Computed tomography of the heads of ancient Egyptian mummies: a systematic review of the medical literature.

Objective: To summarize the current knowledge on CT scanning of Egyptian mummy heads and faces and provide more valid methodology than that previously available. Material and methods: A systematic review was performed by one observer using two biomedical databases: PubMed and EMBASE. Inclusion and exclusion criteria were applied along with language restrictions. Finally, 2120 articles were found, 359 articles were duplicated among all search equations, 1454 articles were excluded, 307 articles were retained for full review, and 28 articles (31 mummies) were selected for the final study (PRISMA workflow). Results: The data were categorized into the following groups: 1) general information; 2) 1st author affiliation; 3) CT radiological protocol; 4) excerebration pathways; 5) soft tissue preservation; 6) dental status and displaced teeth; 7) packing of the mouth, ears, nose, and eyes, and 8) outer facial appearance. The evidence-based quality of the studies was low because only case reports and small case series were found. Discussion: The embalming art applied to a mummified head and face shows great variability across the whole span of Egyptian civilization. The differences among the various embalming techniques rely on multiple tiny details that are revealed by meticulous analysis of CT scans by a multidisciplinary team of experts. Conclusion: There is a need for more systematization of the CT radiological protocol and the description of Egyptian mumm’y heads and faces to better understand the details of embalming methods.  Objective: To summarize the current knowledge on CT scanning of Egyptian mummy heads and faces and provide more valid methodology than that previously available. Material and methods: A systematic review was performed by one observer using two biomedical databases: PubMed and EMBASE. Inclusion and exclusion criteria were applied along with language restrictions. Finally, 2120 articles were found, 359 articles were duplicated among all search equations, 1454 articles were excluded, 307 articles were retained for full review, and 28 articles (31 mummies) were selected for the final study (PRISMA workflow). Results: The data were categorized into the following groups: 1) general information; 2) 1st author affiliation; 3) CT radiological protocol; 4) excerebration pathways; 5) soft tissue preservation; 6) dental status and displaced teeth; 7) packing of the mouth, ears, nose, and eyes, and 8) outer facial appearance. The evidence-based quality of the studies was low because only case reports and small case series were found. Discussion: The embalming art applied to a mummified head and face shows great variability across the whole span of Egyptian civilization. The differences among the various embalming techniques rely on multiple tiny details that are revealed by meticulous analysis of CT scans by a multidisciplinary team of experts. Conclusion: There is a need for more systematization of the CT radiological protocol and the description of Egyptian mumm’y heads and faces to better understand the details of embalming methods. &nbsp

Medical and dental hidden treasures and secrets of 2700-year-old Egyptian mummy: Osirmose - the doorkeeper of the Temple of Re.

