Combination Of Bone Research Articles

Functional Outcomes and a Review of Management Options for Revision Shoulder Arthroplasty.

Increase in the number of primary shoulder arthroplasty has led to an increase in the number of revisions which presents many complex challenges and often has inferior outcomes. Data was collected retrospectively, and patients were classified using Dines classification. Comprehensive case reviews were done to identify preoperative and intra-operative challenges. The primary outcome measure was Oxford shoulder score (OSS). The secondary measures were range of motion (ROM) and patient satisfaction (very satisfied, satisfied, not satisfied or worse). A total of 32 patients were identified with a mean age of 67.64 years and the most common cause of revision was a combination of bone and soft tissue failure (39.3%). All patients (n=8) with hemiarthroplasty had rotator cuff deficiency while patients with resurfacing had both rotator cuff failure and bony erosion. Four patients needed a proximal humeral osteotomy and six patients needed allograft reconstruction of the glenoid for bone loss. Twenty-one shoulders were revised to reverse total shoulder arthroplasty (TSA), 2 to anatomical TSA and 5 were left with cement spacer in situ. Mean duration of follow-up was 41.6 months. Mean OSS at the last follow-up was 26.88 with statistically significant improvement in ROM. There was no statistical difference in clinical outcomes (p>0.05) based on the type of primary prosthesis or cause of revision. A total of 70% patients were pain free. Patients with infection had inferior outcomes with a mean OSS of 17. Management of patients with failed shoulder arthroplasty is often challenging but has good clinical outcome except in infections.

Using a Bone Density Measuring Micromotor to Distinguish Different Cortical/Cancellous Combinations in Vitro: A Study Using Polyurethane Foam Blocks.

To assess whether a recently introduced implant placement micromotor that provides site-specific, operator independent cancellous bone density measurements can detect the presence of a cortical bone layer and measure its thickness and density. An in vitro experiment was performed on six double-layer polyurethane foam blocks mimicking the jawbone with different cortical thickness/cancellous density combinations. The densities were measured using the micromotor after either removing the cortical layer or leaving it intact, both with and without irrigation. The results were compared by means of nonparametric statistical tests. Independent of irrigation, the micromotor detected the cortical layer when it was left intact and accurately estimated its thickness. The micromotor did not discriminate between blocks when they were considered separately, but it did when they were grouped into four or three classes. The present study suggests that the micromotor may represent a valid device to quantitatively assess bone quality and density. If the micromotor can quantitatively distinguish different cortical/cancellous bone combinations in humans, it may be a helpful tool for performing finely tuned, patient-tailored preparations of the implant seat, making tooth rehabilitation in challenging clinical conditions more predictable.

Novel method to biopsy aneurysmal bone cysts in children.

The thin and friable septations composing aneurysmal bone cysts (ABC) may be challenging to target for percutaneous biopsy. The purpose of this study was to describe and evaluate a novel method of ABC biopsy using endomyocardial biopsy forceps as an attempt to capture larger fragments of tissue for diagnosis. This was a retrospective study performed over a 17-year period. Patients <18 years old who underwent percutaneous biopsy for a presumed ABC, based on pre-procedure imaging, were included. Medical records were reviewed to identify age, sex, lesion location, biopsy procedure details, complications, and pathology results. A diagnostic biopsy was defined as conclusive histologic confirmation. Inconclusive findings or findings suggestive of but not diagnostic of an ABC were treated as non-diagnostic, even if imaging and clinical findings were characteristic. Biopsy device selection and quantity of tissue obtained was at the discretion of the pediatric interventional radiologist. Fisher's exact test was used to compare the diagnostic yield of standard biopsies to those employing biopsy forceps. Twenty-three biopsies were performed in 18 patients (11 female) with a median age of 14.7 years (IQR 10.6-15.6). Lesions were located in the extremities (7, 30.4%), chest (6, 26.1%), pelvis (5, 21.7%), spine (4, 17.4%), and mandible (1, 4.3%). Specimens were obtained using a 13- or 15-gauge bone coring needle (11, 47.8%); 14-, 16-, or 18-gauge soft tissue needle (6, 26.1%); or a combination of bone and soft tissue (4, 17.4%) needles. Endomyocardial biopsy forceps were utilized in 7 cases (30.4%), 2 in which it was the only device used. Overall, a conclusive pathologic diagnosis was made in 13/23 (56.5%) biopsies. Of the diagnostic biopsies, 1 was a unicameral bone cyst and all others were ABCs. No malignancy was identified. Compared to the standard approach, the use of forceps was more likely to result in a diagnostic biopsy (40.0% vs 100.0%, p = 0.008). There were no complications. Endomyocardial biopsy forceps offer an additional, novel technique to biopsy presumed ABCs and may improve diagnostic yield.

