Investigation of total cerebellar and flocculonodular lobe volume in Parkinson's disease and healthy individuals: a brain segmentation study.

BACKGROUND: Parkinson's disease (PD) is a neurodegenerative disorder with an unexplored link to the cerebellum. In the pathophysiology of balance disorders in PD, the role of the flocculonodular lobe (FL) is linked to the impairment of the dopaminergic system. Dopamine deficiency can also lead to changes in cerebellum functions, disrupting balance control. This study compares cerebellar and FL volumes between healthy controls (HC) and PD patients, analyzing their correlation with clinical outcomes. METHODS: We used magnetic resonance images of 23 PD patients (14 male, 9 female) and 24 HC (9 male, 15 female). Intracranial (ICV), total cerebellar, FL, and cerebellar gray matter volumes were measured using VolBrain. Clinical outcomes in PD patients were assessed using the Unified Parkinson's Disease Rating Scale (UPDRS-III) to evaluate motor function, with scores correlated to volumetric data. RESULTS: The cerebellar and gray matter volumes in HC were 115.53 ± 10.44 cm3 and 84.83 ± 7.76 cm3, respectively, compared to 126.83 ± 13.47 cm3 and 92.37 ± 9.45 cm3 in PD patients, indicating significantly larger volumes in PD patients (p < 0.05). The flocculonodular lobe gray matter volume was 1.14 ± 0.19 cm3 in PD patients and 1.02 ± 0.13 cm3 in HC, but there was a significant increase in gray matter volume in PD patients between the groups (p < 0.05). In PD patients, significant negative correlations were observed between FL volume and the UPDRS-III scores (r = - 0.467, p = 0.033) and between UPDRS-III scores and both total (r = - 0.453, p = 0.039) and normalized (r = - 0.468, p = 0.032) gray matter volumes of the FL. CONCLUSION: Although total gray matter volumes were larger in PD patients, the volumes of FL did not differ between groups. In Parkinson's disease, increased cerebellar volume may regulate fine motor movements rather than balance.

Anthropometric Periocular Soft Tissue Analysis From Preadolescence to Young Adulthood: Photogrammetric Measurements.

ABSTRACT: The periocular region has a central role in the prediction of ethnicity, understanding emotional expression, age, and sex. The aim of this study was to determine the sex-related growth changes in the periocular region of Turkish preadolescents, adolescents, and young adults. The study included a total of 234 individuals (preadolescents: 34 females and 40 males; adolescents: 40 females, 40 males, and young adults: 40 males and 40 females). A total of 7 periocular parameters (3 bilateral, 3 unilateral linear, and 1 angular measurement) were analyzed statistically to determine sex-related differences. The palpebral fissure and canthal indexes were also calculated. Of the 14 periocular measurements, 9 were found to be sexually dimorphic in certain age groups ( P < 0.05). Right-left palpebral fissure width and left palpebral fissure height were significantly different between young adult males and females ( P = 0.018, P = 0.013, and P = 0.027, respectively). A significant sexual dimorphism was observed for outercanthal distance and canthal index in 3 age groups ( P < 0.05). The data collected in this study may serve as a sex-dependent database source for the Turkish population during normal growth from preadolescence to young adulthood. The present study results would be useful for planning and designing aesthetic and post-traumatic surgical interventions in the periocular region as well as personal identification in this population.

Photographic Nasal Soft Tissue Analysis From Preadolescence to Young Adulthood: Anthropometric Measurements.

