Exploratory analysis of new craniometric measures for the investigation of biological sex using open-access statistical and machine-learning tools on a cone-beam computed tomography sample.

Investigation of the biological sex of human remains is a crucial aspect of physical anthropology. However, due to varying states of skeletal preservation, multiple approaches and structures of interest need to be explored. This research aims to investigate the potential use of distances between bifrontal breadth (FMB), infraorbital foramina distance (IOD), nasal breadth (NLB), inter-canine width (ICD), and distance between mental foramina (MFD) for combined sex prediction through traditional statistical methods and through open-access machine-learning tools. Ethical approval was obtained from the ethics committee, and out of 100 cone beam computed tomography (CBCT) scans, 54 individuals were selected with all the points visible. Ten extra exams were chosen to test the predictors developed from the learning sample. Descriptive analysis of measurements, standard deviation, and standard error were obtained. T-student and Mann-Whitney tests were utilized to assess the sex differences within the variables. A logistic regression equation was developed and tested for the investigation of the biological sex as well as decision trees, random forest, and artificial neural networks machine-learning models. The results indicate a strong correlation between the measurements and the sex of individuals. When combined, the measurements were able to predict sex using a regression formula or machine learning based models which can be exported and added to software or webpages. Considering the methods, the estimations showed an accuracy rate superior to 80% for males and 82% for females. All skulls in the test sample were accurately predicted by both statistical and machine-learning models. This exploratory study successfully established a correlation between facial measurements and the sex of individuals, validating the prediction potential of machine learning, augmenting the investigative tools available to experts with a high differentiation potential.

Morpho-radiological and brain endocast analysis in the study of Hyperostosis Frontalis Interna (HFI): A combined approach.

The purpose of this study is to anatomically evaluate the impact on the patient intra vitam of an endocranial condition on a late 20th century skull housed in the Section of Legal Medicine of the University of Foggia (Foggia, Apulia, Italy). After performing a retrospective diagnosis, the condition is framed in the broader context of studies on this pathology. An anthropological and radiological analysis (X-ray and CT scan imaging) made it possible to confirm the preliminary information and to detail the osteological diagnosis of HFI. In order to assess the impact on the cerebral surface of the endocranial growth a 3D endocast was obtained using the Software OrtogOnBlender. The skull is demonstrated to have belonged to a female senile individual known, from limited documentary evidence, to have suffered from a psychiatric condition during her life. The final diagnosis is hyperostosis frontalis interna (HFI), Type D. Although a direct correlation between the demonstrated intracranial bony growth and the onset of the patient's psychiatric condition is difficult to retrospectively ascertain, the pressure exerted on this female individual's frontal lobe may have contributed to further degenerative behavioural changes in the last years of her life. This case adds to previous knowledge, especially from the palaeopathological literature, on this condition and, for the first time, presents a neuroanatomical approach to assess the global impact of the disease.

Observational and descriptive analysis of broken dental needles: a case series.

PURPOSE: To discuss potential causes of broken dental needles during dental anesthesia and features of this complication, including the anatomical location of fragments in tissues, symptoms, complications, and therapeutic approaches. METHODS: Twelve cases of broken dental needles occurring during dental anesthesia and subsequently referred to Hospital de Base do Distrito Federal, Brazil, between 1992 and 2019 were selected. In addition, similar cases reported in the literature over the past 50 years were reviewed. RESULTS: Needle fractures occur most frequently during inferior alveolar nerve blocks and in younger patients. The leading cause is unexpected patient movement during the anesthetic procedure. The needle fragment is most commonly found in the pterygomandibular space or the deep spaces of the head and neck region. Needle migration is a particular concern; although rare, it is unpredictable and potentially life-threatening. CONCLUSIONS: Needle fracture is an intraoperative complication which has the potential to cause severe patient damage. It is essential that practitioners have knowledge of this possible complication and understand the technical considerations for its prevention. The existing literature and the results of this case series analysis suggest that removal of the fractured needle fragment should be attempted as soon as possible.

Color translation from monoscopic photogrammetry +ID Methodology into a Polyjet final 3D printed facial prosthesis.

