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Park JY, Lee SH, Kim YJ, Kim KG, Lee GJ. Machine learning model based on radiomics features for AO/OTA classification of pelvic fractures on pelvic radiographs. PLoS One 2024; 19:e0304350. [PMID: 38814948 PMCID: PMC11139281 DOI: 10.1371/journal.pone.0304350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 05/10/2024] [Indexed: 06/01/2024] Open
Abstract
Depending on the degree of fracture, pelvic fracture can be accompanied by vascular damage, and in severe cases, it may progress to hemorrhagic shock. Pelvic radiography can quickly diagnose pelvic fractures, and the Association for Osteosynthesis Foundation and Orthopedic Trauma Association (AO/OTA) classification system is useful for evaluating pelvic fracture instability. This study aimed to develop a radiomics-based machine-learning algorithm to quickly diagnose fractures on pelvic X-ray and classify their instability. data used were pelvic anteroposterior radiographs of 990 adults over 18 years of age diagnosed with pelvic fractures, and 200 normal subjects. A total of 93 features were extracted based on radiomics:18 first-order, 24 GLCM, 16 GLRLM, 16 GLSZM, 5 NGTDM, and 14 GLDM features. To improve the performance of machine learning, the feature selection methods RFE, SFS, LASSO, and Ridge were used, and the machine learning models used LR, SVM, RF, XGB, MLP, KNN, and LGBM. Performance measurement was evaluated by area under the curve (AUC) by analyzing the receiver operating characteristic curve. The machine learning model was trained based on the selected features using four feature-selection methods. When the RFE feature selection method was used, the average AUC was higher than that of the other methods. Among them, the combination with the machine learning model SVM showed the best performance, with an average AUC of 0.75±0.06. By obtaining a feature-importance graph for the combination of RFE and SVM, it is possible to identify features with high importance. The AO/OTA classification of normal pelvic rings and pelvic fractures on pelvic AP radiographs using a radiomics-based machine learning model showed the highest AUC when using the SVM classification combination. Further research on the radiomic features of each part of the pelvic bone constituting the pelvic ring is needed.
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Affiliation(s)
- Jun Young Park
- Department of Health Sciences and Technology, Gachon Advanced Institute for Health Sciences and Technology (GAIHST), Gachon University, Incheon, Republic of Korea
| | - Seung Hwan Lee
- Department of Trauma Surgery, Gachon University Gil Medical Center, Gachon University, Incheon, Republic of Korea
- Department of Traumatology, Gachon University College of Medicine, Gachon University, Incheon, Republic of Korea
| | - Young Jae Kim
- Department of Health Sciences and Technology, Gachon Advanced Institute for Health Sciences and Technology (GAIHST), Gachon University, Incheon, Republic of Korea
- Department of Medical Devices R&D Center, Gachon University Gil Medical Center, Gachon University, Incheon, Republic of Korea
- Department of Biomedical Engineering, Pre-medical Course, College of Medicine, Gachon University, Incheon, Republic of Korea
| | - Kwang Gi Kim
- Department of Health Sciences and Technology, Gachon Advanced Institute for Health Sciences and Technology (GAIHST), Gachon University, Incheon, Republic of Korea
- Department of Medical Devices R&D Center, Gachon University Gil Medical Center, Gachon University, Incheon, Republic of Korea
- Department of Biomedical Engineering, Pre-medical Course, College of Medicine, Gachon University, Incheon, Republic of Korea
| | - Gil Jae Lee
- Department of Trauma Surgery, Gachon University Gil Medical Center, Gachon University, Incheon, Republic of Korea
- Department of Traumatology, Gachon University College of Medicine, Gachon University, Incheon, Republic of Korea
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Moon KR, Byon SS, Kim SH, Lee BD. Automated assessment of pelvic radiographs using deep learning: A reliable diagnostic tool for pelvic malalignment. Heliyon 2024; 10:e29677. [PMID: 38660256 PMCID: PMC11040132 DOI: 10.1016/j.heliyon.2024.e29677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 04/12/2024] [Accepted: 04/12/2024] [Indexed: 04/26/2024] Open
Abstract
Pelvic malalignment leads to general imbalance and adversely affects leg length. Timely and accurate diagnosis of pelvic alignment in patients is crucial to prevent additional complications arising from delayed treatment. Currently, doctors typically assess pelvic alignment either manually or through radiography. This study aimed to develop and assess the validity of a deep learning-based system for automatically measuring 10 radiographic parameters necessary for diagnosing pelvic displacement using standing anteroposterior pelvic X-rays. Between March 2016 and June 2021, pelvic radiographs from 1215 patients were collected. After applying specific selection criteria, 550 pelvic radiographs were chosen for analysis. These data were utilized to develop a deep learning-based system capable of automatically measuring radiographic parameters relevant to pelvic displacement diagnosis. The system's diagnostic accuracy was evaluated by comparing automatically measured values with those assessed by a clinician using 200 radiographs selected from the initial 550. The results indicated that the system exhibited high reliability, accuracy, and reproducibility, with a Pearson correlation coefficient of ≥0.9, an intra-class correlation coefficient of ≥0.9, a mean absolute error of ≤1 cm, mean square error of ≤1 cm, and root mean square error of ≤1 cm. Moreover, the system's measurement time for a single radiograph was found to be 18 to 20 times faster than that required by a clinician for manual inspection. In conclusion, our proposed deep learning-based system effectively utilizes standing anteroposterior pelvic radiographs to precisely and consistently measure radiographic parameters essential for diagnosing pelvic displacement.
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Affiliation(s)
- Ki-Ryum Moon
- Department of Computer Science, Kyonggi University, Suwon-si, Gyeonggi-do, 16227, Republic of Korea
| | - Shi Sub Byon
- AI Lab., HealthHub, Co. Ltd., Seoul, Republic of Korea
| | - Sung Hyun Kim
- Human Medical Imaging and Intervention Center, Seoul, Republic of Korea
| | - Byoung-Dai Lee
- Department of Computer Science, Kyonggi University, Suwon-si, Gyeonggi-do, 16227, Republic of Korea
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Peters F, Raith S, Bock A, Kniha K, Möhlhenrich SC, Heitzer M, Hölzle F, Modabber A. Development of a universal cutting guide for raising deep circumflex iliac artery flaps. Int J Comput Assist Radiol Surg 2024:10.1007/s11548-024-03144-9. [PMID: 38676830 DOI: 10.1007/s11548-024-03144-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 04/05/2024] [Indexed: 04/29/2024]
Abstract
PURPOSE The deep circumflex iliac crest flap (DCIA) is used for the reconstruction of the jaw. For fitting of the transplant by computer-aided planning (CAD), a computerized tomography (CT) of the jaw and the pelvis is necessary. Ready-made cutting guides save a pelvic CT and healthcare resources while maintaining the advantages of the CAD planning. METHODS A total of 2000 CTs of the pelvis were divided into groups of 500 by sex and age (≤ 45 and > 45 years). Three-dimensional (3D) pelvis models were aligned and averaged. Cutting guides were designed on the averaged pelvis for each group and an overall averaged pelvis. The cutting guides and 50 randomly selected iliac crests (10 from each group and 10 from the whole collective) were 3D printed. The appropriate cutting guide was mounted to the iliac crest and a cone beam CT was performed. The thickness of the space between the iliac crest and the cutting guide was evaluated. RESULTS Overall the mean thickness of the space was 2.137 mm and the mean volume of the space was 4513 mm3. The measured values were significantly different between the different groups. The overall averaged group had not the greatest volume, maximum thickness and mean thickness of the space. CONCLUSION Ready-made cutting guides for the DCIA flap fit to the iliac crest and make quick and accurate flap raising possible while radiation dose and resources can be saved. The cutting guides fit sufficient to the iliac crest and should keep the advantages of a standard CAD planning.