Evaluation of the suitability of integrated bone char- and biochar-treated groundwater for drinking using single-factor, Nemerow, and heavy metal pollution indexes.

The treatment of contaminated groundwater using integrated bone char and biochar beds has been studied. The bone char and biochar were made in a locally built double-barrel retort utilising cow bones, coconut husks, bamboo, neem trees, and palm kernel shells at 450°C and were graded into 0.05- and 0.315-mm sizes. Eight groundwater treatment experiments (BF2-BF9) were performed in columns with bed heights of 8.5-16.5cm to remove nutrients, heavy metals, microorganisms, and interfering ions from groundwater using bone char, biochar, and a combination of bone and biochar. The water samples were analysed for twenty-one water quality parameters including pH, total dissolved solids, conductivity, turbidity, fluoride, chloride, sodium, and potassium. The rest were total coliforms, faecal coliforms, total heterotrophic bacteria, Escherichia coli, manganese, and total iron. The effectiveness of the treatment processes was assessed using the Ghana standard authority and the World Health Organisation's recommended values for drinking water quality. The results were shared using a simplified single-factor index, Nemerow's pollution index, and a heavy metal pollution index with decision-makers as a technology for groundwater treatment in rural communities in Africa. Bone char was more effective in removing total heterotrophic bacteria than any of the other treatment agents tested. This is because of its compact nature and small particle size. The quality of water treated by BF3, BF5, BF6, BF7, BF8, and BF9 was fit for drinking based on the single-factor and heavy-metal pollution evaluation because they have the lowest level of pollution. However, Nemerow pollution analysis found only BF5 to be the most suitable for public use.

Design of customized coated dental implants using finite element analysis.

Dental implants are used as a traditional technique to replace missing teeth. In the longterm evaluation of dental implants, the stability and durability of the implant-bone interface are crucial. Furthermore, the success of dental implants depends on several factors, such as osseointegration, implant geometry and surface topography. The aim of the study was to investigate the effects of coating materials on dental implants by altering several parameters, including the material used, the coating thickness, and different combinations of the cortical and cancellous bones. The coating materials used were hydroxyapatite (HAP), monticellite (MTC) and titanium nitride (TiN). The coating thickness was varied as 50 μm, 100 μm, 150 μm, and 200 μm. Five different bone combinations were used for the proposed finite element model. An axial compressive load of 150 N was applied. The FEA showed that the HAP coating material had a significant effect on minimizing the induced stress concentration for all 5 bone combinations. However, the MTC coating material had a significant effect only on 2 bone combinations (combination 2 and combination 3). Meanwhile, the TiN coating material induced higher stress values. Based on finite element analysis (FEA), it was observed that the coating thickness greatly influenced the concentration of the mechanical stress. Indeed, when the coating thickness was relatively high, the stress concentration value significantly decreased.

The sex difference of the volume and surface area of the human axial skeleton.