Background: The artistic techniques necessary to fabricate facial prostheses mainly depend on individual skill and are not a resource easily reproduced. Digital technology has contributed to improved outcomes, often combining analog and new digital techniques in the same workflow. Methods: This article aims to present an innovative workflow to produce a final colored 3D printed and facial prosthesis by UV-map color translation into colored resin 3D printing. A modified +ID Methodology was used to obtain 3D models with the calibrated 3D printable patient's skin color. No hands-on physical molding, manual sculpture, or intrinsic silicone coloration was used. Results: The outcome resulted in acceptable aesthetics, adaptation, and an approximate color match after extrinsic coloration. The patient reported good comfort and acceptance. Conclusions: A direct resin 3D printed prosthesis may be a viable alternative, especially for rapid delivery as an immediate prosthesis or an option when there is no experienced anaplastogist to manufacture a conventional prosthesis.

Using 21st-Century Technologies to Determine the Cognitive Capabilities of a 11,000-Year-Old Perak Man Who Had Brachymesophalangia Type A2.

Perak Man, named after the state where the skeleton was found, was the most complete skeleton found in Southeast Asia. The funerary artefacts indicate that Perak Man was highly respected, as he was buried at the centre of the highest cave in Lenggong, and he was the only person buried there. A copy of the original skull was made using computed tomography (CT) and 3D printing. Based on the internal structure of the reconstructed skull, the estimated intracranial volume (ICV) is 1,204.91 mL. The hypothetical face of Perak Man was reconstructed according to established forensic methods. Based on his presumed status, Perak Man was likely a respected person in the group and, perhaps, a shaman and the most knowledgeable person in the group regarding survival, hunting, gathering and other aspects of Palaeolithic daily life.

3D Virtual Planning for Rhinoplasty Using a Free Add-On for Open-Source Software.

BACKGROUND: Rhinoplasty is one of the most frequent aesthetic surgeries; the procedure can be challenging for inexperienced surgeons, and positive outcomes depend on good communication with the patient, proper planning, and precise execution. Three-dimensional (3D) technology has emerged to address these issues, but specific software for 3D planning tends to be expensive. OBJECTIVES: This study presents a simple, low-cost method for 3D simulation to plan rhinoplasty. METHODS: This preliminary report describes 3D rhinoplasty planning in a series of 3 cases employing free software and an add-on especially developed for rhinoplasty (Blender and RhinOnBlender, respectively). The photogrammetry protocol, which can be performed easily with a smartphone, is described in detail along with all the steps in 3D planning. RESULTS: The software and add-on automated the process, making the tool environment accessible to surgeons who are not familiar with graphic design software. The surgeries were uneventful in all cases, and the patients were satisfied with the outcomes. CONCLUSIONS: 3D graphic technology has provided significant advances in health research, improvement, and teaching for surgeons and communication between surgeons and patients. Free open-source software and add-ons are excellent options that offer proven utility, affordability, and ease of utilization to healthcare providers.

Accuracy of three-dimensional virtual simulation of the soft tissues of the face in OrtogOnBlender for correction of class II dentofacial deformities: an uncontrolled experimental case-series study.

PURPOSE: To assess whether virtual simulations of the projection of the soft tissues of the face after class II bimaxillary orthognathic surgery, generated from 3D reconstruction of preoperative computed tomography (CT) scans, differed significantly from the actual soft tissue profile obtained in the late postoperative period (beyond 6 months). Secondarily, to validate the accuracy of a free, open-source software suite for virtual soft tissue planning in orthognathic surgery. METHODS: Helical CT scans were obtained pre- and postoperatively from 16 patients with Angle class II malocclusion who underwent bimaxillary orthognathic surgery. A comparative study between soft tissue meshes constructed for surgical simulation (M1) and the actual meshes obtained from postoperative scans (M2) was then performed. To establish the accuracy of 3D facial soft tissue simulation in a free and open-source software suite (OrtogOnBlender-OOB), 17 predetermined anatomic landmarks were measured in M1 and M2 scans after alignment of cranial structures. RESULTS: The mean error between preoperative simulations and actual postoperative findings was < 2 mm for all anthropometric landmarks. The overall average error for the facial soft tissues was 1.07 mm. CONCLUSION: Comparison between preoperative simulation (M1) and actual postoperative findings (M2) showed clinically relevant ability of the method to reproduce actual surgical movement reliably (< 2-mm error). OOB is capable of accurate soft tissue planning for orthognathic surgery, but mesh deformation methods still require improvement. TRIAL REGISTRATION: RBR-88jff9. Retrospectively registered at Brazilian Registry of Clinical trials-ReBec ( http://www.ensaiosclinicos.gov.br ) May 06, 2020.

3D forensic facial approximation: Implementation protocol in a forensic activity.

