Lessons learned compiling data from multiple clinical sources to understand differences in post-surgical shoulder pathology in diabetics and pre-diabetics

"Diabetic patients suffer from shoulder joint pathologies at a rate five times higher than the non-diabetic population. Diabetes is an independent risk factor for postoperative complications. We sought to determine to what extent prediabetics experience shoulder surgery complications. We set out to review rotator cuff repair (RCR) procedures at the Missouri Orthopaedic Institute (MOI) from January 1st, 2015 through December 31st, 2020. There are significant roadblocks to studying our original research question: Delays associated with data requests. Unexpected source file formatting that required manual manipulation. Multiple patient identifiers used in different records systems. Less-than-expected completion of patient outcome questionnaires. We present the challenges associated with receiving, cross-referencing, and organizing patient data in order to prepare for data collection and analysis."--Introduction

The genetic architecture of the human cerebral cortex

The cerebral cortex underlies our complex cognitive capabilities, yet little is known about the specific genetic loci that influence human cortical structure. To identify genetic variants that affect cortical structure, we conducted a genome-wide association meta-analysis of brain magnetic resonance imaging data from 51,665 individuals. We analyzed the surface area and average thickness of the whole cortex and 34 regions with known functional specializations. We identified 199 significant loci and found significant enrichment for loci influencing total surface area within regulatory elements that are active during prenatal cortical development, supporting the radial unit hypothesis. Loci that affect regional surface area cluster near genes in Wnt signaling pathways, which influence progenitor expansion and areal identity. Variation in cortical structure is genetically correlated with cognitive function, Parkinson's disease, insomnia, depression, neuroticism, and attention deficit hyperactivity disorder

Estimating peak height velocity in individuals: a comparison of statistical methods

Background Estimates pertaining to the timing of the adolescent growth spurt (e.g. peak height velocity; PHV), including age at peak height velocity (aPHV), play a critical role in the diagnosis, treatment, and management of skeletal growth and/or developmental disorders. Yet, distinct statistical methodologies often result in large estimate discrepancies. Aim The aim of the present study was to assess the advantages and disadvantages of three modelling methodologies for height as well as to determine how estimates derived from these methodologies may differ, particularly those that may be useful in paediatric clinical practice. Subjects and methods Height data from 686 individuals of the Fels Longitudinal Study were modelled using 5th order polynomials, natural cubic splines, and SuperImposition by Translation and Rotation (SITAR) to determine aPHV and PHV for all individuals together (i.e. population average) by sex and separately for each individual. Estimates within and between methodologies were calculated and compared. Results In general, mean aPHV was earlier, and PHV was greater for individuals when compared to estimates from population average models. Significant differences between mean aPHV and PHV for individuals were observed in all three methodologies, with SITAR exhibiting the latest aPHV and largest PHV estimates. Conclusion Each statistical methodology has a number of advantages when used for specific purposes. For modelling growth in individuals, as one would in paediatric clinical practice, we recommend the use of the 5th order polynomial methodology due to its parameter flexibility

Geometric morphometric analysis of growth patterns among facial types

Introduction: Extreme patterns of vertical facial divergence are of great importance to clinicians because of their association with dental malocclusion and functional problems of the orofacial complex. Understanding the growth patterns associated with vertical facial divergence is critical for clinicians to provide optimal treatment. This study evaluates and compares growth patterns from childhood to adulthood among 3 classifications of vertical facial divergence using longitudinal, lateral cephalograms from the Craniofacial Growth Consortium Study. Methods: Participants (183 females, 188 males) were classified into 1 of 3 facial types on the basis of their adult mandibular plane angle (MPA): hyperdivergent (MPA \u3e39°; n = 40), normodivergent (28° ≤ MPA ≤ 39°; n = 216), and hypodivergent (MPA \u3c28°; n = 115). Each individual had 5 cephalograms between ages 6 and 20 years. A set of 36 cephalometric landmarks were digitized on each cephalogram. Landmark configurations were superimposed to align 5 homologous landmarks of the anterior cranial base and scaled to unit centroid size. Growth trajectories were calculated using multivariate regression for each facial type and sex combination. Results: Divergent growth trajectories were identified among facial types, finding more similarities in normodivergent and hypodivergent growth patterns than either share with the hyperdivergent group. Through the use of geometric morphometric methods, new patterns of facial growth related to vertical facial divergence were identified. Hyperdivergent growth exhibits a downward rotation of the maxillomandibular complex relative to the anterior cranial base, in addition to the increased relative growth of the lower anterior face. Conversely, normodivergent and hypodivergent groups exhibit stable positioning of the maxilla relative to the anterior cranial base, with the forward rotation of the mandible. Furthermore, the hyperdivergent maxilla and mandible become relatively shorter and posteriorly positioned with age compared with the other groups. Conclusions: This study demonstrates how hyperdivergent growth, particularly restricted growth and positioning of the maxilla, results in a higher potential risk for Class II malocclusion. Future work will investigate growth patterns within each classification of facial divergence