We assessed the sex difference in the volume and surface area of the bone using three-dimensional bone models generated from computer tomography images of axial skeletal elements from 110 Korean cadavers. The volume and surface area of all bones were significantly different between females and males. The accuracy of sex determination ranged from 55.6%-93.7% in univariate discriminant function analysis, with the second thoracic vertebra showing the highest accuracy. In discriminant analysis using paired bone combinations, 22 combinations of bone volume and surface area yielded > 90% accuracy in sex determination. The highest accuracy in the stepwise analysis was 94.7% when using the surface area of the ribs, sternum, and vertebrae for determining sex. This result shows a higher or similar accuracy than previous metric and non-metric studies using the axial skeleton, however, it shows lower accuracy than previous study which used volume and surface area of the appendicular skeleton. Nevertheless, this method might have advantage that is possible to determine sex quickly due to base on the computation with medical images.

Outcomes of Cranioplasty Strategies for High-Risk Complex Cranial Defects: A 10-Year Experience.

Although the literature contains reports of the risks and complications of calvarial vault reconstruction for acquired defects, there are few publications addressing the specific patient population who require such reconstructions in cases preceded by prior infection, radiation, massive associated soft tissue trauma, and so on. We define such clinical presentations as a hostile environment for large surface area reconstruction. Our objective is to compare the safety and efficacy of autologous bone and alloplastic reconstruction in hostile cranial defects. An institutional review board-approved retrospective review of patients who underwent cranioplasty of a hostile site at the University of Alabama at Birmingham between January 2008 and December 2018 was performed. The patients were stratified into 3 groups based on the type of implant used: autogenous (bone), alloplastic (polyetheretherketone [PEEK], titanium, polymethyl methacrylate), or mixed (combination of bone and prosthetic). The primary outcome metric was a complication in the year after cranioplasty, identified by implant failure, necrosis, or infection. Statistical analysis included t tests and χ2 tests where appropriate using SPSS. There were 55 total cases in this period: 27 autogenous, 23 alloplastic, and 5 mixed. The purely autogenous group had the highest complication rate (44%), and the alloplastic group had the lowest complication rate (38%), which was not statistically different between the 3 groups (P = 0.121). When stratified by specific material used for reconstruction (27 bone, 14 PEEK, 10 titanium, and 5 polymethyl methacrylate), overall complication rate was statistically significant (P = 0.009, χ2 test), with PEEK implants having the lowest complication rate (21%). This analysis interestingly found that in the setting of hostile cranial defects, cranioplasties would benefit from the use of prosthetic implants instead of autologous bone grafts, not only for avoidance of donor site morbidity but also for a decrease in overall complications.

Cortical Thickness, Bone Density, and the Insertion Torque/Depth Integral: A Study Using Polyurethane Foam Blocks.

Bone density and implant primary stability parameters have been introduced that are based on calculating (1) the average of the instantaneous torque needed to keep the rotation speed of a bone density probe constant while it descends into bone or (2) the integral of the instantaneous torque-depth curve at implant insertion (I), a quantity that is equal to the insertion energy multiplied by a constant. This study aimed to determine how these two quantities are affected by the presence and thickness of a cortical bone layer. An instantaneous torque-measuring micromotor was used to measure the density of six double-layer polyurethane foam blocks mimicking different cortical/cancellous bone combinations. Twenty measurements per block were collected, averaged, and compared. The insertion torque and the integral (I) of the instantaneous torque-depth curve at implant insertion were recorded when 20 3.75 × 12-mm cylindrical implants were inserted in each of nine blocks, including three single-layer blocks simulating the absence of a cortical layer, under three final cortical (countersink) preparations: 4.0, 3.7, and 3.5 mm. The relationship between the insertion torque, the integral of the instantaneous torque-depth curve at implant insertion (I), cortical thickness, and the final diameter preparation were investigated with regression and best-fit slope analyses. Bone density measurements showed that the average of the instantaneous torque at probing allowed differentiation of five of six different bone classes (hard-hard, hard-normal, hard-soft, normal-normal, normal-soft, soft-soft); the post hoc analysis of variance (ANOVA) comparisons were all statistically significant except for the hard-soft-normal-soft pair. The insertion torque and the integral (I) of the instantaneous torque-depth curve at implant insertion increased proportionally with cortical bone thickness (Pearson's r > 0.96 in all cases). When the final preparation varied from 3.7 mm to 3.5 mm, the insertion torque-thickness plot slope did not change significantly, while that of the instantaneous torquedepth curve integral (I)-thickness plot did change, suggesting that the torque-depth curve at implant insertion integral (I) may detect the increase in implant stability consequent to slight anatomical changes or changes in the site preparation protocol better than the insertion torque when measuring the cortical bone layer stress while undergoing insertion. These findings concerning bone density and primary stability should be investigated further using different experimental settings. If confirmed, they might generate improvements in the predictability of implant and prosthetic rehabilitation outcomes.

