Conference Presentations by Adam Kolatorowicz
The study of anatomical science in a hands-on, interactive fashion with whole-body donors is a co... more The study of anatomical science in a hands-on, interactive fashion with whole-body donors is a cornerstone of many healthcare professional education programs. However, access to anatomical materials is limited and rapidly growing programs require increased amounts of materials. The purpose of this presentation is to share with the medical community a donor program in eastern Tennessee and an alternative option for end-of-life planning for providers’ patients. The Lincoln Memorial University – DeBusk College of Osteopathic Medicine Anatomical Donation Program (LMU-DCOM ADP) accepts whole body donations for use in professional health education and anatomical research, while maintaining the highest standards of privacy, dignity, respect, and security for our donors and their families. Students in DO, DPT, OTD, PA, PhD, and MS programs learn human anatomy through the gift of our benevolent donors. Importantly, many of the osteopathic physicians fortunate to access the LMU-DCOM ADP remain in Appalachia, often serving the very communities our donors and their families call home. As a result, access to comprehensive healthcare in these historically underserved communities is increasingly possible. Additionally, donor material is routinely utilized in medical research conducted by students and/or medical professionals in surrounding service areas. Donation is free of cost for participants and surviving family, excepting the cost of obtaining a death certificate. LMU-DCOM ADP serves those individuals in the greater TN-KY-VA tri-state area. Individuals 18 years or older and within an approximate 150 miles radius from LMU at the time of death are eligible for donation. Individual donations serve at most 3 years; however, participants can allow for the protracted use of their donation. At the conclusion of service, remains are individually cremated in accordance with law and returned to a designated representative. Alternatively, cremains can be buried in the communal cemetery plot owned and maintained by LMU-DCOM. Annually, an anatomical donation memorial service is held to honor donors and their families; donors may choose to be recognized by name or remain anonymous, and full military honors are provided. Third year Osteopathic Medical Students participating in the Anatomy Scholars Program assist the LMU-DCOM ADP by taking informational and donor registration phone calls using our 24/7/365 phone line. Currently, it is the intention of the program to expand operations, to promote whole-body donation in the tri-state region, and to increase accepted donations. Recently, the LMU-DCOM ADP has approved electronic acceptance of “at-need” donations, meaning that potential donors need not be pre-registered. Instead, with individual and family consent, donations can be made near or at the time of death. In so doing, we hope to further support the mission of LMU-DCOM “to prepare outstanding osteopathic physicians who are committed to the premise that the cornerstone of meaningful existence is service to humanity,” a mission uniquely embraced by our selfless donors. Go to www.lmunet.edu/ADP, email [email protected], or call 423.869.6745 during business hours or 865.558.7428 after hours for more information about the program.
INTRODUCTION. Post-operative complications following mitral annuloplasty are reported at a surpri... more INTRODUCTION. Post-operative complications following mitral annuloplasty are reported at a surprisingly high incidence, despite major advancements in the procedure over the past few decades. Limited knowledge of mitral annulus structure in females and males across the lifespan remains a concern for surgeons, primarily due to limitations in imaging modalities used to visualize the annulus prior to surgery. This study aims to quantify morphological variation of the mitral annulus as it fluctuates by age and sex using landmark morphometric techniques. METHODS. Hearts from 70 formalin-fixed, whole-body donors (38 females, 32 males, aged 47-103 yo) were dissected and examined. A MicroScribe® 3DX digitizer was used to register 3D landmark coordinates of the annulus rim as well as the anterior and posterior leaflet junctions. After further dissection, anterior and posterior leaflet lengths along with annulus circumference were measured with sliding calipers. Heart dominance and the number of valve leaflets were noted. Geometric morphometric techniques were used to visualize and identify areas of greatest shape variation in the annulus. SUMMARY. Principal components analysis of Procrustes shape data reveals that annulus curvature, closeness of the anterior and posterior margins, and posterior displacement of the annulus account for 31.3%, 21.6%, and 12.1% of total shape variation, respectively. Canonical variate analysis shows that the anterior and posterior edges of the annular rim are closer in the middle aspect in females compared to males. Regression analysis reveals annulus shape does not significantly change with age. CONCLUSIONS. Data collected from this study will allow surgeons to better predict normal anatomical variation of the mitral annulus, as well as expect and mitigate intraoperative and postoperative complications based on structural variations of the annulus and proximity of surrounding structures, such as the left circumflex artery.
