Use of laser-scanning confocal microscopy in the detection of diagenesis in bone.

This research demonstrates the value of laser scanning confocal microscopy (LSCM) as a research tool in osteological studies, and diagenetic studies in particular. LSCM combines properties of light and scanning electron microscopy using laser light to excite fluorophores throughout the z-axis, developing a 3-D image. Using differential staining and selecting for specific wavelengths of light, one can image targeted materials. This research is divided into two parts: visualizing bone structures such as proteins and their decompositional products and visualizing diagenesis. Part one of this study utilized pig bones as a means of testing the overall ability of LSCM to fluoresce bone. Twenty-three samples were imaged, including 13 samples from a decompositional study conducted 5 years previous, and 10 "fresh" samples collected from a commercial butcher. This part of the study determined that protein and organic components of the bone could be fluoresced and diagenetic alteration could be imaged. The second part of the study used human samples as a means of imaging and mapping diagenetic alterations. The second part of the study used 13 samples, including 4 clinical, 7 ancient, and 2 modern controls. The pig study used Basic Fuchsin and SlowFade Gold stains, while the human study used toluidine blue. Images were also taken with unstained elements. The results of the non-human study found that a fresh bone fluoresced differently than that of a 5-year subset, while the results of the human study confirmed these findings and determined that the bone diagenesis can be mapped using LSCM.

A Curious Case of Croup: Laryngotracheitis Caused by COVID-19.

We describe a case of croup in a 14-month-old boy caused by severe acute respiratory syndrome coronavirus 2, the virus that causes coronavirus disease 2019. The patient presented with classic signs and symptoms consistent with croup. Workup was remarkable for a positive point-of-care test for severe acute respiratory syndrome coronavirus 2. This case represents recognition of a new clinical entity caused by coronavirus disease 2019.

Consistency of selected craniometric landmark locations and the resulting variation in measurements.

Recently, forensic anthropology has undergone a major shift to quantitative methodologies, including the standardization of osteometric measurements. This study is an analysis of inter-observer error rates for eight "standardized" cranial measurements. Thirty participants, of varied experience, were asked to note the location of landmarks used in each measurement, and to record the resulting measurement. None of the tested measurements met the previously established 80% consensus rate necessary to be considered "standardized-in-practice" [1]. The highest consensus rate was that of nasal breadth (67.9%), followed by that of the mastoid height (57.1%). This low precision yielded percent mean differences of 2-48% of the total measurement, with range differences of up to 42mm. These results indicate that the field should take steps to improve osteometric standardization, including re-examining all measurements currently listed in osteometric canon and re-issuing a comprehensive guide.

Outcome of medical management of intraabdominal abscesses in children with Crohn disease.

INTRODUCTION: Crohn disease (CD) is a chronic inflammatory condition of the gastrointestinal tract that is complicated by fistulas, strictures, and intraabdominal abscesses (IAA) in 10%-30% of patients. To avoid surgical resection of the bowel, medical therapy with antibiotics (Ab) with or without percutaneous drainage (PD) is first undertaken. Our objectives are to examine the outcome of IAA in CD patients treated with antibiotics alone vs antibiotics and PD, and to identify risk factors for medical therapy failure. METHODS: Charts for patient with CD who were diagnosed between 2004 and 2016 at the Women and Children's Hospital of Buffalo were retrospectively reviewed. We compared the two modalities of medical therapy (Ab + PD vs Ab alone) in terms of abscess resolution and the need for surgical intervention. RESULTS: Twenty-nine patients, ages ranging from 12 to 18years, mean 15.5±2.5, 48% Male with IAA were identified. Overall, 69% of abscesses failed medical therapy including 87% of the drained abscesses and 50% of nondrained abscesses, p=0.04. The abscesses that failed medical therapy were more likely to have been drained (P=0.03) as they were larger in size (P = 0.03), patients were more likely to have a known CD on immunosuppression (P=0.016), and more likely to have an associated upper GI disease (P=0.002), when compared to those that were successful with medical therapy alone. CONCLUSION: Our results show that the majority of our patients required surgical intervention for abscess treatment and resolution of associated findings despite drainage. Risk factors include big drainable abscesses, developing IAA while on immunosuppression, and a more extensive disease with associated fistulae and strictures. Small undrainable abscesses are likely to resolve with antibiotics alone, therefore early detection and treatment are essential. TYPE OF STUDY: Level 2, retrospective study.

