Fundamental ratios and logarithmic periodicity in human limb bones

Addressing Obesity Care in Children With Chronic Health Conditions

Obesity care in pediatric populations has entered a new era. The recent discovery of molecular genetic causes for abnormal weight gain, development of antiobesity medications, mounting data on the robust efficacy and favorable safety profile of bariatric surgery, and implementation of clinical guidelines fill a long-standing gap in the care of children affected by obesity, one of the most challenging pediatric diseases. However, these novel clinical approaches do not appear to have reached every individual who is in need, particularly children with chronic health conditions (CHCs), raising important questions for equitable medical care. In this study, we discuss specific etiologies, challenges, and ideas for future directions in diagnosing and managing obesity in children with CHCs. Although this article is not intended to be utilized as clinical guidelines, it underscores potential practical solutions for the current issues.

Geometry-driven self-supervision for 3D human pose estimation

Although 3D human pose estimation has recently made strides, it is still difficult to precisely recreate a 3D human posture from a single image without the aid of 3D annotation for the following reasons. Firstly, the process of reconstruction inherently suffers from ambiguity, as multiple 3D poses can be projected onto the same 2D pose. Secondly, accurately measuring camera rotation without laborious camera calibration is a difficult task. While some approaches attempt to address these issues using traditional computer vision algorithms, they are not differentiable and cannot be optimized through training. This paper introduces two modules that explicitly leverage geometry to overcome these challenges, without requiring any 3D ground-truth or camera parameters. The first module, known as the relative depth estimation module, effectively mitigates depth ambiguity by narrowing down the possible depths for each joint to only two candidates. The second module, referred to as the differentiable pose alignment module, calculates camera rotation by aligning poses from different views. The use of these geometrically interpretable modules reduces the complexity of training and yields superior performance. By adopting our proposed method, we achieve state-of-the-art results on standard benchmark datasets, surpassing other self-supervised methods and even outperforming several fully-supervised approaches that heavily rely on 3D annotations.

Is human height based on a Lucas sequence relationship between the foot height, tibial length, femur length and upper body length?

This is a retrospective chart and radiographic review of 145 patients who underwent full-body EOS imaging; 109 males and 36 females. The mean ages of the female and male subsets are 28.8 (SD = 11.6) years and 29.5 (SD = 11.8) years, respectively. The sum of the foot height (Ft) and the tibial length (T) for each subject was compared to their femur length (Fe). Subsequently, the sum of the tibial (T) and femoral lengths (Fe) were compared to their respective upper body lengths (UB), as measured from the tops of the femoral heads. A linear regression test was performed to determine whether a Lucas sequence-based relationship exists between Ft + T and Fe, and between T + Fe and UB. The regression for the relationship between Ft + T and Fe for the entire cohort (R = 0.82, R2 = 0.70), the female subset (R = 0.94, R2 = 0.88) and the male subset (R = 0.75, R2 = 0.57), all demonstrated a strong positive correlation between Ft + T and Fe and showed that Ft + T is a likely predictor of Fe. The regression test for the entire cohort demonstrated a moderately positive correlation between T + Fe and UB (R = 0.41, R2 = 0.17, F(1, 145) = 29.42, p = 2.4E-07). A stronger correlation was found for the relationship between T + Fe and UB (R = 0.57, R2 = 0.32, F(1, 35) = 16.64, p = 2.5E-05) for the female subset relative to the male subset (R = 0.20, R2 = 0.038, F(1, 35) = 4.37, p = 0.04). There appears to be a Lucas sequence relationship between the lengths of the foot height, tibial length, femoral length and upper body length, which together make up standing height. This mathematical proportion relationship is stronger in females than males.

Undercorrection: the undesired effect of compression on the osteotomy gap of the medial opening wedge high tibial osteotomy and its clinical significance

INTRODUCTION

Undercorrection is a common problem in opening wedge high tibial osteotomy (OWHTO). We investigated the compression effect of cortex screw on the osteotomy gap and its clinical significance.

MATERIALS AND METHODS

A standard OWHTO using the TomoFix plate was conducted on 20 bone models in two groups to get a 10-mm medial osteotomy gap. A cortex screw was used temporarily in a neutral (at the center) and an eccentric position (near the inclined plane) of the dynamic hole in group 1 and group 2, respectively. The mean of undercorrection observed in the two groups was compared using an independent t test. Also, the effect of compression on the gap between the plate and medial tibial cortex, and the osteotomy gap was evaluated using a Sine rule. Besides, the mean undercorrection observed was assessed for clinical significance based on the effect on the weight-bearing axis (WBA) using a Cosine Rule.

