Age-related Anatomical Changes Research Articles

Optimising needle depth in temporomandibular joint arthrocentesis: a magnetic resonance-based study for safety and efficacy

The aim of this paper was to determine the optimal needle depth for temporomandibular joint (TMJ) arthrocentesis using magnetic resonance imaging (MRI), with the aim of improving procedural safety and efficacy in clinical practice. A retrospective analysis of 264 TMJ MRIs from 132 patients at Istanbul Medipol Mega University Hospital was conducted. T2-weighted MRI sequences were utilised to measure distances from skin to joint capsules at varying needle entry points, applying the double puncture technique. The study adhered to ethical standards with appropriate approvals. The analysis revealed significant gender-related variations in needle depths (females showing shorter distances than males, p < 0.05). No significant gender differences were found in condylar angles. An inverse correlation between age and condylar angle suggested age-related anatomical changes. Crucially, a 20 mm needle depth was identified as safer and more effective than the previously recommended 25 mm. This study underscores the necessity of revising needle depth to 20 mm in TMJ arthrocentesis. These findings hold significant implications for improving procedural safety and catering to demographic variations.

Guidance to Improve Prehospital Trauma Triage Decisions for Geriatric Patients: A Review of the Literature

Major trauma has become a major issue in older people. Prehospital assessment of older trauma patients is not clearly defined, with reported high rates of undertriage. There are several factors that potentially impact upon appropriate prehospital assessment and decision-making for older trauma patients: (a) the presentation of trauma in this population including mechanism, location, and pattern of injury; (b) unique factors with older adults including age-related anatomical and physiological changes, comorbidities, and medication use; (c) distance to trauma centers; and (d) paramedics’ subjective judgments. These factors may have contributed to suboptimal assessment and triage decisions and, hence, increased undertriage rates for this population in prehospital care. This paper aims to provide guidance for paramedics to appropriately assess and accurately triage these patients through applying adjusted physiological criteria specifically for older trauma patients and considering the assessment of mechanism of injury, age cutoffs, comorbidities, and anticoagulants as a method of triage. It also highlights and provides recommendations about other important aspects to optimize prehospital trauma triage decisions for older patients including the integration of frailty assessment in prehospital care and shared decision-making.

In childhood, a different electrode placement improves the recording of pattern reversal visual evoked potentials.

In childhood, a different electrode placement improves the recording of pattern reversal visual evoked potentials.

Pattern visual evoked potentials show an inferior-superior topographic shift through maturation in childhood.

The pattern-reversal visual evoked potential (prVEP) is an established routine clinical test. Its objectivity is particularly valuable for assessing visual pathway function in children. International standards specify at a minimum that an active electrode is placed on the occiput at Oz, but we find an additional inferior electrode at the inion (Iz) provides larger and more sensitive prVEPs in young persons. This study assesses the significance and age-dependence of these observations. PrVEPs were recorded from 1487 patients considered ophthalmologically normal aged <20years old, to a range of check widths including International Society for Clinical Electrophysiology of Vision (ISCEV)standard large (50') and small (12.5') check widths. P100 peak-time and amplitude from both electrode sites were analysed. A subset of 256 children were studied longitudinallybyfitting logistic regression models including a random effect on subjects. PrVEPs were largest over the Iz electrode for the majority of infants and children. This transitioned with age to become equal or smaller at Oz as a function of check width. For ISCEV standard large and small check widths, transition periods were ∼8 and ∼12years of age, respectively. We estimated abnormal result classifications of 3.7% with use of an Oz electrode alone, which decreases to 0.0-0.5% when adding or using an Iz electrode. The inferior dominance of prVEP topography in children may be explained by age-related anatomical changes altering the cortical dipole, combined with physiological maturation of the neural generators of the prVEP. We recommend the Iz electrode is used routinely in recording of prVEPs in children. KEY POINTS: Pattern visual evoked potentials (PVEPs) are an established clinical test which provide objective assessment of visual pathway function. These are particularly valuable in providing objective information of vision in children. International standards specify the active recording electrode should be placed at the mid-occiput (Oz), but we find that pattern-reversal visual evoked potential amplitudes are larger for a lower placed electrode (Iz) in young persons. This was assessed in 1487 patients who had simultaneous PVEP recording at both electrode positions, and it was found that the majority of PVEPs in children were larger over the Iz electrode. The developmental differences in PVEP distribution transitioned to be equal between Iz and Oz with increasing age as a function of check width, at ∼8 and ∼12years old for large and small check widths, respectively. These differences will improve diagnostic accuracy of paediatric PVEPs. We hypothesise these changes reflect developmental anatomical and neurophysiological changes altering the PVEP dipole.