Epidermal growth factor receptor (EGFR) mutant lung cancers tend to respond well to EGFR tyrosine... more Epidermal growth factor receptor (EGFR) mutant lung cancers tend to respond well to EGFR tyrosine kinase inhibitors (TKIs). However, resistance has been described. Molecular studies have revealed that concurrent mutations of tumor driver genes are associated with TKI resistance. To delineate the role of concurrent mutation of tumor suppressor gene p53 in TKI resistance, a meta-analysis was performed using published observations of EGFR mutant lung cancer patients treated with first or second generation TKIs. 31 studies are included in the analysis following a search of PubMed. Probability of TKI resistance and progress free survival (PFS) were compared in patients with or without p53 mutation. An increased probability of TKI resistance is seen in p53 mutant lung cancers. Interestingly, when resistance is defined as PFS<6 months, there is insignificant increase of resistance in p53 mutant patients (OR=1.93, 95% CI [0.38, 9.85], p=0.43). When resistance is defined as PFS<4 months there is a marked increase in resistance (OR=20.16, 95% CI [2.61, 155.75], p=0.004). In addition, p53 mutation is associated with a significantly shortened progress free survival in these patients (HR=1.57, 95% CI [1.26,1.97], p<0.0001). These findings suggest that p53 mutation is associated with resistance to TKIs in EGFR mutant lung cancers.
Introduction:
While most kidneys are supplied by a single renal artery at the level of the L2 ver... more Introduction:
While most kidneys are supplied by a single renal artery at the level of the L2 vertebral body, findings of supernumerary renal vessels are a common occurrence. The origin, number, and path of these vessels are highly variable. Cephalad ascent of the embryonic kidney during development results in the obliteration of existing vessels as new vasculature is established. Failure of degeneration of the supporting vasculature during this ascension can result in blood supply variations. Literature shows a wide variation in the incidence of ‘all type’ supernumerary renal vessels ranging from 7-76% of cadaveric and CT-scan specimens. This larger category of supernumerary renal vessels can be categorized based on the type of accessory renal vasculature found, variations in attachment site into the renal parenchyma, total number of accessory vessels, and course taken from either the abdominal aorta or the IVC. Incidences of bilateral accessory renal arteries are approximately 10% of cases. This case report adds to the existing literature of uncommon supernumerary renal vessels with bilateral inferior pole arteries.
Case Description:
The routine dissection of a 78-year-old female, formalin-fixed, whole body donor resulted in the incidental finding of bilateral renal vascular variations. Dissection had been completed during a first-year medical school anatomy course with only minor cleaning of the kidneys and surrounding vasculature. Further investigation of this donor revealed, in addition to classically found hilar vessels, an extra renal artery on the right starting slightly above the bifurcation of the abdominal aorta traveling anterior to the ureter before inserting into the inferior pole of the kidney. On the left, two accessory renal vessels were found inserting into the inferior pole of the kidney. Disrupted by previous dissection, visualization suggested an additional renal artery departing the abdominal aorta slightly above the bifurcation as well as an additional renal vein traveling to the inferior vena cava.
Discussion:
Understanding renal vasculature variations is vital as it influences urological procedures, renal transplantation, and other surgical procedures involving the retroperitoneum. When transplant teams must deal with multiple renal vessels, the Warm Ischemia Time (WIT) increases which has been shown to alter the ability and time for reperfusion following transplant, as well as varied outcomes in organ function upon reperfusion. As the number of supernumerary renal vessels increases, this WIT increases causing delays which can further impact transplant success. Additionally, the path of these accessory renal vessels over the pelvi-ureteric junction (PUJ) can cause issues in a patient as well. Studies demonstrate the effect of alterations in pressure in the renal pelvis in patients with accessory vessels that cross the PUJ compared to those without this crossing. Evidence of increased renal pelvis pressure was found in these patients with crossing vessels as well as increased incidence of PUJ obstruction.
