitosan in situ-forming hydrogel by introducing two-dimensional nanoclay particles with intercalation chemistry. The presence of the nanosilicates increases the Young's modulus and stalls the degradation rate of the resulting hydrogels. We demonstrate that the reinforced hydrogels promote the proliferation as well as the attachment and induced the differentiation of encapsulated mesenchymal stem cells in vitro. Furthermore, we explore the effects of nanoengineered hydrogels in vivo with the critical-sized mouse calvarial defect model. Our results confirm that chitosan-montmorillonite hydrogels are able to recruit native cells and promote calvarial healing without delivery of additional therapeutic agents or stem cells, indicating their tissue engineering potential.


Assuntos
Regeneração Óssea/efeitos dos fármacos , Hidrogéis/administração & dosagem , Nanocompostos/administração & dosagem , Engenharia Tecidual/métodos , Cicatrização/efeitos dos fármacos , Animais , Bentonita/administração & dosagem , Bentonita/química , Materiais Biocompatíveis/administração & dosagem , Materiais Biocompatíveis/química , Diferenciação Celular/efeitos dos fármacos , Quitosana/administração & dosagem , Quitosana/química , Modelos Animais de Doenças , Módulo de Elasticidade , Humanos , Hidrogéis/química , Masculino , Células-Tronco Mesenquimais , Camundongos , Nanocompostos/química , Osteogênese/efeitos dos fármacos , Crânio/diagnóstico por imagem , Crânio/efeitos dos fármacos , Crânio/lesões , Microtomografia por Raio-X
15.
Neurocirugía (Soc. Luso-Esp. Neurocir.) ; 30(4): 198-201, jul.-ago. 2019. ilus
Artigo em Espanhol | IBECS | ID: ibc-183587

RESUMO

El Pott's puffy tumor (PPT) es una rara entidad que en la actualidad representa un abombamiento del cuero cabelludo asociado a un absceso subperióstico y a una osteomielitis craneal, pudiendo acompañarse o no de infección intracraneal. Suele asociarse a la sinusitis frontal, tratándose de una complicación típica, aunque poco frecuente de la misma. Por su parte las osteomielitis causadas por Actinomyces son raras y suelen tener lugar a nivel mandibular, no encontrándose apenas casos de osteomielitis craneal causada por este género bacteriano, en especial tras traumatismo craneoencefálico. Presentamos un caso especialmente poco usual al tratarse de un PPT frontal tras traumatismo cerrado, con componente intracraneal y en el que tras cirugía se aisló Actinomyces como copartícipe de dicha infección, junto con Fusobacterium y Propionibacterium


Pott's puffy tumour (PPT) is a rare entity that involves scalp swelling associated with subperiosteal abscess and cranial osteomyelitis, occasionally accompanied by intracranial infection. It is usually affiliated with frontal sinusitis, which is a typical but infrequent complication. On the contrary, Osteomyelitis by Actinomyces is rare and usually occurs at the mandibular level, with very few cases of cranial osteomyelitis caused by this bacterial specie, especially after traumatic brain injury. We report an exceptionally unusual case of a PPT frontal tumor after blunt trauma (closed head injury), with an intracranial lesion whereby Actinomyces was isolated after surgery, as a co-participant of the mentioned infection besides Fusobacterium and Propionibacterium


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Traumatismos Craniocerebrais/complicações , Traumatismos Craniocerebrais/cirurgia , Osteomielite/complicações , Actinomyces/patogenicidade , Actinomyces/isolamento & purificação , Osso Frontal/diagnóstico por imagem , Osso Frontal/lesões , Dura-Máter/diagnóstico por imagem , Dura-Máter/cirurgia , Crânio/diagnóstico por imagem , Crânio/cirurgia , Antibacterianos/administração & dosagem
16.
Yonsei Med J ; 60(8): 768-773, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31347332