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Affiliation(s)
- Florian Peters
- Department of Oral, Maxillofacial and Facial Plastic Surgery, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany.
| | - Stefan Raith
- Department of Oral, Maxillofacial and Facial Plastic Surgery, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Anna Bock
- Department of Oral, Maxillofacial and Facial Plastic Surgery, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Kristian Kniha
- Department of Oral, Maxillofacial and Facial Plastic Surgery, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany
| | | | - Marius Heitzer
- Department of Oral, Maxillofacial and Facial Plastic Surgery, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Frank Hölzle
- Department of Oral, Maxillofacial and Facial Plastic Surgery, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Ali Modabber
- Department of Oral, Maxillofacial and Facial Plastic Surgery, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany
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de Sena Fraga CD, de Araújo RC, de Sá L, Santos Bertoldo AJ, Rodarti Pitangui AC. Use of a peanut ball, positioning and pelvic mobility in parturient women shortens labour and improves maternal satisfaction with childbirth: a randomised trial. J Physiother 2024; 70:134-141. [PMID: 38494404 DOI: 10.1016/j.jphys.2024.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 02/12/2024] [Accepted: 02/26/2024] [Indexed: 03/19/2024] Open
Abstract
QUESTION What is the effect of a protocol targeted at the various stages of labour - with a peanut ball, positioning and pelvic mobility - on the duration of labour, pain severity, fatigue, maternal outcomes, neonatal outcomes and satisfaction in parturients without analgesia? DESIGN A randomised trial with concealed allocation, blinding of assessors and intention-to-treat analysis. PARTICIPANTS One hundred women in active labour. INTERVENTION The experimental group received the protocol targeted at the various stages of labour, with a peanut ball, positioning and pelvic mobility, whilst the control group received usual care. OUTCOME MEASURES The primary outcomes were the duration of labour and pain severity. The secondary outcomes were maternal fatigue, mode of delivery, risk of perineal laceration, severity of perineal laceration, use of synthetic oxytocin, satisfaction with delivery, Apgar scores, admission of the neonate to an intensive care unit and resuscitation of the neonate in the delivery room. In the active phase of labour, the numerical rating scale and maternal perception of childbirth fatigue questionnaire were applied; they were taken again when the parturient had 8 to 10 cm of dilation. The numerical rating scale was also applied postpartum to evaluate satisfaction with childbirth. RESULTS The use of the protocol with a peanut ball reduced the duration of active and expulsive phases and the total duration of labour, with mean differences of 82 minutes (95% CI 41 to 125), 8 minutes (95% CI 0 to 18) and 89 minutes (95% CI 45 to 132), respectively. Maternal satisfaction was better in the experimental group: mean between-group difference on the 10-point scale was 1.1 (95% CI 0.4 to 1.8). The effects on the other outcomes were either similar between groups or unclear. CONCLUSION A protocol with a peanut ball, positioning and pelvic mobility reduced the duration of labour and improved maternal satisfaction with childbirth. REGISTRATION RBR-74wcnjc.
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Affiliation(s)
| | - Rodrigo Cappato de Araújo
- Postgraduate Program of Rehabilitation and Functional Performance, University of Pernambuco, Petrolina, Brazil
| | - Layane de Sá
- Postgraduate Program of Rehabilitation and Functional Performance, University of Pernambuco, Petrolina, Brazil
| | - Ana Julia Santos Bertoldo
- Postgraduate Program of Rehabilitation and Functional Performance, University of Pernambuco, Petrolina, Brazil
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Oyem PC, Burke ZD, Mesko NW, Nystrom LM. Custom three-dimensional printed implants for reconstruction of oncologic pelvic defects. J Surg Oncol 2024; 129:424-435. [PMID: 37754672 DOI: 10.1002/jso.27465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 09/12/2023] [Accepted: 09/18/2023] [Indexed: 09/28/2023]
Abstract
The use of three-dimensional printed implants in the field of orthopedic surgery has become increasingly popular and has potentiated hip reconstruction in the setting of oncologic resections of the pelvis and acetabulum. In this review, we examine and discuss the indications and technical considerations for custom implant reconstruction of pelvic defects.
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Affiliation(s)
- Precious C Oyem
- Cleveland Clinic, Lerner College of Medicine of Case Western University, Cleveland, Ohio, USA
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Zachary D Burke
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Nathan W Mesko
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Lukas M Nystrom
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
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Delgado A, Amorim MM, Oliveira ADAP, Souza Amorim KC, Selva MW, Silva YE, Lemos A, Katz L. Active pelvic movements on a Swiss ball reduced labour duration, pain, fatigue and anxiety in parturient women: a randomised trial. J Physiother 2024; 70:25-32. [PMID: 38036399 DOI: 10.1016/j.jphys.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 08/30/2023] [Accepted: 11/01/2023] [Indexed: 12/02/2023] Open
Abstract
QUESTION How much do active pelvic movements on a Swiss ball during labour affect maternal and neonatal outcomes? METHOD A randomised trial with concealed allocation, blinded assessors and intention-to-treat analysis. PARTICIPANTS Two-hundred parturient women. INTERVENTION The experimental group performed pelvic anteversion and retroversion, lateral pelvic tilts and circular hip movements according to individual obstetric evaluation (foetal station and position, cervical dilatation and the presence of early pushing urge) on a Swiss ball. The control group received usual care. Both groups were permitted to walk and shower. OUTCOME MEASURES The primary outcome was the duration of the first stage of labour. The secondary outcomes were the duration of the second stage of labour, pain intensity, delivery mode, medication use, local swelling, fatigue, anxiety, satisfaction and neonatal outcomes. RESULTS The experimental intervention reduced the duration of labour by 179 minutes (95% CI 146 to 213) in stage one and 19 minutes (95% CI 13 to 25) in stage two. It decreased pain by approximately 2 points (95% CI 2 to 2) on a 0-to-10 scale at 30, 60 and 90 minutes. It reduced the risk of a caesarean section (ARR 0.14, 95% CI 0.03 to 0.25; NNT 7, 95% CI 4 to 32) and vulvar swelling (ARR 0.11, 95% CI 0.03 to 0.19; NNT 9, 95% CI 5 to 31). It reduced fatigue by 18 points (95% CI 16 to 21) on a 15-to-75-point scale and anxiety by 9 points (95% CI 8 to 11) on an 18-to-72-point scale. Other effects were negligible or unclear. CONCLUSION Active pelvic movements on a Swiss ball during labour reduced the duration of labour, pain intensity, and maternal fatigue and anxiety; they also lowered the risk of caesarean section and vulvar swelling. Several effects exceeded the smallest worthwhile effect. REGISTRATION NCT04124835.
