Histomorphological analysis of the variability of the human skeleton: forensic implications

One of the fundamental questions in forensic medicine and anthropology is whether or not a bone or bone fragment is human. Surprisingly at times for the extreme degradation of the bone (charred, old), DNA cannot be successfully performed and one must turn to other methods. Histological analysis at times can be proposed. However, the variability of a single human skeleton has never been tested. Forty-nine thin sections of long, flat, irregular and short bones were obtained from a well-preserved medieval adult human skeleton. A qualitative histomorphological analysis was performed in order to assess the presence of primary and secondary bone and the presence, absence and orientation of vascular canals. No histological sections exhibited woven or fibro-lamellar bone. Long bones showed a higher variability with an alternation within the same section of areas characterized by tightly packed secondary osteons and areas with scattered secondary osteons immersed in a lamellar matrix. Flat and irregular bones appeared to be characterized by a greater uniformity with scattered osteons in abundant interstitial lamellae. Some cases of “osteon banding” and “drifting osteons” were observed. Although Haversian bone represent the most frequent pattern, a histomorphological variability between different bones of the same individual, in different portions of the same bone, and in different parts of the same section has been observed. Therefore, the present study has highlighted the importance of extending research to whole skeletons without focusing only on single bones, in order to have a better understanding of the histological variability of both human and non-human bone

Is Orthodontic Treatment with Microperforations Worth It? A Scoping Review

Malformations of teeth and dental arches can produce functional modifications intermingled with esthetic alterations. Children’s rehabilitation may be long, requiring multiple interventions. One of the main challenges of contemporary orthodontics is to reduce treatment time by accelerating orthodontic tooth movements. Among the currently used methods, micro-osteoperforations (MOPs) are flapless, minimally invasive perforations that induce a local trauma to the bone, increase healing capacity, and accelerate dental movements. The use of MOPs in orthodontics is spreading but there are no definite and recognized protocols for their application. This scoping review collected the available evidence in the effect of MOPs during orthodontic therapy as compared to current treatments, to summarize the evidence. The guidelines proposed by PRISMA-ScR were followed: original clinical studies carried out from 2010 to 2021 were retrieved by medical databases combining the terms “micro-osteoperforations” and “accelerated orthodontic tooth movement”. From a total of 965 articles, nine were finally selected. The studies' aims, designs, methods, measurements, outcomes, and main findings were very heterogenous, with a duration ranging from 4 weeks to 7 months. This included only Class I malocclusion to any malocclusion. It assessed the effects of MOPs coupled with a variety of orthodontic mechanics on either the retraction of maxillary canines, the distalization of maxillary molars, or the modifications on premolar roots. Mostly, variations in the number, location, and timing of MOPs impeded a global assessment. Overall, most of the studies (six out of nine) reported moderately useful effects of MOPs, one was negative, and only two found significant advantages of MOPs over conventional treatment. The review synthesized the available evidence about MOP applications in orthodontics and identified some important gaps in knowledge that could be starting points for a systematic review of the literature. In conclusion, even if MOPs can accelerate tooth movements, the variety of aims and methods of the published research prevents suggestion of their widespread use

Histomorphometric analysis of the variability of the human skeleton: forensic implications

In the last decades, the histomorphometric analysis of bone tissue has been utilized to develop equations for species discrimination of fragmentary bone. Although this technique showed promising results, its main limitation concerns the lack of knowledge on the histomorphometric variability which may exist between different bones of the skeleton. In a previous study, we demonstrated a significant histomorphological variability in different bones of the same individual and even in different sections of the same bone. The present study aimed at investigating the extent of intra-individual variability in bone histomorphometry throughout the human adult skeleton and areas of a single bone. Samples were taken along an entire medieval male adult human skeleton (aged between 26 and 45 years), including long, flat, irregular and sesamoid bones for a total of 49 cross-sections. The histomorphometric analysis revealed that the size of both Haversian systems and Haversian canals were statistically significantly larger in long and irregular bones compared to flat bones. Moreover, osteons were generally bigger in the diaphysis compared to the proximal and distal metaphyses, whereas Haversian canals showed a higher uniformity in the different portions of each bone. The present study has highlighted the importance of conducting similar studies on both human and nonhuman skeletons at different stages of skeletal maturity in order to shed light on the extent of variability in the size of osteons and Haversian canals. This, in fact, represents an important prerequisite to develop reliable histological methods for species discrimination of fragmented bone