Conclusion:
Detailed documentation of renal vasculature variations and associated medical implications is essential for anatomists and physicians. Further investigation into incidence and impact of these variations is recommended to broaden understanding, reduce risk of complications during medical interventions, and mitigate adverse outcomes.
Background: Needle thoracostomy is a life-saving procedure for patients with a tension pneumothor... more Background: Needle thoracostomy is a life-saving procedure for patients with a tension pneumothorax and it is crucial skill for prehospital and intrahospital emergency medical providers to maintain. Despite the mortality associated with poor management of a tension pneumothorax, the success rate of the needle thoracostomy has been historically low. Over the past 10 years, there has been increase in studies attempting to investigate how to improve the procedure. Although certain facets of a procedure have been well studied in current literature, there remains a lack of continuity between research on the procedure.
Objective: The primary aim of this study was to provide continuity to the current literature on the needle thoracostomy. To accomplish this, the current study examines the extent of research regarding needle thoracostomy, summarizes the findings of prior research, and identifies gaps in existing literature.
Design/Methods: A scoping review was conducted using a modified version of the Arksey and O’ Malley framework. Inclusion and exclusion criteria were predetermined, along with a precise, working definition of the procedure. A search was conducted in six online databases to identify all studies relating to needle thoracostomy. Full text review was completed on 103 articles. The articles were assessed for relevance and categorized by two independent reviewers.
Results: The search yielded 60 relevant articles. After review, the articles were categorized into six common themes: placement site, needle length, procedural complications, provider training, pediatric studies, and miscellaneous. A broad, succinct review of current literature regarding needle thoracostomy could inform much needed changes in standard of practice and provide multiple avenues of future research.
Conclusion: This review illustrates that the location of needle thoracostomy and length of the needle used have been thoroughly researched. In addition, current literature has proposed multiple training modalities on the procedure in an attempt to increase provider confidence and competency. Specialized devices created to perform a needle thoracostomy have also been proposed more recently. However, there has been relatively little research done on the complications of the procedure and how the procedure should be adjusted for pediatric patients.
Impact: A broad, succinct review of current literature regarding needle thoracostomy could inform much needed changes in standard of practice and provide multiple avenues of future research.
Video of ePlatform presentation: https://tinyurl.com/splenicartery.
INTRODUCTION. The splenic ar... more Video of ePlatform presentation: https://tinyurl.com/splenicartery.
INTRODUCTION. The splenic artery is well known for its conspicuously tortuous path, often having many loops, turns, and even elaborate coils. Previous hypotheses suggest that the coiled nature of the artery accommodates the expansion of the stomach, the movement of the diaphragm, is a result of higher blood pressure, or even the result of vascular disease. Pathologically tortuous vessels are more likely to experience aneurysm. The purpose of this study is to quantify splenic artery tortuosity and identify explanatory and confounding factors. METHODS. One hundred thirty-one formalin-fixed donors were dissected to expose the splenic artery from its origin on the celiac trunk to its branching prior to entering the spleen (63 females, 68 males, aged 50-101 years). Vessel tortuosity, vessel diameter, vessel wall thickness, and splenic volume were measured with spreading calipers. Presence, extent and calcification of atheroma was visually observed. Sex, age of death, and cause of death were abstracted from donor records. Correlations between variables were calculated to explore potential relationships. ANCOVA was used to examine variable effect magnitude on tortuosity. All analyses were performed with α = 0.05 in SPSS v26. SUMMARY. The average tortuosity index is 1.80 (1.00-4.08) and 51.1% of the sample had atheromas. No significant associations exist between tortuosity and the other parameters. The general linear model shows that vessel thickness, splenic volume, and presence of atheroma influence tortuosity, explaining 0.5%, 15.1%, and 7.1% of the variation in tortuosity, respectively. All other variables have no effect. CONCLUSIONS. Results suggest that vascular health and biomechanical factors influence tortuosity. Atherosclerotic plaques would alter blood flow dynamics, vessel dimensions, and vessel wall microstructure. An incidental finding of marked splenic artery tortuosity in a patient could indicate systemic vascular disease that warrants further investigation.