Objective: To perform a ‘virtual autopsy’ on the Egyptian mummy and to study, understand, and interpret three-dimensional (3D) high-resolution computed tomography (CT) scan images of Osirmose’s mummy with a multidisciplinary team composed of radiologists, archaeologists, and oral and maxillofacial surgeon. Material and methods: We studied the Osirmose’s mummy, the doorkeeper of the Temple of Re, who lived during the XXVth dynasty. His mummy belongs to the Royal Museum of Art and History (Inv. E.5889). We performed a high resolution CT scanning of Osirmose’s mummy. We also 3D printed the upper maxilla of the mummy and a tooth found in the oesophagus with a clinically validated low-cost 3D printer. Results: We confirmed the male sex of the mummy. We found the heart, aorta, and  kidneys inside the mummy’s body. Brain excerebration was performed through the right ethmoid bone pathway. A wood stick embedded in the dura mater tissue was found inside the skull. The orbicularis oculi muscle, internal canthus, optical nerves, and calcified eye were still present. Artificial eyes were added above the stuffing of eye globes. The skull and face were embalmed with multiple layers of inner bandages in a sophisticated manner. The wear of maxillary teeth was asymmetrical and more pronounced on the maxilla. We discovered three anomalies of the upper maxilla: 1) a rectangular hole on the palatine side of tooth n°26 (the palatine root of tooth n°26 was missing), 2) an indentation at a right angle palatine to tooth n°27, and 3) a semilunar shape of edges around the osteolytic lesion distal and palatine to tooth n°28. Conclusions: The present study provides the first evidence of a tooth removal site, and of oral surgery procedures previously conducted in a 2700-year-old Egyptian embalmed mummy. We found traces of dental root removal, and the opening of a tooth-related osteolytic lesion before the person’s death. The multidisciplinary team, the use of a high resolution 3D CT scan and a 3D-printed model of the upper maxilla helped in this discovery.Objective: To perform a ‘virtual autopsy’ on the Egyptian mummy and to study, understand, and interpret three-dimensional (3D) high-resolution computed tomography (CT) scan images of Osirmose’s mummy with a multidisciplinary team composed of radiologists, archaeologists, and oral and maxillofacial surgeon. Material and methods: We studied the Osirmose’s mummy, the doorkeeper of the Temple of Re, who lived during the XXVth dynasty. His mummy belongs to the Royal Museum of Art and History (Inv. E.5889). We performed a high resolution CT scanning of Osirmose’s mummy. We also 3D printed the upper maxilla of the mummy and a tooth found in the oesophagus with a clinically validated low-cost 3D printer. Results: We confirmed the male sex of the mummy. We found the heart, aorta, and  kidneys inside the mummy’s body. Brain excerebration was performed through the right ethmoid bone pathway. A wood stick embedded in the dura mater tissue was found inside the skull. The orbicularis oculi muscle, internal canthus, optical nerves, and calcified eye were still present. Artificial eyes were added above the stuffing of eye globes. The skull and face were embalmed with multiple layers of inner bandages in a sophisticated manner. The wear of maxillary teeth was asymmetrical and more pronounced on the maxilla. We discovered three anomalies of the upper maxilla: 1) a rectangular hole on the palatine side of tooth n°26 (the palatine root of tooth n°26 was missing), 2) an indentation at a right angle palatine to tooth n°27, and 3) a semilunar shape of edges around the osteolytic lesion distal and palatine to tooth n°28. Conclusions: The present study provides the first evidence of a tooth removal site, and of oral surgery procedures previously conducted in a 2700-year-old Egyptian embalmed mummy. We found traces of dental root removal, and the opening of a tooth-related osteolytic lesion before the person’s death. The multidisciplinary team, the use of a high resolution 3D CT scan and a 3D-printed model of the upper maxilla helped in this discovery

Risk factors for obstetric fistula: a clinical review

Obstetric fistula is the presence of a hole between a woman’s genital tract and either the urinary or the intestinal tract. Better knowledge of the risk factors for obstetric fistula could help in preventing its occurrence. The purpose of this study was to assess the characteristics of obstetric fistula patients. We conducted a search of the literature to identify all relevant articles published during the period from 1987–2008. Among the 19 selected studies, 15 were reports from sub-Saharan Africa and 4 from the Middle East. Among the reported fistula cases, 79.4% to 100% were obstetrical while the remaining cases were from other causes. Rectovaginal fistulae accounted for 1% to 8%, vesicovaginal fistulae for 79% to 100% of cases, and combined vesicovaginal and rectovaginal fistulae were reported in 1% to 23% of cases. Teenagers accounted for 8.9% to 86% of the obstetrical fistulae patients at the time of treatment. Thirty-one to 67% of these women were primiparas. Among the obstetric fistula patients, 57.6% to 94.8% of women labor at home and are secondarily transferred to health facilities. Nine to 84% percent of these women delivered at home. Many of the fistula patients were shorter than 150 cm tall (40–79.4%). The mean duration of labor among the fistula patients ranged from 2.5 to 4 days. Twenty to 95.7% of patients labored for more than 24 h. Operative delivery was eventually performed in 11% to 60% of cases. Obstetric fistula was associated with several risk factors, and they appear to be preventable. This knowledge should be used in strengthening the preventive strategy both at the health facility and at the community level

Development Of A Prototype Of Video Synchronisation For Relocalization Of Biopsy Sites During Endoscopic Evaluation Of Barrett's Oesophagus: Preliminary Experimental And Clinical Study