How frequent is ponticulus posticus in italian people? A lateral cephalometric study in an orthodontic population

The term “ponticulus posticus” refers to a partial or complete bony arch over the vertebral artery as it crosses the superolateral surface of the posterior arch of the atlas. This anatomical modification is linked to different symptoms, ranging from neckache to headache and migraine (1). This bony arch may also be incorrectly assessed during orthopedic surgery for fixation of C1-C2, with consequent risk of damaging the vertebral artery (2). Its frequency in the general population has been widely analysed by literature in different geographic contexts (3), but an analysis of the prevalence of such feature in the Italian population is still missing. The present investigation aims at providing data concerning the prevalence of ponticulus posticus in a sample of 221 patients. All the patients underwent lateral cephalometry for odontoiatric purposes and none of them was affected by congenital diseases or skeletal deformities. In the analysed sample ponticulus posticus had a prevalence of 7.7% for the complete form, and 9.0% for the incomplete form. Complete and partial forms were observed respectively in 8.8% and 11.0% of males, and in 6.9% and 7.7% of females, without statistically significant differences (chi-square test, p>0.01). Italian prevalence seems lower than that observed in American populations, and higher than that reported in India and Far East countries. The current investigation provided the first data concerning the frequency of posticulus posticus in Italy: further studies are needed in order to widen the sample and improve the analysis by more advanced radiological examinations such as CT and cone beam CT scans

Sexual Dimorphism of Cranial Morphological Traits in an Italian Sample: A Population-Specific Logistic Regression Model for Predicting Sex

Although not without subjectivity, the cranial trait scoring method is an easy visual method routinely used by forensic anthropologists in sex estimation. The revision presented by Walker in 2008 has introduced predictive models with good accuracies in the original populations. However, such models may lead to unsatisfactory performances when applied to populations that are different from the original. Therefore, this study aimed to test the sex predictive equations reported by Walker on a contemporary Italian population (177 individuals) in order to evaluate the reliability of the method and to identify potential sexual dimorphic differences between American and Italian individuals. In order to provide new reference data to be used by forensic experts dealing with human remains of modern/contemporary individuals from this geographical area, we designed logistic regression models specific to our population, whose accuracy was evaluated on a validation sample from the same population. In particular, we fitted logistic regression models for all possible combinations of the five cranial morphological traits (i.e., nuchal crest, mastoid process, orbital margin, glabella, and mental eminence). This approach provided a comprehensive set of population-specific equations that can be used in forensic contexts where crania might be retrieved with severe taphonomic damages, thus limiting the application of the method only to a few morphological features. The results proved once again that the effects of secular changes and biogeographic ancestry on sexual dimorphism of cranial morphological traits are remarkable, as highlighted by the low accuracy (from 56% to 78%) of the six Walker’s equations when applied to our female sample. Among our fitted models, the one including the glabella and mastoid process was the most accurate since these features are more sexually dimorphic in our population. Finally, our models proved to have high predictive performances in both training and validation samples, with accuracy percentages up to 91.7% for Italian females, which represents a significant success in minimizing the potential misclassifications in real forensic scenarios

Polyphenols–Gut–Heart: An Impactful Relationship to Improve Cardiovascular Diseases

