Variations in pelvic floor thickness in relation to bony dimensions in South African women : using computed tomography scans

Pelvic floor disorders (PFDs) are a common reason for urogynaecological consultation around the world, especially in elderly women. These disorders have been associated with disruption to the structural integrity of the pelvic floor. This study explored whether there are variations in pelvic floor muscle (PFM) thickness in relation to parity, population group and age. Additionally, the study explored whether there were any correlations between PFM thickness and the bony pelvic parameters measured. This was a quantitative retrospective analysis of computerised tomography (CT) scans. A total of 125 CT scans of women belonging to black and white South African population groups were sampled from a tertiary hospital in Pretoria, South Africa. Statistical analyses were performed using Paleontological Statistics (PAST). A thicker pelvic floor was noted in black compared to white women. Pelvic floor thickness decreased with parity and age in both population groups. The intertuberous diameter, as well as the surface areas of the urogenital triangle and the perineum, were statistically significantly larger in white than in black women. Correlations between PFM thickness and bony dimensions were statistically significant for anteroposterior (AP) pelvic outlet diameter, where a greater AP outlet was associated with thinner PFMs in black women. Bony correlations with parity showed that the interspinous diameter in black women increased significantly with parity. The variations in bony pelvic dimensions and pelvic floor muscle thicknesses noted between population groups, in addition to the co-factors of parity and aging, will contribute to a better understanding of the anatomical reasons for incontinence.The National Research Fund (NRF) and Bakeng se Afrika, an Erasmus plus project of the EU.https://eurjanat.comhj2024Obstetrics and GynaecologySDG-03:Good heatlh and well-bein

Reassessment of the TM 1517 odonto-postcranial assemblage from Kromdraai B, South Africa, and the maturational pattern of Paranthropus robustus

Objectives The Pleistocene taxon Paranthropus robustus was established in 1938 following the discovery at Kromdraai B, South Africa, of the partial cranium TM 1517a and associated mandible TM 1517b. Shortly thereafter, a distal humerus (TM 1517g), a proximal ulna (TM 1517e), and a distal hallucial phalanx (TM 1517k) were collected nearby at the site, and were considered to be associated with the holotype. TM 1517a‐b represents an immature individual; however, no analysis of the potentially associated postcranial elements has investigated the presence of any endostructural remnant of recent epiphyseal closure. This study aims at tentatively detecting such traces in the three postcranial specimens from Kromdraai B. Materials and Methods By using μXCT techniques, we assessed the developmental stage of the TM 1517b's C‐M3 roots and investigated the inner structure of TM 1517g, TM 1517e, and TM 1517k. Results The M2 shows incompletely closed root apices and the M3 a half‐completed root formation stage. The distal humerus was likely completely fused, while the proximal ulna and the distal hallucial phalanx preserve endosteal traces of the diaphyseo‐epiphyseal fusion process. Discussion In the hominin fossil record, there are few unambiguously associated craniodental and postcranial remains sampling immature individuals, an essential condition for assessing the taxon‐specific maturational patterns. Our findings corroborate the original association of the craniodental and postcranial remains representing the P. robustus type specimen. As with other Plio‐Pleistocene hominins, the odonto‐postcranial maturational pattern of TM 1517 more closely fits an African great ape rather than the extant human pattern

Repeatability of a morphoscopic sex estimation technique for the mental eminence on micro-focus X-ray computed tomography models

OBJECTIVES : Walker's sex estimation method is based on five morphoscopic features of the human skull. This study aimed at testing the repeatability of one of the five traits, the mental eminence, visually on three-dimensional (3D) models, compared to the traditional, tactile scoring approach on bone. MATERIALS AND METHODS : The sample comprised 105 mandibles from the Pretoria Bone Collection and their respective virtual 3D models, obtained from micro-focus X-ray computed tomography (micro-XCT) scans. Four observers independently scored the bones first, followed by the virtual 3D modality. Intra- and interobserver errors (interOE and intraOE) were performed with Fleiss’ and Cohen's Kappa, respectively. We calculated the intermodality agreement per observer with Wilcoxon Signed-Rank tests. RESULTS : The intraOE was moderate on bone (κ=0.448) and substantial on 3D (κ=0.799), while the Fleiss’ Kappa test for the interOE resulted in slight agreement both on bone (κ=0.163) and 3D (κ=0.169) irrespective of level of experience. All Wilcoxon Signed-Rank test P-values were significant. DISCUSSION AND CONCLUSION : The application of the morphoscopic sex estimation for the mental eminence to micro-XCTs could be a matter of personal affinity as the level of experience did not play a role in the results. The expression of the mental eminence trait being population-specific, the individual's population affinity should be considered when sex is estimated in South African skeletons. It remains unclear whether the slight agreement between observers is due to the unreliability of the trait for sex estimation or whether the modalities are not easily interchangeable.UP Postgraduate Bursary, AESOP Erasmus Mundus program, the University of Pretoria, the National Research Foundation of South Africa, the Bakeng se Afrika funding and Erasmus+ KA2 Capacity Building in Higher Education.https://www.sciencedirect.com/journal/forensic-imaginghj2022Anatom