RESULTS

The mean undercorrection was 1.3 ± 0.6 mm and 2.6 ± 0.6 mm in group 1 and group 2, respectively. A significantly greater undercorrection was observed in group 2 (p < 0.001). The correction loss in group 2 has resulted from combinations of the sliding effect of the dynamic hole and oblique compression effect over the gap between the plate and medial tibial cortex whereas in group 1 it has only resulted from the oblique compression effect. The observed undercorrection in group 2 has resulted in clinically significant WBA shift (10%) over the width of the tibial plateau.

CONCLUSIONS

In OWHTO, compression is important for the stability and healing of osteotomy, but it can also cause loss of correction. In patients requiring large correction, the surgeon should control the amount of compression required and consider making extra osteotomy gap to avoid undercorrection. Furthermore, the placement of cortex screws in neutral is essential to lower the risk of undercorrection.

Simulating the evolution of bipedalism and the absence of static bipedal hexapods

In nature, very few animals locomote on two legs. Static bipedalism can be found in four limbed and five limbed animals like dogs, cats, birds, monkeys and kangaroos, but it cannot be seen in hexapods or other multi-limbed animals. In this paper, we present a simulation with a novel perspective on the evolution of static bipedalism, with a virtual creature evolving its body and controllers, and we apply an evolutionary algorithm to explore the locomotion transition from octapods to bipods. We find that the presence of four limbs in the evolutionary trajectory of the creature scaffolds a parametric jump that enables bipedalism, and shows that hexapods, without undergoing such transformation, struggle to evolve into bipeds. An analysis of the transitional parameters points to the role of a shorter femur length in helping maintain the stability of the body, and the tibia length is responsible for improving the forward speed.

A Baseline for Cross-Database 3D Human Pose Estimation

Vision-based 3D human pose estimation approaches are typically evaluated on datasets that are limited in diversity regarding many factors, e.g., subjects, poses, cameras, and lighting. However, for real-life applications, it would be desirable to create systems that work under arbitrary conditions (“in-the-wild”). To advance towards this goal, we investigated the commonly used datasets HumanEva-I, Human3.6M, and Panoptic Studio, discussed their biases (that is, their limitations in diversity), and illustrated them in cross-database experiments (for which we used a surrogate for roughly estimating in-the-wild performance). For this purpose, we first harmonized the differing skeleton joint definitions of the datasets, reducing the biases and systematic test errors in cross-database experiments. We further proposed a scale normalization method that significantly improved generalization across camera viewpoints, subjects, and datasets. In additional experiments, we investigated the effect of using more or less cameras, training with multiple datasets, applying a proposed anatomy-based pose validation step, and using OpenPose as the basis for the 3D pose estimation. The experimental results showed the usefulness of the joint harmonization, of the scale normalization, and of augmenting virtual cameras to significantly improve cross-database and in-database generalization. At the same time, the experiments showed that there were dataset biases that could not be compensated and call for new datasets covering more diversity. We discussed our results and promising directions for future work.

Working out the bipedal walking expenditure of energy based on foot morphology of different hominid genera: Implications for foot evolution

Among the Hominidae family of primates, Homo is characterized by more economical bipedal walking. Over the course of evolution towards bipedalism, the foot becomes the only organ directly interacting with substrate and likely influence the bipedal walking economy. However, working out the energy expenditure in bipedal walking from the specific aspect of foot morphology is still challenging, which hinders the understanding of the evolution of both hominid feet and economical bipedal walking. Here we present a functional model to quantitatively assess bipedal walking expenditure of energy from hominid foot morphology. According to our results, the feet of Homo are most suited to economical bipedal walking among hominids. However, the genus whose feet possess second best ability for economical bipedal walking is not our closest relative Pan, but is Gorilla. Using phylogenetically informed morphometric analyses, we further infer the evolutionary changes of hominid foot morphology and investigate the corresponding variation of bipedal walking expenditure. Our results reveal the economical bipedal walking benefits from the morphological changes of human foot after descending from the last common ancestor of hominids. Conversely, the foot morphologies of great apes reflect selections for other locomotor modes, at cost of larger energy expenditure in bipedal walking.