How "standardized" is standardized? A validation of postcranial landmark locations.

Since the mid-1990s, osteometrics have been a major aspect in forensic anthropology. However, recent evidence has shown that practitioners have been using differing points to establish certain measurements; namely those involving the clavicle, scapula, ulna, femur, and tibia. Engaging 61 practitioners, this study examined and confirmed how extensive this discord is. The highest consistency rate among practitioners was the scapular breadth (62.3%), followed by the femoral anteroposterior subtrochanteric diameter (55%). All other levels fell below these, particularly the physiological length of the ulna which was the most inconsistently measured bone. Furthermore, these low consistency rates yielded percent mean differences between two and 20% of the measurement length, with ranges averaging 14 mm. In light of these results, it is recommended that the field take steps to improve the standardization of such problematic measurements, including reexamining all measurements currently listed in osteometric texts, reassessing the utility of each, and reissuing a comprehensive guide.

The effects of sharp-force thoracic trauma on the rate and pattern of decomposition.

Given the multiple factors that may alter the rate of decomposition, one of the more difficult tasks that anthropologists and pathologists face is determining of the postmortem interval (PMI). While trauma has been widely accepted as being among those factors, recent published studies have contradicted this premise. However, major issues exist with these studies. Consequently, this study was designed to simulate a more realistic setting in an effort to settle this discrepancy in the literature. This study utilized eight porcine remains; three of which received incised wounds penetrating the thoracic cavity, three others received nonpenetrating wounds, and two were designated nontrauma controls. Measurements included evaluating the total body score (TBS) on temporal and accumulated degree days (ADD). Using a two-way repeated measures ANOVA, the results of this study found that while trauma does have an influence in the pattern of decomposition, it does not influence the rate of decomposition.

Hypocaloric, high-protein nutrition therapy in older vs younger critically ill patients with obesity.

BACKGROUND: Older patients require more protein than younger patients to achieve anabolism, but age-associated renal dysfunction may limit the amount of protein that can be safely provided. This study examined whether older, critically ill trauma patients with obesity can safely achieve nitrogen equilibrium and have positive clinical outcomes similar to younger obese patients during hypocaloric, high-protein nutrition therapy. METHODS: Adult patients with traumatic injury and obesity (body mass index [BMI] >30 kg/m(2)), admitted to the Presley Trauma Center from January 2009 to April 2011, were evaluated. Patients were targeted to receive hypocaloric, high-protein nutrition therapy (<25 kcal/kg ideal body weight [IBW]/d and >2 g/kg IBW/d of protein) for >10 days. Patients were stratified as older (≥60 years) or younger (18-59 years). RESULTS: Seventy-four patients (33 older, 41 younger) were studied. Older and younger patients were similar in BMI and injury severity. When given isonitrogenous regimens (2.3 ± 0.2 g/kg IBW/d), nitrogen balance was similar between older and younger patients (-3.2 ± 5.7 g/d vs -4.9 ± 9.0 g/d; P = .363). Older patients experienced a greater mean serum urea nitrogen concentration than younger patients (30 ± 14 mg/dL vs 20 ± 9 mg/dL; P = .001) during nutrition therapy. Clinical outcomes were not different between groups. CONCLUSIONS: Older critically ill trauma patients exhibited an equivalent net protein response as younger patients during hypocaloric, high-protein nutrition therapy. Older patients are at greater risk for developing azotemia. Close monitoring is warranted.