A comparison of maceration methods for the preparation of infant skeletal remains for forensic anthropological analysis

Very little literature currently exists prescribing which maceration method to use when preparing infant human remains, resulting in bone quality that is suitable for forensic anthropological analysis. The aim of the study was to test five maceration methods to determine which is most suitable for infant remains for forensic anthropological analysis. The sample included five neonate pig carcasses (Sus scrofa domesticus), ranging between one to three days old. Five maceration methods were tested on the pig carcasses (one pig per maceration method) to determine their effectiveness. The methods included invertebrate maceration by meal worms, chemical maceration by bleach, chemical maceration by borax solution, enzymatic maceration by laundry detergent and sodium carbonate solution, and chemical maceration by sodium hypochlorite. A scoring method was created to assess the effectiveness of each maceration method. Invertebrate maceration and chemical maceration using bleach were the least successful methods of maceration (total maceration score = 8 respectively). Chemical maceration using borax and chemical maceration using sodium hypochlorite achieved complete maceration of the skeletal remains; however, they both resulted in artifacts that are unsuitable for forensic analysis (total maceration score = 14 respectively). Enzymatic maceration using laundry detergent and sodium carbonate was the most successful method (total maceration score = 17). The detergent technique subsequently successfully macerated all five sets of infant human remains. This study has validated that the enzymatic maceration technique using laundry detergent and sodium carbonate can be used to effectively macerate the remains of infant skeletal remains for forensic anthropological analysis.

Manners of terminology and description in Galen's anatomy in the ancient Rome and their historical consequences up to the modern time

The oldest extant anatomy textbooks compiled in ancient Rome were by Galen who described in writing most of the various parts and organs of the body. History tells us that ever since the time of Galen, anatomical terminology would be a necessary and beneficial feature, but it also brought unexpected and annoying consequences into the field. The benefits are readily apparent in the case of muscle terminology. Galen identified more than 150 different kinds of skeletal muscles, most of which were unnamed, hence difficult to identify without professional knowledge of anatomy. Vesalius introduced detailed anatomical illustrations in Fabrica (1543), which made the identification of the muscles easier. Bauhin then introduced proper descriptive names for the muscles in Theatrum anatomicum (1605), which enabled the identification of the muscles without illustrations. After the terminology became complex and diverse, a logically consistent standard nomenclature was established by Nomina anatomica (1895). The unexpected consequences may be found in the terminology of bones and joints. Galen gave 39 proper names for individual bones, and classified and termed the types of bony joints. Many of these terms have survived in modern anatomy as literal translations of the bone terms, as well as the joint terms. The annoying consequences may be found in the terminology of intestines. Galen divided the small and large intestines into three portions, such that the major part of the small intestine suspended by the mesentery was divided into two without sufficient reason. The Latin translations of jejunum and ileum were, respectively assigned to them by Mondino in his Anatomia written in 1316.

Quantitative and qualitative evaluation of three MSCT for high resolution bone imaging

INTRODUCTION

Strategies for achieving high resolution varies between manufacturers. In CT, the helical mode with narrow collimation has long been considered as the gold standard for high-resolution imaging. More recently, incremental modes with small dexels and focal spot, have been developed but have not been compared with helical acquisitions under optimal conditions. The aim of this work is to compare the high-resolution acquisition strategies currently proposed by recent MSCT.

METHODS

Three CT systems were compared. A phantom was used to evaluate geometric accuracy, uniformity, scan slice geometry, and spatial resolution. Human dry bones were used to test different protocols on real bone architecture. A blind visual analysis was conducted by trained CT users for classifying the different acquisitions (p-values).

RESULTS

All systems give satisfactory results in terms of geometric accuracy and uniformity. The in-plane MTF at 5% were respectively 13.4, 15.9 and 18.1 lp/cm. Dry-bones evaluation confirms that acquisition#3 is considered as the best.

CONCLUSIONS

The incremental acquisition coupled with à small focal spot, and a high-sampling detector, overpasses the reference of low-pitch helical acquisitions for high-resolution imaging. Cortical bone, bony vessels, and tumoral matrix analysis are the very next challenges that will have to be managed to improve normal and pathologic bone imaging thanks to the availability UHR-CT systems.

Environmental sustainability assessment of a new food waste anaerobic digestion and pyrolysis hybridization system

This research conducted an environmental life cycle assessment (LCA) to evaluate an anaerobic digestion-co-pyrolysis (ADCo-Py) system in which pyrolysis was added to traditional food waste (FW) anaerobic digestion (AD) systems to treat the solid fraction and impurities separated from FW. The solid fraction, including impurities such as wooden chopsticks, plastics, eggshells, and bones, is usually incinerated, while pyrolysis can be a viable alternative to optimize FW treatment. The environmental impact of ADCo-Py was compared with stand-alone AD, pyrolysis, and ADCo-INC (AD with incineration of separated solids). The results indicated that both ADCo-Py (-1.726 kg CO2-Eq/kgFW) and ADCo-INC (-1.535 kg CO2-Eq/kgFW) outperform stand-alone AD (-0.855 kg CO2-Eq/kgFW) and pyrolysis (-0.181 kg CO2-Eq/kgFW) in mitigating global warming potential (GWP). Additionally, pretreatments were found to have the most significant influence on GWP, ecotoxicity potential (ETP), and acidification potential (AP). The two-step pretreatment in ADCo-Py, including the separation of solids and drying, significantly improved the environmental sustainability of the system when compared with standalone pyrolysis.

Effect of Excess Fluoride Exposure on Radiographic and Histopathological Changes in Long Bones of Rabbit

The present study aimed to investigate the effects of excess fluoride exposure on long bones in young rabbits (Oryctolagus cuniculus). New Zealand White rabbits (n = 30) were randomly divided into five equal groups and were provided drinking water containing 0, 50, 100, 200, and 400 µg added fluoride per ml ad lib for a period of 90 days. Blood samples were collected on days 0, 45, and 90 of the experiment, and femur samples were collected for fluoride estimation on day 90 after radiography of long bone before sacrifice. Study revealed significant increase in serum fluoride concentration following oral intake of excess fluoride. Alterations in activities of alkaline phosphatase, aspartate transaminase, alanine transaminase, and concentrations of creatinine and urea nitrogen in blood plasma were also recorded in animals receiving excess fluoride, though changes revealed inconsistent pattern. Radiographic changes in long bones in fluoride exposed rabbits included widening of metaphysis, thinning of cortical region, and a variety of osteopenic changes like osteoporosis and osteomalacia that were more prominent in animals receiving 200 ppm or more than 200 ppm fluoride in drinking water. Important changes in histomorphology of growth plate in long bones recorded in excess fluoride (> 100 ppm) exposed rabbits included irregular thickening of epiphyseal growth plate with haphazard orientation of chondrocytes forming nodular protrusion into metaphysis. Fluoride exposure induced both osteogenesis and osteoporosis to a degree varying with dose of fluoride exposure.

The effect of caponization on tibia bone histomorphometric properties of crossbred roosters

The negative effect of caponization on the structural, geometric and mechanical parameters of femur and tibia has been shown in a few studies. Nevertheless, its influence on tibia bone microarchitecture is still largely unknown. Therefore, this study aimed to assess the effect of castration on the microstructural parameters of the trabecular and compact bone of tibia bone in crossbred chickens. The experiment involved 96 roosters derived from crossing Yellowleg Partridge hens ([Formula: see text]-33) and Rhode Island Red cockerels (R-11) fattened until the 16th, 20th and 24th week of life. Animals were randomly divided into 2 groups of 48 each. Group I (control) consisted of intact roosters and group II (experimental) consisted of birds subjected to caponization at the 8th week of age. The castration surgery had no influence on some properties within compact bone such as osteon diameter On.Dm, osteon perimeter On.Pm, osteon area On.Ar, osteocyte lacunar number Ot.Lc.N, osteon bone area On.B.Ar, osteon wall thickness On.W.Th as well as thick-mature collagen content in all analyzed age groups of animals. Nevertheless, our results demonstrate that castration caused a decrease of Haversian canal area Hc.Ar, osteocyte lacunar area Ot.Lc.Ar and osteocyte lacunar porosity Ot.Lc.Po among the 16-week-old birds, decrease of Haversian canal perimeter Hc.Pm and increase of fraction of bone area On.B.Ar/On.Ar among 16- and 24-week-old individuals and also an increase of osteocyte lacunar density Ot.Lc.Dn in the osteons of the oldest roosters. Additionally, some microstructural parameters of trabecular bone show the negative effect of caponization. The youngest 16-week-old capons were characterized by thinnin the trabecular in the epiphysis part of tibia. Moreover, in the case of 24-week-old, there is an increase in the trabecular separation Tb.Sp with simultaneous decrease of trabecular number Tb.N compared to roosters, which may suggest the increase of the bone resorption among the oldest individuals. The increased bone turnover in the epiphysis part of the tibia bone also indicates changes in the collagen fibers distribution, where among 20-week-old animals there is a decrease in the content of immature thin collagen fibers with simultaneous increase in the content of mature thick collagen fibers. Furthermore, among the oldest 24-week-old individuals we can observe the increased thick-to-thin collagen ratio, which may be a sign of slowing down in bone formation.

