Computed tomographic age estimation from the pubic symphysis using the Suchey-Brooks method: A Systematic Review and Meta-analysis.

Forensic age estimation is routinely applied in investigations involving identification of individuals. Over the past century a myriad of methods have been devised for age estimation. One such method, proposed by Suchey and Brooks in 1990, groups the observed changes occurring in the pubic symphysis into six phases, each defined by a corresponding age range. The present study was piloted with the focussed question being to empirically determine the accuracy of the Suchey-Brooks method in computed tomographic age estimation by analysing morphological changes occurring in the pubic symphysis. Original articles pertaining to the use of the Suchey-Brooks method for CT based age estimation were extracted from four different databases- PubMed, CENTRAL, Google Scholar and ScienceDirect. Research papers which were answering the focussed question were selected for data analysis. After assessing the risk of bias of the selected articles, the data was subjected to Meta-analysis. Pooled analysis of correctly/accurately aged individuals/remains using the random and fixed effect models yielded a prediction percentage of 78% and 86%, respectively. Higher percentages were obtained for phase-wise and subgroup analysis, indicating that the Suchey-Brooks method is a reliable method for age estimation.

Age estimation based on computed tomography exploration: a combined method.

Despite an extensive number of existing methods, age estimation of human remains is still an unsolved matter in the field of forensic anthropology, especially when it comes to mature adults. The specific aim of this work was to propose a combined method for age estimation, for forensic purposes, by coupling the Suchey-Brooks method and the measure of the pubic bone density. For this purpose, we used an independent test sample comprising 339 CT scans of living individuals aged 15 to 99 years old. Measurement of bone density and staging according to the Suchey-Brooks phases were performed, followed by estimation of ages based on a combined method and an existing virtual reference sample. Results highlighted a significant negative correlation between bone density and age. Good accuracy was obtained for the measurement of pubic bone density for age estimation of men and women, especially concerning mature adults, with an absolute error ranging from 9 to 16 years for all individuals. The authors propose a practical combined method consisting of, first, allocating phases according to the scannographic approach of the Suchey-Brooks method. For phases I to IV, the age estimation is given using the Suchey-Brooks method. For phases V to VI, the pubic bone density measurement is used. Further study will be needed to assess the reproducibility of these results on cadavers and dry bones, as the post-mortem process could interfere with the measurement of mineral bone density.

Age estimation in forensic anthropology: quantification of observer error in phase versus component-based methods.

The purpose of this study was to assess observer error in phase versus component-based scoring systems used to develop age estimation methods in forensic anthropology. A method preferred by forensic anthropologists in the AAFS was selected for this evaluation (the Suchey-Brooks method for the pubic symphysis). The Suchey-Brooks descriptions were used to develop a corresponding component-based scoring system for comparison. Several commonly used reliability statistics (kappa, weighted kappa, and the intraclass correlation coefficient) were calculated to assess observer agreement between two observers and to evaluate the efficacy of each of these statistics for this study. The linear weighted kappa was determined to be the most suitable measure of observer agreement. The results show that a component-based system offers the possibility for more objective scoring than a phase system as long as the coding possibilities for each trait do not exceed three states of expression, each with as little overlap as possible.

Image analysis of pubic bone for age estimation in a computed tomography sample.

Radiology has demonstrated great utility for age estimation, but most of the studies are based on metrical and morphological methods in order to perform an identification profile. A simple image analysis-based method is presented, aimed to correlate the bony tissue ultrastructure with several variables obtained from the grey-level histogram (GLH) of computed tomography (CT) sagittal sections of the pubic symphysis surface and the pubic body, and relating them with age. The CT sample consisted of 169 hospital Digital Imaging and Communications in Medicine (DICOM) archives of known sex and age. The calculated multiple regression models showed a maximum R (2) of 0.533 for females and 0.726 for males, with a high intra- and inter-observer agreement. The method suggested is considered not only useful for performing an identification profile during virtopsy, but also for application in further studies in order to attach a quantitative correlation for tissue ultrastructure characteristics, without complex and expensive methods beyond image analysis.

Radiographic features of pelvis and hip joint development of English Bulldogs.