International audienceINTRODUCTION: The prevalence of Barrett's oesophagus (BE) is 5 to 6% in the general population, with a progression from dysplasia to adenocarcinoma 0.6 to 0.7 patient-years. Hence, endoscopic surveillance is justified to detect early lesions accessible to endoscopic treatment. However, the relocalisation of lesions detected by biopsies may be difficult during follow-up endoscopies. The purpose of this study was to evaluate the prototype of a magnetic probe for accurate location of the position of the endoscope, allowing the relocalisation of this position in a subsequent endoscopy. We report the results of a feasibility study in pigs and the use of this device in two patients with BE. AIMS & METHODS: The system consists of an electromagnetic (EM) field transmitter and an EM probe constituting the electromagnetic tracking system (EMS) (NDI, Aurora). The EM probe is inserted through the operating channel of a double channel gastroscope. The EM field generator is positionned on the patient chest wall. The system also includes a new software developed at IHU/IRCAD, which performs simultaneous recording of the video from the endoscope alongwith its corresponding position, as measured by the EMS. During a second endoscopy, this software allows automatic synchronization of the recorded video to provide relocalisation of the endoscope in front of previous biopsy sites in the oesophagus. The system was tested in 5 anesthetized pigs. During the first endoscopy, ten markings were performed by argon plasma electrocoagulation (ERBE Tübingen, Germany) in the distal esophagus. The position of each marking was recorded by the system. A second operator to then performed a blind endoscopy on the same pigs and was asked to follow the system implicitly as a guide to relocate the markings. In 2 patients with BE, the system was then tested to facilitate relocalization of the biopsy sites. RESULTS: Ten markings were made in the distal oeosphagus of 5. After withdrawal of the endoscope the second operator found 48 of the 50 markings (96%) using the guidance provided by the system. The positioning of the endoscope provided by the EMS system was within a 2mm range from the initial positionning. In the evaluation of BE patients, the system relocalized the biospy sites within a range of 3mm. CONCLUSION: This preliminary study shows the feasibility of the EMS prototype to relocalize the endoscope in the oesophagus within an acceptable range. The clinical usefulness of this system should be evaluated further during the follow-up of patients with BE

M & L Jaargang 7/2

GeneriekAn Malliet De restauratie van de Egyptische tempel. [The restoration of the Egyptian temple in the Antwerp Zoo.]Sinds de bouw in 1856, reeds kort na het nog prille ontstaan van de Antwerpse Zoologie, zou het grootse giraffen- en olifantenpaviljoen schier ononderbroken intense aandacht blijven opeisen.Toch blijkt de jongste, verreikende restauratie-ingreep, in velerlei opzichten opzienbarend.Voor dit evenement vraagt An Malliet nu even extra aandacht.Eugène Warmenbol en Petra Maclot Tempel en stal in één: de Egyptische tempel in de Antwerpse zoo in kunsthistorisch en historisch perspectief. [Temple and stable united: the Egyptian temple in the Antwerp Zoo from a arthistorical an historical viewpoint.]De onverstoorbare speurderstalenten van Eugène Warmenbol en Petra Maclot naar Egyptiserende archetypen zijn reeds langer bekend.Bij deze tempelzoektocht naar Charles Servais en Lodewijk Delgeur, gaat ruim wat aandacht bevooroordeeld ook naar de mindere goden. Een document... dat wordt vervolgd.Guido Jan Bral Van vooronderzoek tot uitvoeringsontwerp. [The restoration of the Egyptian temple in the Antwerp zoo: from preliminary inquiry to final design.]Naast het toch reeds bijzondere bestek vroegen de intrigerende beschilderingen van het tempelvoorportaal om een uitzonderlijke aanpak. Ter inleiding blikt Guido J. Bral terug op de totstandkoming van een uniek ontwerp.Lode De Clercq De restauratie van de strucwerken van het peristilium en het portaal van de Egyptische tempel. [The Egyptian temple in the Antwerp zoo: restoration of the stucco of the peristyle and the porch.]Wat stuc is helen vormt de eerste uitdaging. Tussen graffito en moulages vat Lode De Clercq de koe meteen weloverwogen bij de horens.M. Dupas en Eddy De Witte Antwerpen-Zoo. Egyptische tempel. Controle van de zoutextracties. [The restoraton of the Egyptian temple in the Antwerp Zoo: monitoring the salt extractions.]Wateroplosbare zouten vormen ook in Egyptiserende tempelmuren nochtans oplosbare problemen. Voor M. Dupas en Eddy De Witte is de behandeling van deze capillaire kwaal bondig geformuleerd: extractie, zonder meer.Walter Schudel De restauratie van de taferelen 20 en 21. [The restoration of the scenes 20 and 21 of the Egyptian temple in the Antwerp Zoo.]Gewapend met scalpels en engelengeduld zal Walter Schudel zich spreekwoordelijk fixeren op de vrijlegging van Antwerpen.Guido Jan Bral, Bernard Delmotte, Jan Verbeke De reconstructie van de monumentale polychromie van het voorportaal van de Egyptische tempel. [Reconstruction of the monumental polychromy in the porch of the Egyptian temple of the Antwerp Zoo.]Guido Jan Bral, Bernard Delmotte en Jan Verbeke bespreken verder samen hoe 1250 steekproeven via 300 meter polyesterkalk, 3 kleurenschemas en 2 kleurenkaarten tot de reconstructie zouden leiden van een 54 polychrome taferelen.Eugène Warmenbol en Luc Delvaux Oud-Egyptische teksten uit de tijd van farao Leopold I van Opper- en Neder-België. [Ancient Egyptian texts from the time of pharaoh Leopold I of Upper- and Lower-Belgium.]Marchand de latin, allicht - maar niettemin is Lodewijk Delgeur vooreerst spitsvondig, onderlegd en schalks.Zo moge althans blijken uit de sobere vertaling door Eugène Warmenbol en Luc Delvaux van de nu weer genietbare hiërogliefen van het voorportaal.SummaryM&L Binnenkran

PCSK9 inhibitors and ezetimibe for the reduction of cardiovascular events: a clinical practice guideline with risk-stratified recommendations.