A healthy gut provides the perfect habitat for trillions of bacteria, called the intestinal microbiota, which is greatly responsive to the long-term diet; it exists in a symbiotic relationship with the host and provides circulating metabolites, hormones, and cytokines necessary for human metabolism. The gut–heart axis is a novel emerging concept based on the accumulating evidence that a perturbed gut microbiota, called dysbiosis, plays a role as a risk factor in the pathogenesis of cardiovascular disease. Consequently, recovery of the gut microbiota composition and function could represent a potential new avenue for improving patient outcomes. Despite their low absorption, preclinical evidence indicates that polyphenols and their metabolites are transformed by intestinal bacteria and halt detrimental microbes’ colonization in the host. Moreover, their metabolites are potentially effective in human health due to antioxidant, anti-inflammatory, and anti-cancer effects. The aim of this review is to provide an overview of the causal role of gut dysbiosis in the pathogenesis of atherosclerosis, hypertension, and heart failure; to discuss the beneficial effects of polyphenols on the intestinal microbiota, and to hypothesize polyphenols or their derivatives as an opportunity to prevent and treat cardiovascular diseases by shaping gut eubiosis

Correlation Analysis on Anatomical Variants of Accessory Foramina in the Sphenoid Bone for Oncological Surgery

The sphenoid bone presents several anatomical variations, including accessory foramina, such as the foramen meningo-orbitale, the foramen of Vesalius, the canaliculus innominatus and the palatovaginal canal, which may be involved in tumor invasion or surgery of surrounding structures. Therefore, clinicians and surgeons have to consider these variants when planning surgical interventions of the cranial base. The prevalence of each variant is reported in the published literature, but very little information is available on the possible correlation among different variants. Here, 300 CT scans of patients (equally divided among males and females) were retrospectively assessed to investigate the presence of the foramen meningo-orbitale, the foramen of Vesalius, the canaliculus innominatus and the palatovaginal canal. Possible differences in the prevalence of each accessory foramen according to sex were assessed, as well as possible correlations among different variants through the Chi-square test (p p > 0.01). A significant positive correlation was found between the foramen of Vesalius and canaliculus innominatus, both in males and in females (p < 0.01). In detail, subjects with canaliculus innominatus in 85.7–100.0% of cases also showed the foramen of Vesalius, independently from sex and side. The present study provided novel data about the prevalence of four accessory foramina of the sphenoid bone in an Italian population, and a correlation between the foramen of Vesalius and the canaliculus innominatus was found for the first time. As these accessory foramina host neurovascular structures, the results of this study are thus useful for appropriate planning surgical procedures that are tailored to the anatomical configuration of the patient and for improving techniques to avoid accidental injuries in cranial base surgery. Knowledge of the topography, frequencies and the presence/absence of these additional foramina are pivotal for a successful procedure. Clinicians and surgeons may benefit from these novel data for appropriate recognition of the variants, decision-making, pre-operative and treatment planning, improvement of the procedures, screening of patients and prevention of misdiagnosis

The Difficult Task of Assessing Perimortem and Postmortem Fractures on the Skeleton: A Blind Text on 210 Fractures of Known Origin

