Forensic age estimation in adults based on multidetector computed tomography analysis of bone density in the medial meta-epiphyseal region of clavicle.

The aim of this study was to investigate the potential of using multidetector computed tomography (MDCT) to measure the bone mineral density (BMD) in the medial meta-epiphyseal region of clavicle (MERC) for adult age estimation. A total of 1064 chest MDCT scans from individuals aged 21 to 102 years were utilized to determine the MERC BMD. The Mimics software was used for the BMD measurements, and the average BMD of both MERC was also calculated. Regression analysis was conducted with chronological age as a dependent variable and MERC BMD as an independent variable to establish a mathematical model for age estimation. The mean absolute error (MAE) was calculated to evaluate the accuracy of the regression model using an independent validation sample. Among all the models, the cubic regression model showed the highest correlation between MERC BMD and chronological age and also provided the most accurate age prediction for both males and females (MAE = 9.41 for males, MAE = 10.38 for females). Our study suggests that BMD measured by MERC can be utilized for age estimation in adults when more reliable indicators are not available.

The first rib as a method of adult age-at-death estimation in a modern South African sample.

An age-at-death estimation method using the first rib may be particularly advantageous as this rib is relatively easy to identify, not easily damaged postmortem, and associated with less mechanical stresses compared to other age indicators. Previously, mixed results have been achieved using the first rib to estimate age-at-death. This study aimed to develop and test an age-at-death estimation method using the first rib. An identified modern black South African sample of 260 skeletons were used to collect age-related data from the first rib. Multiple linear regression analysis equations were created from this data for male, female, and combined samples. When tested on a hold-out sample, equations generated mean inaccuracies of 7-13 years for point estimates. The 95% confidence intervals contained the true age in 11-33% of individuals depending on the equation used, but wider intervals generated using 95% prediction intervals contained true ages for 100% of individuals. Point estimate inaccuracies are comparable to other age-at-death estimation methods and may be useful if single indicator estimation is unavoidable in the case of missing or damaged bones. However, combined methods that use indicators from many areas of the skeleton are preferable and may reduce interval widths.

Forensic age estimation in adults by pubic bone mineral density using multidetector computed tomography.

Radiology plays a crucial role in forensic anthropology for age estimation. However, most studies rely on morphological methods. This study aims to investigate the feasibility of using pubic bone mineral density (BMD) as a new age estimation method in the Chinese population. 468 pubic bone CT scans from living individuals in a Chinese hospital aged 18 to 87 years old were used to measure pubic BMD. The BMD of the bilateral pubic bone was measured using the Mimics software on cross-sectional CT images and the mean BMD of the bilateral pubic bone was also calculated. Regression analysis was performed to assess the correlation between pubic BMD and chronological age and to develop mathematical models for age estimation. We evaluated the accuracy of the best regression model using an independent validation sample by calculating the mean absolute error (MAE). Among all established models, the cubic regression model had the highest R2 value in both genders, with R2 = 0.550 for males and R2 = 0.634 for females. The results of the best model test showed that the MAE for predicting age using pubic BMD was 8.66 years in males and 7.69 years in females. This study highlights the potential of pubic BMD as a useful objective indicator for adult age estimation and could be used as an alternative in forensic practice when other better indicators are lacking.

Performance of three mathematical models for estimating age-at-death from multiple indicators of the adult skeleton.

The mathematical method which will achieve the most accurate and precise age-at-death estimate from the adult skeleton is often debated. Some research promotes Bayesian analysis, which is widely considered better suited to the data construct of adult age-at-death distributions. Other research indicates that methods with less mathematical complexity produce equally accurate and precise age-at-death estimates. One of the advantages of Bayesian analysis is the ability to systematically combine multiple indicators, which is reported to improve the age-at-death estimate. Few comparisons exist between Bayesian analysis and less complex mathematical models when considering multiple skeletal indicators. This study aims to evaluate the performance of a Bayesian approach compared to a phase-based averaging method and linear regression analysis using multiple skeletal indicators. The three combination methods were constructed from age-at-death data collected from 330 adult skeletons contained in the Raymond A Dart and Pretoria Bone Collections in South Africa. These methods were tested and compared using a hold-out sample of 30 skeletons. As is frequently reported in literature, a balance between accuracy and precision was difficult to obtain from the three selected methods. However, the averaging and regression analysis methods outperformed the Bayesian approach in both accuracy and precision. Nevertheless, each method may be suited to its own unique situation-averaging to inform first impressions, multiple linear regression to achieve statistically defensible accuracies and precisions and Bayesian analysis to allow for cases where category adjustments or missing indicators are necessary.