OBJECTIVES: To evaluate distinctive features of pelvis and hip joint development of English Bulldogs throughout the first year of life. METHODS: The pelves of 20 English Bulldogs were radiographed at three different ages (<4, 6-8, and 12-14 months). At each time point, the dogs were clinically evaluated and the abnormal hip joints were classified as mild, moderate, or severely deformed. The pelves were compared to a phantom study in which external rotation of a normal hemipelvis around its long axis was artificially created at different degrees, with different pelvic inclinations, and classified as either normal and without deformity, or as mild, moderate, or severely deformed. Hip joints and pelvic scores were statistically compared. RESULTS: Although none of the dogs were considered lame at the end of the study, none of the hips showed normal development; 77.5% were moderately to severely deformed at 12-14 months of age. At this age, 75% of the hemipelves had moderate to severe torsional deformity (>5.2 degrees of external rotation), with retroversion of the acetabulum confirmed by the presence of the crossover sign. An external rotation of the hemipelvis on its long axis >5 degrees was likely associated with a moderate to severely altered hip joint conformation. CLINICAL SIGNIFICANCE: Abnormal hip conformation was common in this series of English Bulldogs. Torsional deformity of the pelves with acetabular retroversion was a common and distinctive feature, which has not yet been thoroughly studied in dogs. These findings need further evaluation in English Bulldogs as well as in other breeds.

Estimation of adult skeletal age-at-death using the Sugeno fuzzy integral.

Age-at-death estimation of an individual skeleton is important to forensic and biological anthropologists for identification and demographic analysis, but it has been shown that the current aging methods are often unreliable because of skeletal variation and taphonomic factors. Multifactorial methods have been shown to produce better results when determining age-at-death than single indicator methods. However, multifactorial methods are difficult to apply to single or poorly preserved skeletons, and they rarely provide the investigator with information about the reliability of the estimate. The goal of this research is to examine the validity of the Sugeno fuzzy integral as a multifactorial method for modeling age-at-death of an individual skeleton. This approach is novel because it produces an informed decision of age-at-death utilizing multiple age indicators while also taking into consideration the accuracies of the methods and the condition of the bone being examined. Additionally, the Sugeno fuzzy integral does not require the use of a population and it qualitatively produces easily interpreted graphical results. Examples are presented applying three commonly used aging methods on a known-age skeletal sample from the Terry Anatomical Collection. This method produces results that are more accurate and with smaller intervals than single indicator methods.

Variability of the pattern of aging on the human skeleton: evidence from bone indicators and implications on age at death estimation.

Age at death assessment of adult skeletons is one of the most difficult problems in forensic and physical anthropology. Two fundamental sources of error are described: the complex variability in the process of skeletal aging and methodological bias. Taking into account these limits, we developed a new scoring system for the auricular surface of the ilium and the pubic symphysis. In order to address a large variability, we examine reference samples from Europe, North America, Africa, and Asia. Data were processed using Bayesian prediction in order to classify specimens in age range categories. Results show that combining indicators do not perform better than the auricular surface used as a single indicator. Morphological changes with aging are variable between Asian, African, and European populations, confirming the necessity to use population-specific standards. Bayesian prediction produces reliable classification and is applicable for subjects over 50 years old, a real methodological improvement.

[Use of morphologic changes in the pubic symphysis for age determination in the Polish male population]. / Wykorzystanie zmian morfologicznych zachodzacych w spojeniu lonowym do oceny wieku mezczyzn w populacji polskiej.

The aim of this study was to determine if the Suchey-Brooks age at death estimation method could be applied to a male sample from the Polish population. Public symphyses were taken from cadavers of 83 males of age 13-88 years. On the base of the morphological key features every symphysis was qualified to the appropriate age phase. The estimation of means and standard deviations of chronological age of every phase was the next step in the study. The differences turned out to be insignificant for phases I-III and significant for phases IV-VI. These results suggests using the Suchey method only for age estimation of younger males.

Collagen studies in late pregnant relaxin null mice.