Osteometric data of Avian Fauna of Armenia: A baseline for zoologists and archaeozoologists

Modern bird skeletons stored in the faunal collections of the Institute of Zoology of the Scientific Center of Zoology and Hydroecology NAS Armenia constitute a source material for this dataset. The osteological material in the scientific collections has been accumulated in the course of faunal studies in Armenia over the span of 60 years. The osteometric dataset sheds light on the country's species diversity and includes cranial and postcranial measurements (carpometacarpus, humerus, tibia, femur, tarsometatarsus, radius and ulna) of 141 bird skeletons which belong to 81 bird species, 34 families and 17 orders. Bird skeletons have been collected by means of specimen collection from the wild for scientific study prior to 1990s when the practice was common and recovered opportunistically after 1990s from birds found dead through natural causes and incidents. Recent bird skeletons (bones) serve as a unique comparative resource for zoological research and for identifying bird bones recovered from archaeological and natural deposits.

Complete fatty replacement of lytic bone metastases following treatment. A case report, assessing response to treatment of bone metastases on CT imaging

Bone is the most common site for breast cancer metastases, occurring in up to 70% of patients, who have metastatic disease. The treatment of advanced breast cancer with bony metastases has significant health and economic implications including the costs of imaging, systemic therapy, and hospital admission. Therefore, accurate interpretation of response to therapy in bone metastases on post-treatment computed tomography (CT) imaging is an essential role of the radiologist in daily practice. It is well recognized that lytic metastases become sclerotic in response to treatment, but it is less appreciated that lytic metastases can become fatty in response to treatment as in this index case. We present a case of post-treatment lytic bone metastases demonstrating an unusual finding of complete fatty replacement within the lesions indicating a response to treatment.

Assessing the usefulness of Raman spectroscopy and lipid analysis of decomposed human bones in forensic genetics and molecular taphonomy

Bones are among the structures most likely to be recovered after death. However, the low quantity of preserved DNA and complex processing from sample to DNA profile make forensic DNA analysis of bones a challenging task. Raman spectroscopy and gas chromatography-mass spectrometry (GC/MS), have the potential to be useful as screening tools for DNA analysis and in decomposition studies. The objective of this research was to assess the usefulness of such molecular investigations. Femur samples collected from 50 decomposing human bodies were subjected to Raman spectroscopy and GC/MS. Assessment of nuclear DNA quantity and short tandem repeat (STR) genotyping efficiency were also performed. Raman parameters (crystallinity, carbonate-to-phosphate ratio, mineral-to-matrix ratio) and detected lipids were recorded. Background fluorescence proved problematic for Raman analysis of forensic bones. Regardless, it was not associated with less preserved DNA or less detected STR alleles. Fatty acids, hydrocarbons, and five types of fatty acid methyl esters (FAMEs) were detected. The main phosphate peak position in Raman spectra was significantly correlated with preserved DNA (p = 0.03713), while significantly more STR alleles were detected in bones containing methyl hexadecenoate (p = 0.04236). Detection of FAMEs in the bone matrix suggests a reaction between methanol produced by bacteria and free fatty acids, which are not associated with the level of preservation of endogenous DNA. The techniques assessed have shown to be useful in molecular taphonomy studies and forensic genetics.

Genetic determinants of periosteum-mediated craniofacial bone regeneration: a systematic review

BACKGROUND

Periosteum-mediated bone regeneration (PMBR) is a recognized method for mandibular reconstruction. Despite its unpredictable nature and the limited degree to which it is understood, it does not share the concerns of developmental changes to donor and recipient tissues that other treatment options do. The definitive role of the periosteum in bone regeneration in any mammal remains largely unexplored. The purpose of this study was to identify the genetic determinants of PMBR in mammals through a systematic review.

METHODS

Our search methodology was designed in accordance with the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) guidelines. We conducted a quality assessment of each publication, and evaluated the differences in gene expression between days 7 and 15.

RESULTS

A total of four studies satisfied the inclusion criteria. The subjects and tissues examined in these studies were Wistar rat calvaria in two studies, mini-pigs in one study, and calves and mice in one study. Three out of the four studies achieved the necessary quality score of ≥ 3. Gene expression analysis showed increased activity of genes responsible for angiogenesis, cytokine activities, and immune-inflammatory responses on day 7. Additionally, genes related to skeletal development and signaling pathways were upregulated on day 15. Conclusions: The results suggest that skeletal morphogenesis is regulated by genes associated with skeletal development, and the gene expression patterns of PMBR may be characterized by specific pathways.

The effects of PPARγ inhibitor on bones and bone marrow fat in aged glucocorticoid-treated female rats

Progressive bone marrow (BM) fat accumulation is a common bone loss characteristic in older populations and glucocorticoid (GC)-induced skeletal destruction that is inversely associated with bone synthesis and directly associated with increased peroxisomal proliferator-activated receptor gamma (PPARγ) expression. PPARγ inhibition is an efficient therapeutic strategy for aged- and GC-related skeletal disorders. This study aimed to evaluate the effect of PPARγ inhibition on aged GC-treated female rats. It was hypothesised that bisphenol A diglycidyl ether (BADGE) could inhibit marrow adiposity and improve osteogenesis by inhibiting PPARγ, thereby preventing GC-induced osteoporosis (GIO). Female Sprague-Dawley rats (n = 32, age = 18 months) were randomly allocated to one of the following groups: (1) control, (2) BADGE (30 mg/kg/day, intraperitoneal), (3) methylprednisolone (MP; 30 mg/kg/day, subcutaneous), and (4) MP + BADGE. After eight weeks of treatment, bone density (BD) and trabecular bone microarchitectures were quantified by micro-computed tomography (CT), and BM adipocytes were quantified by histopathology. Additionally, mRNA and protein expression of adipogenic and osteogenic markers were quantified by reverse transcription-quantitative polymerase chain reaction. Furthermore, serum bone turnover biomarker levels were quantified by enzyme-linked immunosorbent assay. MP treatment led to marrow adipogenesis and bone deterioration. However, rats treated with MP + BADGE showed lower marrow adipogenesis, as indicated by smaller marrow adipocyte diameter, decreased density and area percentages, reduced expression of marrow adipogenic genes and proteins, improved BD and trabecular microarchitectures, increased expression of osteogenic genes and proteins, and higher levels of serum bone formation markers. These results were consistent with the differences observed between control and BADGE mono-treated rats. In conclusion, BADGE treatment attenuates BM adiposity and improves bone formation in aged GC-treated female rats by inhibiting PPARγ. Therefore, PPARγ might be a potential target for treating GIO in older populations.

Macromorphometric Analysis of Metastatic Lesions in Bones due to Breast Cancer: Contribution to Human Identification

OBJECTIVE

This study aimed to report the metastatic lesions observed in identified skeletons whose deaths were caused by breast cancer complications to provide information and evidence that can be used in cases of human identification forensics.

METHODS

The research was conducted at the Centre for Forensic Anthropology Studies of the Faculty of Odontology of the University of Pernambuco (CEAF/FOP/UPE), Recife, Brazil. The data bank of the CEAF/FOP/UPE was searched for skeletons with the cause of death reported as due to breast cancer, resulting in five cases. The skeletons were arranged in anatomical positions and macroscopically inspected to register, describe and measure the lesions present to establish the macroscopic patterns of bone destruction caused by breast cancer.

RESULT

Of the five skeletons, two presented metastatic lesions. In the first, lesions were observed in a disseminated form, affecting almost all bones. The lesions were predominantly osteolytic and ellipsoid-shaped; however, mixed and circular lesions were also found. The second skeleton presented four lesions of mixed characteristics. The finding of bone lesions in the macroscopic analysis of skeletons may reveal a more advanced stage of the neoplasm, as well as its dissemination in areas little rich in hematopoietic tissue, such as the diaphyses of long bones, a situation widely observed in the first reported case.

CONCLUSION

Besides providing more excellent knowledge of their macroscopic presentation, bone metastatic lesions may act as an individualizing factor in human identification cases, narrowing the sample of possible victims.