Application and analysis of the Rissech acetabular adult aging method in a Colombian sample.

The classical age indicators of the innominate have been the pubic symphysis and auricular surface. However, recently, the acetabulum has been highlighted as an indicator of adult age, with applicability in young, middle-aged, and older adults. The Rissech acetabular method was developed in a Portuguese population and tested in European and European-Americans, giving estimates within 10 years of age in more than 89% of the sample. The main goal of this paper is to test the Rissech acetabular method in a modern South American sample. The material used for the study was 184 women and 378 men from a Colombian-documented skeletal collection. The obtained morphological scores from the acetabulum were analyzed through the IDADE2 web page, a Bayesian statistical program that estimates a relative likelihood distribution for the target individuals, produces age estimates, and provides 95% confidence intervals. Results showed this method is useful in the modern Colombian population with an average absolute error of 10.63 years in females and 9.44 years in males. These errors are similar to those obtained in other European and North American samples when this method was performed and similar or lower than those obtained when the 3 classical aging methods (Suchey-Brooks, Buckberry-Chamberlain, and Lovejoy) were applied in the same collection (absolute error: 10.29 years ♀ and 9.05 years ♂ in Suchey-Brooks, 12.5 years ♀, and 12.17 years ♀ in Buckberry-Chamberlain, and 13.54 years ♀ and 10.99 years ♂ in Lovejoy). Although Rissech's method was developed in a Western European sample, the results of this study indicate its applicability in modern Colombian samples with reasonable accuracy.

The acetabulum as an adult age marker and the new IDADE2 (the IDADE2 web page).

OBJECTIVE: In 2006, an age estimation method was proposed utilizing Bayesian inference to interpret age-progressive changes in the acetabulum. This was accompanied by the IDADE2 software to facilitate calculations. However, the MS-DOS operating system on which the software was based became obsolete. The main goal of this article is to present the new IDADE2, which incorporates web-based facilities. MATERIALS AND METHODS: The original IDADE2 has been re-written in R and presented as a web page. As in the original, this web page uses Bayesian inference to estimate age of unidentified individuals. The materials used to create the reference datasets of this web page include acetabular scores from documented skeletal samples from Spain (n = 24♀ and 52♂), Portugal (n = 317♀ and 294♂), and the US (n = 370♀ and 456♂). RESULTS: The IDADE2 website has eight sections. Six of these are informative to guide the user. The other two (Option 1 and Option 2) are dedicated to estimating age at death. Option 1 allows users to estimate the age of individual(s) in their test sample based on our reference data of acetabular scores. Option 2 allows users to estimate age from the acetabulum with their own reference and test collections or-if the users prefer-another age marker and method of choice. DISCUSSION: The IDADE2 website is applicable both to forensic anthropological casework on single individuals and to bioarchaeological analyses of large skeletal samples. This website is easy to use and freely accessible, responding to previous critiques and incorporating method advancements.

Variations in epiphyseal fusion and persistence of the epiphyseal line in the appendicular skeleton of two identified modern (19th-20th c.) adult Portuguese and Italian samples.