The ‘ins and outs’ of colonoscopy at Wits Donald Gordon Medical Centre, South Africa: A practice audit of the outpatient endoscopy unit

Background. In South Africa, there are no national guidelines for the conduct or quality assessment of colonoscopy, the gold standard for investigation and diagnosis of bowel pathology.Objectives. To describe the clinical profile of patients and evaluate the practice of colonoscopy using procedural quality indicators at the Wits Donald Gordon Medical Centre (WDGMC) outpatient endoscopy unit (OEU).Methods. We conducted a prospective, clinical practice audit of colonoscopies performed on adults (≥18 years of age). A total of 1 643 patients were included in the study and variables that were collected enabled the assessment of adequacy of bowel preparation, length of withdrawal time and calculation of caecal intubation rate (CIR), polyp detection rate (PDR) and adenoma detection rate (ADR). We stratified PDR and ADR by sex, age, population group, withdrawal time and bowel preparation. CIR, PDR and ADR estimates were compared between patient groups by the χ2 test; Fisher’s exact test was used for 2 × 2 tables. A p-value <0.05 was used. Benchmark recommendations by the American Society for Gastrointestinal Endoscopy (ASGE)/American College of Gastroenterology (ACG) Task Force on Colorectal Cancer (CRC) were used in this audit to assess individual endoscopist performance and that of the endoscopy unit as a whole.Results. The mean age of patients was 55.7 (standard deviation (SD) 14.4; range 18 - 91) years, ~60% were female, and the majority (75.5%) were white. Of the outpatients, 77.6% had adequate bowel preparation (ASGE/ACG benchmark ≥85%). The CIR was 97.0% overall, and screening colonoscopy was 96.3% (ASGE/ACG benchmark ≥90% overall and ≥95% for screening colonoscopies). The median withdrawal time for negative-result screening colonoscopies was 5.7 minutes (interquartile range (IQR) 4.2 - 9.3; range 1.1 - 20.6) (ASGE/ACG benchmark ≥ 6minutes), and PDR and ADR were 27.6% and 15.6%, respectively (ASGE/ACG benchmark ADR ≥25%). We demonstrated a 23.7% increase in PDR and 14.1% increase in ADR between scopes that had mean withdrawal times of ≥6 minutes and <6 minutes, respectively. Although the number of black Africans in the study was relatively small, our results showed that they have similar ADRs and PDRs to the white population group, contradicting popular belief.Conclusions. The WDGMC OEU performed reasonably well against the international guidelines, despite some inadequacy in bowel preparation and lower than recommended median withdrawal times on negative-result colonoscopy. Annual auditing of clinical practice and availability of these data in the public domain will become standard of care, making this audit a baseline for longitudinal observation, assessing the impact of interventions, and contributing to the development of local guidelines

Gemcitabine and oxaliplatin (GEMOX) in gemcitabine refractory advanced pancreatic adenocarcinoma: a phase II study

Gemcitabine and oxaliplatin (GEMOX) are active as first-line therapy against advanced pancreatic cancer. This study aims to evaluate the activity and tolerability of this combination in patients refractory to standard gemcitabine (GEM). A total of 33 patients (median age of 57) were included with locally advanced and metastatic evaluable diseases, who had progressed during or following GEM therapy. The GEMOX regimen consisted of 1000 mg m−2 of GEM at a 100-min infusion on day 1, followed on day 2 by 100 mg m−2 of oxaliplatin at a 2-h infusion; a cycle that was given every 2 weeks. All patients received at least one cycle of GEMOX (median 5; range 1–29). Response by 31 evaluable patients was as follows: PR: 7/31(22.6%), s.d. ⩾8 weeks: 11/31(35.5%), s.d. <8 weeks: 1/31(3.2%), PD: 12/31(38.7%). Median duration of response and TTP were 4.5 and 4.2 months, respectively. Median survival was 6 months (range 0.5–21). Clinical benefit response was observed in 17/31 patients (54.8%). Grade III/IV non-neurologic toxicities occurred in 12/33 patients (36.3%), and grade I, II, and III neuropathy in 17(51%), 3(9%), and 4(12%) patients, respectively. GEMOX is a well-tolerated, active regimen that may provide a benefit to patients with advanced pancreatic cancer after progression following standard gemcitabine treatment

Skin cancers in albinos in a teaching Hospital in eastern Nigeria - presentation and challenges of care

<p>Abstract</p> <p>Background</p> <p>Albinism is a genetic disorder characterized by lack of skin pigmentation. It has a worldwide distribution but is commoner in areas close to the equator like Nigeria. Skin cancers are a major risk associated with albinism and are thought to be a major cause of death in African albinos. Challenges faced in the care of these patients need to be highlighted in order to develop a holistic management approach with a significant public health impact. The aim of the study was to determine the pattern of skin cancers seen in Albinos, and to highlight problems encountered in their management.</p> <p>Method</p> <p>Case records of albinos managed in Imo state University teaching Hospital from June 2007 to May 2009 were reviewed. The data obtained was analyzed using descriptive statistics.</p> <p>Results and discussion</p> <p>In the period under review, albinos accounted for 67% of patients managed for primary skin cancers. There were twenty patients with thirty eight (38) lesions. Sixty one percent of the patients were below 40 years. Average duration of symptoms at presentation was 26 months. The commonest reason for late presentation was the lack of funds. Squamous cell carcinoma was the commonest histologic variant. Most patients were unable to complete treatment due to lack of funds.</p> <p>Conclusion</p> <p>Albinism appears to be the most important risk factor in the development of skin cancers in our environment. Late presentation and poor rate of completion of treatment due to poverty are major challenges.</p

