The frequency and presentation of upper thoracic spinous process deviations, their relationship to articular morphology, and the potential influence on static palpation techniques

BACKGROUND

Static palpation of vertebral spinous process deviations from the midline are often utilized by manual therapists as a means to determine area for treatment of manipulable lesions. Previous research has discussed the diagnostic validity of this technique, but no correlation to vertebral morphology has been presented.

AIM

To evaluate the frequency and presentation of vertebral spinous process deviations and their relationship with articular morphology, and the impact this may have in terms of static palpation techniques in the upper thoracic spine.

SETTING

This study was conducted on human T1-T6 vertebrae.

METHOD

A skeletal sample consisting of 58 humans T1-T6 vertebrae were photographed and linear and angular measurements taken utilizing ImageJ software and non-metric visual observations.

RESULTS

Spinous process deviations in the entire sample group (n = 348) were found to occur in a frequency ranging from 19% (n = 11) at T1 to 41.4% (n = 24) at T3. However, when evaluated in terms of frequency within an individual's T1-T6, 83.3% (n = 25) of males and 67.86% (n = 19) of females demonstrated this feature, with an overall incidence of 77.59% (n = 45). Age of individuals did not show an increase in frequency, and no clear pattern could be identified regarding metric measurements and its presence.

CONCLUSION

Spinous process deviations in the upper thoracic spine are most probably the result of random normal variations between individuals and are more frequent in males. Static palpation without pain criteria is not a reliable diagnostic technique to determine areas needing manual treatment, as these may be considered normal osseous anatomical variations.

Assessing the need for a standardised paediatric assessment tool for podiatrists in South Africa

There is no literature to support the existence of an effective standardised assessment tool in South Africa that aids the podiatrist in the early diagnosis of developmental delay in the paediatric patient from age one to five. Podiatrists in South Africa (SA) need a suitable assessment tool to evaluate child development. A potential proforma that could be used by South African podiatrists is the Gait and Lower Limb Observation Proforma (GALLOP) Assessment Tool.

AIM

The aim of this research was to evaluate the "ease of use" and "usefulness" of the GALLOP Assessment Tool for podiatrists to effectively assess the paediatric patient from age one to age five.

METHODS

The study was of a mixed methods descriptive design type, targeting all Health Professions Council of South Africa (HPCSA) registered podiatrists in the Johannesburg Metropolitan Municipal area. After allowing the participants to use the GALLOP Assessment Tool for a period of time, a survey was conducted to establish the "ease of use" and "usefulness" of the GALLOP Assessment Tool.

RESULTS

All participants agreed that the GALLOP Assessment Tool would be beneficial to South African podiatrists and that the assessment tool does not need to be improved upon.

Revisiting mandibular symphyseal shape in juvenile early hominins and modern humans using a deformation-based approach

The juvenile mandible is important in the investigation of ontogenetic and evolutionary changes among early hominins. We revisit the mandibular symphysis in juvenile specimens of Australopithecus africanus and Paranthropus robustus with two main contributions. First, we employ, for the first time, methods of computational anatomy to model complex symphyseal shape differences. Second, we present new fossil evidence from Kromdraai to improve our knowledge of symphyseal morphology. We describe differences between shapes by landmark-free diffeomorphism needed to align them. We assess which features of the mandibular symphysis best discriminate the juvenile symphysis in these fossil species, relative to the intraspecific variation observed among modern humans. Our approach eliminates potential methodological inconsistencies with traditional approaches (i.e., the need for homologous anatomical landmarks, assumption of linearity). By enabling detailed comparisons of complex shapes in juvenile mandibles, our proposed approach offers new perspectives for more detailed comparisons among Australopithecus, Paranthropus and early Homo.