OBJECTIVES: The aim of this work is to study age, sex, and population variations in epiphyseal fusion and persistence of the epiphyseal line in the appendicular skeleton of two identified modern (19th-20th c.) adult skeletal samples, using a specifically designed macroscopic scoring method. The use of epiphyseal closure and persistence of the epiphyseal line as an adult-age marker is also discussed. MATERIALS AND METHODS: This study examined 981 adult skeletons of both sexes from two identified modern (20th c.) skeletal samples from the Sassari Collection (Museum of Anthropology, University of Bologna, Italy) and the Colecção de Esqueletos Identificados (Museum of Anthropology, University of Coimbra, Portugal). Our scoring method considers a five-degree scale, from nonfusion (Degree 0) to complete fusion (Degree 4). In addition, the persistence of the epiphyseal line, a feature that is not commonly collected during routine anthropological analyses, is taken into account here as Degree 3. RESULTS: Intra- and interobserver errors of 1.2% and 5.2%, respectively, were found, suggesting a good reproducibility of this scoring method. Some sites show variable degrees of epiphyseal fusion still in adult skeletons (e.g., secondary center of ossification of the clavicle, iliac crest, ischial tuberosity, distal epiphysis of the radius and ulna). CONCLUSIONS: Population differences have been observed, showing a delay in the complete epiphyseal closure for the Sassari sample compared to the Coimbra sample. Degree 3 seems to be a good adult-age indicator for individuals less than 35-year-old.

Nondestructive adult age at death estimation: Visualizing cementum annulations in a known age historical human assemblage using synchrotron X-ray microtomography.

OBJECTIVES: Adult age at death estimation continues to challenge physical anthropologists. One estimation method involves counting tooth cementum annulations (TCA). Non-destructively accessing TCA is a critical step to approaching fossil teeth of unknown age and to verifying life history profiles of human ancestors. This pilot study aims to (a) non-destructively image TCA in teeth from a known age archeological human population by propagation phase contrast X-ray synchrotron µCT (PPC-SR-µCT) (b) test the correlation between real and estimated ages, and the accuracy, precision and bias of age estimates. MATERIALS AND METHODS: We examine 20 permanent human canines (aged 20-81 years), from a 18th to 19th century known age collection from St. Luke's Church (London, England). We scanned transverse segments of acellular cementum in the apical portion of the middle root third using PPC-SR-µCT. We generated virtual transverse sections on which two observers perform two sessions of blind TCA counts. We calculate the estimated ages at death by adding 10 years to the TCA counts. RESULTS: A moderately strong positive linear relationship exists between real and estimated ages (r = 0.76, p < .001), with an average inaccuracy of 16.1 years and an average bias towards underestimation of 15.7 years. This difference is lower in individuals <50 years (6.8 and 6.5 years, respectively, n = 10) compared with those >50 years (24.9 years, n = 10). DISCUSSION: We reliably imaged and identified TCA in individuals <50 years from a known-age archeological sample. Scanning refinement will yield a promising alternative to current destructive methods of TCA analyses and to aid access to life history events in adult fossil hominins.

The influence of bone loss on the three adult age markers of the innominate.

To evaluate the influence of bone loss on the three adult age markers of the innominate, 30 males and 30 females aged between 16 and 80 years coming from the British Coventry collection were analyzed. The pubic symphysis, auricular surface, and acetabulum age variables were evaluated following the descriptions of Schmitt, Buckberry-Chamberlain, and Rissech, respectively. The second metacarpal cortical index was used to evaluate bone loss. Possible sexual differences in metrical variables were explored by a Student t-test taking into account the entire sample. The possible relationships between the cortical index and the three age methods' stages were assessed by the Kruskall-Wallis test and Spearman's correlation coefficient. There were no sexual differences in the cortical index. In general, we observed no significant differences between the cortical index in the different stages of the pubic symphysis, auricular surface, or acetabulum variables in men and women. Most correlation coefficients are negatives, and their absolute values are between 0.001 and 0.44, indicating an extremely low influence of bone loss on the analyzed variables. Our findings suggest little influence of bone loss in the three ageing methods. However, further research on this topic is necessary. This is the first study to analyze the influence of bone loss in the ageing changes undergone by the variables of the three adult age indicators of the innominate taking into account both sexes.

The third molar maturity index in indicating the legal adult age in Kosovar population.