CLINICAL QUESTION In adults with low density lipoprotein (LDL) cholesterol levels >1.8 mmol/L (>70 mg/dL) who are already taking the maximum dose of statins or are intolerant to statins, should another lipid-lowering drug be added, either a proprotein convertase subtilisin/kexin 9 (PCSK9) inhibitor or ezetimibe, to reduce the risk of major cardiovascular events? If so, which drug is preferred? Having decided to use one, should we add the other lipid-lowering drug? CURRENT PRACTICE Most guidelines emphasise LDL cholesterol targets in their recommendations for prescribing PCSK9 inhibitors and/or ezetimibe in adults at high risk of experiencing a major adverse cardiovascular event. However, to achieve these goals in very high risk patients with statins alone is almost impossible, so physicians are increasingly considering other lipid-lowering drugs solely for achieving LDL cholesterol treatment goals rather than for achieving important absolute cardiovascular risk reduction. Most guidelines do not systematically assess the cardiovascular benefits of adding PCSK9 inhibitors and/or ezetimibe for all risk groups across primary and secondary prevention, nor do they report, in accordance with explicit judgments of assumed patients' values and preferences, absolute benefits and harms and potential treatment burdens. RECOMMENDATIONS The guideline panel provided mostly weak recommendations, which means we rely on shared decision making when applying these recommendations. For adults already using statins, the panel suggests adding a second lipid-lowering drug in people at very high and high cardiovascular risk but recommends against adding it in people at low cardiovascular risk. For adults who are intolerant to statins, the panel recommends using a lipid-lowering drug in people at very high and high cardiovascular risk but against adding it in those at low cardiovascular risk. When choosing to add another lipid-lowering drug, the panel suggests ezetimibe in preference to PCSK9 inhibitors. The panel suggests further adding a PCSK9 inhibitor to ezetimibe for adults already taking statins at very high risk and those at very high and high risk who are intolerant to statins. HOW THIS GUIDELINE WAS CREATED An international panel including patients, clinicians, and methodologists produced these recommendations following standards for trustworthy guidelines and using the GRADE approach. The panel identified four risk groups of patients (low, moderate, high, and very high cardiovascular risk) and primarily applied an individual patient perspective in moving from evidence to recommendations, though societal issues were a secondary consideration. The panel considered the balance of benefits and harms and burdens of starting a PCSK9 inhibitor and/or ezetimibe, making assumptions of adults' average values and preferences. Interactive evidence summaries and decision aids accompany multi-layered recommendations, developed in an online authoring and publication platform (www.magicapp.org) that also allows re-use and adaptation. THE EVIDENCE A linked systematic review and network meta-analysis (14 trials including 83 660 participants) of benefits found that PCSK9 inhibitors or ezetimibe probably reduce myocardial infarctions and stroke in patients with very high and high cardiovascular risk, with no impact on mortality (moderate to high certainty evidence), but not in those with moderate and low cardiovascular risk. PCSK9 inhibitors may have similar effects to ezetimibe on reducing non-fatal myocardial infarction or stroke (low certainty evidence). These relative benefits were consistent, but their absolute magnitude varied based on cardiovascular risk in individual patients (for example, for 1000 people treated with PCSK9 inhibitors in addition to statins over five years, benefits ranged from 2 fewer strokes in the lowest risk to 21 fewer in the highest risk). Two systematic reviews on harms found no important adverse events for these drugs (moderate to high certainty evidence). PCSK9 inhibitors require injections that sometimes result in injection site reactions (best estimate 15 more per 1000 in a 5 year timeframe), representing a burden and harm that may matter to patients. The MATCH-IT decision support tool allows you to interact with the evidence and your patients across the alternative options: https://magicevidence.org/match-it/220504dist-lipid-lowering-drugs/. UNDERSTANDING THE RECOMMENDATIONS The stratification into four cardiovascular risk groups means that, to use the recommendations, physicians need to identify their patient's risk first. We therefore suggest, specific to various geographical regions, using some reliable risk calculators that estimate patients' cardiovascular risk based on a mix of known risk factors. The largely weak recommendations concerning the addition of ezetimibe or PCSK9 inhibitors reflect what the panel considered to be a close balance between small reductions in stroke and myocardial infarctions weighed against the burdens and limited harms.Because of the anticipated large variability of patients' values and preferences, well informed choices warrant shared decision making. Interactive evidence summaries and decision aids linked to the recommendations can facilitate such shared decisions. The strong recommendations against adding another drug in people at low cardiovascular risk reflect what the panel considered to be a burden without important benefits. The strong recommendation for adding either ezetimibe or PCSK9 inhibitors in people at high and very high cardiovascular risk reflect a clear benefit.The panel recognised the key uncertainty in the evidence concerning patient values and preferences, namely that what most people consider important reductions in cardiovascular risks, weighed against burdens and harms, remains unclear. Finally, availability and costs will influence decisions when healthcare systems, clinicians, or people consider adding ezetimibe or PCSK9 inhibitors