ABSTRACT: The nose has a tremendous effect on facial esthetics and overall facial harmony, accordingly it contributes to the physical appearance of individuals. The aim of this study is to establish sex-related nasal soft tissue norms for preadolescents, adolescents, and young adults in Anatolian population. A total of 300 volunteers (150 males and 150 females) with ages varying from 10 to 24 years were divided into 6 subgroups according to gender and educational status. The anthropometric measurements of the nose in preadolescent, adolescent, and young adult males and females were performed on digital photographs. A total of 16 nasal parameters, 13 linear and 3 angular measurements, were analyzed for sex-related variations. A significant sexual dimorphism was observed for nasofrontal and nasolabial angles in adolescent and young adult groups (P < 0.001, P = 0.011, and P = 0.007, respectively). All linear measurements of the nose were larger in males as compared to females, except for left alar thickness, which were similar between males and females in young adult group. Of the 16 nasal measurements, 13 were found to be sexually dimorphic in certain age groups (P < 0.05). In Anatolian population, the nasal shape and dimensions displayed significant sexual dimorphism in preadolescents, adolescents, and young adults. The average values of nasal soft tissue in this population could serve as a database for the planning of cosmetic and reconstructive rhinoplasty in the pediatric and adult population and obtaining the desired outcomes.

Comparison of quadriceps muscle volume after unilateral total knee arthroplasty with and without tourniquet use.

PURPOSE: Determination of the effect of tourniquet use in total knee arthroplasty (TKA) on thigh and quadriceps muscle volume using magnetic resonance imaging (MRI). METHODS: A total of 148 knees of 74 patients (mean age 66.5 ± 4.8 years; female/male, 62/12) with bilateral primary varus gonarthrosis underwent unilateral TKA with a tourniquet (Group A, n = 35) or without a tourniquet (Group B, n = 39). The total thigh volume and connective, bone, and muscle tissue volumes were stereologically measured on preoperative and postoperative MRI. The Knee Society Score (KSS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score were calculated to evaluate functional outcomes. RESULTS: After TKA, the knees of patients in Group A exhibited a significant decrease in all tissue measurements, except bone tissue volume; however, the knees of patients in Group B exhibited no significant difference in tissue measurements. Although no difference was found between the operated and contralateral non-operated thighs (4076.9 and 4073.4 cm(3), respectively) in Group B postoperatively at 1 month (p > 0.05), the operated thighs had lost 20 % of its volume in Group A postoperatively at 1 month (p < 0.001). A significant difference was found in all tissue measurements, except the connective and bone tissue volumes of the thigh between the operated and contralateral non-operated knees in Group A. No significant difference was identified between the operated and contralateral non-operated knees in Group B. The total WOMAC score was significantly higher, and the total KSS was significantly lower in Group A than in Group B during the postoperative follow-up period of 1-6 months (p < 0.001 for all) but not 12 months (n.s.). CONCLUSION: Tourniquet use in TKA decreases the thigh and quadriceps muscle volumes and postoperatively delays the recovery of knee function. Therefore, caution should be exercised for tourniquet use during TKA in daily clinical practice and using alternative methods for tourniquet application in preventing intraoperative blood loss. LEVEL OF EVIDENCE: III.

The effect of minimally invasive surgical repair on the lung volumes of patients with pectus excavatum.

OBJECTIVES: To assess the increase in lung volume after Nuss surgery in patients with pectus excavatum (PE) by using stereological methods and to evaluate the correlation between the lung volume and spirometry findings. METHODS: Twenty patients, treated for PE between 2008 and 2010, were evaluated prospectively. They underwent preoperative chest radiography, computed thorax tomography (CTT), and spirometry. Thereafter, the Haller index was calculated for each patient. In the third postoperative month, CTT and spirometry were repeated.Lung volumes and volume fractions were evaluated using CTT images, applying the Cavalieri principle for stereological methods. Then the correlation between the pre- and postoperative values of the lung volumes with spirometry findings was determined. RESULTS: Volumes of the right and left lungs were calculated stereologically, using CTT images. Postoperative volume increase of ∼417.6 ± 747.6 mL was detected. The maximum volume increase was observed in the left lung. In the postoperative period, the total volume increase and the volume increase detected in the left lung were found to be statistically significant (p < 0.05).The preoperative correlation coefficients (r) for forced vital capacity, forced expiratory volume in 1 second, and forced expiratory flow 25 to 75% were 0.67, 0.68, and 0.61, respectively; the postoperative r figures were 0.43, 0.42, and 0.35, respectively. Although there was a strong correlation between the preoperative lung volume and spirometry findings (p < 0.05), no correlation was observed between the postoperative lung volume and spirometry findings (p > 0.05). CONCLUSIONS: Postoperative pulmonary volume increase occurs in patients with PE after Nuss surgery. However, postoperative spirometry findings may not reflect morphological improvement because pain restricts thoracic movements. Therefore, in patients with PE, quantitative evaluation of the results of surgical repair is possible using the CTT images through a combination of stereological methods.