Hominin fossils from Kromdraai and Drimolen inform Paranthropus robustus craniofacial ontogeny

Ontogeny provides critical information about the evolutionary history of early hominin adult morphology. We describe fossils from the southern African sites of Kromdraai and Drimolen that provide insights into early craniofacial development in the Pleistocene robust australopith Paranthropus robustus. We show that while most distinctive robust craniofacial features appear relatively late in ontogeny, a few do not. We also find unexpected evidence of independence in the growth of the premaxillary and maxillary regions. Differential growth results in a proportionately larger and more postero-inferiorly rotated cerebral fossa in P. robustus infants than in the developmentally older Australopithecus africanus juvenile from Taung. The accumulated evidence from these fossils suggests that the iconic SK 54 juvenile calvaria is more likely early Homo than Paranthropus. It is also consistent with the hypothesis that P. robustus is more closely related to Homo than to A. africanus.

Frontal sinuses and human evolution

The frontal sinuses are cavities inside the frontal bone located at the junction between the face and the cranial vault and close to the brain. Despite a long history of study, understanding of their origin and variation through evolution is limited. This work compares most hominin species' holotypes and other key individuals with extant hominids. It provides a unique and valuable perspective of the variation in sinuses position, shape, and dimensions based on a simple and reproducible methodology. We also observed a covariation between the size and shape of the sinuses and the underlying frontal lobes in hominin species from at least the appearance of Homo erectus. Our results additionally undermine hypotheses stating that hominin frontal sinuses were directly affected by biomechanical constraints resulting from either chewing or adaptation to climate. Last, we demonstrate their substantial potential for discussions of the evolutionary relationships between hominin species.

The immature Homo naledi ilium from the Lesedi Chamber, Rising Star Cave, South Africa

Objectives

Homo naledi is represented by abundant remains from the Dinaledi Chamber of the Rising Star Cave system in South Africa. While pelvic elements from the Dinaledi Chamber of the cave are fragmentary, a relatively complete ilium (U.W. 102a–138) was recovered from the Lesedi Chamber. We reconstructed and analyzed the Lesedi ilium, providing qualitative descriptions and quantitative assessment of its morphology and developmental state.

Materials and Methods

We compared the Lesedi ilium to remains from the Dinaledi Chamber, other South African hominin fossils, and an ontogenetic series of human ilia. We used the Dinaledi adults as a guide for reconstructing the Lesedi ilium. To assess development of the Lesedi ilium, we compared immature/mature proportional ilium height for fossils and humans. We used 3D geometric morphometrics (GMs) to examine size and shape variation among this sample.

Results

The Lesedi ilium showed incipient development of features expressed in adult H. naledi ilia. The proportional height of the Lesedi ilium was within the range of human juveniles between 4–11 years of age. GM analyses showed that the Lesedi ilium had an iliac blade shape similar to those of australopiths and an expanded auricular surface more similar to humans.

Conclusions

The reconstructed Lesedi specimen represents the best preserved ilium of H. naledi, confirming the australopith‐like iliac blade morphology first hypothesized in adult specimens, and establishing that this anatomy was present early in this species' ontogeny. In contrast to australopiths, the Lesedi ilium displays an enlarged sacroiliac joint, the significance of which requires further investigation.

Cochlear morphology of Indonesian Homo erectus from Sangiran

Homo erectus s.l. is key for deciphering the origin and subsequent evolution of genus Homo. However, the characterization of this species is hindered by the existence of multiple variants in both mainland and insular Asia, as a result of divergent chronogeographical evolutionary trends, genetic isolation, and interbreeding with other human species. Previous research has shown that cochlear morphology embeds taxonomic and phylogenetic information that may help infer the phylogenetic relationships among hominin species. Here we describe the cochlear morphology of two Indonesian H. erectus individuals (Sangiran 2 and 4), and compare it with a sample of australopiths, Middle to Late Pleistocene humans, and extant humans by means of linear measurements and both principal components and canonical variates analyses performed on shape ratios. Our results indicate that H. erectus displays a mosaic morphology that combines plesiomorphic (australopithlike) features (such as a chimplike round cochlear cross section and low cochlear thickness), with derived characters of later humans (a voluminous and long cochlea, possibly related to hearing abilities)-consistent with the more basal position of H. erectus. Our results also denote substantial variation between the two studied individuals, particularly in the length and radius of the first turn, as well as cross-sectional shape. Given the small size of the available sample, it is not possible to discern whether such differences merely reflect intraspecific variation among roughly coeval H. erectus individuals or whether they might result from greater age differences between them than currently considered. However, our results demonstrate that most characters found in later humans were already present in Indonesian H. erectus, with the exception of Neanderthals, which display an autapomorphic condition relative to other Homo species.