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Affiliation(s)
- Alexandre Delgado
- Instituto de Medicina Integral Prof. Fernando Figueira, Recife, Brazil.
| | - Melania M Amorim
- Instituto de Medicina Integral Prof. Fernando Figueira, Recife, Brazil; Medical Academic Unit, Federal University of Campina Grande, Campina Grande, Brazil
| | | | | | | | | | - Andrea Lemos
- Physical Therapy Department, Universidade Federal de Pernambuco, Recife, Brazil
| | - Leila Katz
- Instituto de Medicina Integral Prof. Fernando Figueira, Recife, Brazil
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Jiang D, Wang X, Dlixiat A, Ma L, Xu Z, Sun G, Jia R, Wu Y, Zhang Y. Comparison of two surgical interventions for advanced stages pubis and pubic symphysis tuberculosis in adults: A retrospective study of 33 cases. Injury 2023; 54:111155. [PMID: 37919114 DOI: 10.1016/j.injury.2023.111155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 10/16/2023] [Accepted: 10/23/2023] [Indexed: 11/04/2023]
Abstract
PURPOSE To compare the clinical efficacy of two surgical interventions in treating advanced stages TB of the pubis and pubic symphysis. METHODS Between June 2010 and January 2020, 33 cases of the advanced pubis and pubic symphysis TB were treated with a one-stage debridement procedure (debridement only group, n = 15) or a one-stage debridement with bone grafting and plate fixation procedure (debridement + plating group, n = 18). The visual analog scale (VAS) score, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), operation time, intraoperative blood loss, complications, time of bone graft fusion, and improvement in the mental component summary (MCS) and physical component summary (PCS) of Short Form-36 (SF-36) were compared and analyzed. RESULTS All patients were followed for 24.9 (SD 1.6) months. All patients were completely cured of the pubis and pubic symphysis TB with no recurrence. There were no significant differences (P >0.05) between the two groups in terms of age, follow-up period and intraoperative blood loss. The post-operative VAS scores, ESR and CRP levels, PCS and MCS scores of two groups significantly improved compared to pre-therapy. The mean operation time in debridement + plating group was 140.9 (43.2) min, which was significantly longer than in debridement only group [94.9(21.8) min, P < 0.01]. The final follow-up (FFU) indices of the VAS score in debridement only group were higher than those in debridement + plating group [1.9 (0.8) vs 1.3 (0.5), P=0.012]. A satisfactory average bony fusion time of 12.2 (3.3) months was achieved in debridement + plating group . CONCLUSIONS A one-stage debridement, bone grafting, and reconstruction plate fixation procedure achieved reconstruction of the integrity and stability of the pelvic ring, pain relief, and rapid cure of bone TB. This procedure is a safe and effective treatment option for advanced pubis and pubic symphysis TB.
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Affiliation(s)
- Dingyu Jiang
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital of Central South University, 87# Xiangya Road, Changsha, Hunan 410008, China; Hunan Engineering Laboratory of Advanced Artificial Osteo-Materials, 87# Xiangya Road, Changsha, Hunan, 410008, China
| | - Xiyang Wang
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital of Central South University, 87# Xiangya Road, Changsha, Hunan 410008, China; Hunan Engineering Laboratory of Advanced Artificial Osteo-Materials, 87# Xiangya Road, Changsha, Hunan, 410008, China.
| | - Abulizi Dlixiat
- Department of Orthopedics, The Eighth Affiliated Hospital of Xinjiang Medical University, No.106 Yan 'an Road, Tianshan District, Urumqi city, Xinjiang Uygur Autonomous Region 830049, China
| | - Liang Ma
- Department of Orthopedics, The Eighth Affiliated Hospital of Xinjiang Medical University, No.106 Yan 'an Road, Tianshan District, Urumqi city, Xinjiang Uygur Autonomous Region 830049, China
| | - Zhenchao Xu
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital of Central South University, 87# Xiangya Road, Changsha, Hunan 410008, China; Hunan Engineering Laboratory of Advanced Artificial Osteo-Materials, 87# Xiangya Road, Changsha, Hunan, 410008, China
| | - Guannan Sun
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital of Central South University, 87# Xiangya Road, Changsha, Hunan 410008, China; Hunan Engineering Laboratory of Advanced Artificial Osteo-Materials, 87# Xiangya Road, Changsha, Hunan, 410008, China
| | - Runze Jia
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital of Central South University, 87# Xiangya Road, Changsha, Hunan 410008, China; Hunan Engineering Laboratory of Advanced Artificial Osteo-Materials, 87# Xiangya Road, Changsha, Hunan, 410008, China
| | - Yunqi Wu
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital of Central South University, 87# Xiangya Road, Changsha, Hunan 410008, China; Hunan Engineering Laboratory of Advanced Artificial Osteo-Materials, 87# Xiangya Road, Changsha, Hunan, 410008, China
| | - Yilu Zhang
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital of Central South University, 87# Xiangya Road, Changsha, Hunan 410008, China; Hunan Engineering Laboratory of Advanced Artificial Osteo-Materials, 87# Xiangya Road, Changsha, Hunan, 410008, China
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Ballit A, Hivert M, Rubod C, Dao TT. Fast soft-tissue deformations coupled with mixed reality toward the next-generation childbirth training simulator. Med Biol Eng Comput 2023:10.1007/s11517-023-02864-5. [PMID: 37382859 DOI: 10.1007/s11517-023-02864-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 06/07/2023] [Indexed: 06/30/2023]
Abstract
High-quality gynecologist and midwife training is particularly relevant to limit medical complications and reduce maternal and fetal morbimortalities. Physical and virtual training simulators have been developed. However, physical simulators offer a simplified model and limited visualization of the childbirth process, while virtual simulators still lack a realistic interactive system and are generally limited to imposed predefined gestures. Objective performance assessment based on the simulation numerical outcomes is still not at hand. In the present work, we developed a virtual childbirth simulator based on the Mixed-Reality (MR) technology coupled with HyperMSM (Hyperelastic Mass-Spring Model) formulation for real-time soft-tissue deformations, providing intuitive user interaction with the virtual physical model and a quantitative assessment to enhance the trainee's gestures. Microsoft HoloLens 2 was used and the MR simulator was developed including a complete holographic obstetric model. A maternal pelvis system model of a pregnant woman (including the pelvis bone, the pelvic floor muscles, the birth canal, the uterus, and the fetus) was generated, and HyperMSM formulation was applied to simulate the soft tissue deformations. To induce realistic reactions to free gestures, the virtual replicas of the user's detected hands were introduced into the physical simulation and were associated with a contact model between the hands and the HyperMSM models. The gesture of pulling any part of the virtual models with two hands was also implemented. Two labor scenarios were implemented within the MR childbirth simulator: physiological labor and forceps-assisted labor. A scoring system for the performance assessment was included based on real-time biofeedback. As results, our developed MR simulation application was developed in real-time with a refresh rate of 30-50 FPS on the HoloLens device. HyperMSM model was validated using FE outcomes: high correlation coefficients of [0.97-0.99] and weighted root mean square relative errors of 9.8% and 8.3% were obtained for the soft tissue displacement and energy density respectively. Experimental tests showed that the implemented free-user interaction system allows to apply the correct maneuvers (in particular the "Viennese" maneuvers) during the labor process, and is capable to induce a truthful reaction of the model. Obtained results confirm also the possibility of using our simulation's outcomes to objectively evaluate the trainee's performance with a reduction of 39% for the perineal strain energy density and 5.6 mm for the vertical vaginal diameter when the "Viennese" technique is applied. This present study provides, for the first time, an interactive childbirth simulator with an MR immersive experience with direct free-hand interaction, real-time soft-tissue deformation feedback, and an objective performance assessment based on numerical outcomes. This offers a new perspective for enhancing next-generation training-based obstetric teaching. The used models of the maternal pelvic system and the fetus will be enhanced, and more delivery scenarios (e.g. instrumental delivery, breech delivery, shoulder dystocia) will be designed and integrated. The third stage of labor will be also investigated to include the delivery of the placenta, and the clamping and cutting of the umbilical cord.