Performance of lateritic soil stabilized with combination of bone and palm bunch ash for sustainable building applications

Various research works have been carried out on cement and lime stabilization of lateritic soil. The production of cement is too expensive and environmentally unfriendly due to the required huge em...

Fibrous Dysplasia and Ossifying Fibroma - Solving the Diagnostic Dilemma

Fibrous dysplasia (FD) and Ossifying fibroma (OF) of the jaws belong to a group of lesions called benign fibro-osseous lesions of the craniofacial skeleton (BFOL). This group of intraosseous disease processes which are comparable in their microscopic features are characterized by hypercellular fibroblastic stroma containing various combinations of bone or cementum-like tissue and other calcified structures. Of these lesions, FD and OF are the most closely related, and although FD is recognized as a harmatomatous lesion and OF a tumour, these lesions are difficult to distinguish both clinically and histologically from each other. This review of current literature aims to highlight emerging features clinically, genetically and histologically that can help in distinguishing these two lesions.&#x0D;

Congenital hypodontia in three horses diagnosed by computed tomography

SummaryDental agenesis is a congenital disease defined as failure of formation of one or more teeth, which has been extensively described in human literature and that has been documented in several other species including cats, dogs, seals and sea lions, mice, and ungulates. The aim of this study was to review the clinical and computed tomographic (CT) features of tooth agenesis in a population of horses. Retrospective review of the imaging records from the Langford Equine Hospital was performed, including all horses that underwent head CT between January 2015 and June 2017. Of a total number of 167 CT scans, three horses with hypodontia were found. All three cases had agenesis of the maxillary 08s and one case had additional agenesis of the 307 and 308 teeth. Delayed resorption of the corresponding deciduous teeth was reported in all cases. The empty space left by the absent teeth was filled either by heterogeneous bone tissue alone (two cases) or by a combination of bone and soft tissue (one case). Alignment between teeth was preserved, and there was no displacement of the neighbouring teeth adjacent to the agenesis site. All three horses presented a symmetric pattern of dental agenesis within the maxillary arcades. The maxillary 08s, which are the latest to erupt, were the most affected teeth. This was similar to that reported in human literature, where the teeth that form later during development are the most vulnerable to dental agenesis.

Thiol-ene Hydrogels for Local Delivery of PTH for Bone Regeneration in Critical Size defects.

Neither allograft nor commercially available bone graft substitutes provide the same quality of bone healing as autograft. Incorporation of bioactive molecules like parathyroid hormone (PTH) within bone graft substitute materials may provide similar, if not better treatment options to grafting. The goal of this work was to develop a biomaterial system for the local delivery of PTH to large bone defects for promoting bone regeneration. PTH was loaded in a thiol-ene hydrogel at several concentrations and polymerized in and around an osteoconductive poly(propylene fumarate) (PPF) scaffold. PTH was shown to be bioactive when released from the hydrogel for up to 21 days. Eighty percent of the PTH was released by day 3 with the remaining 20% released by day 14. Bone healing was quantified in rat critical size femoral defects that were treated with hydrogel/PPF and 0, 1, 3, 10, or 30 µg of PTH. Although complete osseous healing was not observed in all samples in any one treatment group, all samples in the 10 µg PTH group were bridged fully by bone or a combination of bone and cartilage containing hypertrophic chondrocytes and endochondral ossification. Outcome measures indicated improved defect bridging by a combination of bony and cartilaginous tissue in the 10 μg treatment group compared with empty bone defects and defects treated with only hydrogel/PPF (i.e., without PTH). Given the tailorability of the hydrogel, future studies will investigate the effects of prolonged gradual PTH release on bone healing. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:536-544, 2020.