Volumetric analysis of the subthalamic and red nuclei based on magnetic resonance imaging in patients with Parkinson's disease.

Parkinson's disease (PD) is associated with degeneration of the dopaminergic neurons in the substantia nigra. The subthalamic nucleus (STN) plays a pivotal role in the pathogenesis. However, there is not much known about the morphological changes in the STN. The red nucleus (RN) has many connections with the motor coordinating pathways although it is not primarily involved in the pathogenesis. In this study we aimed to compare the volumes of the STN and RN measured by magnetic resonance imaging in PD patients and controls to investigate how these structures are affected at the morphological level. Twenty patients with PD and twenty age/sex matched controls were enrolled in this study. Severity score was determined by Hoehn & Yahr staging: 6 at stage II and 14 at stage III in med-off state. Imaging was performed by a 1.5 Tesla (T) MR scanner. Measurements of total brain and normalized STN and RN volumes were performed by manual planimetry using Image J software. No statistically significant differences were observed between two groups based on age or gender and disease stage and nuclei volumes. The total estimated brain volumes were not different between PD patients and controls. However, normalized volumes of the STN and RN were 14% and 16% larger, respectively, in PD patients compared to the controls (p < 0.05). Our findings suggest that the volumes of the STN and RN are increased in patients with PD. These changes possibly reflect the altered metabolic activity of these regions demonstrated by neurophysiological studies.

Postoperative lung volume change depending on the resected lobe.

OBJECTIVES: The aim of this study was to evaluate the lung volume changes depending on the resected lobes. The changes were quantitatively evaluated using stereological methods on computed tomography images and by pulmonary function tests (PFTs). METHODS: The study subjects included 30 patients who underwent lung resection. Of these, 26 patients underwent lung resection due to non-small cell lung cancer and 4 patients for benign reasons. Patients were classified into the following six groups according to the resected lobes and lungs: right lower lobectomy, right upper lobectomy, left lower lobectomy, left upper lobectomy, right pneumonectomy, and left pneumonectomy cases. All patients were evaluated with the PFT and computed thorax tomography (CTT), preoperatively and in the postoperative 3rd month. Volume changes due to resection were estimated on CTT scans using the Cavalieri principle of the stereological methods, and their relationships to the PFTs were evaluated. RESULTS: Stereologically estimated data showed that the volume loss was 19.01% in upper lobectomy and 5.57% in lower lobectomy (p < 0.05). The highest volumetric increase of the contralateral lung and minor volume loss of the ipsilateral lung was observed in lower lobectomy. After right lower lobectomy, the highest postoperative volume increase was observed at the contralateral lung and the least volume loss in the remaining ipsilateral lung. In PFT, forced vital capacity (FVC) decreased to 3.07% after lower lobectomy whereas it decreased to 11.94% after upper lobectomy. FVC revealed that no significant change occurred after right lower lobectomy (p < 0.05). CONCLUSIONS: Although the parenchyma resected in lower lobectomy is larger, the postoperative total lung volume reduction is less than that of upper lobectomy. After lower lobectomy, postoperative compensation is achieved specifically by the expansion of contralateral lung, together with the remaining ipsilateral lung.

Physical properties of nanostructured CdO films from alkaline baths containing saccharin as additive.