Localized Pancreatitis in an Elderly Patient Without Suspected Etiology

Once pancreatic inflammation is triggered, it spreads throughout the pancreas. Here, we present a case of localized pancreatitis wherein the inflammation was confined to the pancreatic head. A 91-year-old woman was admitted with complaints of vomiting and epigastric pain. Blood tests showed elevated pancreatic enzyme levels, whereas imaging studies showed an enlarged pancreatic head and an area of increased density in the surrounding fatty tissue extending along the retroperitoneum below the subrenal pole. Atrophy of the pancreatic parenchyma in the pancreatic body and tail and dilatation of the main pancreatic duct were observed. The patient was diagnosed with acute pancreatitis, was kept nil by mouth, and was administered supplemental fluids. The symptoms resolved within two weeks. Age-related anatomical and histological changes in the pancreas may influence the development of pancreatitis, making it difficult to rule out the possibility of cancer. As age-related changes in the pancreas could lead to the development of pancreatitis, it is an important differential diagnosis of abdominal pain, even in older patients without suspected etiologies.

Changes in Patellofemoral Joint Morphology During Skeletal Growth and Maturation are not Sex-Dependent

Background:Patellofemoral disorders account for approximately 25% of patients seen in sports medicine clinics. A variety of anatomic risk factors have been identified in the pathogenesis of patellofemoral instability. While studies have analyzed these factors in adults, or compared them between healthy controls and patients with patellar injuries, little is known about how these anatomic markers change during skeletal growth and development.Hypothesis/Purpose:(A) The anatomic risk factors associated with patellar instability and dislocation change significantly during skeletal maturation. (B) These age-related changes during maturation will differ between male and female patients.Methods:After institutional review board approval, magnetic resonance imaging data from 239 unique knees (patient age 7-18; 55% female), without previous or current injury, were randomly selected and used to measure patellar height, lateral patellar tilt angle, trochlear width, trochlear depth, trochlear sulcus angle, and tibial tubercle trochlear groove distance. Linear regression was used to test the associations between age and anatomic measurement indices. Subsequently, patients were divided into four age groups: pre-pubertal school-aged children (7-10 years old), early adolescents (11-14 years old), and late adolescents (15-18 years old). Additionally, two-way analysis of variance with the Holm-Sidak post hoc test was used to compare anatomic morphologies between male and female patients in each age group.Results:Patellar height (Caton-Deschamps index), lateral patellar tilt angle and trochlear sulcus angle all decreased significantly with age (P<0.001). Trochlear width, depth, and tibial tubercule trochlear groove distance all increased significantly with age (P<0.001). Except for trochlear width in late adolescence (P<0.001) where males had wider trochlea (medial and lateral) compared to matched females, the age-related anatomic changes were similar between males and females (P>0.1).Conclusion:The findings partially support our hypothesis, as we observed significant age-related changes in all quantified anatomical indices, which was not different (except trochlear width in late adolescence) between males and females. The lack of significant differences in key morphological features of the patellofemoral joint that are linked to patellar dislocation between females and males is consistent with a similar prevalence of this injury between the two. However, the findings suggest that there are significant differences in the trochlear width between females and males at later stages of growth and maturation. The current observations suggest that these anatomic risk factors undergo significant changes during skeletal growth, providing us with a window of opportunity to use prophylactic interventions to prevent or minimize the development of high-risk morphology.Figure 1.1.CDI: Caton-Deschamps Index; TD: Trochlear Depth; TSA: Trochlear Sulcus Angle; LPTA: Lateral Patellar Tilt Angle TTTG: Tibial Tubercle Trochlear Groove Distance.Figure 1.2.Age- and sex-dependent changes in patellofemoral joint morphology during skeletal growth and maturation. Data are presented as mean and SEM (* P<0.05).