[Reconstruction of posttraumatic deformities and defects]

The reconstruction of posttraumatic defects of bone and soft tissue, as well as residual deformities of the bone is often a lengthy and complicated procedure. Multiple surgical interventions are necessary to reconstruct the affected extremity and restore its functionality. To achieve an optimal result it often takes months or years and requires great patience and compliance of the patient. This treatment should be carried out in centers with the appropriate instrumental and human resources. Since the pathologies are often complex with bony deformities or loss of bone, as well as infections and soft tissue defects, the treatment should be carried out by very experienced surgeons to successfully manage these complex reconstructions. This often requires interdisciplinary cooperation, especially with experienced plastic surgeons. A soft tissue reconstruction for better blood circulation in the exposed bony structures, as well as the bony defects themselves, can be reconstructed at the same time.

Severe hypocalcemia after denosumab administration in a patient with chronic kidney disease: a case report

Patients with altered kidney function are at increased risk of hypocalcemia after denosumab administration. There is however a small number of studies and case reports describing hypocalcemia refractory to treatment. We describe a case of severe hypocalcemia, after the administration of three doses of denosumab, in a young patient with lupus nephritis under corticosteroid coverage and osteopenia. However, more studies are needed in order to extract a safe conclusion about the factors that contribute to the development of severe hypocalcemia in this group of patients.

Fauna of flies (Diptera) on bones and emergence succession: Forensic implications in skeletal remains

Fauna of flies on pig carcasses and bones and their emergence succession were investigated in Hokkaido, Japan. A total of 55,937 flies consisting 23 identified species in 16 families was collected from emergence traps after removal of carcasses and emergence containers containing bones. In emergence traps, Lucilia caesar (Linnaeus) emerged earliest, followed by Hydrotaea ignava (Harris). Piophilid flies emerged 22-25 days later than L. caesar, and their emergence periods were prolonged. In emergent flies from bones, Piophilidae was the dominant family, comprising five species; Stearibia nigriceps (Meigen) was the most abundant, followed by Liopiophila varipes (Meigen) and Protopiophila latipes (Meigen). Stearibia nigriceps and L. varipes remarkably dominated in summer bones and overwintering spring bones, respectively. Piophilids emerged from all 11 types of bones; the thoracic spine significantly yielded the most numerous individuals in S. nigriceps. The developmental duration of larvae of S. nigriceps in bones was estimated to be 12-34 days after placement of carcasses in summer. Observations of overwintering bones showed that L. varipes and Centrophlebomyia grunini (Ozerov) overwintered in larvae inside of bones. The importance of examining piophilid larvae in bones and their potential forensic usefulness are discussed.

Diagnostic accuracy of ultra-low-dose CT compared to standard-dose CT for identification of non-displaced fractures of the shoulder, knee, ankle, and wrist

OBJECTIVES

To compare the performance of ultra-low-dose computed tomography (ULD-CT) with standard-dose computed tomography (SD-CT) for the diagnosis of non-displaced fractures of the shoulder, knee, ankle, and wrist.

METHODS

This prospective study enrolled 92 patients receiving conservative treatment for limb joint fractures who underwent SD-CT followed by ULD-CT at a mean interval of 8.85 ± 1.98 days. Fractures were characterized as displaced or non-displaced. Objective (signal-to-noise ratio, contrast-to-noise ratio) and subjective CT image quality were evaluated. Observer performance for ULD-CT and SD-CT detecting non-displaced fractures was estimated by calculating the area under the receiver operating characteristic (ROC) curve (A_z).

RESULTS

The effective dose (ED) for the ULD-CT protocol was significantly lower than the ED for the SD-CT protocol (F = 422.21~2112.25, p < 0.0001); 56 patients (65 fractured bones) had displaced fractures, and 36 patients (43 fractured bones) had non-displaced fractures. Two non-displaced fractures were missed by SD-CT. Four non-displaced fractures were missed by ULD-CT. Objective and subjective CT image quality was significantly improved for SD-CT compared to ULD-CT. The sensitivity, specificity, PPV, NPV, and diagnostic accuracy of SD-CT and ULD-CT for non-displaced fractures of the shoulder, knee, ankle and wrist were similar: 95.35% and 90.70%; 100% and 100%; 100% and 100%; 99.72% and 99.44%; and 99.74% and 99.47%, respectively. The A_z was 0.98 for SD-CT and 0.95 for ULD-CT (p = 0.32).

CONCLUSION

ULD-CT has utility for the diagnosis of non-displaced fractures of the shoulder, knee, ankle, and wrist and can support clinical decision-making.

Fetal facial bone growth: Post-mortem CT analysis

OBJECTIVE

To describe and model the normal growth of fetal facial bones and angles.

MATERIAL AND METHODS

A total of 118 fetal CT scans obtained at 19 to 41 weeks gestation after in utero fetal death or late miscarriage were analyzed. CT scan was followed by autopsy and pathological examination and only fetuses free from brain disease or abnormal craniofacial development were included. The measurements were taken using software for frontal, sagittal and 3D reconstruction from native axial sections. The optimal plane for bone analysis was chosen and the measurements made by multiplanar reconstruction.

RESULTS

There was a statistically significant increase (P<0.001) in all measurements regardless of gestational age (GA) except those of the mandibulo-fronto-maxillary angle (P=0.412), the naso-mandibulo-maxillary angle (P=0.828) and mandibular width (P=0.86). There was no significant difference according to fetal sex. Based on these results, the corresponding growth curves were created. The anteroposterior mandibular diameter (APD) was very strongly correlated with GA (R=0.926, P<0.001). The following equation: GA=(8.187×APD)+4.257 can be used to estimate GA with a confidence interval (CI) of±2.42. The same applies to maxillary width (MW) (R=0.922; P<0.001). The equation GA=(11.059×MW)+7.571 can be used to estimate GA with a CI of 2.17.

CONCLUSION

The growth of the mandible, maxilla, zygomatic bone and orbits was measured and the corresponding growth curves were established. Several measurements were strongly correlated with gestational age.

A casework study: The effect of the porcine digestive process on animal carcasses and human teeth

What happens if a human body is fed to pigs? Although a popular notion in the entertainment industry, no scientific published literature exists that documents this porcine feeding behaviour, nor, more importantly, what elements of the cadaver may survive such a process. A study conducted in 2020, born out of a casework enquiry, aimed to investigate the following two questions; Would pigs feed on a human body? And, if so, what could be recovered post feeding event? Kangaroo carcasses, porcine carcasses (as human analogues) and 90 human teeth were prepared, and fed, to two domestic pigs, in a variety of feed scenarios. Biological traces including bones, bone fragments, teeth and tooth fragments were recovered both post-digestion from the faeces of the pigs, as well as uneaten from the porcine enclosure. 29% of all human teeth were recovered from the study; 35% of which were recovered post-digestion from the faeces and 65% were recovered uneaten from the porcine enclosure, Of the recovered human teeth, 81% were deemed suitable for identification by a forensic odontologist. From the 447 bones recovered from the enclosure, 94% could be identified to a bone type and species. From all 3338 bone fragments recovered from the faeces of the pigs, none retained any morphological traits that would allow further intelligence to be generated. Overall, it was found that pigs will feed on human analogues and will consume soft tissue, bones, and human teeth. Biological traces in the form of bones, bone fragments, teeth and tooth fragments may be recovered both post-digestion from the faeces, or from the porcine enclosure. The biological traces can be used for identification of an individual via forensic odontology, identification of a species via forensic anthropology and may be suitable for DNA analysis. The outcomes of this study generated new avenues for investigation in the case and may be used to inform future operational resources.

Comparing preservation substrates under field conditions for efficient DNA recovery in bone

Often bones are the only biological material left for the identification of human remains. As situations may occur where samples need to be stored for an extended period without access to cooling, appropriate storage of the bone samples is necessary for maintaining the integrity of DNA for profiling. To simulate DNA preservation under field conditions, pig rib bones were used to evaluate the effects of bone cleaning, buffer composition, storage temperature, and time on DNA recovery from bone samples. Bones were stored in three different buffers: TENT, solid sodium chloride, and ethanol-EDTA, at 20 °C and 35 °C for 10, 20, and 30 days. Bones were subsequently dried and ground to powder. DNA was extracted and quantified. Results show that temperature and storage time have no significant influence on DNA yield. DNA recovery from bones stored in solid sodium chloride or ethanol-EDTA was significantly higher compared to bones stored in TENT, and grinding of bones was facilitated by the extent of dehydration in solid sodium chloride and ethanol-EDTA compared to TENT. Overall, solid sodium chloride was found to be superior over ethanol-EDTA; when it comes to transportation, dry material such as salt eliminates the risk of leaking; it is non-toxic and in contrast to ethanol not classified as dangerous goods. Based on this study's results, we recommend NaCl as a storage substrate for forensic samples in cases where no cooling/freezing conditions are available.