The third molar tooth, known as the "wisdom tooth," is the only tooth that can be used to determine legal adult age. This study aimed to test the accuracy of Cameriere's third molar maturity index (I3M) in assessing the legal adult age of 18 years in the Kosovar population. Orthopantomographs (OPTs) of 1221 healthy living Kosovar individuals, aged between 12 and 23 years and with no congenital or developmental anomalies, were analyzed. Intra-class correlation coefficients were 0.858 (95% CI, 0.786 to 0.906) and 0.852 (95% CI, 0.779 to 0.903) for intra-rater and for inter-rater agreement, respectively. The sample was divided into training dataset (800 OPTs) and test dataset (421 OPTs). The training dataset was used to generate the logistic regression model, while the test dataset was used to study the performance of the model. I3M and gender as independent variables and adult age (≥ 18 years) or minor age (< 18 years) as the dependent variable were used for logistic regression analysis. The receiver operating curve (ROC) analysis was used to determine the specific cut-off value of I3M for predicting adult age. The results showed that only I3M statistically significantly contributed to discriminating adults and minors. ROC analysis showed that the cut-off value of I3M < 0.08 was the best in discriminating adults and minors. An analysis of the test dataset (421 OPTs) showed that as I3M decreased the age gradually increased. The performance of the cut-off value of I3M < 0.08, to discriminate between adults and minors, was analyzed by contingency tables for both sexes. In males, the accurate classification (Acc) was 0.968 (95% CI, 0.926 to 0.985), the sensitivity (Se) was 0.962 (95% CI, 0.925 to 0.978), and the specificity (Sp) was 0.976 (95% CI, 0.929 to 0.995). The Bayes post-test probability (Bayes PTP) was 0.975 (95% CI, 0.905 to 1.00). In females, Acc was 0.909 (95% CI, 0.870 to 0.917), Se and Sp were 0.826 (95% CI, 0.787 to 0.834) and 0.991 (95% CI, 0.953 to 1.00) respectively, while Bayes PTP was 0.989 (95% CI, 0.926 to 1.00). Our data support the usefulness of I3M < 0.08 to indicate legal adult age in a Kosovar population.

Age estimation by assessment of pulp chamber volume: a Bayesian network for the evaluation of dental evidence.

PURPOSE: The present study aimed to investigate the performance of a Bayesian method in the evaluation of dental age-related evidence collected by means of a geometrical approximation procedure of the pulp chamber volume. Measurement of this volume was based on three-dimensional cone beam computed tomography images. METHODS: The Bayesian method was applied by means of a probabilistic graphical model, namely a Bayesian network. Performance of that method was investigated in terms of accuracy and bias of the decisional outcomes. Influence of an informed elicitation of the prior belief of chronological age was also studied by means of a sensitivity analysis. RESULTS: Outcomes in terms of accuracy were adequate with standard requirements for forensic adult age estimation. Findings also indicated that the Bayesian method does not show a particular tendency towards under- or overestimation of the age variable. Outcomes of the sensitivity analysis showed that results on estimation are improved with a ration elicitation of the prior probabilities of age.

Age estimation in older adults: Use of pulp/tooth ratios calculated from tooth sections.

OBJECTIVES: Accurate age estimates are foundational for bioarchaeological research, yet the ability to accurately age older adult skeletons remains elusive. This study uses a new version of pulp/tooth area calculations to investigate chronological age of older archaeological individuals. MATERIALS AND METHODS: Pulp/tooth area ratios were calculated on modern control teeth (n = 10) that were first radiographed and then sectioned for comparative analysis. Pulp/tooth area ratios were determined on sectioned teeth using ImageJ software for: (a) modern individuals of known age (n = 26); (b) individuals from Belleville, Ontario, Canada (1821-1874) with documented age (n = 50); and (c) Belleville individuals with skeletally estimated age (n = 122). RESULTS: Calculations from tooth sections on modern teeth (n = 10) resulted in a mean absolute error (MAE) of ±3.9 years, whereas the radiographic method for the same teeth had an MAE of ±14.45 years. Results indicate that sectioned pulp/tooth area ratios are a significant predictor of chronological age (p < .005), with MAEs of ±4.53 years for Belleville and ±3.77 years for modern individuals. There were no statistically significant differences in age estimations between modern and archaeological individuals, or with respect to tooth type, sex, or intra/inter-observer estimations. DISCUSSION: This study provides a new more accurate method for estimating age-at-death, particularly for individuals in the 50+ age category. Sectioning the teeth and directly measuring exposed pulp chambers results in age estimations that were within ±4.15 years for both modern and archaeological individuals, thus presenting a method that will enhance the ability to age older individuals.