Nanostructured cadmium oxide (CdO) films were fabricated on glass substrates from alkaline baths containing saccharin as an additive by a successive ionic layer adsorption and reaction (SILAR) method. The effects of saccharin concentration in the bath on the structural, morphological, and optical properties were studied by means of scanning electron microscopy (SEM), X-ray diffraction (XRD), photoluminescence, and Raman spectroscopy. The analyses showed that the surface morphologies, XRD peak intensities, Raman spectroscopy, and photoluminescence properties of CdO films changed with saccharin concentration. From the results, it can be said that morphological characteristic and optical properties of the films could be calibrated by adding various saccharin percentages in the growth bath.

The effect of slice thickness on the assessment of bone defect volumes by the Cavalieri principle using cone beam computed tomography.

The purpose of this study was to investigate the possible effects of section thickness on volume estimations obtained by cone beam computed tomography. Intraosseal cavities representing bone defects on vestibular sides of the two dry sheep mandibles were scanned by a cone beam computed tomography system. Consecutive sections at 0.2, 0.6, 1, 1.4, and 2.2 mm thickness were used to estimate the volumes of the cavities using the Cavalieri principle of stereological methods. Estimated volumes are then compared with the volumes obtained by the Archimedean principle. In 0.2-, 0.6-, and 1-mm-thick slices, the volumes estimated by the Cavalieri principle did not differ from the volumes by the Archimedean principle (p > 0.05). The 0.2 mm slice-thickness group had the highest asymptotic significance value (p = 0.6). Although the thinnest slice appears to provide the most accurate values, slice thickness up to 1 mm can be chosen for volume calculations on CBCT images.

Nanostructured CuO Thin-Film-Based Conductometric Sensors for Real-Time Tracking of Sweat Loss.

Enhanced sweat sensors lead to real-time, sustained, noninvasive tracking of sweat loss, ensure insight into individual health conditions at the molecular level, and have obtained prominent interest for their hopeful implementations in customized health tracking. Metal-oxide-based nanostructured electrochemical amperometric sensing materials are the best selection for continuous sweat monitoring devices owing to their high stability, high-sensing capacity, cost-effectiveness, miniaturization, and wide applicability. In this research, CuO thin films have been fabricated by successive ionic layer adsorption and reaction technique (SILAR) with and without the addition of Lawsonia inermis L. (Henna, (LiL)) leaf extract (C10H6O3, 2-hydroxy-1,4-naphthoquinone) with a high-sensitive and rapid response for sweat solution. Despite the pristine film being responsive to the 65.50 mM sweat solution (S = 2.66), the response characteristic improves to 3.95 for the 1.0% LiL-implemented CuO film. Unmodified, 1.0% LiL and 3.0% LiL-substituted thin-film materials assure considerable linearity with linear regression ranges, R2, of 0.989, 0.997, and 0.998, respectively. It is noteworthy here that this research aims to determine an enhanced system that could potentially be implemented in real-life sweat-tracking administrations. Real-time sweat loss tracking capabilities of CuO samples was found to be promising. Derived from these outcomes, we concluded that the fabricated nanostructured CuO-based sensing system is a useful application for the continuous observation of sweat loss as a biological argument and compatibility with other microelectronic technologies.

Conductometric Flexible CuO-Based Sweat-Loss Monitoring Sensor for Future Wearable Technology in Healthcare.

Healthcare tracking supports early diagnosis of illnesses, real-time tracking of the impacts of therapy and treatment, and tracking of cases of human health. Based on this, real-time tracking of sweat loss provides an easy, convenient, and noninvasive approach to the early diagnosis of physical illness in individuals. To date, copper oxide (CuO) as a nanostructured semiconductor metal-oxide is regarded as a hopefully p-type sensing material. The corresponding sweat rate monitoring systems were fabricated using a repeatable and cost-effective SILAR system using a cellulose acetate-based organic substrate. To provide a practical application, we investigated the working efficiency of Al:CuO under room conditions since most clinical and healthcare industries operate under ambient temperature. Fabricated flexible devices immediately respond to the implementation of the sweat solution and reach a steady-state value in a short time. It can be obtained from experimental results that the sweat-loss monitoring performances of CuO-based devices can be enhanced by employing Al-doping. The increment in the sensing efficacy was interpreted in terms of structural and morphological characterization and electrical data. Our designed flexible thin film-based system can be used in conjunction with a customized wearable, healthcare industry integrated, low-cost fabrication source.