Artificial intelligence vs. radiologist: accuracy of wrist fracture detection on radiographs

OBJECTIVE

To compare the performances of artificial intelligence (AI) to those of radiologists in wrist fracture detection on radiographs.

METHODS

This retrospective study included 637 patients (1917 radiographs) with wrist trauma between January 2017 and December 2019. The AI software used was a deep neuronal network algorithm. Ground truth was established by three senior musculoskeletal radiologists who compared the initial radiology reports (IRR) made by non-specialized radiologists, the results of AI, and the combination of AI and IRR (IR+AI) RESULTS: A total of 318 fractures were reported by the senior radiologists in 247 patients. Sensitivity of AI (83%; 95% CI: 78-87%) was significantly greater than that of IRR (76%; 95% CI: 70-81%) (p < 0.001). Specificities were similar for AI (96%; 95% CI: 93-97%) and for IRR (96%; 95% CI: 94-98%) (p = 0.80). The combination of AI+IRR had a significantly greater sensitivity (88%; 95% CI: 84-92%) compared to AI and IRR (p < 0.001) and a lower specificity (92%; 95% CI: 89-95%) (p < 0.001). The sensitivity for scaphoid fracture detection was acceptable for AI (84%) and IRR (80%) but poor for the detection of other carpal bones fracture (41% for AI and 26% for IRR).

CONCLUSIONS

Performance of AI in wrist fracture detection on radiographs is better than that of non-specialized radiologists. The combination of AI and radiologist's analysis yields best performances.

KEY POINTS

• Artificial intelligence has better performances for wrist fracture detection compared to non-expert radiologists in daily practice. • Performance of artificial intelligence greatly differs depending on the anatomical area. • Sensitivity of artificial intelligence for the detection of carpal bones fractures is 56%.

Organic Matrix and Secondary Metabolites in Nacre

Nacre, also called mother-of-pearl, is a naturally occurring biomineral, largely studied by chemists, structural biologists, and physicists to understand its outstanding and diverse properties. Nacre is constituted of aragonite nanograins surrounded by organic matrix, and it has been established that the organic matrix is responsible for initiating and guiding the biomineralization process. The first challenge to study the organic matrix of nacre lays in its separation from the biomineral. Several extraction methods have been developed so far. They are categorized as either strong (e.g., decalcification) or soft (e.g., water, ethanol) and they allow specific extractions of targeted compounds. The structure of the nacreous organic matrix is complex, and it provides interesting clues to describe the mineralization process. Proteins, sugars, lipids, peptides, and other molecules have been identified and their role in mineralization investigated. Moreover, the organic matrix of nacre has shown interesting properties for human health. Several studies are investigating its activity on bone mineralization and its properties for skin care. In this review, we focus on the organic constituents, as lipids, sugars, and small metabolites which are less studied since present in small quantities.

Purification, structural characterization, and anticoagulant activity evaluation of chondroitin sulfate from codfish (Gadus macrocephalus) bones

Chondroitin sulfate (CCS) was purified from discarded codfish (Gadus macrocephalus) bones, and its chemical structure and anticoagulant activity were assessed. CCS was obtained via enzymatic lysis and ion-exchange column chromatography, with a yield of approximately 0.15%. High-performance gel performance chromatography revealed CCS to be a largely homogeneous polysaccharide with a relatively low molecular weight of 12.3 kDa. FT-IR spectroscopy, NMR spectroscopy, and SAX-HPLC indicated that CCS was composed of monosulfated disaccharides (ΔDi4S 73.85% and ΔDi6S 19.06%) and nonsulfated disaccharides (ΔDi0S 7.09%). In vitro anticoagulation analyses revealed that CCS was able to significantly prolong activated partial thromboplastin time (APTT) and thrombin time (TT) (p < 0.05). At a CCS concentration of 5 μg/mL and 25 μg/mL, APTT and TT were approximately 1.08 and 1.12 times higher, respectively, compared to the negative control group. The results indicated that CCS might offer value as a dietary fiber supplement with the potential to prevent the incidence of coagulation-related thrombosis.

Critical aspects of Raman spectroscopy as a tool for postmortem interval estimation

The estimation of the postmortem interval (PMI) from skeletal remains represents a challenging task in forensic science. PMI is often influenced by extrinsic factors (humidity, dryness, scavengers, etc.) and intrinsic factors (age, sex, pathology, way of life, medical treatments, etc.). Raman spectroscopy combined with multivariate data analysis represents a promising tool for forensic anthropologists. Despite all the advantages of the technique, Raman spectra of skeletal remains are influenced by these extrinsic and intrinsic factors, which impairs precision and reproducibility. Both parameters have to reach a high level of confidence when such spectroscopy is used as a way to predict PMI. As a consequence, advanced multivariate data analysis is necessary to quantify the effect of all factors to improve the estimation of the PMI. The objective of this work is to evaluate the effect of intrinsic and extrinsic factors on the Raman spectra of skeletal remains. We designed a protocol close to a real-world scenario. We used ANOVA-simultaneous component analysis (ASCA) to unmix and quantify the effect of 1 intrinsic (source body) and 1 extrinsic (burial time) factors on the Raman spectra. In our model, the burial time was found to generate the highest variability after the source body. ASCA showed that the variability due to the burial time has 2 mixed contributions. Seasonal variations are the first contribution. The second contribution is attributed to diagenesis. A decrease in the mineral bands and an increase in the organic bands are observed. The source body was also found to contribute to the variability in Raman spectra. ASCA showed that the source body induces variability related to the composition of bones. This quantification cannot be assessed by basic chemometrics methods such as PCA. The results of this study highlighted the need to use an advanced chemometric data analysis tool (like ASCA) combined with Raman spectroscopy to estimate the postmortem interval.

Effect of inflammation on bones in diabetic patients with periodontitis via RANKL/OPG system-A review

Purpose

Diabetes mellitus and periodontitis are inflammatory diseases, the severity of inflammation results in the progression and persistence of both the disorders and affects bones. Diabetic complications aggravate in diabetic subjects having periodontitis; similarly, diabetic patients are more prone to developing gingivitis and periodontitis. Periodontal and diabetic inflammation disturbs bone homeostasis, which possibly involves both innate and adaptive immune responses. The pathogenic processes that link the two diseases are the focus of much research and it is likely that upregulated inflammation arising from each condition adversely affects the other. RANKL/OPG pathway plays a prominent role in periodontal and diabetic inflammation and bone resorption.

Method

This review article summarises the literature on the link between inflammatory cytokines and the prevalence of disturbed bone homeostasis in diabetic patients with periodontitis. An extensive search was done in PubMed, Scopus, Medline and Google Scholar databases between April 2003 and May 2021.

Result

A total of 27 articles, including pilot studies, case-control studies, cross-sectional studies, cohort studies, randomized control trials, longitudinal studies, descriptive studies and experimental studies, were included in our literature review.

Conclusion

Since RANKL/OPG are cytokines and have immune responses, regulating these cytokines expression will help control diabetes, periodontitis and bone homeostasis. The growing evidence of bone loss and increased fracture risk in diabetic patients with periodontitis makes it imperative that health professionals carry out planned treatment focusing on monitoring oral health in diabetic patients; bone markers should also be evaluated in patients with chronic periodontitis with an impaired glycemic state.

Nutritional reconstruction in an early modern population: Searching for a relationship between dental microwear and bone element composition

BACKGROUND

Observing the microwear patterns of the dental crowns enamel surface can provide information on the ingredients and structure of the food consumed, but also on eating habits and lifestyle. Major role in reconstructing the diet and lifestyle of past populations is played by the analysis of alkaline earth metals, such as strontium, barium, zinc and calcium. Ba and Sr are indicators of the consumption of vegetables, plants (cereals and legumes) and marine organisms. This study aims to assess dietary diversity and identify its components based on microscopic techniques and chemical analyses of material from early modern archaeological sites in Wrocław, Poland.

METHODS

The material consisted of 36 permanent molars and the intrasternal parts of 122 first ribs, collected from 6 Wroclaw early modern cemeteries. Tooth microwear was evaluated on Scanning electron microscopy images, with Microwear 4.02 software. Bone chemical composition (Ca, P, Ba, Sr content) was evaluated with mass spectrometry.