Clinical implications of age-related change of the mandibular plane angle

Objective: To identify trajectories of ontogenetic change in the mandibular plane angle (MPA) and to describe the influence of sex and other factors on MPA during growth. Setting/Sample: The data consisted of 7026 MPA measurements from lateral cephalographs representing longitudinal series from ages 6 to 21 for 728 individuals from the Craniofacial Growth Consortium Study (CGCS). Materials and Methods: Facial type was determined from MPA for each assessment, with the assessment closest to age 18 representing the adult facial type. The sample includes 366 males and 362 females, each with between 2 and 15 cephalographs. The mean number of cephalographs per individual is 10. Variation in childhood MPA (earliest assessment between 6 and 9 years of age) and adult MPA (closest assessment to age 18 between 15 and 21 years of age), and change in MPA from childhood to adulthood were compared by sex and adult facial type using ANOVA and post hoc t tests. Results: Mandibular plane angle decreased from childhood to adulthood in 92% of males and 81% of females, yet increased in 36% of males and 50% of females with the hyper-divergent adult facial type. Childhood MPA and overall change in MPA were significantly different by adult facial type. Conclusions: Adult facial type is associated with differences in childhood MPA and change in MPA during growth. There are multiple ontogenetic pathways by which an individual can achieve a normo-divergent adult facial type, and an individual\u27s childhood MPA does not necessarily correspond to his or her adult facial type

Growth-related change in the mandibular plane angle with clinical implications

Mandibular plane angle (MPA) is used clinically to diagnose malocclusion and dysmorphology and assess treatment. Numerous cephalometric systems use MPA to categorize individuals into facial types. Accurate models of ontogenetic change in MPA will maximize the efficacy of orthodontic treatment by elucidating normal variation in MPA at different time points. Change in MPA captures several aspects of mandibular and craniofacial development, including mandibular growth rotation and changing anterior and posterior facial heights, resulting in considerable variation between individuals in the rate and magnitude of growth-related change in the MPA. Previous studies demonstrate a tendency for MPA to decrease during childhood and adolescence (1-3), although the timing and rate of these changes vary by study. To evaluate patterns of growth-related change, we examine MPA using cephalometric data compiled from six longitudinal studies of human growth and development.Anna M. Hardin (1), Ryan P. Knigge (1,2), Heesoo Oh (3), Dana L. Duren (2), Manish Valiathan (4), Kieran P. McNulty (5), Emily V. Leary (2) and Richard J. Sherwood (1,2,4) Department of Pathology and Anatomical Sciences (1), Department of Orthopaedic Surgery, Missouri Orthopaedic Institute (2), University of Missouri; Department of Orthodontics, University of the Pacific (3); Department of Orthodontics, Case Western Reserve University (4); Department of Anthropology, University of Minnesota (5)

Geometric morphometric analysis of growth patterns among facial types

Introduction: Extreme patterns of vertical facial divergence are of great importance to clinicians because of their association with dental malocclusion and functional problems of the orofacial complex. Understanding the growth patterns associated with vertical facial divergence is critical for clinicians to provide optimal treatment. This study evaluates and compares growth patterns from childhood to adulthood among 3 classifications of vertical facial divergence using longitudinal, lateral cephalograms from the Craniofacial Growth Consortium Study. Methods: Participants (183 females, 188 males) were classified into 1 of 3 facial types on the basis of their adult mandibular plane angle (MPA): hyperdivergent (MPA \u3e39°; n = 40), normodivergent (28° ≤ MPA ≤ 39°; n = 216), and hypodivergent (MPA \u3c28°; n = 115). Each individual had 5 cephalograms between ages 6 and 20 years. A set of 36 cephalometric landmarks were digitized on each cephalogram. Landmark configurations were superimposed to align 5 homologous landmarks of the anterior cranial base and scaled to unit centroid size. Growth trajectories were calculated using multivariate regression for each facial type and sex combination. Results: Divergent growth trajectories were identified among facial types, finding more similarities in normodivergent and hypodivergent growth patterns than either share with the hyperdivergent group. Through the use of geometric morphometric methods, new patterns of facial growth related to vertical facial divergence were identified. Hyperdivergent growth exhibits a downward rotation of the maxillomandibular complex relative to the anterior cranial base, in addition to the increased relative growth of the lower anterior face. Conversely, normodivergent and hypodivergent groups exhibit stable positioning of the maxilla relative to the anterior cranial base, with the forward rotation of the mandible. Furthermore, the hyperdivergent maxilla and mandible become relatively shorter and posteriorly positioned with age compared with the other groups. Conclusions: This study demonstrates how hyperdivergent growth, particularly restricted growth and positioning of the maxilla, results in a higher potential risk for Class II malocclusion. Future work will investigate growth patterns within each classification of facial divergence