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Affiliation(s)
- Abbass Ballit
- Univ. Lille, CNRS, Centrale Lille, UMR 9013-LaMcube-Laboratoire de Mécanique, Multiphysique, Multiéchelle, Lille, F-59000, France
| | - Mathieu Hivert
- Université Lille Nord de France, Faculté de Médecine, F-59000, Lille, France
- CHU Lille, Service de Chirurgie Gynécologique, F-59000, Lille, France
| | - Chrystèle Rubod
- Univ. Lille, CNRS, Centrale Lille, UMR 9013-LaMcube-Laboratoire de Mécanique, Multiphysique, Multiéchelle, Lille, F-59000, France
- Université Lille Nord de France, Faculté de Médecine, F-59000, Lille, France
- CHU Lille, Service de Chirurgie Gynécologique, F-59000, Lille, France
| | - Tien-Tuan Dao
- Univ. Lille, CNRS, Centrale Lille, UMR 9013-LaMcube-Laboratoire de Mécanique, Multiphysique, Multiéchelle, Lille, F-59000, France.
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Kubicka AM. Changes in plasticity of the pelvic girdle from infancy to late adulthood in Homo sapiens. Sci Rep 2023; 13:9698. [PMID: 37322042 PMCID: PMC10272276 DOI: 10.1038/s41598-023-36703-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 06/08/2023] [Indexed: 06/17/2023] Open
Abstract
Previous research on the effects of body mass on the pelvic girdle focused mostly on adult females and males. Because the ontogenetic plasticity level in the pelvis remains largely unknown, this study investigated how the association between body mass index (BMI) and pelvic shape changes during development. It also assessed how the large variation in pelvic shape could be explained by the number of live births in females. Data included CT scans of 308 humans from infancy to late adulthood with known age, sex, body mass, body stature, and the number of live births (for adult females). 3D reconstruction and geometric morphometrics was used to analyze pelvic shape. Multivariate regression showed a significant association between BMI and pelvic shape in young females and old males. The association between the number of live births and pelvic shape in females was not significant. Less plasticity in pelvic shape in adult females than during puberty, perhaps reflects adaptation to support the abdominopelvic organs and the fetus during pregnancy. Non-significant susceptibility to BMI in young males may reflect bone maturation accelerated by excessive body mass. Hormonal secretion and biomechanical loading associated with pregnancy may not have a long-term effect on the pelvic morphology of females.
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Affiliation(s)
- Anna Maria Kubicka
- Department of Zoology, Poznań University of Life Sciences, Wojska Polskiego 71C, 60-625, Poznań, Poland.
- PaleoFED Team, Département Homme et Environnement, Muséum National d'Histoire Naturelle. Musée de l'Homme, UMR 7194, CNRS, Place du Trocadéro 17, 75016, Paris, France.
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Mishra S, Satapathy D, Zion N, Lodh U. Early Outcome Analysis of Management of Closed Pelvic Ring Fractures in Emergency: Conservative Versus Surgical at Level III Trauma Center in India. Cureus 2022; 14:e26195. [PMID: 35891872 PMCID: PMC9306436 DOI: 10.7759/cureus.26195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2022] [Indexed: 11/26/2022] Open
Abstract
Introduction: Pelvic bone fracture is often observed in high-speed road traffic accidents, and forms a medical emergency as it is often complicated with associated internal exsanguination, shock, and mortality. Managing such cases cost-effectively in a developing country with limited assets, without compromising on patient outcomes still remains an obstacle. Objective: To compare and contrast the clinical aftermath of urgent non-surgical and surgical treatment of closed pelvic ring fracture patients and to analyze the types and severity of complications and final functional outcome. Material and methods: Twenty-five patients with pelvic fractures received at the casualty of IMS and SUM Hospital, Bhubaneswar, between January 2017 and January 2018 were included in the study. Marvin Tile classification was used to classify the fractures. Analysis and assessment of patients were done preoperatively and at six-month follow-up after management, with radiology and functional score using D’Aubinge-Postel Scale. The mode of injury, various management protocols for each type of fracture pattern, and associated complications were also noted. And finally, an outcome comparison was drawn between surgical and non-surgical options for various fractures. A Chi-square test was used to compare the outcomes. Results: The functional outcome as per the D'Aubigne-Postel Scale, on average six months, was excellent in nine patients (36%), good in seven (28%), fair in four (16%), and poor in four (16%). The outcome comparison was insignificant statistically in both radiological assessment (p 0.614) and functional scores (p 0.26) between the conservative and surgical outcomes. The average duration of hospital stay, duration to ambulation, duration to full recovery, and complications were significantly more in patients managed conservatively. While the cost of treatment was more in the surgical group. One death was observed in the study group due to septicemia which might have been directly related to the severity of pelvic injury and choice of treatment. Conclusion: Tile’s Type B and C fractures, managed surgically allow faster mobilization of the patient and a shorter recovery period while the cost of treatment is significantly more. Tiles type A is best managed conservatively.
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Eryiğit S, Al Kafee A, Akan A. Analysis of the quadratus lumborum muscle activity on leg length discrepancy: A randomized controlled trial. J Back Musculoskelet Rehabil 2022; 35:525-530. [PMID: 34366317 DOI: 10.3233/bmr-181177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Quadratus lumborum (QL) discrete region extensions might change depending on whether leg length discrepancy (LLD) individually has any extra erector spinae action in the lumbar spine, which can result in serious injury to the lower extremities and lumbar vertebrae. OBJECTIVE This study aims to investigate the effect of QL muscle activity on LLD by using electromyography (EMG) signals. METHODS The study employed a randomized controlled design. A total of 100 right-handed volunteers were included in this study. All participants were assessed manually by tape measurement for LLD. EMG signals were recorded during the resting and maximal isometric contraction positions to determine QL muscle activity. The power spectral density (PSD) methods were applied to compute EMG signals. RESULTS In maximal isometric contraction position, comparing the short right LLD (Right side = 0.00064 ± 0.00001, Left side = 0.00033 ± 0.0006) and short left LLD (Right side = 0.00001 ± 0.00008, Left side = 0.00017 ± 0.0001), it was found that the short right LLD group had significantly increased PSD of EMG values. In resting position, the short right LLD (Right side = 0.0002 ± 0.0073, Left side = 0.00016 ± 0.0065) had significantly increased PSD of EMG compared to the short left LLD (Right side = 0.00004 ± 0.0003, Left side = 0.0001 ± 0.0008) values of the QL muscle activity. The results of both groups were also statistically significant (p< 0.05). CONCLUSIONS The present study showed that it is possible to determine effective experimental interventions for functional LLD using EMG signal analysis of QL muscle activity on an asymptomatic normal population.