The Thorny Issue of African Porcupines: a New Mandible of Hystrix makapanensis from Olduvai Gorge (Tanzania) and Rediagnosis of the Species

Several porcupine taxa are reported from the middle Miocene to the early Holocene in the Old World. Among these, five species of the subfamily Hystricinae occurred in Africa approximately in the last 6 Ma: the extinct Hystrix makapanensis, Hystrix leakeyi, and Xenohystrix crassidens and the still living Hystrix africaeaustralis and Hystrix cristata. The large-sized H. makapanensis is reported from numerous sites in East and South Africa between the early Pliocene and Early Pleistocene. In this paper, we describe a new mandible of H. makapanensis from the world-renowned Tanzanian paleontological and archeological site of Olduvai Gorge (HWK West; lowermost Bed II; ca. 1.8-1.7 Ma). The discovery of the new mandible triggered a comprehensive review of the entire African record of H. makapanensis. In particular, we describe or re-analyze the samples from South Africa (Makapansgat Limeworks, Gondolin, Kromdraai, Swartkrans, and Sterkfontein), Tanzania (Olduvai and Laetoli), Ethiopia (Omo Shungura and Hadar), and Kenya (Chemeron), enriching the quantity of specimens confidently referable to this species and above all improving the information on its craniodental anatomy. On this basis, we: (1) propose an emended diagnosis of H. makapanensis; (2) point out the morphological and biometric differences between H. makapanensis and other African Hystricinae (also in terms of body mass); and (3) broaden the knowledge on the geographical and chronological distribution of this extinct species.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10914-021-09588-z.

Mechanical loading of primate fingers on vertical rock surfaces

Mechanical loading of finger bones (phalanges) can induce angular curvature, which benefits arboreal primates by dissipating forces and economising the recruitment of muscles during climbing. The recent discovery of extremely curved phalanges in a hominin, Homo naledi, is puzzling, for it suggests life in an arboreal milieu, or, alternatively, habitual climbing on vertical rock surfaces. The importance of climbing rock walls is attested by several populations of baboons, one of which uses a 7-m vertical surface to enter and exit Dronkvlei Cave, De Hoop Nature Reserve, South Africa. This rock surface is an attractive model for estimating the probability of extreme mechanical loading on the phalanges of rock-climbing primates. Here we use three-dimensional photogrammetry to show that 82–91% of the climbable surface would generate high forces on the flexor tendon pulley system and severely load the phalanges of baboons and H. naledi. If such proportions are representative of vertical rock surfaces elsewhere, it may be sufficient to induce stress-mitigating curvature in the phalanges of primates.

Cochlear shape distinguishes southern African early hominin taxa with unique auditory ecologies

Insights into potential differences among the bony labyrinths of Plio-Pleistocene hominins may inform their evolutionary histories and sensory ecologies. We use four recently-discovered bony labyrinths from the site of Kromdraai to significantly expand the sample for Paranthropus robustus. Diffeomorphometry, which provides detailed information about cochlear shape, reveals size-independent differences in cochlear shape between P. robustus and Australopithecus africanus that exceed those among modern humans and the African apes. The cochlea of P. robustus is distinctive and relatively invariant, whereas cochlear shape in A. africanus is more variable, resembles that of early Homo, and shows a degree of morphological polymorphism comparable to that evinced by modern species. The curvature of the P. robustus cochlea is uniquely derived and is consistent with enhanced sensitivity to low-frequency sounds. Combined with evidence for selection, our findings suggest that sound perception shaped distinct ecological adaptations among southern African early hominins.