COMPARATIVE MORPHOLOGICAL CHARACTERIZATION OF THE HUMAN BRAINSTEM IN THE FIRST PERIOD OF MATURE AND OLD AGE

The knowledge of brain aging patterns, in particular its trunk, is necessary for understanding age-related compensatory resources of the body's nervous tissue. Objective: to determine the human brain stem volume in the first period of mature age and in old age using magnetic resonance imaging (MRI) and to compare these parameters in age-related aspect. Material and methods: we analyzed the results of brainstem morphometric study of 94 people (48 men and 46 women) using MRI, who underwent brain examination in the Department of Radiation Diagnostics in the period 2019-2021. Criteria for inclusion of subjects in the study: the first period of mature age or old age of the subject; craniotype - mesocranial; history without diseases and injuries of both central and peripheral nervous system organs, exclusion of drug and alcohol addiction; absence of signs of pathology of brain departments detected during the study. Results: MRI of the brain stem revealed a statistically significant decrease of its volume indices both in men and in women by senile age p &lt; 0,01). There was revealed a tendency for predominance of brain stem volume indices in men both in the first period and old age in comparison with women without statistically reliable difference (p &gt; 0,05). The obtained results will serve as a basis for understanding age-related anatomical changes of the brain stem and allow more accurate diagnostics of patients in the conditions of personalized medicine.

Age related Anatomical Changes in Acetabulum and its Cartilage in Buffalo (Bubalus bubalis)

Age related Anatomical Changes in Acetabulum and its Cartilage in Buffalo (Bubalus bubalis)

Towards improving prehospital triage for older trauma patients

The proportion of older adults with major trauma is increasing. High-quality care for this population requires accurate and effective prehospital trauma triage decisions. Anatomical and physiological changes with age, comorbidities, and medication use for older adults may affect the accuracy of prehospital trauma triage. This narrative review focusses on age-related anatomical and physiological changes, comorbidities, and medication use for older adults with an emphasis on their impact on the accuracy of prehospital trauma triage tools. It also addresses the efforts to develop alternative triage criteria to reduce undertriage. Age-related anatomical and physiological changes, comorbidities, and medication use were shown to affect physiological responses to injury and mechanism of injury for older people. Current triage tools poorly predicted injury severity. Geriatric-specific physiological measures and comorbidities significantly improved sensitivity with much lower specificity. Assessing anticoagulant or antiplatelet use in head injury notably improved sensitivity to identify traumatic intracranial hemorrhage, neurosurgery or death with modest decrease in specificity. Improving prehospital providers' knowledge about the challenges of assessing older people with trauma may reduce undertriage. Assessing frailty could help in improving prehospital providers' judgments. Future research is needed to improve triage decisions for this population.

Age-related radiomorphometric changes on panoramic radiographs.

ObjectivesWe aimed to analyse age‐related anatomical changes in teeth and mandibular structures using panoramic radiographs.Materials and MethodsWe included 471 subjects aged 13–70 years (mean, 35.12 ± 18.72 years). Panoramic radiographs were used to record intraoral condition and radiomorphometric parameters. After grouping the subjects by age decade, descriptive statistics and analysis of variance were performed to assess age‐related patterns.ResultsThe number of missing teeth, endodontically treated teeth, full veneer crowns, and implant prosthesis increased with age (all p < .05). The prevalence of periodontitis significantly increased after the 40s and was the highest in the 60s (57.1%). The maxillary canine root was the longest in the 10s and 20s (p < .001). With age, the mandibular canal and mental foramen moved towards the alveolar bone crest, on the opposite side of the mandibular inferior border. The pulp area and pulp‐to‐tooth ratio of maxillary/mandibular first molars were significantly higher in the 10s and 20s than in other age groups (all p < .05).ConclusionsWe provided comprehensive information on age‐related anatomical changes in teeth and mandibular structures based on panoramic radiographs. Various radiographic parameters showed specific changes with increasing age. Assessing these age‐related changes can be useful in determining an individual's age, and may aid in medico‐legal and forensic judgments.