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Affiliation(s)
- Sevim Eryiğit
- Department of Biomedical Engineering, Istanbul University, Istanbul, Turkey
| | - Abdullah Al Kafee
- Department of Biomedical Engineering, Istanbul University, Istanbul, Turkey
| | - Aydin Akan
- Department of Electrical and Electronics Engineering, Izmir University of Economics, Izmir, Turkey
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12
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Delgado A, Katz L, Melo RS, Amorim M, Lemos A. Effectiveness of the peanut ball use for women with epidural analgesia in labour: a systematic review and meta-analysis. J OBSTET GYNAECOL 2022; 42:726-733. [PMID: 34996318 DOI: 10.1080/01443615.2021.1997959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This meta-analysis aimed to evaluate, using the best level of evidence, the possible benefits and advantages of using peanut ball (PB) in women with an epidural during labour on the maternal and neonatal outcomes. This research was conducted using MEDLINE/PubMed, Embase, LILACS, CINAHL, CENTRAL, PEDro, Web of Science and SCOPUS databases, with no period or language restrictions. The terms 'labor' and 'peanut ball' were used. Clinical trials (randomised and non-randomised) were included when comparing a group of parturients using PB with a control group under usual care. Randomised clinical trials (RCTs) or quasi-randomised were eligible for this systematic review. Two reviewers independently screened studies, extracted data and assessed the quality of evidence which was evaluated by the GRADE system. Quantitative analysis through meta-analysis was also applied whenever possible. In this updated review, we included four studies with a total of 818 women in labour after the use of pharmacological analgesia. Our GRADE ratings of evidence ranged from high to low quality. Overall, the included studies varied in their risk of bias, in which most were considered with some concerns. There is high evidence that the use of PB after epidural analgesia reduces the duration of the first period of labour by 87 minutes and moderate evidence that it increases the chance of vaginal delivery 11%. However, there is no evidence about other maternal and neonatal outcomes.Impact StatementWhat is already known on this subject? The peanut ball (PB) is used after the use of pharmacological analgesia, as it favours the opening of the pelvic canal and helps women to adopt more comfortable postures, but its real effects are not clear.What do the results of this study add? Our results suggest that using the PB reduces the duration of the first period of labour after an epidural and increases the chance of a vaginal birth.What are the implications of these findings for clinical practice and/or further research? These findings recommend the use of a PB after an epidural and further research with women without the use of pharmacological analgesia.
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Affiliation(s)
- Alexandre Delgado
- Post-Graduate Program on Integral Medicine, Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Recife, Brazil
| | - Leila Katz
- Post-Graduate Program on Integral Medicine, Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Recife, Brazil
| | - Renato S Melo
- Department of Physical Therapy, Universidade Federal de Pernambuco (UFPE), Recife, Brazil
| | - Melania Amorim
- Post-Graduate Program on Integral Medicine, Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Recife, Brazil
| | - Andrea Lemos
- Department of Physical Therapy, Universidade Federal de Pernambuco (UFPE), Recife, Brazil.,Post-Gratuate Program of Physical Therapy, Universidade Federal de Pernambuco (UFPE), Recife, Brazil
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13
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The Most Common Functional Disorders and Factors Affecting Female Pelvic Floor. Life (Basel) 2021; 11:life11121397. [PMID: 34947928 PMCID: PMC8704638 DOI: 10.3390/life11121397] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 12/09/2021] [Accepted: 12/11/2021] [Indexed: 12/13/2022] Open
Abstract
The pelvic floor (PF) is made of muscles, ligaments, and fascia, which ensure organ statics, maintain muscle tone, and are involved in contractions. This review describes the myofascial relationships of PF with other parts of the body that determine the proper functions of PF, and also provides insight into PF disorders and the factors contributing to them. PF plays an important role in continence, pelvic support, micturition, defecation, sexual function, childbirth, and locomotion, as well as in stabilizing body posture and breathing, and cooperates with the diaphragm and postural muscles. In addition, PF associates with distant parts of the body, such as the feet and neck, through myofascial connections. Due to tissue continuity, functional disorders of muscles, ligaments, and fascia, even in the areas that are distant from PF, will lead to PF disorders, including urinary incontinence, fecal incontinence, prolapse, sexual dysfunction, and pain. Dysfunctions of PF will also affect the rest of the body.
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14
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Jeffery NS, Humphreys C, Manson A. A human craniofacial life-course: Cross-sectional morphological covariations during postnatal growth, adolescence, and aging. Anat Rec (Hoboken) 2021; 305:81-99. [PMID: 34369671 DOI: 10.1002/ar.24736] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 04/19/2021] [Accepted: 06/30/2021] [Indexed: 01/22/2023]
Abstract
Covariations between anatomical structures are fundamental to craniofacial ontogeny, maturation, and aging and yet are rarely studied in such a cognate fashion. Here, we offer a comprehensive investigation of the human craniofacial complex using freely available software and MRI datasets representing 575 individuals from 0 to 79 years old. We employ both standard craniometrics methods as well as Procrustes-based analyses to capture and document cross-sectional trends. Findings suggest that anatomical structures behave primarily as modules, and manifest integrated patterns of shape change as they compete for space, particularly with relative expansions of the brain during early postnatal life and of the face during puberty. Sexual dimorphism was detected in infancy and intensified during adolescence with gender differences in the magnitude and pattern of morphological covariation as well as of aging. These findings partly support the spatial-packing hypothesis and reveal important insights into phenotypic adjustments to deep-rooted, and presumably genetically defined, trajectories of morphological size and shape change that characterize the normal human craniofacial life-course.
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Affiliation(s)
- Nathan S Jeffery
- Human Anatomy Resource Centre & Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Craig Humphreys
- Human Anatomy Resource Centre & Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Amy Manson
- Human Anatomy Resource Centre & Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
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15
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Fan X, Zhou Z, Stewart M, Wang D, Lan X, Dang S, Yan H. Comparing the pelvis of Tibetan and Chinese Han women in rural areas of China: two population-based studies using coarsened exact matching. J OBSTET GYNAECOL 2021; 42:403-409. [PMID: 34165006 DOI: 10.1080/01443615.2021.1908241] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This study aims to investigate the difference of pelvic size and shape between Tibetan and Chinese Han women. Data on pelvic dimension measures including interspinous diameter (IS), intercrestal diameter (IC), external conjugate (EC) and transverse outlet (TO) were acquired from two population-based studies amongst Tibetan women in Lhasa, and Chinese Han women in Shaanxi province in China. After coarsened exact matching, there was no statistical difference between any characteristics amongst Tibetan and Chinese Han women (p>.05). The generalised estimating equation models showed Tibetan women had significantly lower IS and IC means than Chinese Han women (IS: 24.39 cm vs. 24.77 cm, p<.001; IC: 26.35 cm vs. 26.93 cm, p<.001) but statistically higher in TO mean (9.12 cm vs. 9.03 cm, p<.001). This study showed Tibetan women have smaller pelvis compared to Chinese Han women. This should offer a useful literature on the comparison of pelvis between Tibetan and Chinese Han women although the difference is small.Impact StatementWhat is already known on this subject? Previous studies in China indicated different populations have different dimensions of pelvis, with the pelvis of Uighur women being bigger than Chinese Han women, and that of Zhuang and Tu women being smaller than Chinese Han women. Little research reports the specific size of Tibetan women's pelvis. Living at high altitude, the Tibetan population have differentiated demographics and show local adaptions, such as unelevated haemoglobin, and significant catch-up growth for infants compared with Chinese Han infants. Therefore, there is a strong rationale for better understanding pelvic characteristics amongst this population.What the results of this study add? This study showed Tibetan women have smaller pelvises compared to Chinese Han women. Tibetan women have a smaller interspinous diameter and intercrestal diameter than Chinese Han women, which leads to relatively narrow hip.What the implications are of these findings for clinical practice and/or further research? This study provides useful comparative information on pelvic features between Tibetan and Chinese Han women although the findings of differences were small. In addition, during the formulation of women's health policy, the results of this study can provide data to support the selection of appropriate indicators of obstetrics and gynaecology for different populations of pregnant women during antenatal care and delivery.