Exploratory Evidence of Sex-Dimorphic Associations of the Ulna-to-Fibula Ratio, a Potential Marker of Pubertal Sex Steroid Exposure, with the Implicit Need for Power

Objectives

We propose a novel marker of pubertal organizing hormone effects on the brain, long bone length, and assess its relationships to implicit motives, especially the implicit need for power (nPower).

Methods

In a partly exploratory approach, we tested 126 participants (after exclusions; 53 men, 73 women), in a cross-sectional design using the Picture-Story Exercise (nPower, activity inhibition), standard anthropometric measurements (BMI, height), and calipers to assess bone length of the ulna and fibula.

Results

Results indicated that a sex-dimorphic (d = 0.55) Ulna-to-Fibula Ratio (UFR), which is independent of body height, best captures the variance in our data. While we did not find bivariate relationships between long bone length and nPower, a sex-dimorphic interaction of nPower and activity inhibition on UFR-asymmetry (UFRr-l; right versus left UFR) emerged. High UFRr-l scores were related to the inhibited power motive (high nPower, high activity inhibition) in men, while for women the pattern was (non-significantly) reversed. In addition, UFR was predicted by a sex-dimorphic effect of nPower, with low UFR scores being associated with a higher nPower in men and a tendency for high UFR scores being related to lower nPower in women.

Conclusions

We discuss our results regarding UFR’s potential as a sex-dimorphic marker of the organizing effects of pubertal steroid hormones on the motivational brain beyond hand and face parameters routinely used in current research. Finally, we examine how our findings fit recent results obtained for the relationship between 2D:4D digit ratio or facial width-to-height ratio and nPower.

Metalloprotease inhibitor TIMP proteins control FGF-2 bioavailability and regulate skeletal growth

Saw et al. show via the combinatorial deletion of Timp family members in mice that metalloprotease regulation of FGF-2 is a crucial event in the chondrocyte maturation program, underlying the growth plate development and bone elongation responsible for attaining proper body stature.

Regulated growth plate activity is essential for postnatal bone development and body stature, yet the systems regulating epiphyseal fusion are poorly understood. Here, we show that the tissue inhibitors of metalloprotease (TIMP) gene family is essential for normal bone growth after birth. Whole-body quadruple-knockout mice lacking all four TIMPs have growth plate closure in long bones, precipitating limb shortening, epiphyseal distortion, and widespread chondrodysplasia. We identify TIMP/FGF-2/IHH as a novel nexus underlying bone lengthening where TIMPs negatively regulate the release of FGF-2 from chondrocytes to allow IHH expression. Using a knock-in approach that combines MMP-resistant or ADAMTS-resistant aggrecans with TIMP deficiency, we uncouple growth plate activity in axial and appendicular bones. Thus, natural metalloprotease inhibitors are crucial regulators of chondrocyte maturation program, growth plate integrity, and skeletal proportionality. Furthermore, individual and combinatorial TIMP-deficient mice demonstrate the redundancy of metalloprotease inhibitor function in embryonic and postnatal development.

Towards a Dynamic Model of the Kangaroo Knee for Clinical Insights into Human Knee Pathology and Treatment: Establishing a Static Biomechanical Profile

There is limited understanding of how patella realignment or patellectomy to surgically manage patellofemoral pain (PFP) affects knee biomechanics. By analysing marsupials like kangaroos that lack an ossified patella, actionable biomimetic insight for the management of end-stage PFP could be gained. This study aimed to provide the foundation of a multi-stage approach, by establishing a static biomechanical profile of the kangaroo stifle that informs the inputs and factors requiring consideration for future dynamic analyses. Volumetric CT and MRI sequences were obtained for four hindlimbs from two Macropus giganteus specimens, from which three-dimensional models of the stifles were created. Two limbs were dissected to visualise the insertion points, origins and lines of action of the quadriceps muscles and the knee extensor mechanism. Static measurements were obtained from the three-dimensional models to establish the biomechanical profile. The results confirmed structural differences in the kangaroo stifle with lack of an ossified patella, a prominent tuberosity and a shorter femur, which functionally affect the mechanical advantage and the torque-generating capability of the joint. The data reported in this study can be used to inform the inputs and constraints of future comparative analyses from which important lessons can be learned for the human knee.