Inter-individual variations in electric fields induced in the brain by exposure to uniform magnetic fields at 50 Hz

The International Commission on Non-Ionizing Radiation Protection (ICNIRP) guidelines and the Institute of Electrical and Electronics Engineers (IEEE) standard establish safety limits for human exposure to electromagnetic fields. At low frequencies, only a limited number of computational body models or simplified geometrical shapes are used to relate the internal induced electric fields and the external magnetic fields. As a consequence, both standard/guidelines derive the exposure reference levels for the external magnetic field without considering the variability between individuals. Here we provide quantitative data on the variation of the maximum electric field strengths induced in the brain of 118 individuals when exposed to uniform magnetic fields at 50 Hz. We found that individual characteristics, such as age and skull volume, as well as incident magnetic field direction, have a systematic effect on the peak electric field values. Older individuals show higher induced electric field strengths, possibly due to age-related anatomical changes in brain. Peak electric field strengths are found to increase for larger skull volumes, as well as for incident magnetic fields directed along the lateral direction. Moreover, the maximum electric fields provided by the anatomical models used by ICNIRP for deriving exposure limits are considerably higher than those obtained here. On the contrary, the IEEE elliptical exposure model produces a weaker peak electric field strength. Our findings are useful for the revision and harmonization of the current exposure standard and guidelines. The present investigation reduces the dosimetric uncertainty of the induced electric field among different anatomical induction models. The obtained results can be used as a basis for the selection of appropriate reduction factors when deriving exposure reference levels for human protection to low-frequency electromagnetic exposure.

Autonomic Nervous System and Cognitive Impairment in Older Patients: Evidence From Long-Term Heart Rate Variability in Real-Life Setting.

Background: In geriatric age, cognitive impairment and cardiovascular disorders are frequent comorbidities. Age-related anatomical and functional cardiac changes, including the autonomic system, could interfere with the control of different cognitive domains. Therefore, we assess the relationship between long-term heart rate variability (HRV), as a measure of autonomic nervous system (ANS) functioning, and cognitive performance in elderly patients representative of outpatients in a real-life setting.Methods: Of 155 elderly outpatients (aged >65 years) screened, 117 enrolled patients underwent anthropometric evaluation, cardiac assessment by 12-lead electrocardiogram, 24-h ECG recording, and blood pressure (BP) measurement, as well as global cognitive evaluation by a standardized multidimensional assessment, including the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment test (MoCA). HRV analysis was performed on 24-h ECG recordings focusing on time-domain indices [Standard deviation of the NN intervals (SDNN), standard deviations of 5-min mean values of the NN intervals for each 5-min interval (SDANN), and root mean squares of successive differences of the NN intervals (RMSSD)] and on frequency-domain measurements [heart rate (HR), low frequency (LF), high frequency (HF), and LF/HF]. Multivariate linear analysis was used to explore the influence of the HRV significant variables on MMSE and MoCA test values.Results: The MMSE and MoCA scores were both significantly and positively correlated with the sympathetic system parameters (SDNN, SDANN, LF, and LF/HF ratio), but not with the parasympathetic system parameters (RMSSD and HF). Multivariate analysis confirms this relationship.Conclusions: Our results show that, in a representative real-life community elderly population, an increased sympathetic activity, but not decreased vagal activity, is associated with better cognitive performances. These results support the sympathetic autonomic function, in that the relationship between better cognitive performances and a moderate prevalence of autonomic function appears dependent on long-term changes in heart rate, mediated by sympathetic activation.

Radiologic changes in the aging nasal cavity

With an aging population, it is important to understand age-related anatomic changes in the nasal cavity and cribriform plate (CP) that may have clinical implications. Computed tomography (CT) scans obtained for non-rhinologic conditions were divided into a young cohort (N=35, 18-34 years old) and an older adult cohort (N=32, 80-99 years old). Intranasal airspace volumes and bony anatomy of the CP were manually segmented using OsiriX software. The CP was assessed for mean Hounsfield Units (HU) and percentage of olfactory foramina. Deformation based morphometry (DBM) was then performed on the same cohort and correlated with manual measurements. Individual nasal cavity volumes increased 17-75% with age. Regression analysis of all scans revealed age to be the predominant variable influencing intranasal volume differences when controlling for sex and head size. Mean HU of the CP negatively correlated with age. No age-related differences in bone stenosis of olfactory foramina were identified. Automated DBM measurements of intranasal volumes, as well as CP and zygoma mean HU correlated with manual measurements. Older subjects have a global increase in intranasal volumes and diffuse bone density loss in the CP. The clinical impact of age-related anatomic changes in the nasal cavity and CP requires further investigation.