The primary objective of this paper is to report on the successful implementation of forensic facial approximation in a real case in the forensic context. A three-dimensional (3D) facial approximation protocol of the skull was performed with free software, applying techniques in a virtual environment that have already been consolidated in the literature. The skull was scanned with the photogrammetry technique, the digital replica was imported in the Blender software (Blender Foundation, Amsterdam) and individualized model sketches of the face were traced with the MakeHuman software (MakeHuman Org) according to the anthropological profile of the victim. The face created was imported in Blender, where it was adapted, modeled, and sculpted on the 3D skull and its soft tissue markers, using an American open-source application of the technique in the digital environment. The face created in a virtual environment was recognized and legal identification procedures were started, resulting in the more agile delivery of the disappeared body to its next of kin. It is therefore concluded that facial approximation may not be a primary method of human identification, but it can be satisfactorily applied in the forensic field as an individual recognition resource. It has great value in narrowing the search, reducing the number of alleged victims, and leading to identification tests, therefore significantly reducing the number of genetic DNA (deoxyribonucleic acid) tests-which are considered costly for the State or Federation-and consequently reducing the waiting time before delivery of the body to its family.

Unilateral mandibular condylar process fractures: a retrospective clinical comparison of open versus closed treatment.

PURPOSE: To retrospectively compare the clinical outcomes of closed treatment (closed reduction and intermaxillary fixation) with open treatment (open reduction and internal fixation with miniplates and screws) of unilateral mandibular condylar process fractures. METHODS: Adult patients with unilateral condylar fractures treated from January 2011 to July 2013 in the Oral and Maxillofacial Surgery Service at the Base Hospital of the Federal District, Brazil, were invited to participate. Those who agreed to participate were scheduled for clinical evaluation, which consisted of a subjective questionnaire (completed by the examiner) and an objective physical examination of the temporomandibular joints and mandibular range of motion. The following variables were analyzed: mouth opening; lateral excursions of the mandible; presence of clicking; mandibular function impairment (speech, chewing); and occlusion. RESULTS: Seventeen patients (15 men and 2 women) attended the scheduled appointment: 9 had received open treatment (surgical) and 8 had received closed treatment (nonsurgical). Patients were evaluated at 6-30 months postoperatively. Only maximum mouth opening (p = 0.044) and maximum lateral excursion to the unaffected side (p = 0.030) showed a significant difference between the closed and open treatment groups. CONCLUSIONS: Our findings are consistent with those reported in the literature as both methods (closed and open treatment) produced satisfactory outcomes. The only between-group difference was the amount of maximum mouth opening and lateral excursion to the unaffected side. Further randomized studies with a larger number of patients with condylar process fractures are needed to verify the results obtained with each treatment.

New technique in facial reconstruction: the case of Giovanni Battista Morgagni.

ABSTRACT: Morgagni is considered the father of pathological anatomy. He died in 1771, 89 years old, and was buried in Saint Maxim church in Padua, where his wife and five of his 15 children were already buried. In 2011, an anthropological analysis confirmed that one of the skulls belonged to the oldest individuals among those found in Morgagni's tomb. A genetic analysis proved a kinship between this skull and the fragments of young individuals (one male and two females), supporting the hypothesis that they were Morgagni and his children. Thanks to the interaction between historical studies, anthropological research, and molecular analysis we can assume that the skull belongs to Giovanni Battista Morgagni and the skull fragments came from his children. Having obtained the identification of Morgagni, we performed a forensic facial reconstruction with new 3D technology. We compared the facial reconstruction with Morgagni's portraits done when he was living and near to his death, as to be closest to his real resemblances. Finally, we performed a superimposition test with busts and portraits, as to achieve a further confirmation of the molecular identification.

Comparação entre cinco sistemas de digitalização 3D por fotogrametria aplicados à antropologia forense e odontologia legal / Comparison of five photogrammetry 3D digitizing systems of applied to Forensic Anthropology and Forensic Dentistry