Clinical Application of Mathematical Long Bone Ratios to Calculate Appropriate Donor Limb Lengths in Bilateral Upper Limb Transplantation

Background: Limited methods exist to aid in deciding the appropriate donor limb lengths in bilateral upper limb amputees qualifying for vascularized composite allotransplantation. We hypothesized mathematical equations could be created using long bone length ratios, and applied to radiographs, to approximate the patient's limb length prior to amputation. Methods: A data set of 30 skeletons' unilateral upper limb long bones measured using osteometric board and calipers was used. Anatomic segment ratios were calculated based on humerus length after multivariate linear regression analysis. For clinical application testing, 5 cadavers' upper limbs were radiographed. Radiographic bone lengths were then measured along the long axis of each long bone. These measured radiographic lengths were then compared with the predicted bone lengths, generated from the skeleton data set ratios, for each cadaver. Results: The chi-square goodness-of-fit test showed excellent fit (P < .01) between the predicted and radiographically measured lengths for the 5 cadavers, and interobserver measurements showed no statistical difference. Depending on the cadaver, percent error in total limb length predicted to measure ranged from 0.9% to 2.7%. The variables to multiply an individual humerus length to calculate a given anatomic segment thus proved to be effective. Conclusions: If a bilateral upper limb amputee has 1 intact humerus, ratios to the humerus length can be reliably applied to calculate the preamputation limb length based on the patient's radiographic humerus length. These formulas are indicated for finding the appropriate limb lengths, and smaller anatomic segments, for donor-recipient matching in upper limb transplantation.

Hip Function 6 to 10 Months After Arthroscopic Surgery: A Cross-sectional Comparison of Subjective and Objective Hip Function, Including Performance-Based Measures, in Patients Versus Controls

Background:

Little is known about hip-related function, mobility, and performance in patients after hip arthroscopic surgery (HA) during the time that return to sports can be expected.

Purpose:

To evaluate measures of subjective and objective hip function 6 to 10 months after HA in patients compared with healthy controls and to compare objective function in the HA group between the operated and nonoperated hips.

Study Design:

Cross-sectional study; Level of evidence, 3.

Methods:

A total of 33 patients who had undergone HA (mean, 8.1 ± 2.6 months postoperatively) and 33 healthy participants matched on sex, age, and activity level were compared regarding subjective hip function (Copenhagen Hip and Groin Outcome Score [HAGOS]) and objective function including hip range of motion (ROM; flexion, internal rotation, and external rotation), isometric hip muscle strength (adduction, abduction, flexion, internal rotation, and external rotation), and performance-based measures: the Y Balance Test (YBT), medial and lateral triple-hop test, and Illinois agility test. Group differences were analyzed using independent-samples t tests. Paired-samples t tests were used for a comparison of the operated and nonoperated hips. Standard effect sizes (Cohen d) were provided for all outcomes.

Results:

The HA group reported worse subjective hip function than the control group (HAGOS subscores: d = –0.7 to –2.1; P ≤ .004). Objective measures of hip ROM (d = –0.5 to –1.1; P ≤ .048), hip flexion strength (d = –0.5; P = .043), and posteromedial reach of the YBT (d = –0.5; P = .043) were also reduced in the HA group, although there were no significant differences between groups regarding the remaining objective measures (d = –0.1 to –0.4; P ≥ .102 to .534). The only significant difference between the operated and nonoperated hips in the HA group was reduced passive hip flexion (d = –0.4; P = .045).

Conclusion:

Patients who had undergone HA demonstrated reduced subjective hip function compared with controls 6 to 10 months after surgery, when return to sports can be expected. While most objective strength and performance test results were comparable between the HA and control groups at 6 to 10 months after surgery, the HA group presented with impairments related to hip mobility and hip flexion strength. No consistent pattern of impairments was found in operated hips compared with nonoperated hips.

Validation of a novel 3D flow model for the optimization of construct perfusion in radial-flow packed-bed bioreactors (rPBBs) for long-bone tissue engineering

Osteogenic cell culture in three-dimensional (3D) hollow cylindrical porous scaffolds in radial-flow packed-bed bioreactors (rPBBs) may overcome the transport limitations of static and axial perfusion bioreactors in the engineering of long-bone substitutes. Flow models of rPBBs help optimize radial flux distribution of medium and tissue maturation in vitro. Only a 2D model is available for steady flow transport in rPBBs with axisymmetric inlet and outlet accounting for the fluid dynamics of void spaces, assessed against literature information. Here, a novel 3D model is proposed for steady flow transport in the three compartments of rPBBs with a more practical lateral outlet. A 3D model of transient tracer transport was developed based on the flow model to predict bioreactor residence time distribution (RTD). Model-predicted flow patterns were validated in terms of RTD against tracer experiments performed with bioreactor prototypes equipped with commercial scaffolds for bone tissue engineering. Bioreactors were challenged with a step change in entering tracer concentration in an optimized set-up under conditions promoting uniform radial flux distribution and typical shunt flows. Model-predicted RTDs agreed well with those experimentally determined. In conclusion, tracer experiments validate the use of the 3D flow model for optimizing construct perfusion in rPBBs to engineer long-bone substitutes.