Cortical covariance networks in ageing: Cross-sectional data from the Irish Longitudinal Study on Ageing (TILDA)

Ageing is associated with widespread alterations to the brain's anatomy and to attendant cortical networks. Yet, few studies to date have indexed anatomical covariance network differences within the age distribution of older adulthood, despite known phenotypic variation. Here, we explored cortical anatomical covariance networks in middle and older age cross-sectionally, using a large sample of community-dwelling older adults from the Irish Longitudinal Study on Ageing (TILDA). We assayed age-related anatomical changes via cortical thickness. Moreover, we explored age-related alterations in small-world and global properties of cortical thickness covariance networks, by targeting analyses towards the elder (ages 75–88; n = 88) and younger (ages 52–64; n = 95) sample members. Age, sex, and chronic disease-adjusted vertex-wise analyses revealed robust reductions in cortical thickness with age. Graph theoretical analyses of cortical thickness covariance networks revealed significantly lower betweenness centrality (i.e., network hub status) at left inferior parietal cortex in the eldest participant group as compared to the youngest. Furthermore, indices of small-worldness revealed greater lambda (i.e., less effective integration) across the right hemisphere of the eldest participant group versus the youngest. Our results are interpreted in the context of mechanisms of cortical atrophy in ageing, functional network organisation, and cognition in ageing.

Chapter 10 - Aging

This chapter reviews studies that have examined age-related anatomic and functional changes in sensory, neuromuscular, and cognitive systems that impair the control of balance and gait. Specifically, we examine age-related changes in peripheral systems: lower-limb sensation, visual functions such as contrast sensitivity and depth perception, vestibular sense, strength, and power in the lower-limb muscle groups, as well as central factors including processing speed and executive functioning. Significant impairments in any one of the above systems can predispose older people to falls, with the risk of falling increasing substantially with the number of impairments present. There is increasing evidence that interventions aimed at addressing specific sensory and neuromuscular impairments can improve balance control and reduce fall risk. In particular, task-specific exercise can improve muscle strength, balance, gait and mobility and prevent falls in older people.

Analyse clinique avant chirurgie de rajeunissement cervico-facial

The first step to determine a medical or surgical intervention is the clinical exam. The clinical exam is the paramount step to provide a treatment plan that can be modified and individualized accounting the patient preferences. During the consultation for facial rejuvenation, attention should be paid to understand the patient's motivation and expectations. A thorough understanding of the anatomy and the natural history of ageing will facilitate the analysis of the face. Not only the degree of ptosis but also the degree of volume loss will need to be assessed, as well as the influence of the facial muscles, the skin quality, and the different causes of rythids. The comprehensive age-related anatomical changes are often perceived and described as tiredness or sadness. Patients very commonly only point out a single anatomical region. During the consultation, the surgeon should provide the patient with the information of the comprehensive interplay of the different anatomical regions and their individual ageing process. Obtaining a harmonious, natural appearing outcome is the result of excellent surgical skills and applied knowledge. The clinical exam should also find out traps and technical difficulties. Although standardized photographs allow a static evaluation of one's result, video may deliver additional information about the postoperative result, and may contribute to the understanding of the technique used. Spending the additional time by performing a thorough facial analysis and preoperative planning is well-invested time. Having a good understanding of the possible surgical improvements and limitations will be beneficial for both, the patient and the surgeon. Managing the expectations of the patient and careful preoperative planning will increase patient's satisfaction. At the same time, the surgeon will able to critically assess his/her own result and taking pleasure improving their own technique.