Interphanlangeal and First Metatarsophalangeal Joint Fusion for Osteomyelitis and Septic Arthritis in Patients with Forefoot Diabetic Foot Ulcers

Category:Diabetes, infectionIntroduction/Purpose:In cases of Diabetic Foot ulcers over joints with assocuated septic arthritis or osteomylitis, the erradication of the infection can be difficult to achieve. In order to avoid amputations which are often associated with reduced quality of life, we try to be as conservative as possible in order to save as many big toes as possible.The backbone of our noval treatment protocol involve performing a thorough soft tissue and bony debridement, stabilizing the infected bones or joint by fusing them in the acute phase, and closing the skin over the infected ulcer.We present our experience of this concept.Methods:Retrospective study between the years 2012-2016, in a single centre, treating diabetic foot patients.29 patients, 31 feet, were identified with IPj or 1st MTPJ fusion for Infection. All patients had a combination of bone and soft tissue infections. All patients had a preoperative radiograph, 22patients had a pre-operative MRI scan to define the extent of the bony and soft-tissue infection.In all cases the involved joint was fused in the acute phase using screws, kw’s, plates, combination of the above fusion techniques. In all cases the skin was closed above the infected ulcer.Results:Closed ulcers of the fitst ray after fusing the infected joint were achieved in 26 patients (84%) by 12 months after surgery. The radiographic fusion rate was 55% by one year after surgery while 77% of the cases were clinically stable by 1 year after surgery. 5 patients (16%) endend up with an amputation. In 4 of them the base of the proximal phalangx could be left to ensure the biomechanical properties as good as possible. 1 patient needed a BKA.In 26 patients, pathogens could be identified; in 77%, polymicrobial flora were found.Conclusion:Arthrodesis of IPJ- or 1st MTPJ in diabetic foot patients presents a successful way of treatmentin order to achieve a stable situation which allow healing of bony and soft-tissue problems.Fusing an infected joint is a safe procedure that allows maintaining functional capabilities.

Simplified Statistical Image Reconstruction for X-ray CT With Beam-Hardening Artifact Compensation.

CT images are often affected by beam-hardening artifacts due to the polychromatic nature of the X-ray spectra. These artifacts appear in the image as cupping in homogeneous areas and as dark bands between dense regions such as bones. This paper proposes a simplified statistical reconstruction method for X-ray CT based on Poisson statistics that accounts for the non-linearities caused by beam hardening. The main advantages of the proposed method over previous algorithms are that it avoids the preliminary segmentation step, which can be tricky, especially for low-dose scans, and it does not require knowledge of the whole source spectrum, which is often unknown. Each voxel attenuation is modeled as a mixture of bone and soft tissue by defining density-dependent tissue fractions and maintaining one unknown per voxel. We approximate the energy-dependent attenuation corresponding to different combinations of bone and soft tissues, the so-called beam-hardening function, with the 1D function corresponding to water plus two parameters that can be tuned empirically. Results on both simulated data with Poisson sinogram noise and two rodent studies acquired with the ARGUS/CT system showed a beam hardening reduction (both cupping and dark bands) similar to analytical reconstruction followed by post-processing techniques but with reduced noise and streaks in cases with a low number of projections, as expected for statistical image reconstruction.