Trabecular bone properties in the ilium of the Middle Paleolithic/Middle Stone Age Border Cave 3 Homo sapiens infant and the onset of independent gait

The Border Cave 3 (BC3) infant skeleton has been understudied, despite its importance as an example of a well-preserved and fairly complete immature skeleton of early Homo sapiens which potentially provides a rare window into various aspects of ontogenetic development, including locomotor activity (e.g., timing of gait events). Trabecular structure in the BC3 ilium was evaluated to investigate whether it matches that of an equivalently aged infant from a postindustrialized society. Microcomputed tomography (μCT) scans were acquired from the BC3 infant and from an ontogenetic series of 25 postindustrial infants that were divided into three age classes (ACs) ranging from neonates to toddlers (<36 months). All ilia were qualitatively compared and then digitally subdivided into 10 volumes of interest (VOIs) based on anatomical reference points. The VOIs were quantified and ontogenetic differences in trabecular structure were statistically evaluated. Across the comparative ontogenetic series, trabecular architectural properties overlapped in all regions. However, trabecular thickness increased significantly after the first year of life. The BC3 infant demonstrated generally similar trabecular structure to that observed in the age-equivalent postindustrial infants (AC2), including relatively strong development of the trabecular chiasma qualitatively. However, some interesting distinctions were observed in BC3, such as low strut thickness compared with infants from the postindustrial sample, that bear further exploration in future studies. Evaluation of only one individual from the Middle Stone Age (MSA), coupled with the relatively small comparative sample, limit our ability to distinguish more meaningful biological differences in trabecular structure throughout ontogeny from idiosyncratic characteristics. Nonetheless, results of this study extend ongoing research on infant locomotor and morphological development to archeological populations in the Middle Stone Age. Further cross-cultural studies consisting of larger comparative postindustrial samples may provide additional information on trabecular structure in the infant ilium during this important developmental timeframe.

Manual therapy interventions in the treatment of plantar fasciitis: A comparison of three approaches

Background

Plantar fasciitis is one of the common causes of heel pain and a common musculoskeletal problem often observed by clinicians. Numerous options are available in treating plantar fasciitis conservatively, but no previous studies have compared combined conservative management protocols.

Aim

The aim of this study was to compare manipulation of the foot and ankle and cross friction massage of the plantar fascia; cross friction massage of the plantar fascia and gastrocsoleus complex stretching; and a combination of the aforementioned protocols in the treatment of plantar fasciitis.

Setting

This study was conducted at the University of Johannesburg, Chiropractic Day Clinic, and included participants that complied with relevant inclusion criteria.

Methods

Forty-five participants between the ages of 18 and 50 years with heel pain for more than 3 months were divided into three groups and received one of the proposed treatment interventions. The data collected were range of motion (ROM) of the ankle (using a goniometer) and pain perception using the McGill Pain Questionnaire and Functional foot index and algometer.

Results

The results of this study indicate that cross friction massage of the plantar fascia and stretching of the gastrocsoleus complex showed the greatest overall improvement in terms of reducing the pain and disability and ankle dorsiflexion ROM, whereas the combination group showed the greatest increase in plantar flexion.

Conclusion

The results demonstrated that all three protocols had a positive effect on the ROM and pain perception to patients with plantar fasciitis.

Cerebral blood flow rates in recent great apes are greater than in Australopithecus species that had equal or larger brains

Brain metabolic rate (MR) is linked mainly to the cost of synaptic activity, so may be a better correlate of cognitive ability than brain size alone. Among primates, the sizes of arterial foramina in recent and fossil skulls can be used to evaluate brain blood flow rate, which is proportional to brain MR. We use this approach to calculate flow rate in the internal carotid arteries (Q˙ICA), which supply most of the primate cerebrum. Q˙ICA is up to two times higher in recent gorillas, chimpanzees and orangutans compared with 3-million-year-old australopithecine human relatives, which had equal or larger brains. The scaling relationships between Q˙ICA and brain volume (V_br) show exponents of 1.03 across 44 species of living haplorhine primates and 1.41 across 12 species of fossil hominins. Thus, the evolutionary trajectory for brain perfusion is much steeper among ancestral hominins than would be predicted from living primates. Between 4.4-million-year-old Ardipithecus and Homo sapiens, V_br increased 4.7-fold, but Q˙ICA increased 9.3-fold, indicating an approximate doubling of metabolic intensity of brain tissue. By contrast, Q˙ICA is proportional to V_br among haplorhine primates, suggesting a constant volume-specific brain MR.