RESULTS

Most lines were present on the teeth from St. Mary Magdalene Cemetery, with the lowest average number of lines observed on the teeth from St. Barbara Cemetery. The Ca/P ratios calculated for different sites formed two clusters that allows to distinguish two groups of archaeological sites with different bone preservation status. Number of differences in Ba/Sr, Sr/Ca, Ba/Ca ratios was found between disctinct archaeological sites. A number of correlations were found between the concentration of the chemical elements, but no statistically significant correlation was found between the microwear characteristics and the proportion of the elements studied. Some strong correlations were found between microwear features and the Ca/P ratio.

CONCLUSIONS

the different values of Sr/Ca, Ba/Ca and Ba/Sr ratios indicate different diets in the different communities. The data obtained indicate a mixed diet, with a relatively high proportion of animal products throughout Wrocław. Conclusions should be treated with caution due to secondary diagenesis. The lack of interdependence between microwear and chemical composition characteristics suggests that the two methods should be considered complementary and not overlapping, as they provide different insights into the diets of past populations. The comparison of microwear between different sites should always take into account secondary diagenesis and the burial environment, as these influence the characteristics of microwear.

Effects of immune cells on mesenchymal stem cells during fracture healing

In vertebrates, bone is considered an osteoimmune system which encompasses functions of a locomotive organ, a mineral reservoir, a hormonal organ, a stem cell pool and a cradle for immune cells. This osteoimmune system is based on cooperatively acting bone and immune cells, cohabitating within the bone marrow. They are highly interdependent, a fact that is confounded by shared progenitors, mediators, and signaling pathways. Successful fracture healing requires the participation of all the precursors, immune and bone cells found in the osteoimmune system. Recent evidence demonstrated that changes of the immune cell composition and function may negatively influence bone healing. In this review, first the interplay between different immune cell types and osteoprogenitor cells will be elaborated more closely. The separate paragraphs focus on the specific cell types, starting with the cells of the innate immune response followed by cells of the adaptive immune response, and the complement system as mediator between them. Finally, a brief overview on the challenges of preclinical testing of immune-based therapeutic strategies to support fracture healing will be given.

Identification of a Slovenian prewar elite couple killed in the Second World War

Genetic identification of a Slovenian prewar elite couple killed in 1944 was performed by typing autosomal and Y-chromosomal STRs, and phenotypic HIrisPlex SNPs for hair and eye color prediction were analyzed for the female skeleton using next-generation sequencing (NGS) technology. The clandestine grave containing the couple's skeletal remains was found in 2015 and only the partial remains were found. Living distant relatives could be found only for the male victim. Because of a lack of comparative reference samples, it was not possible to identify the female victim through autosomal and mitochondrial DNA typing. However, the possibility of comparison of eye and hair color with a painting exhibited in the City Museum of Ljubljana by the prominent Slovenian painter Ivana Kobilca existed. Nuclear DNA obtained from the samples was quantified using the PowerQuant System, and then STR typing was carried out with different autosomal and Y-STR kits. From 0.09-9.36 ng DNA/g of powder was obtained from teeth and bones analyzed. Complete autosomal and Y-STR profiles made it possible to identify the male skeleton via comparison with two nephews. For the female victim, predicted eye and hair color was compared to colors on the painting. Kobilca's painting confirms the genetically predicted eye and hair color. After more than seventy years, the skeletal remains of the couple were handed over to their relatives, who buried the victims with dignity in a family grave.

Management of meat by- and co-products for an improved meat processing sustainability

Large amounts of meat by- and co-products are generated during slaughtering and meat processing, and require rational management of these products for an ecological disposal. Efficient solutions are very important for sustainability and innovative developments create high added-value from meat by-products with the least environmental impact, handling and disposal costs, in its transition to bioeconomy. Some proteins have relevant technological uses for gelation, foaming and emulsification while protein hydrolyzates may contribute to a better digestibility and palatability. Protein hydrolysis generate added-value products such as bioactive peptides with relevant physiological effects of interest for applications in the food, pet food, pharmaceutical and cosmetics industry. Inedible fats are increasingly used as raw material for the generation of biodiesel. Other applications are focused on the development of new biodegradable plastics that can constitute an alternative to petroleum-based plastics. This manuscript presents the latest developments for adding value to meat by- and co-products and discusses opportunities for making meat production and processing more sustainable.

Three-Dimensional Printing-Assisted Masquelet Technique in the Treatment of Calcaneal Defects

Objective

The aim of the present study was to summarize the clinical efficacy of three‐dimensional (3D) printing technology combined with the Masquelet technique in the treatment of calcaneal defects.

Methods

From January 2018 to April 2019, 3D printing combined with induced masquelet technology was used to treat four patients with calcaneal defects, including two men and two women. The patients were aged 22–52 years old, with an average age of 36 years. There were two cases of traffic accident injuries, there was one case of a fall from height, and there was one case of crush injury. CT scans were used to reconstruct the bilateral calcaneus, mirror technology was used to construct the bone defect area, and Materialise 3‐matic software was used to design the calcaneus shaper mold and 3D print the mold. During the operation, the mold was used to shape the bone cement and fill the bone defect. In the second stage, the bone cement was removed and autologous bone was implanted to repair the bone defect. All patients were followed up to observe the effect.

Results

All four patients were followed up for 14 months (range, 10–18 months). There were three cases of infectious bone defects: two cases of Escherichia coli and one case of Pseudomonas aeruginosa. The 3D printed mold was used to shape the bone cement. During the operation, it was found to have a high degree of matching with the defect area of calcaneus. There is no need to adjust it again, and the wound healed well after the first stage. In the second stage of surgery, it was found that the induced membrane formed was complete and of appropriate size; the bone cement was easily removed during the operation. The fracture healing time was 3–6 months, with an average of 4 months. At the last follow up, there was no pain and the patients walked with full weight bearing. The Maryland score was 94 points (range, 88–98 points); three cases were excellent and one case was good. The AOFAS score ranged from 86 to 98, with an average of 92.8 points; three cases were excellent and one case was good.

Conclusion

Three‐dimensional printing technology combined with induced membrane technology is an effective approach for treating calcaneal bone defects.

Diabetes and Bone Fragility

Diabetes is a highly prevalent disease with complications that impact most bodily systems. However, the impact of diabetes on bone health is frequently ignored or underestimated. Both type 1 (T1D) and type 2 diabetes (T2D) are associated with a higher risk of fractures, albeit through different mechanisms. T1D is characterized by near total insulinopenia, which affects the anabolic tone of bone and results in reduced bone mineral density (BMD). Meanwhile, patients with T2D have normal or high BMD, but carry an increased risk of fractures due to alterations of bone microarchitecture and a local humoral environment that stimulates osteoclast activity. Chronic hyperglycemia induces non-enzymatic glycation of collagen in both types of diabetes. Epidemiological evidence confirms a largely increased fracture risk in T1D and T2D, but also that it can be substantially reduced by opportune monitoring of fracture risk and appropriate treatment of both diabetes itself and osteopenia or osteoporosis if they are present. In this review, we summarize the mechanistic, epidemiological, and clinical evidence that links diabetes and bone fragility, and describe the impact of available diabetes treatments on bone health.

Extraskeletal Mesenchymal Chondrosarcoma, a Rare Entity with Unusual Metastases: A Case Report

Introduction

Extraskeletal mesenchymal chondrosarcoma (ESMC) is rare, aggressive, and high grade malignant tumors originating from soft tissues. It carries a poor prognosis with a tendency for local recurrence and distant metastasis, necessitating long-term follow-up. The most common sites for metastasis are the lungs, bones, and lymph nodes. Meanwhile, pancreatic metastases are extremely rare.

Case Description

A 35-year-old female presented with a history of wide local excision for the left upper limb mass; histopathology showed ESMC. She was on surveillance with a computed tomography scan of the thorax and magnetic resonance imaging of the left upper limb at 3-months intervals until she developed vertebral and pancreatic lesions after 6 months post-surgery. No pulmonary metastases were noted. Considering the unusual site for metastasis and to exclude the possibility of any second malignancy, bone biopsy, and endoscopic ultrasound-guided fine-needle aspiration was performed that confirmed metastases. Later she developed osseous metastases in the pelvis and femora.

Practical Implication

Pancreatic metastasis from ESMC is extremely rare. In case of new visceral or osseous lesions in a patient with a past medical history of ESMC, the possibility of metastatic disease should be considered. A biopsy can be performed to confirm the diagnosis.

Chronic nonbacterial osteomyelitis - clinical and magnetic resonance imaging features

BACKGROUND

Chronic nonbacterial osteomyelitis (CNO) is a rare autoinflammatory bone disorder. Little information exists on the use of imaging techniques in CNO.