New approach to age estimation of male and female adult skeletons based on the morphological characteristics of the acetabulum.

Age estimation is essential to the human identification process, both in forensic and archeological contexts. Based on the previous male-specific method of Rissech et al. (J Forensic Sci, 2006, 51:213-229), a new approach to age estimation based on the acetabulum has been described and evaluated in 611 individuals from the Lisbon Collection (Lisbon, Portugal). This paper has two main goals: (1) to revise and better define the variables of Rissech's method related to the acetabular fossa, namely, variables 5, 6, and 7, and (2) to extend the applicability of this new approach to both sexes while analyzing age-related sex differences in the acetabular aging process. The results demonstrate the suitability of combining acetabulum traits and a Bayesian approach to estimating age in adults of both sexes. This study has confirmed the usefulness of the redefined variables of the acetabular fossa when age-related changes are considered. Furthermore, the newly defined variables have good to excellent values of repeatability. The study has also extended the method's applicability to females. The revised method has absolute error averages of 7.28 years for males and 7.09 years for females, based on a sex-specific reference sample. In addition, approximately 74 % of the individuals estimated had an absolute error less than 10 years. Interestingly, the acetabular aging process follows similar trends in both sexes, but the aging rate seems to be different between males and females, especially in middle-aged individuals. Despite the fact that the age estimates, on average, did not improve significantly with the use of a sex-specific reference sample, it is recommended that the sexes be analyzed separately due to the differences in aging rates and inaccuracy values.

Adolescents and adults affected by Cornelia de Lange syndrome: A report of 73 Italian patients.

Cornelia de Lange syndrome (CdLS) is a rare genetic condition related to mutation of various cohesion complex related genes. Its natural history is quite well characterized as regard pediatric age. Relatively little information is available regarding the evolution of the disease in young-adult age. In medical literature, only one specific study has been published on this topic. We report on our experience on 73 Italian CdLS patients (40 males and 33 females) with and age range from 15 to 49 years. Our results confirm the previous study indicating that gastroesophageal reflux disease (GERD) is the main medical problem of these patients in childhood and young-adult age. Other medical features that should be considered in the medical follow-up are tendency to overweight/frank obesity, constipation, discrepancy of limbs' length, epilepsy, hearing, and visual problems. Behavioral problems are particularly frequent as well. For this reason, every source of hidden pain should be actively searched for in evaluating a patient showing such a disorder. Finally, recommendations for medical follow-up in adult age are discussed. © 2016 Wiley Periodicals, Inc.

Accuracy of scoring of the epiphyses at the knee joint (SKJ) for assessing legal adult age of 18 years.

Important aspects of forensic practice are age estimation and discrimination of individuals of unknown age as adults and minors. The developing knee joint was recognized as a potential site for age examination in late adolescence. We analyzed a sample of anteroposterior x-rays of the knee joints from 446 living individuals from Umbria, Italy (234 males and 212 females), aged between 12 and 26 years. We evaluated the ossification of the distal femoral (DF), proximal tibial (PT), and proximal fibular (PF) epiphyses. We took into account possible persistence of the epiphyseal scars in the ossified epiphyses by the adopted stages of those previously introduced by Cameriere et al. (2012). We also used measurements from all three epiphyses to calculate the total score of maturation for the knee joint (SKJ). Cohen Kappa coefficients of intrarater agreement for staging the DF, PT, and PF epiphyses were 0.839, 0.894, and 0.907, while interrater agreement was 0.919, 0.791, and 0.907, respectively. The resulting receiver operating characteristic (ROC) curves of SKJ show better discriminatory power than those for DF, PT, and PF epiphyses in predicting that the participant, either male or female, was an adult or a minor. The areas under the curves for SKJ were 0.991 and 0.968 vs. 0.944, 0.962, 0.974 and 0.891, 0.910, 0.918 for males and females, respectively. The results of the 2 by 2 contingency tables showed that SKJ score of 4 in males and SKJ score of 5 in females were the most suitable cut-off value in discriminating between adults and minors. Principally, the sensitivity test for males was 0.94, with 95 % confidence interval (95 % CI) 0.90 to 0.97 and specificity was 0.96 (95 % CI 0.91 to 0.98). The proportion of correctly classified individuals was 0.95 (95 % CI 0.91 to 0.97). For females, the sensitivity test was 0.89 (95 % CI 0.84 to 0.92) and specificity was 0.92 (95 % CI 0.87 to 0.96), the proportion of correctly classified individuals was 0.90 (95 % CI 0.85 to 0.94). These results indicate that the SKJ method may give valuable supporting information in forensic procedures for discriminating individuals of legal adult age of 18 years. Further studies should address the usefulness of the SKJ method in different populations.