Flexion location of the first metatarsophalangeal joint and the location of forefoot bend in general purpose women's footwear

BACKGROUND

General purpose footwear could have a built-in flexion location which may not match the anatomical fulcrum location for an individual's foot. Mismatched fulcra impact on joint function, and may delay healing of an injured first metatarsophalangeal joint (first MP joint). This study compared the location of the first MP joint in an asymptomatic sample of the South African female population to the bend location set within the lasts (used by footwear manufacturers) to find whether mismatches of the flexion locations of the joint to the bending location of the footwear were likely.

METHODS

The study used a three dimensional foot measurement database of 453 female participants to find the fulcrum location of the first MP joint. The distance between the heel and the first MP joint was expressed as a percentage of the overall length of the unshod foot. Similar measures for sandals and closed shoes were derived, and all were compared to manufacturer last data.

RESULTS

The location of first MP joint ranged from 70% to 79% of total foot length, significantly different from last design specifications of 63% or 66% (p<0.0001). The range of first MP joint fulcrum locations in the same size feet occurred in a wide 24mm mediolateral band under the forefoot, termed a flexion zone.

CONCLUSIONS

The first MP joint cannot properly function as a fulcrum unless footwear has a matching flexion location. Footwear designs should incorporate a wide flexion zone located under the forefoot to permit the range of first MP joint flexion locations. Recommendations to patients are to select appropriate flexible footwear to prevent shear forces, reduce strain, prevent injury and enable range of motion function and healing of injury.

A quantification of calcaneal lateral plantar process position with implications for bipedal locomotion in Australopithecus

The evolution of bipedalism in the hominin lineage has shaped the posterior human calcaneus into a large, robust structure considered to be adaptive for dissipating peak compressive forces and energy during heel-strike. A unique anatomy thought to contribute to the human calcaneus and its function is the lateral plantar process (LPP). While it has long been known that humans possess a plantarly positioned LPP and apes possess a more dorsally positioned homologous structure, the relative position of the LPP and intraspecific variation of this structure have never been quantified. Here, we present a method for quantifying relative LPP position and find that, while variable, humans have a significantly more plantar position of the LPP than that found in the apes. Among extinct hominins, while the position of the LPP in Australopithecus afarensis falls within the human distribution, the LPP is more dorsally positioned in Australopithecus sediba and barely within the modern human range of variation. Results from a resampling procedure suggest that these differences can reflect either individual variation of a foot structure/function largely shared among Australopithecus species, or functionally distinct morphologies that reflect locomotor diversity in Plio-Pleistocene hominins. An implication of the latter possibility is that calcaneal changes adaptive for heel-striking bipedalism may have evolved independently in two different hominin lineages.

The relationship between the distal metatarsal articular angle and intersesamoidal crista: An osteological study

BACKGROUND

As hallux valgus (HV) progresses, the first metatarsal drifts medially and the subsequent lateral drift of the sesamoids results in intersesamoidal crista erosion. This study aimed to provide a novel method of assessing crista erosion and determine if there is a relationship between that erosion and an increase in the distal metatarsal articular angle (DMAA).

METHODS

The DMAA and size of the intersesamoidal crista was measured on the first metatarsals of 120 adult modern human individuals. There was an equitable spread of both sexes, a wide age range (18-88 years), from three South African population groups (Zulu, Sotho, "European"). The following non-metric features were observed: intersesamoidal crista appearance, metatarsal head shape, and first intermetatarsal facet. Correlation tests, t-tests and Analyses of Variance (ANOVA) were used to determine relationships between variables.

RESULTS

The Pearson correlation test showed no significant correlation between the DMAA and crista ratio (r=0.092, p=0.154, α=0.05). DMAA: there was a significant difference between sides (p=0.009), right side larger; there was a significant difference between Zulu and "European" samples (p=0.036) but not between "Europeans" and Sotho (p=0.270); and there was a slight positive correlation with an increase in age. Crista: there was a significant difference between the sexes (p=0.044), with females having less erosion.