Rheumatological manifestations in primary immunodeficiency diseases

Primary immune deficiencies (PIDs) are characterized by quantitative and/or functional abnormalities of the immune system elements. Bone and joint abnormalities are not rare in patients with immunodeficiencies. Joint manifestations, of which arthritis is the most common, occur mainly in humoral PIDs (X-linked agammaglobulinemia, common variable immunodeficiency, and IgA deficiency) and occasionally in defects of the phagocyte system (chronic granulomatous disease, glicogen storage diseases). Monoarthritis or oligoarthritis is the usual pattern, caused by Mycoplasma, Staphylococcus, Streptococcus, Pneumococcus or Haemophilus species. These bacteria can provoke not only synovial infections, but also aseptic arthritogenic inflammatory responses. Infectious arthritis or osteomyelitis must be diagnosed and treated with antimicrobial therapy at the earliest. Bone lesions are far less common and usually present as infectious complications in humoral PID. Larger bone manifestations occur in hyper-IgE syndrome and spondyloepiphyseal dysplasia. Short stature is the most common in reticular dysgenesis, in autoimmune polyendocrinopathy candidiasis ectodermal dysplasia and in DNA repair disorders. Knowledge of PID syndromes both enhances the diagnostic capabilities of physicians and provides understanding the pathophysiology of bone and joint abnormalities associated with immune dysfunction. In children and occasionally in adults, a combination of bone and/or joint manifestations and hypogammaglobulinemia may be the first sign of PID. When lymphoproliferative disease or infection can not be proved, investigations for PID should be accomplished. Orv Hetil. 2018; 159(23): 918-928.

A nestling-sized skeleton of Edmontosaurus (Ornithischia, Hadrosauridae) from the Hell Creek Formation of northeastern Montana, U.S.A., with an analysis of ontogenetic limb allometry

ABSTRACTThe Hell Creek Formation preserves one of the most intensely studied late Cretaceous terrestrial fossil units. Over 22 dinosaur genera are currently recognized from this unit, but the record of juvenile individuals is surprisingly limited. Here, we document a nestling hadrosaur that represents the first occurrence of an articulated nestling dinosaur skeleton from the latest Cretaceous (late Maastrichtian) of North America. The specimen (UCMP 128181) preserves a partial scapula, nearly complete rib cage, vertebral series from the shoulder to mid-tail, a large portion of the pelvic girdle, and both hind limbs through a combination of bone and/or natural impressions in the concretion. It is assignable to the genus Edmontosaurus based on the shape of the prepubic process, or blade, of the pubis. The specimen represents the earliest ontogenetic growth stage of Edmontosaurus cf. annectens and possesses a femur length of 148 mm. It greatly contributes as a new end member to a sample of associated Edmontosaurus skeletons that is well suited for allometrically testing the hypothesized ontogenetic gait shift in hadrosaurs from bipedal juveniles to quadrupedal adults using individual limb proportions. Although UCMP 128181 does not preserve forelimbs, regressions based on associated Edmontosaurus skeletons (N = 25) reveal overall isometry of the forelimb relative to the hind limb, and within each limb. These data indicate that Edmontosaurus nestlings were anatomically capable of fully quadrupedal locomotion and provide no compelling evidence to support an ontogenetic gait shift in hadrosaurids.SUPPLEMENTAL DATA—Supplemental materials are available for this article for free at www.tandfonline.com/UJVPCitation for this article: Wosik, M., M. B. Goodwin, and D. C. Evans. 2018. A nestling-sized skeleton of Edmontosaurus (Ornithischia, Hadrosauridae) from the Hell Creek Formation of northeastern Montana, U.S.A., with an analysis of ontogenetic limb allometry. Journal of Vertebrate Paleontology. DOI: 10.1080/02724634.2017.1398168.

Use of Paley Classification and SUPERankle Procedure in the Management of Fibular Hemimelia.