A análise forense de restos mortais e outros vestígios pode ser complementada pela digitalização tridimensional (3D). A fotogrametria de curta distância, consiste na extração de informações geométricas 3D a partir de imagens fotográficas. O objetivo deste estudo foi comparar cinco sistemas de digitalização (Photoscan®, 123dCatch®, ReCap360®, PPT-GUI® e OpenMVG®+MVS®) quanto à operabilidade e qualidade das malhas 3D geradas a partir de 42 fotografias de um crânio seco, tomadas com um smartphone. Duas escalas métricas ABFO nº2 foram posicionadas rente ao crânio. Após o processamento, as nuvens de pontos 3D resultantes foram convertidas em malhas 3D e/ou texturizadas quando necessário, e redimensionadas em escala 1:1. O número de vértices, faces, fator de escala e uma medida conhecida foram registrados. Recortou-se as regiões que não faziam parte do crânio e novamente o número de faces e vértices foi registrado. Para operabilidade, avaliou-se tempo de processamento, necessidade de conexão à Internet, funcionalidade limitada por versão não paga, texturização automática, entre outros parâmetros. Para qualidade, as malhas também foram avaliadas em seu aspecto visual, em seu aspecto quantitativo de vértices e faces, e diferença estatística das médias das medidas. Embora o uso de duas escalas idênticas tenha gerado artefatos, todos os programas geraram malhas tridimensionais adequadas, com algumas diferenças no resultado final e na operação. Cada ferramenta obteve resultados satisfatórios dentro de suas particularidades. Photoscan® teve operabilidade e resultados bons, porém seu custo pode ser um obstáculo. ReCap360® e 123dCatch® são fáceis de operar, mas dependem de Internet e possuem funcionalidade limitada.

Forensic analysis of skeletal remains and other evidence can be complemented by three-dimensional (3D) scanning. Among the available methods, close-range photogrammetry consists of extracting 3D geometric information from photographic images. The objective of this study was to compare five systems (Photoscan®, 123dCatch®, ReCap360®, PPT-GUI® and OpenMVG®+MVS®) regarding the operability and quality of 3D meshes generated from 42 photographs of a dry skull, taken with a smartphone. Two ABFO n.2 metric scales were placed next to the skull. After processing, the resulting 3D point clouds were converted into 3D meshes and textured when necessary, and resized in 1:1 scale. The number of vertices and faces was recorded. Then, all regions that were not part of the skull itself were cut out and again the number of faces and vertices was recorded. For operability, it was evaluated the processing time, need for Internet connection, functionality limited by unpaid version, automatic texturing, among other parameters. For quality, the meshes were also evaluated in their visual aspect and in their quantitative aspect of vertices and faces, and statistical difference of the mean of the measurements. Although the use of two identical scales has produced artifacts, all programs have generated adequate 3D meshes, with some differences in the result and operation. Each tool reached satisfactory results within its particularities. Photoscan® had good operability and results, but its cost may represent an obstacle. ReCap360® and 123dCatch® are easy to operate, but depend on internet connection and have limited functionality.

A digital approach for design and fabrication by rapid prototyping of orthosis for developmental dysplasia of the hip

Abstract Introduction Immobilization in a hip spica cast is required in surgical and nonsurgical treatments for children aged three months to four years diagnosed with developmental dysplasia of the hip. Skin complications are associated with the use of the spica cast in 30% of the cases. This research explores the use of photogrammetry and rapid prototyping for the production of a lighter, shower friendly and hygienic hip orthosis that could replace the hip spica cast. Methods Digitalized data of a plastic dool was used for design and fabrication of a customised hip orthosis following four steps: 1) Digitalization of the external anatomical structure by photogrammetry using a smartphone and open source software; 2) Idealization and 3D modeling of the hip orthosis; 3) Rapid prototyping of a low cost orthosis in polymer polylact acid; 4) Evaluation tests. Results Photogrammetry provided a good 3D reconstruction of the dool's hip and legs. The manufacture method to produce the hip orthosis was accurate in fitting the hip orthosis to the contours of the doll. The orthosis could be easily placed on the doll ensuring mechanical strength to immobilize the region of the hip. Conclusion A new approach and the feasibility of both techniques for hip orthosis fabrication were described. It represents an exciting advance for the development of hip orthosis that could be used in orthopedics. To test the effectiveness of this orthosis for developmental dysplasia of the hip treatment in newborns, material and mechanical tests, design optimization and physical tests with patients should be carried.