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Affiliation(s)
- Xiaojing Fan
- Institute of Health Management and Policy, School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China
| | - Zhongliang Zhou
- Institute of Health Management and Policy, School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China
| | - Martyn Stewart
- Department of Education and Training, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Duolao Wang
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Xin Lan
- Department of Epidemiology and Health Statistics, School of Public Health, Center of Medical Science, Xi'an Jiaotong University, Xi'an, PR China
| | - Shaonong Dang
- Department of Epidemiology and Health Statistics, School of Public Health, Center of Medical Science, Xi'an Jiaotong University, Xi'an, PR China
| | - Hong Yan
- Department of Epidemiology and Health Statistics, School of Public Health, Center of Medical Science, Xi'an Jiaotong University, Xi'an, PR China
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Dzupa V, Konarik M, Knize J, Veleminsky P, Vranova J, Baca V, Kachlik D. The size and shape of the human pelvis: a comparative study of modern and medieval age populations. Ann Anat 2021; 237:151749. [PMID: 33940120 DOI: 10.1016/j.aanat.2021.151749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 04/19/2021] [Accepted: 04/22/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Great variability in shape and size of the bony pelvis can be observed in the current population, but there is not enough data on how long the historical period must elapse to gain changes in pelvic shape and size. The aim of the study was to identify morphological changes in bony pelvis in males and females after a developmentally short period of approximately one thousand years. MATERIAL AND METHODS Seventeen defined external dimensions of pelvic bone from 120 adult individuals (two craniocaudal, two ventrodorsal, six mediolateral, three acetabular dimensions, and four dimension of the auricular surface) were measured. The medieval sample of 60 pelvic bones (30 male and 30 female) was obtained from the Great Moravian site of Mikulčice-Valy (9th-10th century), while the modern collection of 60 pelvic bones (30 male and 30 female) dates from the late 19th and first half of the 20th centuries. Obtained results were evaluated using the independent t-test at a 5% level of significance. RESULTS A comparison of male and female pelvic dimensions within a single population yielded expected results: the mean male values were greater. In modern population, male pelvis mean values were greater in 15 of defined parameters, while in medieval population, male dimensions were larger in 16 variables. A comparison of modern and medieval female pelvic bones found 11 variables to be greater in medieval sample (one determining the craniocaudal dimension, five the mediolateral, all three the acetabular, and two determining the auricular surface dimensions), but only two were significant (two dimensions determining the mediolateral dimensions). In modern female samples, there were five variables greater (one determining the craniocaudal dimension, one the ventrodorsal, one the mediolateral, and two determining the auricular surface dimensions), but only two were significant as well (one determining the craniocaudal and one the ventrodorsal dimensions). A comparison of male pelvic bones found 13 variables to be greater in medieval pelvis (one determining the craniocaudal dimension, all six the mediolateral, one the ventrodorsal, all three the acetabular, and two determining the auricular surface dimensions), but only four were significant as well (all determining the mediolateral dimensions). In modern male sample, there were only four variables greater (one determining the craniocaudal dimension, one the ventrodorsal, and two determining the auricular surface dimensions), but only one was significant (determining the craniocaudal dimension). CONCLUSION Unexpectedly, our study did not find the early medieval population to have a smaller pelvis compared to the modern population. While pelvic bones of the former were somewhat lower, but wider, those of the latter population were a bit higher and narrower. The study allows a very careful statement that one millennium is a time period long enough for measurable morphological deviations of the pelvic bones shape and size to occur.
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Affiliation(s)
- Valer Dzupa
- Department of Orthopaedics and Traumatology, Third Faculty of Medicine, Charles University, and University Hospital Kralovske Vinohrady, Srobarova 50, 100 00, Prague 10, Czech Republic; Center for Integrated Studies of the Pelvis, Third Faculty of Medicine, Charles University, Ruska 87, 100 00, Prague 10, Czech Republic.
| | - Marek Konarik
- Department of Anatomy, Second Faculty of Medicine, Charles University, V Uvalu 84, 150 06, Prague 5, Czech Republic; Center for Integrated Studies of the Pelvis, Third Faculty of Medicine, Charles University, Ruska 87, 100 00, Prague 10, Czech Republic.
| | - Jakub Knize
- Department of Anatomy, Second Faculty of Medicine, Charles University, V Uvalu 84, 150 06, Prague 5, Czech Republic; Center for Integrated Studies of the Pelvis, Third Faculty of Medicine, Charles University, Ruska 87, 100 00, Prague 10, Czech Republic.
| | - Petr Veleminsky
- Department of Anthropology, National Museum, Vaclavske nam. 68, 110 00, Prague 1, Czech Republic.
| | - Jana Vranova
- Department of Biophysics and Informatics, Third Faculty of Medicine, Charles University, Ruska 87, 100 00, Prague 10, Czech Republic.
| | - Vaclav Baca
- Department of Health Care Studies, Colleague of Polytechnics Jihlava, Tolsteho 16, 586 01, Jihlava, Czech Republic; Center for Integrated Studies of the Pelvis, Third Faculty of Medicine, Charles University, Ruska 87, 100 00, Prague 10, Czech Republic.
| | - David Kachlik
- Department of Anatomy, Second Faculty of Medicine, Charles University, V Uvalu 84, 150 06, Prague 5, Czech Republic; Center for Integrated Studies of the Pelvis, Third Faculty of Medicine, Charles University, Ruska 87, 100 00, Prague 10, Czech Republic.
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Crawford D, Wilson B, Davies K. Biological basis of child health 6: development of the skeletal system and orthopaedic conditions. Nurs Child Young People 2021; 33:32-42. [PMID: 33410607 DOI: 10.7748/ncyp.2020.e1248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2019] [Indexed: 11/09/2022]
Abstract
This article is the sixth in a series on the biological basis of child health. It provides an overview of the development of the skeletal system before and after birth, and outlines the potential congenital anomalies that may occur. The article explains the structure and function of the bones before describing the role of the joints, tendons and ligaments. It also outlines the presentation and management of some of the common orthopaedic conditions seen in infants and children, including fractures, osteogenesis imperfecta, scoliosis, juvenile idiopathic arthritis, developmental dysplasia of the hip and achondroplasia.