RESUMO

PURPOSE: Magnetic resonance-guided focused ultrasound (MRgFUS) thalamotomy has become a standard treatment for medically intractable essential tremor (ET). Skull density ratio (SDR) and skull volume in patients with ET are currently considered useful indicators of the successful application of MRgFUS. We compared the clinical outcomes of MRgFUS thalamotomy with SDR above 0.4 and 0.45. We also described patterns of SDR and skull volume in Korean patients with ET who were eligible to be screened for MRgFUS. MATERIALS AND METHODS: In screening 318 ET patients, we evaluated patterns of skull density and skull volume according to age and sex. Fifty patients with ET were treated with MRgFUS. We investigated the effects of SDR and skull volume on treatment parameters and the outcomes of ET. RESULTS: The mean SDR of the 318 ET patients was 0.45±0.11, and that for skull volume was 315.74±40.95 cm³. The male patients had a higher SDR than female patients (p=0.047). Skull volume significantly decreased with aging. SDR and skull volume exhibited a linear negative relationship. Among therapeutic parameters, maximal temperature was positively related to SDR, while sonication number was not related to either SDR or skull volume. Tremor outcome was also not related to SDR or skull volume. CONCLUSION: SDR varied widely from 0.11 to 0.73, and men had a higher SDR. Therapeutic parameters and clinical outcomes were not affected by SDR or skull volume.


Assuntos
Tremor Essencial/diagnóstico por imagem , Imagem por Ressonância Magnética , Crânio/diagnóstico por imagem , Ultrassom , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade
17.
J Craniofac Surg ; 30(5): 1568-1571, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31299770

RESUMO

INTRODUCTION: Lateral cephalometric radiographs (LCR) have been the standard tool used for cephalometric analysis in craniofacial surgery. Over the past decade, a three-dimensional (3D) revolution in cephalometric analysis and surgical planning has been underway. To date, research has not validated whether cephalometric measurements taken from two-dimensional (2D) and 3D data sources are equivalent and interchangeable. The authors sought to compare angular cephalometric measurements taken with 2D and 3D modalities. METHODS: Sixty-two head CT scans (36 females, 26 males) with an average age of 63 ±â€Š20 years were studied. Twelve cephalometric angular measurements were taken from 3D reconstructed skulls using the software package Mimics 19.0 (Materialize; Leuven, Belgium). These same facial angles were measured from 2D lateral cephalograms reconstructed from the original CT scans using Dolphin 11.9. Measurements taken with both techniques were compared for agreement using a paired t test. Intra-class correlation coefficient assessment was used to determine inter-rater reliability. Statistical significance was set at P < 0.05. RESULTS: Five of the 12 angular measurements (SNA, SNB, MP-FH, U1-SN, and U1-L1) demonstrated statistically significant differences (P < 0.05) between the 2D and 3D analyses. All of these differences were less than the standard deviations for the respective measure. CONCLUSION: The differences between angular cephalometric values obtained from 2D LCRs and 3D CT reconstructions are small. This supports the practices of using 2D and 3D cephalometric data interchangeably in most applications. Clinicians must be selective in which measures they employ to maximize accuracy and care must be taken when measuring dental inclination with lateral cephalograms.


Assuntos
Cefalometria/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Face , Feminino , Humanos , Imagem Tridimensional/métodos , Masculino , Pessoa de Meia-Idade , Radiografia Dentária , Reprodutibilidade dos Testes , Crânio/diagnóstico por imagem , Tomografia Computadorizada por Raios X
18.
Surg Radiol Anat ; 41(9): 1053-1063, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31300839

RESUMO

PURPOSE: Imaging modalities such as micro-CT scanning and three-dimensional reconstruction are providing a mechanism for detailed analysis of skeletal components not only of normal specimens but also through revisitation of the abnormal. The aim of this study was to analyse the craniofacial skeleton of five human fetuses with cyclopia by means of micro-CT scanning and three-dimensional reconstruction. MATERIALS AND METHODS: The study consisted of five cyclopean individuals from the paediatric collection of the School of Anatomical Sciences, University of the Witwatersrand. The specimens ranged in age from 22 to 42 weeks of gestation. The osteological features of each bone of the skull were analysed with the aid of micro-CT scanning and analysis using VG studiomax software. RESULTS: A detailed analysis of all the bones of the skull revealed that the upper two-thirds of the viscerocranium and the anterior region of the basicranium were the most affected regions of the cyclopean fetuses. The ethmoid, nasal, inferior concha and the lacrimal bones were absent in all the cases of cyclopia. Major abnormalities were found in the premaxillary region which affected the development of the anterior dentition. CONCLUSION: This study supports the suggestion that the malformations of the visceral bones are secondary to defective development of the presphenoid and mesethmoid cartilages. The ethmoidal bones are important midline struts during normal development and their absence in cyclopia leads to non-laterality of facial features.