Fibular hemimelia is the most common deficiency involving the long bones. Paley classification is based on the ankle joint morphology, identifies the basic pathology, and helps in planning the surgical management. Reconstruction surgery encompasses foot deformity correction and limb length equalization. The SUPERankle procedure is a combination of bone and soft tissue procedures that stabilizes the foot and addresses all deformities. We retrospectively reviewed 29 consecutive patients (29 limb segments), surgically treated between December 2000 and December 2014. Among the 29 patients, 27 were treated with reconstructive procedures. Type 1 (8 patients) cases were treated with only limb lengthening, and correction of tibial deformities. Type 2 (7 patients) cases were treated by distal tibial medial hemiepiphysiodesis or supramalleolar varus osteotomy. In type 3 (10 patients) cases, the foot deformity was corrected using the SUPERankle procedure. Type 4 (2 patients) cases were treated with supramalleolar osteotomy along with posteromedial release and lateral column shortening. In a second stage, limb lengthening was performed, using the Ilizarov technique. In the remaining 2 patients (type 3A and type 3C), amputation was performed using Syme technique as a first choice of treatment. The results were evaluated using Association for the Study and Application of Methods of Ilizarov scoring. Excellent results were obtained in 15 of 27 (55%) patients. Six (22%) patients had good results, 4 (14.8%) had fair results, and 2 (7%) had poor results. Mean limb length discrepancy at initial presentation was 3.55 cm (range: 2 to 5.5 cm) which significantly improved to 1.01 cm (range: 0 to 3 cm) after treatment (P=0.015). Our results and a review of the literature clearly suggest that limb reconstruction according to Paley classification, is an excellent option in the management of fibular hemimelia. Our 2-staged procedure (SUPERankle procedure followed by limb lengthening) helps in reducing the complications of limb lengthening and incidence of ankle stiffness. Performing the first surgery at an earlier age (below 5 y) plays a significant role in preventing recurrent foot deformities. Level IV.

The effects of iterative reconstruction and kernel selection on quantitative computed tomography measures of lung density

To determine the effects of iterative reconstruction (IR) and high-frequency kernels on quantitative computed tomography (qCT) density measures at reduced X-ray dose. The COPDGene 2 Phantom (CTP 698, The Phantom Laboratory, Salem, NY) with four embedded lung mimicking foam densities (12lb, 20lb, and 4lb), as well as water, air, and acrylic reference inserts, was imaged using a GE 64 slice CT750 HD scanner in helical mode with four current-time products ranging from 12 to 100 mAs. The raw acquired data were reconstructed using standard (STD - low frequency) and Bone (high frequency) kernels with filtered back projection (FBP), 100% ASiR, and Veo reconstruction algorithms. The reference density inserts were manually segmented using Slicer3D (www.slicer.org), and the mean, standard deviation, and histograms of the segmented regions were generated using Fiji (http://fiji.sc/Fiji) for each reconstruction. Measurements of threshold values placed on the cumulative frequency distribution of voxels determined by these measured histograms at 5%, PD5phant , and 15%, PD15phant , (analogous to the relative area below -950HU (RA-950) and percent density 15 (PD15) in human lung emphysema quantification, respectively), were also performed. The use of high-resolution kernels in conjunction with ASiR and Veo did not significantly affect the mean Hounsfield units (HU) of each of the density standards (<4HU deviation) and current-time products within the phantom when compared with the STD+FBP reconstruction conventionally used in clinical applications. A truncation of the scanner reported HU values at -1024 that shifts the mean toward more positive values was found to cause a systematic error in lower attenuating regions. Use of IR drove convergence toward the mean of measured histograms (~100-137% increase in the number measured voxels at the mean of the histogram), while the combination of Bone+ASiR preserved the standard deviation of HU values about the mean compared to STD+FBP, with the added effect of improved spatial resolution and accuracy in airway measures. PD5phant and PD15phant were most similar between the Bone+ASiR and STD+FBP in all regions except those affected by the -1024 truncation artifact. Extension of the scanner reportable HU values below the present limit of -1024 will mitigate discrepancies found in qCT lung densitometry in low-density regions. The density histogram became more sharply peaked, and standard deviation was reduced for IR, directly effecting density thresholds, PD5phant and PD15phant, placed on the cumulative frequency distribution of each region in the phantom, which serve as analogs to RA-950 and PD15 typically used in lung density quantitation. The combination of high-frequency kernels (Bone) with ASiR mitigates this effect and preserves density measures derived from the image histogram. Moreover, previous studies have shown improved accuracy of qCT airway measures of wall thickness (WT) and wall area percentage (WA%) when using high-frequency kernels in combination with ASiR to better represent airway walls. The results therefore suggest an IR approach for accurate assessment of airway and parenchymal density measures in the lungs.