MATERIALS AND METHODS

We retrospectively reviewed clinical and MRI findings in children diagnosed with CNO between 2012 and 2018. Criteria for CNO included unifocal or multifocal inflammatory bone lesions, symptom duration >6 weeks and exclusion of infections and malignancy. All children had an MRI (1.5 tesla) performed at the time of diagnosis; 68 of these examinations were whole-body MRIs including coronal short tau inversion recovery sequences, with additional sequences in equivocal cases.

RESULTS

We included 75 children (26 boys, or 34.7%), with mean age 10.5 years (range 0-17 years) at diagnosis. Median time from disease onset to diagnosis was 4 months (range 1.5-72.0 months). Fifty-nine of the 75 (78.7%) children presented with pain, with or without swelling or fever, and 17 (22.7%) presented with back pain alone. Inflammatory markers were raised in 46/75 (61.3%) children. Fifty-four of 75 (72%) had a bone biopsy. Whole-body MRI revealed a median number of 6 involved sites (range 1-27). Five children (6.7%) had unifocal disease. The most commonly affected bones were femur in 46 (61.3%) children, tibia in 48 (64.0%), pelvis in 29 (38.7%) and spine in 20 (26.7%). Except for involvement of the fibula and spine, no statistically significant differences were seen according to gender.

CONCLUSION

Nearly one-fourth of the children presented with isolated back pain, particularly girls. The most common sites of disease were the femur, tibia and pelvic bones. Increased inflammatory markers seem to predict the number of MRI sites involved.

A Review of osteological remains submitted for forensic examination in south Australia over a 7-year period (2013-2019)

The files of the Pathology section of F Forensic Science South Australia (FSSA) Adelaide, Australia were examined over a seven-year period from January 2013 to December 2019 for all cases where skeletal remains had been submitted for assessment. There were 150 cases comprising 79 non-human (53%), 49 traditional Australian Aboriginal (33%) and 12 Coronial (8%). The remaining cases included anatomically prepared skeletal remains or other historic remains, and four cases which were subsequently determined to be non-osseous. The large number of domestic animal bones found reflects the agricultural nature of much of the state in addition to historical urban butchering practices. The next largest category was that of indigenous remains associated with the long history of Aboriginal occupation. Established protocols ensure that this culturally-sensitive skeletal material is passed on to the appropriate traditional community leaders. This study shows the unique range of skeletal materials that is currently being forensically assessed in South Australia and the varied medicolegal implications of each category.

Strategy for STR typing of bones from the Second World War combining CE and NGS technology: A pilot study

The genetic identification of skeletal remains found in Second World War mass graves is complicated because of the poor quality of the samples. The aim of this study was to set up a workflow for STR typing of such samples combining PCR/CE and PCR/NGS technologies. To this end, 57 DNA samples from an equal number of 75-year-old femurs were studied. After a first round of PCR typing using GlobalFiler CE, 42 samples yielded a full profile and were therefore submitted to our standard workflow. The 15 samples that yielded no or a limited number (2-17/21) of autosomal STR markers as well four bone control samples that provided a full profile with the conventional PCR/CE test were typed in duplicate by the GlobalFiler NGS kit. Despite the degradation of the samples, which resulted in lower coverage and a lower % of on-target reads, reliable sequencing data were obtained from 16/19 samples. The use of a threshold of 30× for the locus call led to a consensus profile (cp) of 20-31/31 STR autosomal loci in 10 samples and to a cp of 8-10/31 loci in two samples, whereas the four control samples yielded a cp of 26-31/31 loci. Finally, the data of the NGS typing were combined with those of the CE typing. This last task allowed us to recover (on average) three alleles per sample and to increase the number of the heterozygous patterns in 37 cases. In total, the combined approach proposed here made possible the genetic typing of 65-100% of the autosomal STR markers in 10/15 (66.6 %) skeletal remains that yielded no or very poor results with the conventional PCR/CE approach. However, because several artefacts (such as allelic drop-out and allelic drop-in) were scored, the risk of mistyping cannot be neglected.

Delimiting the boundaries of sesamoid identities under the network theory framework

Sesamoid identity has long been the focus of debate, and how they are linked to other elements of the skeleton has often been considered relevant to their definition. A driving hypothesis of our work was that sesamoids’ nature relies deeply on their connections, and thus we propose an explicit network framework to investigate this subject in Leptodactylus latinasus (Anura: Leptodactylidae). Through the dissection of L. latinasus’ skeleton, we modeled its anatomical network where skeletal elements were considered nodes while joints, muscles, tendons, and aponeurosis were considered links. The skeletal elements were categorized into canonical skeletal pieces, embedded sesamoids, and glide sesamoids. We inquired about the general network characterization and we have explored further into sesamoid connectivity behavior. We found that the network is structured in a modular hierarchical organization, with five modules on the first level and two modules on the second one. The modules reflect a functional, rather than a topological proximity clustering of the skeleton. The 25 sesamoid pieces are members of four of the first-level modules. Node parameters (centrality indicators) showed that: (i) sesamoids are, in general terms, peripheral elements of the skeleton, loosely connected to the canonical bone structures; (ii) embedded sesamoids are not significantly distinguishable from canonical skeletal elements; and (iii) glide sesamoids exhibit the lowest centrality values and strongly differ from both canonical skeletal elements and embedded sesamoids. The loose connectivity pattern of sesamoids, especially glides, could be related to their evolvability, which in turn seems to be reflected in their morphological variation and facultative expression. Based on the connectivity differences among skeletal categories found in our study, an open question remains: can embedded and glide sesamoids be defined under the same criteria? This study presents a new approach to the study of sesamoid identity and to the knowledge of their morphological evolution.

Myostatin Inhibitors: Panacea or Predicament for Musculoskeletal Disorders?

Myostatin, also known as growth differentiation factor 8 (GDF8), is a transforming growth factor-β (TGF-β) family member that functions to limit skeletal muscle growth. Accordingly, loss-of-function mutations in myostatin result in a dramatic increase in muscle mass in humans and various animals, while its overexpression leads to severe muscle atrophy. Myostatin also exerts a significant effect on bone metabolism, as demonstrated by enhanced bone mineral density and bone regeneration in myostatin null mice. The identification of myostatin as a negative regulator of muscle and bone mass has sparked an enormous interest in developing myostatin inhibitors as therapeutic agents for treating a variety of clinical conditions associated with musculoskeletal disorders. As a result, various myostatin-targeting strategies involving antibodies, myostatin propeptides, soluble receptors, and endogenous antagonists have been generated, and many of them have progressed to clinical trials. Importantly, most myostatin inhibitors also repress the activities of other closely related TGF-β family members including GDF11, activins, and bone morphogenetic proteins (BMPs), increasing the potential for unwanted side effects, such as vascular side effects through inhibition of BMP 9/10 and bone weakness induced by follistatin through antagonizing several TGF-β family members. Therefore, a careful distinction between targets that may enhance the efficacy of an agent and those that may cause adverse effects is required with the improvement of the target specificity. In this review, we discuss the current understanding of the endogenous function of myostatin, and provide an overview of clinical trial outcomes from different myostatin inhibitors.

Radiographic timelines for pediatric healing fractures: a systematic review

Skeletal fractures, a common injury in physically abused children, often go undetected and untreated for significant lengths of time and are sometimes incidentally discovered radiographically. Our objective was to review current literature for scientific studies of pediatric fracture healing with associated timelines. We conducted a search of Embase, EBSCOhost, MEDLINE (PubMed), and Web of Science for literature published from the earliest available up to August 2018. We evaluated the included articles for quality, with consideration for use in clinical and forensic settings. Of a total of 313 full-text articles evaluated, 10 met study inclusion criteria. The patient age range among studies was 0-17 years, with children younger than 1 year included in the majority of studies. The fracture locations included in studies were primarily fractures of the upper limb and pectoral girdle, followed by fractures of the lower limb. The radiographic features of healing varied greatly among the studies. Timelines of common fracture healing variables differed significantly among studies. Scientific, radiographic studies of pediatric fracture healing are limited. Gaps in knowledge regarding fracture healing highlight the need for future research and validation studies. Fracture healing timelines derived from existing timelines should be used with caution.

Imaging features of bone metastases from cholangiocarcinoma

PURPOSE

Cholangiocarcinoma (CCA) is the second most common primary malignant hepatic tumor originating from bile duct epithelia. Bone metastasis is uncommon and less documented. The aim of this study was to characterize the imaging features of bone metastasis from CCA.

METHODS

A retrospective descriptive imaging characteristics in 199 patients (1465 lesions) diagnosed as CCA with bone metastasis were evaluated based on plain radiography, computed tomography (CT), magnetic resonance imaging (MRI) and Tc-99 m methylene diphosphonate bone scan.