Age-modified risk factors for mortality of non-elderly adult kidney transplant recipients: a retrospective database analysis.

PURPOSE: We aimed to investigate the role of the recipient's age strata in modifying the associations between risk factors and mortality in non-elderly adult kidney transplant (KT) recipients (KTR). METHODS: We stratified 108,695 adult KTRs between 2000 and 2016 with conditional 1-year survival after KT into cohorts based on age at transplant: 18-49 years and 50-64 years. We excluded KTRs aged < 18 years or > / = 65 years. KTRs were observed for 5 years during the 2nd through 6th years post-KT for the outcome, all-cause mortality. RESULTS: Increasing recipient age strata (18-49-year-old and 50-64-year-old) correlated with decreasing 6-year post-KT survival rates conditional on 1-year survival (79% and 57%, respectively, p < 0.0001). Middle adult age stratum was associated with a higher risk of all-cause mortality than young adult age stratum in KTRs of Hispanic/Latino and other races [HR = 1.23, 95% CI = 1.04-1.45 and HR = 1.51, 95% CI = 1.16-1.97, respectively] and with a primary native renal diagnosis of hypertension or glomerulonephritis [HR = 1.32, 95% CI = 1.12-1.55 and HR = 1.29, 95% CI = 1.10-151, respectively]. When compared with the young adult age stratum, the middle adult age stratum had a mitigating effect on the higher risk of mortality associated with sirolimus-mycophenolate or sirolimus-tacrolimus than the standard calcineurin inhibitor-mycophenolate regimen [HR = 0.75, 95% CI = 0.57-0.99 and HR = 0.71, 95% CI = 0.57-0.89, respectively]. CONCLUSION: Among adult non-elderly KTRs, the age strata, 18-49 years, and 50-64 years, have varying modifying effects on the strength and direction of associations between some specific risk factors and all-cause mortality.

Effect of Sex, Age and Temperature on the Functional Response of Macrolophus pygmaeus Ramber and Nesidiocoris tenuis Reuter (Heteroptera: Miridae) on Eggs of Tuta absoluta.

The predatory mirids Macrolophus pygmaeus Ramber (Heteroptera: Miridae) and Nesidiocoris tenuis Reuter (Heteroptera: Miridae) are used for the biological control of Tuta absoluta Meyrick (Lepidoptera: Gelechiidae) and other pests in tomato greenhouses. The functional response of 1-day-old (young) and 10-day-old (old) adult females and males of M. pygmaeus and N. tenuis on eggs of T. absoluta was determined on tomato at two temperatures (20 °C and 25 °C) and LD 16:8. Females of M. pygmaeus exhibited higher predation efficiency than males at both tested temperatures. Young M. pygmaeus females had a higher efficiency than old ones, whereas males had a low efficiency irrespective of age. The predation efficiency of N. tenuis was high (but lower than M. pygmaeus) in both young females and males, although old females had a higher efficiency than the respective males. Our results show that the two predatory species have different functional response characteristics to their prey depending mainly on sex and age, which may affect their role as biological control agents.

Beyond survival: the lasting effects of premature birth.

