The third dimension in palaeopathology: How can three-dimensional imaging by computed tomography bring an added value to retrospective diagnosis?

Abstract Three-dimensional (3D) imaging is now extensively used for studying ancient human and animal bones. This method has been consensually adopted by palaeoanthropologists, but its interest in palaeopathology has been challenged. The aim of this paper is to illustrate the contribution of 3D reconstructions to retrospective diagnosis in palaeopathology. We selected six palaeopathological cases among our research corpus representing three nosographic categories (trauma, infection and neoplasia) from various periods ranging from the Middle Palaeolithic to the beginning of the Modern Era. For each case, we compared the diagnostic value of plain X-ray, computed tomography (CT) slices, and 3D reconstructions. The latter were performed using TIVMI program, a free software for research use developed by one of us. Reconstructions are obtained by surface extraction that follows a segmentation process. We showed that this 3D method allowed reconstructing/quantifying pathological processes on ancient bones, usefully supplementing conventional radiological analyses and clearly bringing an added value to retrospective diagnosis in palaeopathology

Earliest cranio-encephalic trauma from the Levantine Middle Palaeolithic: 3D reappraisal of the Qafzeh 11 skull, consequences of pediatric brain damage on individual life condition and social care.

The Qafzeh site (Lower Galilee, Israel) has yielded the largest Levantine hominin collection from Middle Palaeolithic layers which were dated to circa 90-100 kyrs BP or to marine isotope stage 5b-c. Within the hominin sample, Qafzeh 11, circa 12-13 yrs old at death, presents a skull lesion previously attributed to a healed trauma. Three dimensional imaging methods allowed us to better explore this lesion which appeared as being a frontal bone depressed fracture, associated with brain damage. Furthermore the endocranial volume, smaller than expected for dental age, supports the hypothesis of a growth delay due to traumatic brain injury. This trauma did not affect the typical human brain morphology pattern of the right frontal and left occipital petalia. It is highly probable that this young individual suffered from personality and neurological troubles directly related to focal cerebral damage. Interestingly this young individual benefited of a unique funerary practice among the south-western Asian burials dated to Middle Palaeolithic

The effect of bariatric surgery type on cardiac reverse remodelling

Introduction: Bariatric surgery is effective in reversing adverse cardiac remodelling in obesity. However, it is unclear whether the three commonly performed operations; Roux-en-Y Gastric Bypass (RYGB), Laparoscopic Sleeve Gastrectomy (LSG) and Laparoscopic Adjustable Gastric Band (LAGB) are equal in their ability to reverse remodelling. Methods: Fifty-eight patients underwent CMR to assess left ventricular mass (LVM), LV mass:volume ratio (LVMVR) and LV eccentricity index (LVei) before and after bariatric surgery (26 RYGB, 22 LSG and 10 LAGB), including 46 with short-term (median 251–273 days) and 43 with longer-term (median 983–1027 days) follow-up. Abdominal visceral adipose tissue (VAT) and epicardial adipose tissue (EAT) were also assessed. Results: All three procedures resulted in significant decreases in excess body weight (48–70%). Percentage change in VAT and EAT was significantly greater following RYGB and LSG compared to LAGB at both timepoints (VAT:RYGB −47% and −57%, LSG −47% and −54%, LAGB −31% and −25%; EAT:RYGB −13% and −14%, LSG –16% and −19%, LAGB −5% and −5%). Patients undergoing LAGB, whilst having reduced LVM (−1% and −4%), had a smaller decrease at both short (RYGB: −8%, p < 0.005; LSG: −11%, p < 0.0001) and long (RYGB: −12%, p = 0.009; LSG: −13%, p < 0.0001) term timepoints. There was a significant decrease in LVMVR at the long-term timepoint following both RYGB (−7%, p = 0.006) and LSG (−7%, p = 0.021), but not LAGB (−2%, p = 0.912). LVei appeared to decrease at the long-term timepoint in those undergoing RYGB (−3%, p = 0.063) and LSG (−4%, p = 0.015), but not in those undergoing LAGB (1%, p = 0.857). In all patients, the change in LVM correlated with change in VAT (r = 0.338, p = 0.0134), while the change in LVei correlated with change in EAT (r = 0.437, p = 0.001). Conclusions: RYGB and LSG appear to result in greater decreases in visceral adiposity, and greater reverse LV remodelling with larger reductions in LVM, concentric remodelling and pericardial restraint than LAGB