Comparison of the planimetry and point-counting methods for the assessment of the size of the mandible cysts on orthopantomograms.

OBJECTIVE: The purpose of this study is to compare the computer-assisted planimetry and point-counting methods in evaluating the sizes of the mandibular cysts with respect to their agreement and the time required to analyze. STUDY DESIGN: The surface areas of 46 mandibular cyst lesions on orthopantomograms were estimated using the point-counting and computer-assisted planimetry methods. Three observers evaluated the outlined areas twice, using the point-counting (PC) and computer-assisted planimetry (CAP) methods with an interval of two weeks. In the planimetry technique, digitalized images and ImageJ software were used to measure the surface area of the half mandibles and cysts. The grids were superimposed over the same images and the number of points hitting the interested structures was counted for the point-counting technique. The projection area fraction (PAF) of the cysts within the mandible was estimated using the obtained values by means of the two techniques. Intraclass correlation coefficient was used to assess the level of agreement between the two methods. Inter-rater reliability analysis using the Kappa statistic was performed to determine consistency among raters. RESULTS: CAP and PC techniques showed consistent intra-observer values in all observers. Intraclass correlation between CAP and PC measurements of first, second and third observers were found to be 0.9986, 0.9988 and 0.9994 respectively. The durations of PC technique was 32% higher than the CAP technique. CONCLUSION: PC and CAP methods were seemed to show sufficient agreement to be used interchangeably. The main disadvantage of the PC analysis is it takes more time than CAP method.

Examination of the relationship between average plaque volume and clinical and demographic characteristics in multiple sclerosis patients using a stereological method.

AIM: The objectives of this study were to investigate the lesion load on brain magnetic resonance images and the volume of different cerebral anatomical structures, in patients with a diagnosis of definite multiple sclerosis, using a stereological method. METHODS: Fifty patients diagnosed with multiple sclerosis were included in the study. The volume fractions of the hemispheres, lateral ventricles, cerebellum, brain stem, and plaque volumes within the total brain volume were estimated. RESULTS: The mean plaque volume was 0.83 ± 0.14 cm(3) in the cerebellum and 1.14 ± 0.2 cm(3) in the brain stem. There was a significant relationship between left hemisphere volume to whole hemisphere ratio and ventricular volume (p = .034, r = 0.1) in patients with cerebellar lesions compared with patients without cerebellar lesions. Similarly, there was a significant correlation between left hemisphere volume ratio and ventricular volume ratio in all patients (r = -0.286, p = .044). CONCLUSION: These results show that there is significantly greater atrophy in the left hemisphere. In addition, the presence of cerebellar lesions can trigger or accelerate the development of left hemisphere atrophy. Thus, this finding may be an indicator of poor prognosis.

Stereologic orbital volume measurements in zygomatic fractures.

PURPOSE: To evaluate the efficacy of stereologic methods to measure the orbital volume using computed tomography images of patients with zygomatic fractures. MATERIALS AND METHODS: The present study was retrospectively conducted using hard-copy computed tomography images acquired during the postoperative period of 22 patients with unilateral zygomatic fractures. Orbital volume measurements were performed on the surgically treated and contralateral normal orbits using stereologic methods. The estimates obtained from both sides were compared statistically using the paired samples t test. The measurements were repeated by 2 different observers to estimate the interobserver variability. RESULTS: When both observers were taken into account, the mean volume in the normal and surgically treated orbits was 23.6 +/- 3.2 and 24.4 +/- 3.1 cm(3), respectively. A statistically significant difference was noted between the surgically treated and normal orbits (P < .05). The volumes of 16 treated orbits were enlarged by 5.8% +/- 3.8% and 6 were diminished by 2.7% +/- 1.4%. A very high statistical correlation was noted between the 2 observers (R > .95). The total time consumed for calculation in each patient (2 orbits) was 9 to 12 minutes. CONCLUSIONS: Stereologic estimation of the orbital volume is an easy, practical, and time-saving procedure that can be performed on readily available, hard-copy computed tomography images. The high interobserver agreement observed in our study shows that it can be safely used in the quantitative detection of preoperative and postoperative volume changes.