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Affiliation(s)
| | - Beth Wilson
- Sutton Health and Care, Sutton, Surrey, England
| | - Kate Davies
- Children's nursing, School of Health and Social Care, London South Bank University, London, England
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18
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Handrich K, Kamer L, Mayo K, Sawaguchi T, Noser H, Arand C, Wagner D, Rommens PM. Asymmetry of the pelvic ring evaluated by CT-based 3D statistical modeling. J Anat 2020; 238:1225-1232. [PMID: 33382451 PMCID: PMC8053576 DOI: 10.1111/joa.13379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 10/27/2020] [Accepted: 11/18/2020] [Indexed: 12/23/2022] Open
Abstract
The human pelvis is a complex anatomical structure that consists of the innominate bones, sacrum and coccyx to form the pelvic ring. Even though considered to be a symmetric entity, asymmetry of the pelvic ring (APR) might occur to alter its anatomy, function, or biomechanics or to impact assessment and treatment of clinical cases. APR and its assessment is complicated by the intricate anatomy of the pelvic ring. There is only limited information and understanding about APR with no established evaluation methods existing. The objective of the present study was to adopt CT-based 3D statistical modeling and analysis to assess APR within the complex anatomy of the pelvic ring. We were interested to establish a better understanding of APR with knowledge and applications transferred to human anatomy, related research, and development subjects and to clinical settings. A series of 150 routine, clinical, pelvic CT protocols of European and Asian males and females (64 ± 15 (20-90) years old) were post-processed to compute gender- and ancestry-specific 3D statistical models of the pelvic ring. Evaluations comprised principal component analysis (PCA) that included size, shape, and asymmetry patterns and their variations to be assessed. Four different CT-based 3D statistical models of the entire pelvic ring were computed according to the gender and ancestry specific groups. PCA mainly displayed size and shape variations. Examination of additional PCA modes permitted six distinct asymmetry patterns to be identified. They were located at the sacrum, iliac crest, pelvic brim, pubic symphysis, inferior pubic ramus, and near to the acetabulum. Accordingly, the pelvic ring demonstrated not to be entirely symmetric. Assessment of its asymmetry proved to be a challenging task. Using CT-based 3D statistical modeling and PCA, we identified six distinct APRs that were located at different anatomical regions. These regions are more prone to APRs than other sites. Minor asymmetry patterns have to be distinguished from the distinct APRs. Side differences with regard to size, shape, and/or position require to be taken into account. APRs may be due different load mechanisms applied via spine or lower extremity or locally. There is a need for simpler and efficient, yet reliable methods to be routinely transferred to human anatomy, related research, and development subjects and to clinical settings.
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Affiliation(s)
- Kristin Handrich
- AO Research Institute Davos, Davos, Switzerland.,Department of Orthopedics and Traumatology, University Medical Center, Mainz, Germany
| | - Lukas Kamer
- AO Research Institute Davos, Davos, Switzerland
| | - Keith Mayo
- Hansjörg Wyss Hip and Pelvis Center, University of Washington School of Medicine, Seattle, WA, USA
| | - Takeshi Sawaguchi
- Department of Orthopedics und Joint Reconstructive Surgery, Toyama Municipal Hospital, Toyama, Japan
| | | | - Charlotte Arand
- Department of Orthopedics and Traumatology, University Medical Center, Mainz, Germany
| | - Daniel Wagner
- Department of Orthopedics and Traumatology, University Medical Center, Mainz, Germany
| | - Pol M Rommens
- Department of Orthopedics and Traumatology, University Medical Center, Mainz, Germany
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19
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McKerracher L, Fried R, Kim AW, Moffat T, Sloboda DM, Galloway T. Synergies between the Developmental Origins of Health and Disease framework and multiple branches of evolutionary anthropology. Evol Anthropol 2020; 29:214-219. [DOI: 10.1002/evan.21860] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 04/24/2020] [Accepted: 07/15/2020] [Indexed: 02/05/2023]
Affiliation(s)
- Luseadra McKerracher
- Department of Biochemistry and Biomedical Sciences McMaster University Hamilton Ontario Canada
- Department of Anthropology McMaster University Hamilton Ontario Canada
| | - Ruby Fried
- Institute for Circumpolar Health Studies, University of Alaska Anchorage Anchorage Alaska USA
| | - Andrew W. Kim
- Department of Anthropology Northwestern University Evanston Illinois USA
| | - Tina Moffat
- Department of Anthropology McMaster University Hamilton Ontario Canada
| | - Deborah M. Sloboda
- Department of Obstetrics and Gynecology McMaster University Hamilton Ontario Canada
- Department of Pediatrics McMaster University Hamilton Ontario Canada
- Farncombe Institute of Digestive Health McMaster University Hamilton Ontario Canada
| | - Tracey Galloway
- Department of Anthropology University of Toronto Mississauga Ontario Canada
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Sex-Specific Transcriptome Differences in Human Adipose Mesenchymal Stem Cells. Genes (Basel) 2020; 11:genes11080909. [PMID: 32784482 PMCID: PMC7464371 DOI: 10.3390/genes11080909] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 07/24/2020] [Accepted: 08/06/2020] [Indexed: 12/17/2022] Open
Abstract
In humans, sexual dimorphism can manifest in many ways and it is widely studied in several knowledge fields. It is increasing the evidence that also cells differ according to sex, a correlation still little studied and poorly considered when cells are used in scientific research. Specifically, our interest is on the sex-related dimorphism on the human mesenchymal stem cells (hMSCs) transcriptome. A systematic meta-analysis of hMSC microarrays was performed by using the Transcriptome Mapper (TRAM) software. This bioinformatic tool was used to integrate and normalize datasets from multiple sources and allowed us to highlight chromosomal segments and genes differently expressed in hMSCs derived from adipose tissue (hADSCs) of male and female donors. Chromosomal segments and differentially expressed genes in male and female hADSCs resulted to be related to several processes as inflammation, adipogenic and neurogenic differentiation and cell communication. Obtained results lead us to hypothesize that the donor sex of hADSCs is a variable influencing a wide range of stem cell biologic processes. We believe that it should be considered in biologic research and stem cell therapy.
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21
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Grunstra NDS, Zachos FE, Herdina AN, Fischer B, Pavličev M, Mitteroecker P. Humans as inverted bats: A comparative approach to the obstetric conundrum. Am J Hum Biol 2019; 31:e23227. [PMID: 30810261 PMCID: PMC6492174 DOI: 10.1002/ajhb.23227] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Revised: 02/03/2019] [Accepted: 02/06/2019] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES The narrow human birth canal evolved in response to multiple opposing selective forces on the pelvis. These factors cannot be sufficiently disentangled in humans because of the limited range of relevant variation. Here, we outline a comparative strategy to study the evolution of human childbirth and to test existing hypotheses in primates and other mammals. METHODS We combined a literature review with comparative analyses of neonatal and female body and brain mass, using three existing datasets. We also present images of bony pelves of a diverse sample of taxa. RESULTS Bats, certain non-human primates, seals, and most ungulates, including whales, have much larger relative neonatal masses than humans, and they all differ in their anatomical adaptations for childbirth. Bats, as a group, are particularly interesting in this context as they give birth to the relatively largest neonates, and their pelvis is highly dimorphic: Whereas males have a fused symphysis, a ligament bridges a large pubic gap in females. The resulting strong demands on the widened and vulnerable pelvic floor likely are relaxed by roosting head-down. CONCLUSIONS Parturition has constituted a strong selective force in many non-human placentals. We illustrated how the demands on pelvic morphology resulting from locomotion, pelvic floor stability, childbirth, and perhaps also erectile function in males have been traded off differently in mammals, depending on their locomotion and environment. Exploiting the power of a comparative approach, we present new hypotheses and research directions for resolving the obstetric conundrum in humans.