Identification of genetic variants associated with Huntington's disease progression: a genome-wide association study

Background Huntington's disease is caused by a CAG repeat expansion in the huntingtin gene, HTT. Age at onset has been used as a quantitative phenotype in genetic analysis looking for Huntington's disease modifiers, but is hard to define and not always available. Therefore, we aimed to generate a novel measure of disease progression and to identify genetic markers associated with this progression measure. Methods We generated a progression score on the basis of principal component analysis of prospectively acquired longitudinal changes in motor, cognitive, and imaging measures in the 218 indivduals in the TRACK-HD cohort of Huntington's disease gene mutation carriers (data collected 2008–11). We generated a parallel progression score using data from 1773 previously genotyped participants from the European Huntington's Disease Network REGISTRY study of Huntington's disease mutation carriers (data collected 2003–13). We did a genome-wide association analyses in terms of progression for 216 TRACK-HD participants and 1773 REGISTRY participants, then a meta-analysis of these results was undertaken. Findings Longitudinal motor, cognitive, and imaging scores were correlated with each other in TRACK-HD participants, justifying use of a single, cross-domain measure of disease progression in both studies. The TRACK-HD and REGISTRY progression measures were correlated with each other (r=0·674), and with age at onset (TRACK-HD, r=0·315; REGISTRY, r=0·234). The meta-analysis of progression in TRACK-HD and REGISTRY gave a genome-wide significant signal (p=1·12 × 10−10) on chromosome 5 spanning three genes: MSH3, DHFR, and MTRNR2L2. The genes in this locus were associated with progression in TRACK-HD (MSH3 p=2·94 × 10−8 DHFR p=8·37 × 10−7 MTRNR2L2 p=2·15 × 10−9) and to a lesser extent in REGISTRY (MSH3 p=9·36 × 10−4 DHFR p=8·45 × 10−4 MTRNR2L2 p=1·20 × 10−3). The lead single nucleotide polymorphism (SNP) in TRACK-HD (rs557874766) was genome-wide significant in the meta-analysis (p=1·58 × 10−8), and encodes an aminoacid change (Pro67Ala) in MSH3. In TRACK-HD, each copy of the minor allele at this SNP was associated with a 0·4 units per year (95% CI 0·16–0·66) reduction in the rate of change of the Unified Huntington's Disease Rating Scale (UHDRS) Total Motor Score, and a reduction of 0·12 units per year (95% CI 0·06–0·18) in the rate of change of UHDRS Total Functional Capacity score. These associations remained significant after adjusting for age of onset. Interpretation The multidomain progression measure in TRACK-HD was associated with a functional variant that was genome-wide significant in our meta-analysis. The association in only 216 participants implies that the progression measure is a sensitive reflection of disease burden, that the effect size at this locus is large, or both. Knockout of Msh3 reduces somatic expansion in Huntington's disease mouse models, suggesting this mechanism as an area for future therapeutic investigation

Birgit Schlick-Nolte et Vera Von Droste zu Hülshoff, Uschebtis I

Delvaux Luc. Birgit Schlick-Nolte et Vera Von Droste zu Hülshoff, Uschebtis I. In: L'antiquité classique, Tome 56, 1987. pp. 498-499

Birgit Schlick-Nolte et Vera Von Droste zu Hülshoff, Uschebtis I

Delvaux Luc. Birgit Schlick-Nolte et Vera Von Droste zu Hülshoff, Uschebtis I. In: L'antiquité classique, Tome 56, 1987. pp. 498-499