A new method of assessing the size of mandibular cysts on orthopantomograms: projection area fraction.

This study was carried out to describe a simple, accurate, and practical technique for assessing mandible cysts' area on routine orthopantomograms using digital planimetry.Forty orthopantomograms showing mandibular cysts were obtained. The digitalized images were used to measure the surface area of the half mandibles and cysts using ImageJ software by an observer. The projection area of the half mandibles and cysts was provided by the machine. The surface area fraction of the cysts within the half mandibles was estimated by using the projection area fraction (PAF) approach. Estimations were repeated on films 1 month later.The mean PAF (mean +/- SEM) obtained by the same observer in 2 sessions was 10.6% +/- 2.3% and 13.0% +/- 2.0% for the right and left sides, respectively. The estimation results of 2 sessions were compared using the Wilcoxon signed rank test. This study found no statistical difference between the estimated PAF values (P > 0.05). The estimation results of the same observer at 1-month intervals were analyzed statistically to check intraobserver variation using a correlation analysis test, which found a high degree of agreement for the results estimated using the planimetric method for the right and left sides (r = 0.994, P < 0.001 and r = 0.999, P < 0.001, respectively).The method described in this study is inexpensive and fast because planimetry can be performed within a couple of minutes per subject. This method can also be used to monitor the size difference of lesions evaluated for clinical follow-up and research.

Unbiased estimation of the eyeball volume using the Cavalieri principle on computed tomography images.

The size of the eyeball has been the subject of a few studies. None of them used stereological methods to estimate the volume. In the current study, we estimated the volume of eyeball in normal men and women using the stereological methods. Eyeball volume (EV) was estimated using the Cavalieri principle as a combination of point-counting and planimetry techniques. We used computed tomography scans taken from 36 participants (15 men and 21 women) to estimate the EV. The mean (SD) EV values obtained by planimetry method were 7.49 (0.79) and 7.06 (0.85) cm in men and women, respectively. By using point-counting method, the mean (SD) values were 7.48 (0.85) and 7.21 (0.84) cm in men and women, respectively. There was no statistically significant difference between the findings from the 2 methods (P > 0.05). A weak correlation was found between the axial length of eyeball and the EV estimated by point counting and planimetry (P < 0.05, r = 0.494 and r = 0.523, respectively). The findings of the current study using the stereological methods could provide data for the evaluation of normal and pathologic volumes of the eyeball.

Stereological estimation of the orbital volume: a criterion standard study.

Several methodologies have been proposed to assess the orbital volume (OV). However, we have not seen a criterion standard study evaluating the results of the methodologies for the assessment of OV. In the current study, the actual OV of 9 dry skulls was measured using the water filling method as the criterion standard. Consecutive computed tomographic sections at a thickness of 1.5 mm were used to estimate the OV by means of the point counting method. The mean (SD) of the OV measured by the water filling method was 17.84 (1.56) cm3. By using the point counting method, it was 17.05 (1.69) cm3. There was no statistically significant difference between sides (P > 0.001). The results of the OV values obtained by the two methods were compared statistically. The agreements between the two methods were also evaluated using the Bland-Altman plots. There was no statistically significant difference between the OV measurements obtained by the stereological technique and water filling method. The described method could be used for the assessment of OV in vivo.

The estimation of cerebral asymmetries in schizophrenia by the Cavalieri principle.