RESULTS

The common vertebral metastatic sites were lumbar spines (94 [47.2 %], 95 %CI 40.1-54.4), upper thoracic spines (89 patients [44.7 %], 95 % CI 37.7-51.9), and lower thoracic spines (80 [40.2 %], 95 % CI 33.3-47.4). On plain radiograph, most of lesions had osteolytic pattern (68 %) with pedicular destruction (45.3 %) whereas on CT had mixed osteolytic and osteosclerotic destruction (40.8 %). The common non-vertebral metastatic sites were ribs and pelvis (80 patients [40.2 %], 95 % CI 33.3-47.4 and 60 [30.2 %], 95 % CI 23.9-37). On plain radiograph, in the long bones, usually had permeative destruction (58.9 %), whereas on CT showed mixed osteolytic and osteosclerotic (34.6 %). On bone scan, increased-uptake was the common pattern, found in the vertebral and non-vertebral sites (93.6 % and 92.4 %).

CONCLUSIONS

Bone metastasis from CCA usually occurred in the axial skeleton. The common patterns of destruction were osteolytic or mixed osteolytic and osteosclerotic. Periosteal reaction was scant in the appendicular long bones. On bone scan commonly had increased-uptake.

Describing pediatric fractures in the era of ICD-10

Childhood fractures are extremely common. The recent trend is to direct certain fracture care from orthopedic specialists to primary care clinicians. However, to confirm an appropriate level of treatment, the initial diagnosis must be accurate, the description precise, and the communication between those caring for the child consistent. This review illustrates descriptors used at one institution that are based on terminology consensually created between radiologists and orthopedic surgeons for common pediatric fracture types and their displacement, and that satisfy the expanded and detailed International Statistical Classification of Diseases and Related Health Problems (ICD)-10 requirements for successful coding.

Multifactorial effects of hyperglycaemia, hyperinsulinemia and inflammation on bone remodelling in type 2 diabetes mellitus

Bones undergo continuous cycles of bone remodelling that rely on the balance between bone formation and resorption. This balance allows the bone to adapt to changes in mechanical loads and repair microdamages. However, this balance is susceptible to upset in various conditions, leading to impaired bone remodelling and abnormal bones. This is usually indicated by abnormal bone mineral density (BMD), an indicator of bone strength. Despite this, patients with type 2 diabetes mellitus (T2DM) exhibit normal to high BMD, yet still suffer from an increased risk of fractures. The activity of the bone cells is also altered as indicated by the reduced levels of bone turnover markers in T2DM observed in the circulation. The underlying mechanisms behind these skeletal outcomes in patients with T2DM remain unclear. This review summarises recent findings regarding inflammatory cytokine factors associated with T2DM to understand the mechanisms involved and considers potential therapeutic interventions.

The multiscale hierarchical structure of Heloderma suspectum osteoderms and their mechanical properties

Osteoderms are hard tissues embedded in the dermis of vertebrates and have been suggested to be formed from several different mineralized regions. However, their nano architecture and micro mechanical properties had not been fully characterized. Here, using electron microscopy, µ-CT, atomic force microscopy and finite element simulation, an in-depth characterization of osteoderms from the lizard Heloderma suspectum, is presented. Results show that osteoderms are made of three different mineralized regions: a dense apex, a fibre-enforced region comprising the majority of the osteoderm, and a bone-like region surrounding the vasculature. The dense apex is stiff, the fibre-enforced region is flexible and the mechanical properties of the bone-like region fall somewhere between the other two regions. Our finite element analyses suggest that when combined into the osteoderm structure, the distinct tissue regions are able to shield the body of the animal by bearing the external forces. These findings reveal the structure-function relationship of the Heloderma suspectum osteoderm in unprecedented detail. STATEMENT OF SIGNIFICANCE: The structures of bone and teeth have been thoroughly investigated. They provide a basis not only for understanding the mechanical properties and functions of these hard tissues, but also for the de novo design of composite materials. Osteoderms, however, are hard tissues that must possess mechanical properties distinct from teeth and bone to function as a protective armour. Here we provide a detailed analysis of the nanostructure of vertebrate osteoderms from Heloderma suspectum, and show that their mechanical properties are determined by their multiscale hierarchical tissue. We believe this study contributes to advance the current knowledge of the structure-function relationship of the hierarchical structures in the Heloderma suspectum osteoderm. This knowledge might in turn provide a source of inspiration for the design of bioinspired and biomimetic materials.

Forelimb musculoskeletal-tendinous growth in frogs

The tendons unite and transmit the strength of the muscles to the bones, allowing movement dexterity, the distribution of the strength of the limbs to the digits, and an improved muscle performance for a wide range of locomotor activities. Tissue differentiation and maturation of the structures involved in locomotion are completed during the juvenile stage; however, few studies have investigated the ontogenetic variation of the musculoskeletal-tendinous system. We ask whether all those integrated tissues and limb structures growth synchronically between them and along with body length. We examined the ontogenetic variation in selected muscles, tendons and bones of the forelimbs in seventy-seven specimens belonging to seven anuran species of different clades and of three age categories, and investigate the relative growth of the forelimb musculoskeletal-tendinous structures throughout ontogeny. Ten muscles and nine tendons and their respective large bones (humerus and radioulna) were removed intact, and their length was measured and analyzed through a multivariate approach of allometry. We obtained an allometry coefficient, which indicates how the coefficient departures from isometry as well as allometric trends. Our data suggest that along with the post-metamorphic ontogeny, muscles tend to elongate proportionally to bone length, with a positive allometric trend. On the contrary, tendons show a negative allometric growth trend. Only two species show different patterns: Rhinella granulosa and Physalaemus biligonigerus, with an isometric and positive growth of muscles and bones, and most tendons being isometric.

Shortening the acquisition time of whole-body MRI: 3D T1 gradient echo Dixon vs fast spin echo for metastatic screening in prostate cancer

PURPOSE

To compare 3D T1-weighted fast spin echo (FSE) and 3D T1-weighted gradient echo (GE) mDixon as morphologic sequences to complement diffusion-weighted imaging (DWI) for the metastatic screening in prostate cancer (PCa) patients.

MATERIALS AND METHODS

Thirty PCa patients at high risk of metastases prospectively underwent both a 3D T1 FSE (14 min) and a rapid 3D T1 GE^mDixon (1 min 20 s) sequences within a WB-MRI protocol. Two readers assessed the diagnostic performance of the FSE/Fat/in-phase (IP)/IP+Fat sequences in detecting bone and node metastases. The reference standard was established by a panel of four physicians on the basis of all baseline and follow-up imaging, biological and clinical information. The reproducibility of readings, predictive accuracy (Acc) from ROC curves analysis, and contrast-to-reference ratio (CRR) in lesions were assessed for each sequence.

RESULTS

In bone and lymph nodes (per-region analysis), reproducibility was at least good for all sequences/readers, except for nodes in the common iliac/inguinal regions. In bone (per-organ analysis), Acc of FSE was superior to that of mDixon (difference + 4%, p < 0.0083). In nodes (per-organ analysis), Acc of Fat was superior to that of other sequences (difference + 4% to + 6% depending on reader, p < 0.0083). In the per-patient analysis, Acc of FSE was superior to that of mDixon (difference + 4% to + 6% depending on sequence, p < 0.0083). Fat images had higher CRR compared with FSE in the thoracic spine, the bony pelvis and lymph node metastases (p < 0.025).

CONCLUSION

3D T1 GE^mDixon may replace 3D T1 FSE to complement DWI in WB-MRI for metastatic screening in PCa. It demonstrates an Acc ranging from + 4% to + 6% (nodes) to - 4% to - 6% (bone and patient staging) compared with FSE and considerably reduces the examination time, offering the perspective of acquiring WB-MRI examinations in less than 20 min.

KEY POINTS

• The replacement of 3D T1 FSE by the 3D T1 GE mDixon as morphologic sequence to complement DWI drastically reduces the acquisition time of WB-MRI studies. • The 3D T1 GE mDixon sequence offers similar reproducibility of image readings compared with that of the 3D T1 FSE. • Differences in diagnostic accuracy are limited (+ 4%/+ 6% in favor of mDixon to detect node metastases; + 4%/+ 6% in favor of FSE to detect bone metastases/metastatic disease in a patient).

Prostate cancer evaluation using PET quantification in 68Ga-PSMA-11 PET/MR with attenuation correction of bones as a fifth compartment

Background

Tissues with low magnetic resonance (MR) signals, such as bones and lungs differ considerably in their attenuation properties, requiring special considerations for attenuation correction. We evaluated the impact of using the five-compartment segmentation model, which incorporates bones, in ⁶⁸Ga-PSMA-11 PET/MR studies in patients undergoing evaluation for prostate cancer.