The relaxin knockout (rlx -/-) mouse was used to assess the effect, during pregnancy, of relaxin with regard to water, collagen content, growth, and morphology of the nipple (N), vagina (V), uterus, cervix (C), pubic symphysis (PS), and mammary gland (MG). The results presented here indicate that during pregnancy, relaxin increases the growth of the N, C, V, and PS. Large increases in water content in the PS (20%) occurred in pregnant (Day 18.5) wild-type (rlx +/+) mice but not in rlx -/- animals. This indicates that in the PS, relaxin might increase the concentration of a water-retaining extracellular matrix component (hyaluronate). In the pregnant rlx +/+ mouse, collagen content decreased significantly in the N and V but not in other tissues. There were no significant changes in the rlx -/- mouse. This contrasts with findings in the rat, in which relaxin has been found to cause decreases in collagen concentrations in the V, C, and PS. Histological analysis showed that the collagen stain was more condensed in the tissues (V, C, PS, N, and MG) of rlx -/- mice than in those of rlx +/+ mice. This phenomenon indicates that the failure of collagen degradation and lack of growth in the N underlie the inability of the rlx -/- mice to feed their young, as reported previously. Vaginal and cervical luminal epithelia, which proliferated markedly in the rlx +/+ pregnant mice, remained relatively atrophic in the rlx -/- mice. As proliferation and differentiation of uterine and vaginal epithelia are thought to be induced by a paracrine stromal factor that acts upon estrogen stimulation, our results indicate that relaxin may be this paracrine factor.

Effect of public symphysiodesis on pelvic development in the skeletally immature greyhound.

OBJECTIVE: To evaluate the effect of pubic symphysiodesis (PS) on pelvic development in skeletally immature dogs. STUDY DESIGN: Prospective randomized clinical trial. ANIMALS: Eight 4 month-old, sexually intact female Greyhounds. METHODS: Initial PS was performed at 4 months of age using a powered stapling device. Because of failure of the initial surgery, a second PS was performed 1 month later by resecting the pubic symphysis with a rongeur followed by placement of handmade bone staples in four dogs. Sham PS was performed in four control dogs at 4 months of age. Pubic growth rate and pelvic development were evaluated using standard plane radiography and computed tomography. Specific measurements included acetabular ventroversion, Norberg angle, lateral center-edge angle, and pelvic inlet dimensions. Hip distraction indices were determined as well. RESULTS: PS at 4 months of age using a stapling device failed. Pubic symphysiodesis using hand made staples was successful at 5 months of age and did not result in any clinically significant intraoperative or postoperative complications. Pubic symphysiodesis markedly decreased pubic symphysis growth in the treatment group. Hip distraction indices and pelvic inlet circumference, area, and width significantly decreased in treated dogs compared to those in the control group. Acetabular ventroversion was significantly increased in treated dogs compared to those in the control group. CONCLUSIONS: PS decreases pelvic canal size, increases acetabular ventroversion, and does not appear to have any clinically significant complications. CLINICAL RELEVANCE: PS performed in skeletally immature dogs with hip dysplasia may provide an effect similar to a triple pelvic osteotomy and warrants further investigation.

Effect of pubic symphysiodesis on acetabular rotation and pelvic development in guinea pigs.

OBJECTIVE: To evaluate the effect of premature closure of the pubic symphysis on pelvic development. ANIMALS: 18, 21-day-old male guinea pigs. PROCEDURE: The pubic symphysis was surgically approached in 10 guinea pigs of the symphysiodesis group and in 4 of the sham-operated group; 4 guinea pigs served as unoperated controls. The pubic symphysis was destroyed by use of electrocautery in the 10 guinea pigs of the symphysiodesis group. All guinea pigs were allowed to grow to skeletal maturity and were euthanatized at 33 weeks of age. Body weight was recorded throughout the study and was compared between groups. Histologic examination of the symphyses confirmed premature closure of the pubic symphyseal growth plates in guinea pigs of the symphysiodesis group. Pelvic measurements taken from pretreatment radiographic views and from video images of harvested pelves were compared between groups. RESULTS: There were no significant differences between groups with regard to pretreatment radiographic variables, rate of weight gain, or body weight at any time. Pubic symphysiodesis resulted in significant narrowing of the caudal aspect of the pelvis, narrowing and shortening of the pubic bones, and outward rotation of the acetabula. CONCLUSIONS: The pubic symphyseal growth plates contribute significantly to development of the pelvis. Premature closure of these growth plates (pubic symphysiodesis) results in outward rotation of the acetabula, which might be beneficial in some cases of can be hip dysplasia; however, this rotation is accompanied by concomitant narrowing of the caudal aspect of the pelvis.

Management of patients with poor symphysis pubis-fundus growth by Doppler flow velocimetry of the umbilical artery--an effective method to detect the fetus at risk.