Preterm birth, defined as birth before 37 weeks of gestation, is a major public health concern. It affects about 10% of all newborns globally and is the main cause of infant death and morbidity. Prematurity increases the likelihood of respiratory distress syndrome, cerebral palsy, and developmental abnormalities. Furthermore, premature newborns are at risk of acquiring chronic noncommunicable diseases later in life due to interference with organ system development during the in-utero and perinatal period. Because of the greater risk of long-term repercussions, preterm birth should be considered a chronic disorder, and gestational age and other birth histories should be included in all medical records for patients of all ages, especially when assessing the risk of multiple chronic diseases. Conventional methods for assessing preterm infant development, as well as reliable and precise growth monitoring, can lead to the early detection of growth decline and the adjustment of feeding regimens as needed. Because of its unique composition and useful components, human milk is a powerful tool for mitigating the negative outcomes associated with prematurity. It contains a variety of growth factors that promote the development of organs and systems, counteracting the negative effects of the abrupt interruption of intrauterine development and promoting better outcomes in all altered functions. Despite its multiple benefits, human milk cannot totally restore the lasting damage caused by premature birth. Premature infants cannot be completely overcome by nutrition alone, and yet adequate nutritional intake and human milk feeding are critical to their health and development.

Is Masquelet Technique A Successful Viable Treatment In Reconstructing Large Tumor Bone Gaps in Adolescent and Adult?

Objectives: The reconstruction of large bony defect caused by tumor resection can be managed by different technique like bone graft, Masquelet technique, mega-prosthesis etc. Literature lacks studies discussing Masquelet technique in tumor cases especially pertaining to infected tumor in adults. We aimed to determine 1) How often and how fast is the bone healing achieved after resection greater than 10 cm bone in tumour patient's using Masquelet technique?, 2) Whether Masquelet technique can achieve optimum outcomes in adult infected cases too? Methods: We reviewed 154 patients of benign & malignant tumour managed by us between 2013 and 2019. Patients belonging to all the age group with infected tumor/diaphysial tumor/periarticular tumor, where single stage surgery or mega-prosthesis is not a viable option and were treated with Masquelet technique for reconstructing a bone defect of at least 10 cm were included in our study. We evaluated outcomes of eight patients for four parameters i.e. bony union, healing index, number of re-do surgeries required and limb length discrepancy. Results: Mean age of our study group was 20.25 years and patients followed for mean duration of 3.36 years. Mean bone loss after tumor resection was 13.1 cm (range = 11.5 cm to 15 cm). There was no sign of recurrence of tumor in any patient at the time of last follow up. Average time required to achieve bony union was 23.25 months (mean healing index of 1.67 months/cm). All but one patient achieved bony union. Mean limb length discrepancy seen was 1.44cm. Infected cases showed low healing index with higher percentage of re-do surgeries. Conclusion: Induced membrane technique is quick, safe and reliable alternative method of reconstruction to mega-prosthesis in cases with all age group where risk of failure of mega-prosthesis is high, either due to infection or shorter expected lifespan of prosthesis. However, obtaining union can be a difficult preposition in infected tumor cases and multiple surgeries may be required to get the desired result even after two stages. However, a comparative study with large sample size is required to further validate our results.

Automated age-at-death estimation from 3D surface scans of the facies auricularis of the pelvic bone.

This work presents an automated data-mining model for age-at-death estimation based on 3D scans of the auricular surface of the pelvic bone. The study is based on a multi-population sample of 688 individuals (males and females) originating from one Asian and five European identified osteological collections. Our method requires no expert knowledge and achieves similar accuracy compared to traditional subjective methods. Apart from data acquisition, the whole procedure of pre-processing, feature extraction and age estimation is fully automated and implemented as a computer program. This program is a part of a freely available web-based software tool called CoxAGE3D. This software tool is available at https://coxage3d.fit.cvut.cz/ Our age-at-death estimation method is suitable for use on individuals with known/unknown population affinity and provides moderate correlation between the estimated age and actual age (Pearson's correlation coefficient is 0.56), and a mean absolute error of 12.4 years.