Hand grip strength as a physical biomarker of aging from the perspective of a Fibonacci mathematical modeling

Background

The Golden Ratio (GR) and the Fibonacci sequence have wide applications in biodiversity research, and recent studies indicate that the GR can be highlighted in the organization and physiological functioning of many body systems. The aim of this cross-sectional descriptive study is to determine the applicability of a mathematical model derived from the Fibonacci sequence to investigate the changes in hand grip strength (HGS) induced by the aging process.

Methods

We assessed the HGS for both hands, using a Saehan hydraulic hand dynamometer in a group of autonomous elderly subjects. One hundred twenty 55-year-old subjects (58 males and 62 females) and seventy 89-year-old subjects (31 men and 39 women) were included in the study group. All subjects were completely independent or independent with minimal assistance in activities of daily living (ADL), as determined after applying the Barthel index of ADL. The data series were statistically processed using descriptive statistics (univariate analysis) and inferential statistical methods (the t test for unpaired groups, with effect size measure – Cohen’s d and the ratio of the means method).

Results

The decline of the relative HGS between the two age groups can be expressed by values close to the GR value (p < 0.001), both in relation to body symmetry (left hand/right hand evaluation) and laterality (dominant hand/non-dominant hand evaluation), for both sexes. For the whole group of men and women, the rhythm of HGS decline may be expressed by a value (1.61) notably close to the GR, regardless of body symmetry or laterality.

Conclusions

The common pattern of the relative HGS reduction between 55 and 89 years, as expressed by a value notably close to GR, can be considered to be an expression of a specific and predictable manifestation of the aging process, in the absence of disability.

Differential aging of growth plate cartilage underlies differences in bone length and thus helps determine skeletal proportions

Bones at different anatomical locations vary dramatically in size. For example, human femurs are 20-fold longer than the phalanges in the fingers and toes. The mechanisms responsible for these size differences are poorly understood. Bone elongation occurs at the growth plates and advances rapidly in early life but then progressively slows due to a developmental program termed “growth plate senescence.” This developmental program includes declines in cell proliferation and hypertrophy, depletion of cells in all growth plate zones, and extensive underlying changes in the expression of growth-regulating genes. Here, we show evidence that these functional, structural, and molecular senescent changes occur earlier in the growth plates of smaller bones (metacarpals, phalanges) than in the growth plates of larger bones (femurs, tibias) and that this differential aging contributes to the disparities in bone length. We also show evidence that the molecular mechanisms that underlie the differential aging between different bones involve modulation of critical paracrine regulatory pathways, including insulin-like growth factor (Igf), bone morphogenetic protein (Bmp), and Wingless and Int-1 (Wnt) signaling. Taken together, the findings reveal that the striking disparities in the lengths of different bones, which characterize normal mammalian skeletal proportions, is achieved in part by modulating the progression of growth plate senescence.

The various bones found in human extremities vary dramatically in size. For example, the femur in the thigh is approximately 20 times longer than the phalanges of the toes. The mechanisms that regulate how much a particular bone grows to attain the skeletal proportions of each animal remain mostly unknown. In this study, we sought to uncover these mechanisms and found that this scaling in skeletal size is achieved in part by modulating the rate of aging of growth plates in different bones. Bone elongation occurs at the cartilaginous growth plates and proceeds rapidly in early life but slows and eventually stops due to a developmental program termed “growth plate senescence,” which is used to describe the gradual decline in growth plate function with age. We discovered that this developmental program is more advanced in shorter bones than in longer bones and that this differential aging contributes to the disparities in bone growth. We show that the molecular mechanisms that underlie this differential aging between bones involve differential expression of specific local signaling pathways, which regulate cell proliferation and differentiation in the growth plate. Taken together, we conclude that the striking disparities in the lengths of different bones—characteristic of normal mammalian skeletal proportions—are achieved in part by modulating the progression of aging in the growth plates.