Methods

Prostate cancer patients underwent dedicated prostate ⁶⁸Ga-PSMA-11 PET/MR followed by whole-body ⁶⁸Ga-PSMA-11 PET/CT. Coronal µmap images of the pelvis derived from four- and five-compartment segmentation models of magnetic resonance attenuation correction (MRAC) were produced. Standardized uptake values (SUV) calculated by the four and five-compartment MRAC models and by computed tomography attenuation correction (CTAC) were compared and correlated in normal prostate tissue, gluteus muscle, sacrum, intra-prostatic lesions and metastases (i.e., bone lesions and involved lymph nodes), and prostatic lesions to gluteus (L/G) ratio.

Results

Twenty-six patients (mean age 69.4±9.3 years) were included in the study. Twenty-five patients presented for prostate cancer staging and one patient was evaluated for recurrent disease. There was a statistically significant difference between SUVs of the gluteus, sacrum, prostatic lesions and normal prostate tissue measured by the four-compartment vs. the five-compartment MRAC models, with a medium effect size. Very good to good correlation between SUV measured using the four-compartment MRAC model and SUV measured using the five-compartment model were noted in all lesional and non-lesional areas. Very good to good correlation was noted between four-compartment MRAC and CTAC SUVs of prostatic lesions and L/G ratio and between five-compartment MRAC and CTAC SUVs of prostatic lesions, L/G ratio and metastatic lesions.

Conclusions

⁶⁸Ga-PSMA-11 PET/MR using the five-compartment segmentation model affects SUV measurements in prostate lesions and in the normal prostate and therefore patient follow-up studies must be conducted using the same segmentation model.

Lithium and Boron in Calcified Tissues of Vicuna and Their Relation to Chronic Exposure by Water Ingestion in The Andean Lithium Triangle

Vicuna is a wild, endangered species of Andean camelid living in the hyperarid Andean plateau. In the central part of the plateau, the Lithium Triangle defines a zone with lithium-rich salt pans. Brine pools naturally form within the salt pans, and the adaptation strategy of vicuna consists of drinking from brine pools. Together with reporting the first chemical data on vicuna bones and teeth, we analyzed lithium, boron, and arsenic in water and brines, with the aim of assessing their relation to chronic exposure by water ingestion. We collected and analyzed bones of vicuna specimens lying in an Andean salt pan, together with brine and water samples. Brine and water samples are highly saline and contain large amounts of lithium, boron, and arsenic. Lithium (13.50-40 mg kg^-1 ) and boron (40-46.80 mg kg^-1 ), but not arsenic, were found in the vicuna bones and teeth. Based on our results and on previously reported data on human tissues in the Andes, we conducted statistical assessments of the relationships between lithium and boron in body tissues and water samples, and discuss their environmental significance in the context of the Lithium Triangle. Environ Toxicol Chem 2019;39:200-209. © 2019 SETAC.

Dietary calcium intake does not meet the nutritional requirements of children with chronic kidney disease and on dialysis

BACKGROUND

Adequate calcium (Ca) intake is required for bone mineralization in children. We assessed Ca intake from diet and medications in children with CKD stages 4-5 and on dialysis (CKD4-5D) and age-matched controls, comparing with the UK Reference Nutrient Intake (RNI) and international recommendations.

METHODS

Three-day prospective diet diaries were recorded in 23 children with CKD4-5, 23 with CKD5D, and 27 controls. Doses of phosphate (P) binders and Ca supplements were recorded.

RESULTS

Median dietary Ca intake in CKD4-5D was 480 (interquartile range (IQR) 300-621) vs 724 (IQR 575-852) mg/day in controls (p = 0.00002), providing 81% vs 108% RNI (p = 0.002). Seventy-six percent of patients received < 100% RNI. In CKD4-5D, 40% dietary Ca was provided from dairy foods vs 56% in controls. Eighty percent of CKD4-5D children were prescribed Ca-based P-binders, 15% Ca supplements, and 9% both medications, increasing median daily Ca intake to 1145 (IQR 665-1649) mg/day; 177% RNI. Considering the total daily Ca intake from diet and medications, 15% received < 100% RNI, 44% 100-200% RNI, and 41% > 200% RNI. Three children (6%) exceeded the National Kidney Foundation Kidney Disease Outcomes Quality Initiative (KDOQI) upper limit of 2500 mg/day. None with a total Ca intake < RNI was hypocalcemic, and only one having > 2 × RNI was hypercalcemic.

CONCLUSIONS

Seventy-six percent of children with CKD4-5D had a dietary Ca intake < 100% RNI. Restriction of dairy foods as part of a P-controlled diet limits Ca intake. Additional Ca from medications is required to meet the KDOQI guideline of 100-200% normal recommended Ca intake. Graphical abstract.

Three-Dimensional Visualisation of Skeletal Cavities

Bones contain spaces within them. The extraction and the analysis of those cavities are crucial in the study of bone tissue function and can inform about pathologies or past traumatic events. The use of medical imaging techniques allows a non-invasive visualisation of skeletal cavities opening a new frontier in medical inspection and diagnosis. Here, we report the application of a new mesh-based approach for the isolation of skeletal cavities of different size and geometrical structure. We apply a mesh-based approach to extract (i) the main virtual cavities inside the human skull, (ii) a complete human endocast, (iii) the inner vasculature of the malleus bone and (iv) the medullary of a human femur. The detailed description of the mesh-based isolation method and its pioneristic application to four different case-studies show the potential of this approach in medical visualisation.

[Frequency of medical visits due to osteoarticular problems of the adult general population in Spain. EPISER2016 Study]

OBJECTIVE

To estimate the prevalence of medical visits due to osteoarticular problems by the adult general population in Spain and its association with sociodemographic, anthropometric and lifestyle variables.

METHOD

Cross-sectional population-based study. Sample with 4916 subjects aged 20 years and over. A telephone questionnaire, with a question about medical visits due to osteoarticular problems, was used. To estimate the prevalence and its 95% confidence interval (95%CI), weights were calculated according to the probability of selection in each of the sampling stages.

RESULTS

28.9% (95%CI: 27.6-30.2) of the people reported having consulted a doctor in the last year because of osteoarticular problems. We observed an association with age, sex, level of education, and body mass index.

Bone mineral health is sensitively related to environmental cadmium exposure- experimental and human data

Exposure to cadmium (Cd) is recognised as one of the risk factors for osteoporosis, although critical exposure levels and exact mechanisms are still unknown. Here, we first confirmed that in male Wistar rats challenged orally with 6 different levels of Cd (0.3-10 mg/kg b.w.), over 28 days, there was a direct dose relationship to bone Cd concentration. Moreover, bone mineral content was significantly diminished by ∼15% (p < 0.0001) plateauing already at the lowest exposure level. For the other essential bone elements zinc (Zn) loss was most marked. Having established the sensitive metrics (measures of Cd exposure), we then applied them to 20 randomly selected human femoral head bone samples from 16 independent subjects. Bone Cd concentration was inversely proportional to trabecular bone mineral density and mineral (calcium) content and Zn content of bone, but not the donor's age. Our findings, through direct bone analyses, support the emerging epidemiological view that bone health, adjudged by mineral density, is extremely sensitive to even background levels of environmental Cd. Importantly, however, our data also suggest that Cd may play an even greater role in compromised bone health than prior indirect estimates of exposure could reveal. Environmental Cd may be a substantially determining factor in osteoporosis and large cohort studies with direct bone analyses are now merited.

Effect of adjuvant therapy with electroacupuncture on bone turnover markers and interleukin 17 in patients with rheumatoid arthritis

OBJECTIVE

To evaluate the effect of electroacupuncture as an adjuvant treatment with first-line medications on bone metabolism biomarkers and interleukin-17 (IL-17) in the peripheral blood of patients with rheumatoid arthritis (RA).

METHODS

Sixty RA patients were randomized into three groups. The control group was treated with methotrexate plus leflunomide (MTX+LEF), the acupuncture group was treated with simple needling plus MTX + LEF, and the patients in the electroacupuncture (EA) group were treated with EA plus MTX + LEF. EA or acupuncture was applied every other day for a total of 10 times over a treatment period of 8 weeks.

RESULTS

In all three treatment groups, serum levels of the bone metabolism markers PICP, N-MID, and B-ALP were elevated and the concentrations of the inflammatory markers β-CTx, IL-17, CRP, and TRACP-5b were reduced after treatment. These differences were significant for the EA group but not the other groups (P < 0.05).

CONCLUSION

EA could effectively reduce the suffering and improve the quality of life of RA patients. It is a promising adjuvant therapy for enhancing the effectiveness of clinical therapeutics.