Identifying domestic horses, donkeys and hybrids from archaeological deposits: A 3D morphological investigation on skeletons

The first evidence for the domestication of donkeys (Equus asinus) dates back to at least 6000-5000 BP in Northeast Africa, and their dispersion is attributed to the ancient Romans. Latin authors described donkeys as being particularly suitable for the transport of goods and farm work. In addition, they were also bred to produce prized hybrids, particularly mules, which were perfectly adapted to the long-distance transport of people and goods. However, although the historical sources extensively describe their economic importance, both donkey and hybrid remains are surprisingly scarce in the archaeological record. This apparent contradiction is probably due to the difficulties involved in correctly identifying their bones: relatively few bones displaying morphological and metrical criteria can be used for identification, so it is often based purely on bone size. The aim of this study, therefore, is to propose solutions to identify domestic equid bones using 3D geometric morphometrics on isolated and combinations of anatomical elements. A set of 3D coordinates were registered on the 18 main skull and limb bones of 111 modern reference specimens (i.e. 42 horses, 44 donkeys and 25 hybrids). In this paper, we present the classification rate obtained on this reference sample using the k-Nearest Neighbors algorithm. The application of this method on archaeological skeletons from Roman to modern sites is also presented. The percentage of correctly classified specimens was between 77% and 95% for all 18 bones, and higher than 80% for 10 of the fragmentation patterns we defined. Using a combination of several bones enabled us to increase the rate of correct reclassification to a maximum of 97%. The application to archaeological skeletons proved the ability of this method to identify domestic horses and donkeys from archaeological samples. Correspondingly, some bones, and especially combinations of bones, provided good rates to identify hybrids. This method has proved reliable in detecting the presence of donkeys and hybrids from the archaeological samples of equid bones, and should enrich our knowledge regarding their spread across Europe.

Versatility of Fibula Free Flap in Reconstruction of Facial Defects: A Center Study.

To study a series of cases where vascularised fibula flap was used in various combinations of bone with muscle and skin along with its modifications for reconstruction of simple and composite defects of the facial region. The investigators designed a retrospective study composed of patients with any pathology or defect who underwent reconstruction of maxilla or mandible with vascularised fibula free flap from 2009 to 2013. All patients were evaluated for age, gender, location and type of defect, incorporation of adjoining skin paddle and muscle, number of fibula osteotomies, ischaemia time, anticoagulant regimen, length of hospital stay, flap failure rate, dental implant rehabilitation. All patients with a minimum follow-up of 3months post-operatively, were included in this study. The study sample composed of 30 patients with average age of 39.5years. Immediate reconstruction was done in 86.66% of patients. 93.1% were mandibular reconstructions. In 40% of patients, the fibula was double barrelled. Skin island was included with the fibula in 20% of patients. 10% patients underwent dental rehabilitation using implants with 6.66% requiring distraction osteogenesis of the fibula which was not required with double barrel reconstructions. Hematoma at the recipient site was the commonest post-operative complication, although its frequency was low. A significant donor site morbidity of around 3.33% was seen. Average stay in hospital was about 7days. Post-operatively all patients ambulated normally and none used assisted devices. A reconstruction plate was used to achieve the ideal contour of the jaw in most cases. Aesthetic results were usually good, especially in young patients. The overall success rate was 93.33%. The fibula has many assets which make it the ideal choice for bony reconstruction of facial skeleton and adjoining soft tissue with predictable results.