This study evaluated Doppler flow velocimetry of the umbilical artery in patients with suspected intrauterine growth retardation as detected by poor symphysis-fundus growth (SFG). The sensitivity of Doppler in detecting light for gestational age babies and intrauterine growth retardation was poor. Antenatal complications, neonatal morbidity and perinatal mortality occurred significantly more frequently in patients with abnormal flow. Doppler flow velocimetry is an excellent test to identify babies at high risk for perinatal morbidity and mortality, when poor SFG is present.

Pubic symphysis age distributions.

A further discussion of age assessment and palaeodemography requires detailed reviews of methods, especially pubic symphysis techniques. Before reanalysis of changes in symphyseal form, the initial steps in distributing ages must be examined. Use of the mean values for age scores gives age distributions that are not real, but subject to systematic distortions, and cumulative percentages of skeletal samples can be shown to reflect the mean ages. Distributing skeletal ages using 95% probability distributions provides a more accurate estimation of true ages for palaeodemography and a better basis for discussions of pubic symphysis aging techniques.

A revised method of age determination using the os pubis, with a review and tests of accuracy of other current methods of pubic symphyseal aging.

All current standardized methods of age determination using the os pubis were tested by blind assessment of a skeletal sample with documented ages (from the Todd collection; N = 96). No demographic data (sex, age, race, age composition) were known to the assessors prior to completion of the test. Results showed the Todd method to be more reliable than more recent component techniques and that all systems tended to underage. Therefore, modifications were made of the Todd system to eliminate this and other deficiencies, and a second test using a new sample was conducted (N = 109). The age distribution determined by the revised Todd method did not significantly differ from the actual age distribution of the second sample. Error due to race was nonsignificant. Biological stages of pubic metamorphosis are described and possible evolutionary specializations of the hominid symphysis are discussed. Revised standards for age determination are presented.

Ossification of femoral head in infancy. II. Ossification in infants treated for congenital dislocation.

A review of the films obtained in 124 infants conservatively treated for congenital dislocation of the hip revealed deviations from ordinary development of the femoral head before as well as after the treatment. Analysis of these deviations suggested initial acceleration of ossification, modified by retardation ipsilateral to dislocation and followed by bilateral deceleration of growth after treatment.

[Multiplication of the different varieties of cells of the mouse pubic symphysis during growth and early gestation: radioautographic study with the use of tritiated thymidine]. / Multiplication des différentes variétés cellulaires de la symphyse pubienne de souris au cours de la croissance et de la première gestation : étude radioautographique à l'aide de la thymidine tritiée

1) A radioautographic study was undertaken after injection of tritiated thymidine during post-natal growth. The mitotic activity was localized in the three constituents of the mouse pubic symphysis: - in the osteogenic cartilage, labelled nuclei are numerous throughout animal growth; - in the articular cartilage, labelled nuclei are seldom encountered; - in the medial region, the chondroblasts, elongated dorso-ventrally, and the fibroblasts of the dorsal ligament show numerous labelled nuclei. 2. During the first pregnancy, the mitotic activity of the three constituents were examined separately: - in the osteogenic cartilage, the number of labelled cells increases at the beginning of the first pregnancy : the tibia epiphyseal cartilage apparently simultaneously shows revival of mitotic activity. After the 15th day of pregnancy, the osteogenic cartilage disappears by endochondral ossification; - in the articular cartilage and fibrocartilage, no mitotic activity is detectable as long as their typical characteristics are conserved. However, mititic activity becomes evident again when these cartilaginous cells cease to be surrounded by the typical chondroid matrix and become incorporated into the ligament. Cell multiplication therefore participated in symphyseal ligament dilatation.

Age changes in the pubic symphysis of Macaca mulatta.

Age changes in the pubic symphyses of 142 Cayo Santiago rhesus monkeys (known age, sex and maternal genealogy) are described. Symphyseal development is sexually dimorphic. Males generate a ridge and furrow system which is gradually replaced by a solid ankylosis at the mid-sagittal plane. Female development parallels that of the male until puberty. With pregnancy and delivery, relaxation and reaggregation of pelvic ligaments binding the symphysis destroy the symphyseal face. Continued bearing of offspring inhibits mid-sagittal ankylosis. Limited estimates of skeletal age can be made by using symphyseal development as an indicator of senescence.