Eighteenth century Yersinia pestis genomes reveal the long-term persistence of an historical plague focus

© Bos et al. The 14th-18th century pandemic of Yersinia pestis caused devastating disease outbreaks in Europe for almost 400 years. The reasons for plague's persistence and abrupt disappearance in Europe are poorly understood, but could have been due to either the presence of now-extinct plague foci in Europe itself, or successive disease introductions from other locations. Here we present five Y. pestis genomes from one of the last European outbreaks of plague, from 1722 in Marseille, France. The lineage identified has not been found in any extant Y. pestis foci sampled to date, and has its ancestry in strains obtained from victims of the 14th century Black Death. These data suggest the existence of a previously uncharacterized historical plague focus that persisted for at least three centuries. We propose that this disease source may have been responsible for the many resurgences of plague in Europe following the Black Death

Estimation du sexe fœtal à partir de l’ilium

La détermination du sexe est une des problématiques les plus fréquemment rencontrées en anthropologie médico-légale. Chez l’adulte, cette détermination est essentiellement basée sur l’os iliaque et autorise un très fort taux de classification correcte, tandis que chez le fœtus, les études sont beaucoup moins nombreuses et conduisent à des résultats souvent contradictoires.Nous avons recherché sur 83 paires d’ilia fœtaux de la collection ostéologique hongroise de Fazekas et Kosa quels étaient les critères métriques qui décrivaient le mieux le dimorphisme sexuel, en évaluant les différentes méthodes proposées sur l’ilium fœtal et en adaptant certaines de celles proposées chez l’adulte. Nous avons pour cela établi et validé un protocole de prise de clichés photographiques et une méthode de mesure sur image numérisée à partir du logiciel Adobe Photoshop 6‚.Certains des paramètres retenus dans l’étude – principalement ceux qui ont été relevés sur l’échancrure ischiatique – présentant de fortes corrélations avec le sexe, nous avons établi une régression logistique estimant la probabilité d’appartenir à l’un ou l’autre des deux sexes. Le faible pourcentage de discrimination sexuelle obtenu avec cette formule nous a amené à tenir compte de l’âge : nous avons donc structuré notre échantillon en différents groupes d’âge et avons établi une formule permettant de déterminer correctement le sexe dans plus de 85 % des cas (sur l’échantillon qui a servi à l’établir) pour les fœtus dont l’âge est inférieur à 26 semaines d’aménorrhée.Sex estimation is one of the most frequently encountered issues in forensic medicine. While in the case of adults this determination is essentially based on iliac bones and provides a rather reliable classification, there are fewer studies conducted on fetuses and the results are often contradictory.Therefore, we examinated 83 pairs of fetal iliac bones in the Hungarian collection of Fazekas and Kosa and searched for metric criteria that can the best be applied for determining sexual dimorphism. During this research, we tested the different methods proposed for fetal iliac bones and adapted some others used particularly in the case of adults.For this reason, we set up and validated a protocol of taking photographs, as well as a measurement technique developed for numeric pictures with the help of a software program, Adobe Photoshop 6‚.During this study, we selected certain parameters, principally the ones taken on the great sciatic notch, which showed a strong correlation with sex, and we established a logistic regression for estimating the probability of belonging to one sex or the other.The weak percentage of sexual differentiation obtained by this formula led us to take into account age: we organised our sample in different age groups and established a formula that permits correct sex determination in more than 85% of cases (in our sample) for fetuses that are less than 24 gestational weeks old

Interrelationship between implant and orthognathic surgery for the rehabilitation of edentulous cleft palate patients: a case report

A 43-year-old woman with a unilateral cleft lip and palate, presenting a totally edentulous maxilla and mandible with marked maxillomandibular discrepancy, attended the Prosthodontics section of the Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo for treatment. She could not close her mouth and was dissatisfied with her complete dentures. Treatment planning comprised placement of six implants in the maxilla, four in the mandible followed by prostheses installation and orthognathic surgery. The mandibular full arch prosthesis guided the occlusion for orthognathic positioning of the maxilla. The maxillary complete prosthesis was designed to assist the orthognathic surgery with a provisional prosthesis (no metal framework), allowing reverse treatment planning. Maxillary and mandibular realignment was performed. Three months later, a relapse in the position of the maxilla was observed, which was offset with a new maxillary prosthesis. This isa complex interdisciplinary treatment and two-year follow-up is presented and discussed. It should be considered that this type of treatment could also be applied in non-cleft patients