Distinct cytokine profiles of circulating mononuclear cells stimulated with Staphylococcus aureus enterotoxin A in vitro during early and late episodes of chronic osteomyelitis

We investigated the cytokine profile of peripheral mononuclear cells from chronic osteomyelitis (OST) patients following in vitro stimulation with staphylococcal enterotoxin A (SEA). We demonstrate that stimulation with SEA induced prominent lymphocyte proliferation and high levels of tumour necrosis factor (TNF)-α, interleukin (IL)-4 and IL-10 secretion in both OST and non-infected individuals (NI). Even though stimulation with SEA had no impact on IL-6 production in either patient group, the baseline level of IL-6 production by cells from OST patients was always significantly less than that produced by cells from NI. After classifying the osteomyelitic episodes based on the time after the last reactivation event as "early" (1-4 months) or "late" osteomyelitis (5-12 months), we found that increased levels of TNF-α and IL-4 in combination with decreased levels of IL-6 were observed in the early episodes. By contrast, increased levels of IL-10, IL-2 and IL-6 were hallmarks of late episodes. Our data demonstrate that early osteomyelitic episodes are accompanied by an increased frequency of "high producers" of TNF-α and IL-4, whereas late events are characterised by increased frequencies of "high producers" of IL-10, IL-6 and IL-2. These findings demonstrate the distinct cytokine profiles in chronic osteomyelitis, with a distinct regulation of IL-6 production during early and late episodes.

Distinct cytokine profiles of circulating mononuclear cells stimulated with Staphylococcus aureus enterotoxin A in vitro during early and late episodes of chronic osteomyelitis.

We investigated the cytokine profile of peripheral mononuclear cells from chronic osteomyelitis (OST) patients following in vitro stimulation with staphylococcal enterotoxin A (SEA). We demonstrate that stimulation with SEA induced prominent lymphocyte proliferation and high levels of tumour necrosis factor (TNF)-α, interleukin (IL)-4 and IL-10 secretion in both OST and non-infected individuals (NI). Even though stimulation with SEA had no impact on IL-6 production in either patient group, the baseline level of IL-6 production by cells from OST patients was always significantly less than that produced by cells from NI. After classifying the osteomyelitic episodes based on the time after the last reactivation event as "early" (1-4 months) or "late" osteomyelitis (5-12 months), we found that increased levels of TNF-α and IL-4 in combination with decreased levels of IL-6 were observed in the early episodes. By contrast, increased levels of IL-10, IL-2 and IL-6 were hallmarks of late episodes. Our data demonstrate that early osteomyelitic episodes are accompanied by an increased frequency of "high producers" of TNF-α and IL-4, whereas late events are characterised by increased frequencies of "high producers" of IL-10, IL-6 and IL-2. These findings demonstrate the distinct cytokine profiles in chronic osteomyelitis, with a distinct regulation of IL-6 production during early and late episodes.

Lesões nos membros inferiores de crianças provocadas pelos raios da roda de bicicleta / Injuries to children lower limbs due to bicycle wheel spokes

Realizou-se um estudo descritivo das lesões traumáticas provocadas pelos raios da roda da bicicleta nos membros inferiores de crianças, objetivando identificar os fatores predisponentes agravantes e chamando a atenção para o aspecto preventivo. Foram atendidos 125 pacientes, durante o período de setembro de 1998 a agosto de 1999, no Setor de Emergência do Hospital Regional na cidade de Governador Valadares, Minas Gerais. Todos os pacientes foram registrados em um protocolo avaliando algumas características clínicas e epidemiológicas dessas lesões, radiografados e submetidos à limpeza das feridas, sendo incluídos em uma classificação proposta pelos autores. Quase todos foram imobilizados com tala gessada suropodálica e a média de idade foi de 4,3 anos. As lesões foram classificadas, na grande maioria, em lesões de menor gravidade (103 pacientes grau IA e IIA), sendo 20 com fraturas (13 pacientes grau IB, seis grau IIB e um grau IIIB). As crianças eram conduzidas principalmente pelos pais e familiares. As crianças que estavam descalças tinham lesões de maior gravidade. A região lateral do tornozelo foi a mais acometida. Nenhuma bicicleta tinha proteção dos raios. Os autores sugerem que medidas preventivas e educativas sejam realizadas para evitar essas lesões.

A cirurgia de Smith na perda do movimento de aduçäo do polegar / Smith's surgery in the loss of the thumb adduction movement

Os autores analisam os resultados obtidos pela técnica cirúrgica descrita por Smith, que consiste na transferência do tendäo extensor radial curto do carpo para o tendäo do músculo adutor do polegar em sete pacientes com incapacidade da realizaçäo do movimento de aduçäo do polegar, devido à lesäo traumática do nervo ulnal (qatro casos) e neuropatia ulnal (três casos) causada pelo mal de Hansen.