Adjuvant 5-fluorouracil and folinic acid vs observation for pancreatic cancer: composite data from the ESPAC-1 and -3(v1) trials

The ESPAC-1, ESPAC-1 plus, and early ESPAC-3(v1) results (458 randomized patients; 364 deaths) were used to estimate the effectiveness of adjuvant 5FU/FA vs resection alone for pancreatic cancer using meta-analysis. The pooled hazard ratio of 0.70 (95% CI=0.55–0.88) P=0.003, and the median survival of 23.2 (95% CI=20.1–26.5) months with 5FU/FA vs 16.8 (95% CI=14.3–19.2) months with resection alone supports the use of adjuvant 5FU/FA in pancreatic cancer

Evaluation of age, sex, and ancestry-related variation in cortical bone and dentine volumes in modern humans, and a preliminary assessment of cortical bone-dentine covariation in later Homo

DATA SHARING : The data that support the findings of this study are openly available in Zenodo at https://doi. org/10.5281/zenodo.6341546Cortical bone and dentine share similarities in their embryological origin, development, and genetic background. Few analyses have combined the study of cortical bone and dentine to quantify their covariation relative to endogenous and exogenous factors. However, knowing how these tissues relate in individuals is of great importance to decipher the factors acting on their evolution, and ultimately to understand the mechanisms responsible for the different patterns of tissue proportions shown in hominins. The aims of this study are to examine age-, sex-, and ancestry-related variation in cortical bone and dentine volumes, and to preliminary assess the possible covariation between these tissues in modern humans and in five composite Neandertals. The modern analytical sample includes 12 immature individuals from France and 49 adults from France and South Africa. Three-dimensional tissue proportions were assessed from microtomographic records of radii and permanent maxillary canines. Results suggest ontogenic differences and a strong sexual dimorphism in cortical bone and dentine developments. The developmental pattern of dentine also seems to vary according to individual’s ancestry. We measure a stronger covariation signal between cortical bone and dentine volumes than with any other dental tissue. A more complex covariation pattern is shown when splitting the modern sample by age, sex, and ancestry, as no signal is found in some subsamples while others show a covariation between cortical bone and either crown or radicular dentine. Finally, no difference in cortical bone volume is noticed between the modern young adults and the five young adult composite Neandertals from Marine Isotopic Stages (MIS) 5 and 3. Greater dentine volumes are measured in the MIS 5 chimeric Neandertals whereas a strong interpopulation variation in dentine thickness is noticed in the MIS 3 chimeric Neandertals. Further research on the cortical bonedentine covariation will increase understanding of the impact of endogenous and exogenous factors on the development of the mineralized tissues.The “Ministère de l’Enseignement supérieur et de la Recherche, the CNRS, the “Investments for the future” program IdEx Bordeaux, the Région Nouvelle- Aquitaine, the Département des Sciences Archéologiques de Bordeaux, and the Bakeng se Afrika.https://www.jass-anthropology.com/am2024AnatomySDG-03:Good heatlh and well-bein

Impact of Tumor Grade on Prognosis in Pancreatic Cancer: Should We Include Grade in AJCC Staging?

AJCC staging of pancreatic cancer (PAC) is used to determine prognosis, yet survival within each stage shows wide variation and remains unpredictable. We hypothesized that tumor grade might be responsible for some of this variation and that the addition of grade to current AJCC staging would provide improved prognostication. The Surveillance, Epidemiology, and End Results (SEER) database (1991–2005) was used to identify 8082 patients with resected PAC. The impact of grade on overall and stage-specific survival was assessed using Cox regression analysis. Variables in the model were age, sex, tumor size, lymph node status, and tumor grade. For each AJCC stage, survival was significantly worse for high-grade versus low-grade tumors. On multivariate analysis, high tumor grade was an independent predictor of survival for the entire cohort (hazard ratio [HR] 1.40, 95% confidence interval [95% CI] 1.31–1.48) as well as for stage I (HR 1.28, 95% CI 1.07–1.54), stage IIA (HR 1.43, 95% CI 1.26–1.61), stage IIB (HR 1.38, 95% CI 1.27–1.50), stage III (HR 1.28, 95% CI 1.02–1.59), and stage IV (HR 1.58, 95% CI 1.21–2.05) patients. The addition of grade to staging results in a statistically significant survival discrimination between all stages. Tumor grade is an important prognostic variable of survival in PAC. We propose a novel staging system incorporating grade into current AJCC staging for pancreas cancer. The improved prognostication is more reflective of tumor biology and may impact therapy decisions and stratification of future clinical trials