Pathogenetic implications of the age at time of diagnosis and skin location for acrodermatitis chronica atrophicans

BackgroundThe pathogenesis of acrodermatitis chronica atrophicans (ACA) is not well understood. ObjectiveThe purpose of this study was to gain a better understanding of ACA by utilizing a large data set of adult Slovenian patients with Lyme borreliosis. MethodsThe age of 590 ACA patients was compared with that of patients with other manifestations of Lyme borreliosis. The location of the ACA lesion on the body was compared with that of erythema migrans (EM). ResultsPatients diagnosed with ACA were on average 14.3 years older than patients with EM (p<0.001). ACA patients were also significantly older than patients with Lyme neuroborreliosis or Lyme arthritis (p<0.001). The average delay in diagnosis of ACA was 1.6 years (range 0.1–20 years). For 572 (96.9%) of the ACA patients, the site of the skin lesion(s) was confined to an extremity vs. 79.6% for patients with EM, p<0.001. For the 20 ACA patients who reported a preceding untreated EM lesion at the same body site, the mean time between the development of the EM and the onset of ACA was 3.0±4.4 (median 1.3, range 0.1–15.0) years. ConclusionsACA is more likely to be diagnosed in older individuals than any other manifestation of Lyme borreliosis. ACA is more likely than EM to be localized anatomically to the extremities. Available data favor the hypothesis that ACA occurs most often on the extremities of older individuals because of predisposing age-related anatomic or physiologic changes, but more data are needed to define the latency period and other aspects of the pathogenesis of this skin condition.

Perspectives on Aging Vestibular Function.

Much is known about age-related anatomical changes in the vestibular system. Knowledge regarding how vestibular anatomical changes impact behavior for older adults continues to grow, in line with advancements in diagnostic testing. However, despite advancements in clinical diagnostics, much remains unknown about the functional impact that an aging vestibular system has on daily life activities such as standing and walking. Modern diagnostic tests are very good at characterizing neural activity of the isolated vestibular system, but the tests themselves are artificial and do not reflect the multisensory aspects of natural human behavior. Also, the majority of clinical diagnostic tests are passively applied because active behavior can enhance performance. In this perspective paper, we review anatomical and behavioral changes associated with an aging vestibular system and highlight several areas where a more functionally relevant perspective can be taken. For postural control, a multisensory perturbation approach could be used to bring balance rehabilitation into the arena of precision medicine. For walking and complex gaze stability, this may result in less physiologically specific impairments, but the trade-off would be a greater understanding of how the aging vestibular system truly impacts the daily life of older adults.

Return of Visual Acuity to Normal in Old Age

Changes occur in our body through out life. Decreased visual acuity is probably the most common effect of age-related anatomical and neurological changes in the eyes and the visual pathway. However, this case is an exception as at the age of 75 years, his power of accommodation has returned to normal. The improvement in accommodation and visual acuity is hard to explain. Likely explanations given need to be further investigated.

Modeling senescence changes of the pubic symphysis in historic Italian populations: a comparison of the Rostock and forensic approaches to aging using transition analysis.

Age-related anatomical changes to the surface of the pubic symphysis are well-documented in the literature. However, aligning these morphological changes with chronological age has proven problematic, often resulting in biased age estimates. Statistical modeling provides an avenue for forensic anthropologists and bioarchaeologists to increase the accuracy of traditional aging methods. Locating appropriate samples to use as a basis for modeling age estimations can be challenging due to differing sample age distributions and potentially varying patterns of senescence. We compared two approaches, Rostock and Forensic, coupled with a Bayesian methodology, to address these issues. Transition analysis was run specific to each method (which differ by sample selection). A Gompertz model was derived from an informative prior that yielded the mortality and senescence parameters for constructing highest posterior density ranges, i.e., coverages, which are analogous to age ranges. These age ranges were generated from both approaches and are presented as reference tables useful for historic male and female Italian samples. The age ranges produced from each approach were tested on an historic Italian sample, using cumulative binomial tests. These two approaches performed similarly, with the Forensic approach showing a slight advantage. However, the Forensic approach is unable to identify varying senescence patterns between populations, thus preference for one approach over the other will depend on research design. Finally, we demonstrate that while populations exhibit similar morphological changes with advancing age, there are no significant sex differences in these samples, and the timing of these changes varies from population to population.