CONCLUSIONS

There is no significant relationship between the DMAA and crista erosion. Severe cartilaginous erosion is present before osteological changes occur, and the unexpected result may be reflected in skeletal specimens in which no cartilaginous changes can be observed. A novel, experimental method of assessing HV in modern human skeletal material is proposed.

Osteopathology and insect traces in the Australopithecus africanus skeleton StW 431

Abstract We present the first application of high-resolution micro computed tomography in an analysis of both the internal and external morphology of the lumbar region of StW 431 – a hominin skeleton recovered from Member 4 infill of the Sterkfontein Caves (South Africa) in 1987. The lumbar vertebrae of the individual present a number of proliferative and erosive bony processes, which were investigated in this study. Investigations suggest a complex history of taphonomic alteration to pre-existing spinal degenerative joint disease (SDJD) as well as post-mortem modification by an unknown insect. This study is in agreement with previous pathological diagnoses of SDJD which affected StW 431 and is the first time insect traces on this hominin are described. The results of this analysis attest to the complex series of post-mortem processes affecting the Sterkfontein site and its fossil assemblages.

Earliest hominin cancer: 1.7-million-year-old osteosarcoma from Swartkrans Cave, South Africa

Abstract The reported incidence of neoplasia in the extinct human lineage is rare, with only a few confirmed cases of Middle or Later Pleistocene dates reported. It has generally been assumed that pre-modern incidence of neoplastic disease of any kind is rare and limited to benign conditions, but new fossil evidence suggests otherwise. We here present the earliest identifiable case of malignant neoplastic disease from an early human ancestor dated to 1.8–1.6 million years old. The diagnosis has been made possible only by advances in 3D imaging methods as diagnostic aids. We present a case report based on re-analysis of a hominin metatarsal specimen (SK 7923) from the cave site of Swartkrans in the Cradle of Humankind, South Africa. The expression of malignant osteosarcoma in the Swartkrans specimen indicates that whilst the upsurge in malignancy incidence is correlated with modern lifestyles, there is no reason to suspect that primary bone tumours would have been any less frequent in ancient specimens. Such tumours are not related to lifestyle and often occur in younger individuals. As such, malignancy has a considerable antiquity in the fossil record, as evidenced by this specimen.

The foot of Homo naledi

Modern humans are characterized by a highly specialized foot that reflects our obligate bipedalism. Our understanding of hominin foot evolution is, although, hindered by a paucity of well-associated remains. Here we describe the foot of Homo naledi from Dinaledi Chamber, South Africa, using 107 pedal elements, including one nearly-complete adult foot. The H. naledi foot is predominantly modern human-like in morphology and inferred function, with an adducted hallux, an elongated tarsus, and derived ankle and calcaneocuboid joints. In combination, these features indicate a foot well adapted for striding bipedalism. However, the H. naledi foot differs from modern humans in having more curved proximal pedal phalanges, and features suggestive of a reduced medial longitudinal arch. Within the context of primitive features found elsewhere in the skeleton, these findings suggest a unique locomotor repertoire for H. naledi, thus providing further evidence of locomotor diversity within both the hominin clade and the genus Homo.

Homo naledi, a new species of the genus Homo from the Dinaledi Chamber, South Africa

Homo naledi is a previously-unknown species of extinct hominin discovered within the Dinaledi Chamber of the Rising Star cave system, Cradle of Humankind, South Africa. This species is characterized by body mass and stature similar to small-bodied human populations but a small endocranial volume similar to australopiths. Cranial morphology of H. naledi is unique, but most similar to early Homo species including Homo erectus, Homo habilis or Homo rudolfensis. While primitive, the dentition is generally small and simple in occlusal morphology. H. naledi has humanlike manipulatory adaptations of the hand and wrist. It also exhibits a humanlike foot and lower limb. These humanlike aspects are contrasted in the postcrania with a more primitive or australopith-like trunk, shoulder, pelvis and proximal femur. Representing at least 15 individuals with most skeletal elements repeated multiple times, this is the largest assemblage of a single species of hominins yet discovered in Africa.