Humeral lengthening in patients with achondroplasia and in patients with post-septic shortening: comparison of procedure efficiency and safety

PURPOSE

Although humeral lengthening in patients with achondroplasia is an accepted procedure for improving functional status, there is still a paucity of information about the effectiveness of the method. Therefore, the aim of this study was to evaluate the efficacy and safety of humeral lengthening using monolateral fixators in patients with achondroplasia and unilateral shortening.

METHODS

Twenty-one patients (31 humeri) were included in this study. The study group consisted of eight patients with achondroplasia (16 segments). The control group consisted of 13 patients with post-septic shortening of the humerus (15 segments). All subjects underwent distraction osteogenesis with the use of a monolateral fixator.

RESULTS

The mean lengthening in the patients with achondroplasia was 8.29 cm, whereas in the control group it was 7.34 cm (p = 0.1677). The mean lengthening percentage in the patients with achondroplasia (50% of the initial length of the humerus) was significantly greater than in the control group (33% of the initial length of the humerus) (p = 0.0007). The mean healing index was 24.8 days/cm in the patients with achondroplasia and 28.56 days/cm in the control group (p = 0.1832). The overall complication rates for the achondroplastic and post-septic patients were, respectively, 175% and 160% (p = 0.1420).

CONCLUSIONS

Humeral lengthening with use of monolateral fixators in patients with achondroplasia is an efficient method. Although the segment lengthening percentage is significantly greater in patients with achondroplasia than in patients with post-septic shortening of the humerus, the safety of this procedure is comparable.

An Ergonomic Assessment of Hospital Linen Bag Handling

The Joint Commission provides accreditation standards for staging hospital waste, but there are no federal lifting safety standards for linen bags. We evaluated hospital laundry bag lifting using the Revised National Institute for Occupational Safety and Health (NIOSH) Lifting Equation. We hypothesized that the permitted 32-gallon linen container capacity might allow filling to weights above our calculated Recommended Weight Limit (RWL) for some lifting positions and contents. We found that 30- and 40-gallon bags filled with loose dry linen had predicted weights within estimated RWLs only for lifts close to the body. Thirty- and 40-gallon bags filled more than halfway with dry compact linen had predicted weights above estimated RWLs for all lifting positions. Thirty- and 40-gallon bags filled with wet compact linen exceeded estimated RWLs for all positions when less than one-quarter full. Bag volume and filling controls may be considered to ensure linen bags are not excessively heavy.

Bilateral humeral lengthening in achondroplasia with unilateral external fixators

A retrospective study was performed in 18 patients with achondroplasia, who underwent bilateral humeral lengthening between 2001 and 2013, using monorail external fixators. The mean age was ten years (six to 15) and the mean follow-up was 40 months (12 to 104).

The mean disabilities of the arm, shoulder and hand (DASH) score fell from 32.3 (20 to 40) pre-operatively to 9.4 (6 to 14) post-operatively (p = 0.037). A mean lengthening of 60% (40% to 95%) was required to reach the goal of independent perineal hygiene. One patient developed early consolidation, and fractures occurred in the regenerate bone of four humeri in three patients. There were three transient radial nerve palsies.

Humeral lengthening increases the independence of people with achondroplasia and is not just a cosmetic procedure.

Cite this article: Bone Joint J 2015;97-B:1577–81.

Michelangelo, the Last Judgment fresco, Saint Bartholomew and the Golden Ratio

Art and anatomy were particularly closely intertwined during the Renaissance period and numerous painters and sculptors expressed themselves in both fields. Among them was Michelangelo Buonarroti (1475-1564), who is renowned for having produced some of the most famous of all works of art, the frescoes on the ceiling and on the wall behind the altar of the Sistine Chapel in Rome. Recently, a unique association was discovered between one of Michelangelo's most celebrated works (The Creation of Adam fresco) and the Divine Proportion/Golden Ratio (GR) (1.6). The GR can be found not only in natural phenomena but also in a variety of human-made objects and works of art. Here, using Image-Pro Plus 6.0 software, we present mathematical evidence that Michelangelo also used the GR when he painted Saint Bartholomew in the fresco of The Last Judgment, which is on the wall behind the altar. This discovery will add a new dimension to understanding the great works of Michelangelo Buonarroti.