OBJECTIVE: To demonstrate hemispheric asymmetry in patients with schizophrenia using a cheap, simple stereologic method on the basis of standard CT scans of the brain. METHODS: To demonstrate hemispheric asymmetry, standard CT scans of 30 schizophrenic patients (14 males, 16 females) were compared with 39 (13 male, 26 female) control subjects at Eskisehir Osmangazi University, Eskisehir, Turkey in 2005. Brain volumes were investigated by using a cheap, simple stereologic method, namely, Cavalieri. RESULTS: In patients with schizophrenia, we found that as age increases, right and left hemisphere volumes decrease. However, in the control group there was no relationship found between age and hemisphere volumes. In the control group, the left hemisphere was significantly bigger in males compared to females. There was a significant difference in both right and left hemisphere volumes between the control group and the schizophrenic group. In the schizophrenic group, a significant difference was observed in right hemisphere volumes between genders (p=0.002), while there was no difference in the control group. There was a difference in left hemisphere volumes between genders in both groups. Right and left hemispheric volumes of the schizophrenic group were smaller than those of control group. CONCLUSION: Cerebral asymmetry is an arguable subject for the diagnosis of schizophrenia. The method that we used in this study will be useful in estimating hemispheric volumes.

Sex estimation using sternum part lenghts by means of artificial neural networks.

In addition to the pelvis, cranium and phalanges, the sternum is also used for postmortem sex identification. Bone measurements may be obtained on cadaveric bones. Alternatively, computerized tomography may be used to obtain measurements close to the original ones. Moreover, usage of artificial neural networks (ANNs) in the field of medicine has started to provide new horizons. In this study, we aimed to identify sex by an ANN using lengths of manubrium sterni (MSL), corpus sterni (CSL) and processus xiphoideus (XPL) and sternal angle (SA) from computerized tomography (CT) images brought to an orthogonal plane. This study used the thin-slice thoracic CT images of 422 cases (213 female, 209 male) with an age range of 27-60 years brought to the orthogonal plane. Measurements of MSL, CSL, XPL and SA were analyzed with a multilayer artificial neural network that used stochastic gradient descent (SGD) for optimization and two hidden layers. MSL, CSL and XPL were longer, and SA was wider in men (MSL p = 0.000, CSL p = 0.000, XPL p = 0.000, SA p = 0.02). In the case of the two hidden layers of the network with 20 and 14 neurons in the hidden layers, respectively, learning rate of 0.1 and momentum coefficient of 0.9, the accuracy (Acc) of sex prediction was 0.906. In order to define a more realistic performance of the network, bootstrap was run with the confidence interval of 94%. A sensitivity (Sen) value of 0.91 and a specificity (Spe) value of 0.90 were calculated. The success rates that were achieved in sex identification with measurements on the skeleton using ANN were observed to be higher than those achieved by linear models. Also, sometimes all parts of the bones may not be found or might be deformed. In this case, the number of parameters used for the estimation will be incomplete. The ANN has the strong advantage to be able to estimate despite the missing parameter.

Alternative approach to evaluating lumbar lordosis on direct roentgenograms: projection area per length squared.

Several methods have been described to evaluate the degree of lumbar lordosis. However, suggested methods have used non-standardized terminology and landmarks to measure the degree of lumbar lordosis. In the present study a practical method for evaluating the degree of lumbar lordosis is described and, for this purpose, 24 lateral roentgenograms were obtained retrospectively from the archive of Department of Physical Medicine and Rehabilitation, Ondokuz Mayis University, Samsun, Turkey. The length between the superior and inferior angles of the first and fifth lumbar vertebral bodies, and the area behind the lumbar vertebral bodies, were estimated using the point counting and planimetry methods. A new unit, the projection area per length squared (PAL) was described on lateral roentgenograms. The planimetric approach was used as the gold standard in the present study. The point-counting method was also used to estimate the PAL and it was repeated three times to determine the variability of the technique. To evaluate the estimates' accuracy, the results of point-counting were compared with those of the planimetry methods. The PAL changed by between 3.93 and 13.59% for the examined subjects. A high correlation was also noted between the results of the point-counting and planimetry methods (r = 0.997). It is concluded that the PAL approach could provide accurate and reproducible data for evaluating the degree of lumbar lordosis and low back pain.