The Bolton Treovance abdominal stent-graft: European clinical trial design

Endovascular aortic repair (EVAR) has emerged as a promising, less invasive alternative to conventional open surgery for the treatment of infrarenal abdominal aortic aneurysms (AAAs). In the last 20 years, the application rate of EVAR and its clinical results have significantly improved thanks to the evolution of stent-grafts and endovascular delivery systems. However, further development is still needed to reduce the incidence of complications and secondary re-interventions. The Treovance abdominal aortic stent-graft (Bolton Medical, Barcelona, Spain) is a new-generation endovascular device, developed to increase flexibility, lower profile, improve deployment and sealing mechanisms. In particular, it is provided with some innovative features as a double layer of proximal barbs (suprarenal and infrarenal) for supplemental fixation, dull barbs between modules to avoid potential leg disconnections, detachable outer sheath provided with a new-design hemostatic valve, and a double improved mechanism (slow motion and "pin and pull") for precise stent-graft deployment. A European prospective, non-randomized, multi-institutional, "first-in-human" trial (the ADVANCE trial) was conducted from March to December 2011 to assess the safety and performance of the Treovance stent-graft system before commercialization. Thirty patients with anatomically suitable non-ruptured AAAs were enrolled at five clinical sites in Italy, Spain, and Germany. EVAR was completed successfully in all patients. The stent-graft was delivered and deployed safely even in heavily angulated or calcified anatomies. No 30-day device-related complications nor deaths were observed. Preliminary experience with the Treovance abdominal stent-graft within the ADVANCE trial was satisfactory with regard to technical success and perioperative clinical results. Follow-up data are needed to assess mid- and long-term clinical outcomes, along with durability of this new-generation endovascular device.

Brief communication: radiographic study of metatarsal one basal epiphyseal fusion: a note of caution on age determination

This study examines radiographs of first metatarsals of 131 individuals from age 17-88 years to determine whether internal basal epiphyseal lines may be visible past the age of metatarsal fusion, which usually occurs between 14 and 16 years of age (Scheuer and Black: The juvenile skeleton. San Diego: Elsevier Academic Press,2004). In 29% (38 out of 131) of the radiographed first metatarsals (MT1s) the basal epiphyseal scar is visible, including in one individual who was 80 years old. Statistically, there was no relationship between the loss of the epiphyseal scar and age. Thus, the presence of the epiphyseal scar does not necessarily indicate subadult age. These data suggest that OH 8's radiographically visible basal epiphyseal line has no bearing on whether it is a subadult or not.

The foot and ankle of Australopithecus sediba

A well-preserved and articulated partial foot and ankle of Australopithecus sediba, including an associated complete adult distal tibia, talus, and calcaneus, have been discovered at the Malapa site, South Africa, and reported in direct association with the female paratype Malapa Hominin 2. These fossils reveal a mosaic of primitive and derived features that are distinct from those seen in other hominins. The ankle (talocrural) joint is mostly humanlike in form and inferred function, and there is some evidence for a humanlike arch and Achilles tendon. However, Au. sediba is apelike in possessing a more gracile calcaneal body and a more robust medial malleolus than expected. These observations suggest, if present models of foot function are correct, that Au. sediba may have practiced a unique form of bipedalism and some degree of arboreality. Given the combination of features in the Au. sediba foot, as well as comparisons between Au. sediba and older hominins, homoplasy is implied in the acquisition of bipedal adaptations in the hominin foot.

Manual and manipulative therapy compared to night splint for symptomatic hallux abducto valgus: an exploratory randomised clinical trial

CONTEXT

Hallux abducto valgus (HAV) is a frequent cause of great toe pain and disability, yet common treatments are only supported by mixed or equivocal research findings. Surgery often only provides modest improvement and post-surgery complications may significantly hamper outcomes, implying the need for trials testing conservative treatment, such as manual and manipulative therapy, particularly in cases where surgery may be contraindicated or premature. The purpose of this exploratory trial was to test an innovative protocol of manual and manipulative therapy (MMT) and compare it to standard care of a night splint(s) for symptomatic mild to moderate HAV, with a view gather insight into the effectiveness of MMT and inform the design of a definitive trial.

DESIGN

Parallel-group randomised trial set in an out-patient teaching clinic.