Assuntos
Feto/anormalidades , Holoprosencefalia/diagnóstico por imagem , Imagem Tridimensional , Crânio/anormalidades , Feminino , Feto/diagnóstico por imagem , Humanos , Masculino , Crânio/diagnóstico por imagem , Software , Microtomografia por Raio-X
19.
World Neurosurg ; 130: e915-e925, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31301447

RESUMO

OBJECTIVE: To evaluate the clinical and radiographic outcomes of an anterior-only approach for the correction of severe cervical kyphotic deformities. METHODS: We performed a retrospective study of 33 consecutive patients with severe cervical kyphosis treated with an anterior cervical operation and preoperative and intraoperative skull traction. Cobb angle, kyphosis index (KI), kyphosis level, C2-7 sagittal vertical axis (SVA), and T1 slope were measured. The preoperative and postoperative Japanese Orthopedic Association (JOA) scores, visual analog scale (VAS) score for neck pain, Neck Disability Index (NDI) scores, and cervical alignment were compared. RESULTS: The mean angle of the kyphosis was 83.2 ± 20.4°. The mean Cobb angle of the operative region was 71.7 ± 18.5° preoperation, which was reduced to 10.6 ± 5.7° postoperation (mean correction, 85.2%). The mean KI was 75.1 ± 18.2 preoperation, which was reduced to 14.4 ± 9.1 postoperation (mean correction, 80.8%). The preoperative and postoperative mean C2-7 Cobb angle was 53.8 ± 16.5° and 14.7 ± 7.6°, respectively. The preoperative and postoperative mean C2-7 SVA was 3.9 ± 14.5 mm and 12.8 ± 7.3 mm, respectively. The preoperative and postoperative mean T1 slope was -9.4 ± 15.7° and 7.3 ± 13.1°, respectively. The average postoperative C2-7 Cobb angle, Cobb angle of the operative region, KI, C2-7 SVA, and T1 slope changed significantly compared with preoperative values (P < 0.05). The average postoperative JOA, VAS, and NDI scores improved significantly compared with preoperative scores (P < 0.05). CONCLUSIONS: Preoperative and intraoperative skull traction combined with anterior-only cervical operation may be a safe and effective technique for treating severe cervical kyphosis. If the postoperative correction is >80%, sufficient decompression could be achieved.


Assuntos
Vértebras Cervicais/cirurgia , Cuidados Intraoperatórios/métodos , Cifose/cirurgia , Cuidados Pré-Operatórios/métodos , Crânio/cirurgia , Tração/métodos , Adolescente , Adulto , Vértebras Cervicais/diagnóstico por imagem , Estudos de Coortes , Terapia Combinada/métodos , Terapia Combinada/tendências , Feminino , Humanos , Cuidados Intraoperatórios/tendências , Cifose/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Cuidados Pré-Operatórios/tendências , Estudos Retrospectivos , Índice de Gravidade de Doença , Crânio/diagnóstico por imagem , Tração/tendências , Resultado do Tratamento , Adulto Jovem
20.
Adv Exp Med Biol ; 1138: 57-70, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31313258

RESUMO

Advances in technology are facilitating wider access to delicate, and often irreplaceable, anatomy specimens for teaching. Moreover, 3-dimensional (3D) models and interactive applications may help students to understand the spatial arrangement of complex 3D anatomical structures in a way not afforded by the 2-dimensional (2D) textbook images of traditional teaching.Historical specimens from the University of Glasgow's Museum of Anatomy were digitised for the creation of a 3D learning tool to help students better understand the growth and development of the juvenile skull. The overarching goal of this project was to assess whether interactive 3D applications can provide a useful tool for teaching more complex, non-static, anatomy subjects such as growth and development.The application received positive feedback from the small test group of 12 anatomy students. The majority of participants strongly agreed that the application helped them learn more about the human skull and they positively rated the use of 3D models in helping them learn about the position and structure of anatomical features, and in comparing skulls at different stages of development. Following on from this positive feedback, further tests could be conducted to assess if this 3D application confers an advantage in student learning over traditional teaching methods.


Assuntos
Imagem Tridimensional , Modelos Anatômicos , Crânio/diagnóstico por imagem , Adolescente , Crescimento e Desenvolvimento , Humanos , Aprendizagem , Crânio/crescimento & desenvolvimento
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