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Affiliation(s)
- Nicole D. S. Grunstra
- Department of Theoretical BiologyUniversity of ViennaViennaAustria
- Mammal CollectionNatural History Museum ViennaViennaAustria
| | - Frank E. Zachos
- Mammal CollectionNatural History Museum ViennaViennaAustria
- Department of Integrative ZoologyUniversity of ViennaViennaAustria
| | | | - Barbara Fischer
- Konrad Lorenz Institute for Evolution and Cognition ResearchKlosterneuburgAustria
| | - Mihaela Pavličev
- Cincinnati Children's Hospital Medical CenterCincinnatiOhio
- Department of PediatricsUniversity of Cincinnati College of MedicineCincinnatiOhio
- Department of PhilosophyUniversity of CincinnatiCincinnatiOhio
| | - Philipp Mitteroecker
- Department of Theoretical BiologyUniversity of ViennaViennaAustria
- Konrad Lorenz Institute for Evolution and Cognition ResearchKlosterneuburgAustria
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Musielak B, Kubicka AM, Rychlik M, Czubak J, Czwojdziński A, Grzegorzewski A, Jóźwiak M. Variation in pelvic shape and size in Eastern European males: a computed tomography comparative study. PeerJ 2019; 7:e6433. [PMID: 30809442 PMCID: PMC6387581 DOI: 10.7717/peerj.6433] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 01/10/2019] [Indexed: 12/22/2022] Open
Abstract
Background The significantly accelerated development of human society in the last millennium has brought about changes in human behavior and body mass that may have influenced human bone morphology. Our objective was to analyze the variation in pelvic shape and size in males from modern and medieval populations. Methods We obtained 22 pelvic girdles of adult males from a medieval cemetery located in Cedynia, Poland. The control group comprised 31 contemporary male pelves from individuals inhabiting the same region. The analyzed parameters were: interspinous distance (ISD), intercristal distance (ICD), intertuberous distance (ITD), anatomic conjugate of the pelvis, height of the pelvis (HP), iliac opening angle (IOA), iliac tilt angle (ITA), and ISD/ITD/HP ratio. Geometric morphometrics was used to analyze differences in shape in the pelves. All analyses were carried out on three-dimensional CT reconstructions of pelves. Results ISD, ICD, and IOA were significantly greater in modern pelves than in those from Cedynia, but no significant differences were seen between the two groups in ITD, anatomical conjugate, HP, or ITA. ISD/ITD/HP ratios were significantly lower in the Cedynia group. Geometric morphometrics revealed significant differences in pelvic shape between the analyzed groups. Discussion The pelves of modern males are larger, wider, and flatter than those of medieval males. Changes in the set of daily activities that produce mechanical loading and estimated body mass may constitute the main factors explaining pelvic variability. However, differences in ontogenesis should also be taken into consideration, especially since growth in past populations is often found to be reduced relative to modern populations.
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Affiliation(s)
- Bartosz Musielak
- Department of Pediatric Orthopedics and Traumatology, Poznań University of Medical Sciences, Poznań, Poland
| | - Anna Maria Kubicka
- Department of Zoology, Poznań University of Life Sciences, Poznań, Poland
| | - Michał Rychlik
- Division of Virtual Engineering, Poznań University of Technology, Poznań, Poland
| | - Jarosław Czubak
- Department of Orthopedics, Pediatric Orthopedics and Traumatology, Centre of Postgraduate Medical Education, Otwock, Poland
| | - Adam Czwojdziński
- Department of Orthopedics, Pediatric Orthopedics and Traumatology, Centre of Postgraduate Medical Education, Otwock, Poland
| | - Andrzej Grzegorzewski
- Department of Orthopedics and Pediatric Orthopedics, Medical University of Lódź, Łódź, Poland
| | - Marek Jóźwiak
- Department of Pediatric Orthopedics and Traumatology, Poznań University of Medical Sciences, Poznań, Poland
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Young M, Selleri L, Capellini TD. Genetics of scapula and pelvis development: An evolutionary perspective. Curr Top Dev Biol 2019; 132:311-349. [PMID: 30797513 PMCID: PMC6430119 DOI: 10.1016/bs.ctdb.2018.12.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
In tetrapods, the scapular and pelvic girdles perform the important function of anchoring the limbs to the trunk of the body and facilitating the movement of each appendage. This shared function, however, is one of relatively few similarities between the scapula and pelvis, which have significantly different morphologies, evolutionary histories, embryonic origins, and underlying genetic pathways. The scapula evolved in jawless fish prior to the pelvis, and its embryonic development is unique among bones in that it is derived from multiple progenitor cell populations, including the dermomyotome, somatopleure, and neural crest. Conversely, the pelvis evolved several million years later in jawed fish, and it develops from an embryonic somatopleuric cell population. The genetic networks controlling the formation of the pelvis and scapula also share similarities and differences, with a number of genes shaping only one or the other, while other gene products such as PBX transcription factors act as hierarchical developmental regulators of both girdle structures. Here, we provide a detailed review of the cellular processes and genetic networks underlying pelvis and scapula formation in tetrapods, while also highlighting unanswered questions about girdle evolution and development.
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Affiliation(s)
- Mariel Young
- Department of Human Evolutionary Biology, Harvard University, Cambridge, MA, United States
| | - Licia Selleri
- Program in Craniofacial Biology, Department of Orofacial Sciences, Eli and Edythe Broad Center of Regeneration Medicine & Stem Cell Research, University of California, Institute of Human Genetics, San Francisco, CA, United States; Program in Craniofacial Biology, Department of Anatomy, Eli and Edythe Broad Center of Regeneration Medicine & Stem Cell Research, University of California, Institute of Human Genetics, San Francisco, CA, United States.
| | - Terence D Capellini
- Department of Human Evolutionary Biology, Harvard University, Cambridge, MA, United States; Broad Institute of Harvard and MIT, Cambridge, MA, United States.
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Laitman JT, Albertine KH. The Anatomical Record Marches on by Exploring Evolution in the Second Part of Our Special Issue on the Human Pelvis. Anat Rec (Hoboken) 2018; 300:783-785. [PMID: 28406560 DOI: 10.1002/ar.23574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 02/15/2017] [Indexed: 11/07/2022]
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Rosenberg KR, DeSilva JM. Evolution of the Human Pelvis. Anat Rec (Hoboken) 2017; 300:789-797. [PMID: 28406563 DOI: 10.1002/ar.23580] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 02/15/2017] [Indexed: 12/12/2022]
Abstract
No bone in the human postcranial skeleton differs more dramatically from its match in an ape skeleton than the pelvis. Humans have evolved a specialized pelvis, well-adapted for the rigors of bipedal locomotion. Precisely how this happened has been the subject of great interest and contention in the paleoanthropological literature. In part, this is because of the fragility of the pelvis and its resulting rarity in the human fossil record. However, new discoveries from Miocene hominoids and Plio-Pleistocene hominins have reenergized debates about human pelvic evolution and shed new light on the competing roles of bipedal locomotion and obstetrics in shaping pelvic anatomy. In this issue, 13 papers address the evolution of the human pelvis. Here, we summarize these new contributions to our understanding of pelvic evolution, and share our own thoughts on the progress the field has made, and the questions that still remain. Anat Rec, 300:789-797, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Karen R Rosenberg
- Department of Anthropology, University of Delaware, Newark, Delaware
| | - Jeremy M DeSilva
- Department of Anthropology, Dartmouth College, Hanover, New Hampshire
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Laitman JT. How We Came to Be: Evidence from Primate Relatives and Fossil Ancestors Offer Clues to How Human Capabilities for Birth, Posture, and Walking Evolved. Anat Rec (Hoboken) 2017; 300:786-788. [PMID: 28406556 DOI: 10.1002/ar.23575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 02/13/2017] [Indexed: 11/08/2022]
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Laitman JT. A Bone for All Seasons: The Human Pelvis. Anat Rec (Hoboken) 2017; 300:624-627. [DOI: 10.1002/ar.23562] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 01/11/2017] [Indexed: 01/11/2023]
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Laitman JT, Albertine KH. A Prism by Which to See How Humans Came to Be:The Anatomical RecordExplores the Many Dimensions of the Human Pelvis. Anat Rec (Hoboken) 2017; 300:621-623. [DOI: 10.1002/ar.23560] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 01/18/2017] [Indexed: 01/14/2023]
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