PARTICIPANTS

A convenience sample of 75 patients was assessed for eligibility, with 30 participants (15 per group) being consented and randomly allocated to either the control group (standard care with a night splint) or the experimental group (MMT).

INTERVENTION

Participants in the control group used a night splint(s) and those in the experimental group (MMT) received a structured protocol of MMT, with the participants in the experimental group receiving 4 treatments over a 2-week period.

OUTCOME MEASURES

Visual analogue scale (HAV-related pain), foot function index (HAV-related disability) and hallux dorsiflexion (goniometry).

RESULTS

There were no participant dropouts and no data was missing. There were no statistical (p<0.05) or clinically meaningful differences (MCID<20%) between the two groups based on outcome measure scores. However, the outcome measure scores in the control group (night splint) regressed between the 1-week follow-up and 1-month follow-up, while the scores in the experimental group (MMT) were sustained up to the 1-month follow-up. The within-group data analysis produced statistically and clinically significant changes from baseline to the 1-week flow-up across all outcome measures. Post hoc power analysis and sample size calculations suggest that the average between group power of this trial was approximately 60% (ES = 0.33) and that a definitive trial would require a minimum of 102 participants per group (N = 204) to achieve satisfactory power of ≥80%.

CONCLUSIONS

The trend in results of this trial suggest that an innovative structured protocol of manual and manipulative therapy (experimental group) is equivalent to standard care of a night splint(s) (control group) for symptomatic mild to moderate HAV in the short term. The protocol of MMT maintains its treatment effect from 1-week to 1-month follow-up without further treatment, while patients receiving standard care seem to regress when not using the night splint. Insights from this study support further testing of MMT for symptomatic mild to moderate HAV, particularly where surgery is premature or where surgical outcomes may be equivocal, and serve to inform the design of a future definitive trial.

Tooth chipping can reveal the diet and bite forces of fossil hominins

Mammalian tooth enamel is often chipped, providing clear evidence for localized contacts with large hard food objects. Here, we apply a simple fracture equation to estimate peak bite forces directly from chip size. Many fossil hominins exhibit antemortem chips on their posterior teeth, indicating their use of high bite forces. The inference that these species must have consumed large hard foods such as seeds is supported by the occurrence of similar chips among known modern-day seed predators such as orangutans and peccaries. The existence of tooth chip signatures also provides a way of identifying the consumption of rarely eaten foods that dental microwear and isotopic analysis are unlikely to detect.

Thoraco-abdominal aortic aneurysm branched repair

Open thoraco-abdominal aortic aneurysm repair is a demanding procedure with high impact on the patient and the operating team. Results from expert centres show mortality rates between 3-21%, with extensive morbidity including renal failure and paraplegia. Endovascular repair of abdominal aortic aneurysms initially required an undilated portion of the aorta below the renal arteries to safely fixate the stent-graft. More complex abdominal artic aneurysms (i.e., short-necked, juxta- and suprarenal aneurysms) were later successfully treated with fenestrated grafts. The development of branched grafts opened the way to treat thoraco-abdominal aneurysms endovascularly. In this review, a comprehensive overview of technical aspects and results of the available literature is given. Mortality rates are below 10%, with spinal cord ischemia reported between 2.7% and 20%. Target vessel branch patency invariably has been reported between 95% and 100%, with first mid-term results demonstrating evidence for durability. Most series included high-risk patients, who were denied open repair. Nevertheless, risks associated with endovascular repair of thoraco-abdominal aneurysm should be acknowledged. Technique-specific complications including perforation of small vessels due to multiple catheterization resulting in retroperitoneal hematoma, and compartment syndrome of the lower limbs should be mentioned. Technical evolution of branched grafts is ongoing. Tapering down the main graft to allow for room for the branches has resulted in easier catheterization of target vessels and insertion of bridging stent-grafts. For the same reason, the branches for celiac artery and superior mesenteric artery are deliberately off-set in position. To stabilise the usually long devices, additional spiral wires have been added, to facilitate deployment in the correct orientation. Endovascular repair of thoraco-abdominal aneurysms will continue to evolve and gradually take over from open repair, in view of the much lower physical impact on the patient.