this study aims at highlighting the difficulties and pitfalls a forensic anthropologist has to face when diagnosing bone fractures as perimortem and postmortem. Impact statement: any morphological and macroscopic evaluation on bone fractures has to be handled with care since the evaluation of a bone fracture as being peri or postmortem may be difficult, treacherous and at times observer-dependent and thus influenced by knowledge, intuition and training of the observer. If postmortem fractures can be detected more easily, on the other hand perimortem fractures can be wrongly identified, especially when spongy bone is involved and when time has taken its toll on the remains. In the field of forensic anthropology, the difference between perimortem and postmortem fractures is one of the most difficult challenges. Indicators of perimortality have been suggested (for example \u201cgreen\u201d aspect or colouring of the fractured margins) but most forensic anthropologist know how many times it may be impossible to reach a decision. Few studies have focused on the actual error anthropologists can run into when classifying bone fractures as post or perimortem. How many times will a postmortem or taphonomical fracture be mistaken for a perimortem fracture and viceversa? Which bones are the trickiest? The present study aims at verifying the error behind such a diagnosis by blind testing two experienced anthropologists (both trained as anthropologists, observer A with a 7 year working experience in the field and observer B with a 3 year working experience in the field) on 210 fractures of known origin. Four skeletons were selected from a skeletal series of 250 individuals who died in 1991 and whose skeletons were exhumed in 2001, unclaimed and thus available for scientific research according to Italian Mortuary Police Regulations. Of these four skeletons three had died in traffic accidents (case 1: pedestrian run over by a tram; case 2: pedestrian run over by a car; case 3: pedestrian run over by a truck, thus all presenting blunt force trauma) and one of natural causes. Autopsy reports were available for all with detailed descriptions of soft tissue and bone lesions. It was evident upon an initial examination of the skeletons (before the test) that several postmortem fractures were due to taphonomical events related to burial and exhumation; furthermore actual perimortem lesions (registered upon autopsy) had been evidently ruined by soil and other taphonomical variables. For all cases the number and site of bone fractures detected at autopsy in 1991 were recorded as well as those known to have been certainly caused by postmortem events (because not present at autopsy). The total number of fractures was 210. Then the two observers (forensic anthropologists) were asked to blindly score all lesions on the four skeletons as perimortem, postmortem or uncertain. Results were then evaluated by comparing the scores to the real perimortem or postmortem nature of the fracture. The results of the osteological analyses show the highest success rate for both observers in the correct identification of postmortem fractures, with percentages for correct identification between 75% and 100%. On the other hand, with perimortem fractures, the correct classification falls to a mean of 45%, with very minimum differences between observers (43.5% and 46%). In other words only 45% of all perimortem fractures were identified as such by the two observers. In 16.5% of perimortem fractures and in 7% of postmortem fractures the origin was defined as non assessable (uncertain) by the observers, and thus considered \u201cdubious\u201d. When observing the bones involved, the highest number of mistakes were noticed when the observer had to evaluate spongy bone (mostly ribs or bones of the pelvis). Much fewer errors were performed when evaluating fractures on long bones and skull. Globally, the present study clearly shows the difficulty and dangers of this crucial task. The correct identification of peri- and postmortem lesions is fundamental, but macroscopic and morphological criteria are still unsatisfactory, and sometimes misleading. The present results therefore should serve as a cautionary note concerning interpretation of peri and postmortem fractures as well as an invitation to search for novel methods of analysis (such as histology, immunochemistry, electronic microscopy), in order to find new tools towards a more comprehensive solution of this problem

Bone microscopy: guiding knowledge from history to forensic medicine

Calcified tissues are well known microscopically, but the diagnostic potential of bone micro-anatomy is still underestimated. The shape and size of osteons or of lamellar bone are unique and fundamental for determining the species of origin of human remains, and for understanding age, disease, and trauma; thus micro-anatomy is crucial to many disciplines, from archaeology to forensic medicine. This presentation aims at illustrating and reviewing all such applications. The first question arising when studying skeletal remains is: “is it human?”. Macroscopic analysis alone can sometimes be insufficient in understanding if they belong to a human or to another animal; in such cases, the microscopic characteristics can be the only instrument capable of providing a reply, by evaluating the presence of osteons, their pattern and distribution, as well as the their metrical parameters [1]. Secondly, bone tissue formation as well as the constant bone remodeling process result in a strong correlation between the age of an individual and both the tissue pattern and the number of osteons per unit area in a bone cross-section, parameters on which most of the histological age-estimating methods are based. These methods are particularly important in distinguishing subadults from adults, and, among the latter, in estimating age where other methods result unsatisfactory [2]. Bone histology can also be diagnostic in the research for pathological diseases and traumatic events, especially with concern to the moment in which a trauma occurred [2]. Finally, the type and degree of microscopic damage can give some insight into the environmental surroundings in which the bone was, and a taphonomic profile useful for the verification of taphonomic events and clues on the post mortem interval of the sample [3]. All these contributions demonstrate that even just a small piece of bone, in fact a microscopic part of it, is fundamental and can sometimes be the only instrument for the correct interpretation of the story that human remains can tell