American Association of Clinical Anatomists Annual Meeting, 2020
INTRODUCTION. Damage to the thoracodorsal nerve can potentially produce profound functional defic... more INTRODUCTION. Damage to the thoracodorsal nerve can potentially produce profound functional deficits involving back and shoulder pain as well as reduced shoulder mobility. Investigations into the variation of this nerve have focused on its origin on the brachial plexus and its spinal nerve contributions. The present study aims to quantify the variation in the pathway of the thoracodorsal nerve relative to thoracic cage landmarks and is the first to investigate morphological variation relevant to surgical procedures involving the axillary region and the lateral thoracic wall. METHODS. A MicroScribe™ G2X digitizer was used to register 14, 3D landmarks from 44 thoracodorsal nerves in 32 fully embalmed, whole-body donors (20 males and 12 females, aged 50-97 years). After exposure via dissection, the nerve was examined from its origin on the brachial plexus to its entry in the latissimus dorsi muscle at points perpendicular to the anterior and mid-axillary lines along the ribs. Distances between the axillary lines and the nerve were computed from the raw coordinates. Geometric morphometric analyses of the landmarks were performed to visualize areas of greatest shape variation in the nerve and axillary lines. SUMMARY. Along the anterior axillary line at ribs 1-3, the nerve has an average distance of 98 mm (range 15-160 mm). Along the mid-axillary line at ribs 1-4, the nerve has an average distance of 58 mm (range 10-133 mm). The distance of the nerve from the axillary line increases in variation as the nerve descends along the thoracic wall. The terminus of the nerve is the most variable point, entering the muscle between costal levels four and seven. CONCLUSIONS. Surgeons can use these data to locate safe areas on the thoracic cage and avoid damage to the thoracodorsal nerve; thus, decreasing adverse outcomes in procedures such as chest tubes, video/robotic-assisted thoracoscopic lobectomies, and mastectomies.
This session will demonstrate how teaching and learning is enriched by the collaboration between ... more This session will demonstrate how teaching and learning is enriched by the collaboration between faculty and staff. A medical school faculty and staff member will describe a graduate-level human anatomy teaching course that is team-taught by anatomy professors, assessment staff, and laboratory staff. Attendees will develop methods to break down the faculty-staff divide, recognize their organizational culture, and reach out to staff members to take part in classroom instruction. This session will be of interest to faculty whose departments or administrative units have staff with expertise in helping students develop their non-cognitive skills, particularly in laboratory, field, or practicum-based courses.
Purpose
Osteoarthritis (OA) is largely viewed as a chronic disease that is both inevitable and di... more Purpose
Osteoarthritis (OA) is largely viewed as a chronic disease that is both inevitable and difficult to manage. Lifespan has markedly increased worldwide over the last hundred years and it is thought that the increase in lifespan has led to an increase in the prevalence of chronic diseases. The joints of the body experience more degeneration than in previous generations, thereby increasing the likelihood that an individual acquires OA in their lifetime. In addition to increased lifespan, obesity is a major risk factor for OA. The increased weight load placed on the knee joint, and the increased tissue adiposity, which leads to meta-inflammation via adipokines and pro-inflammatory cytokines, deteriorates the structural integrity of bone and cartilage in the joint. However, recent research comparing knee OA in preindustrial and postindustrial skeletons has shown that its increased prevalence in the modern era is not due to obesity and increased lifespan as conventionally assumed. Arguably, the largely worldwide decrease in physical activity may be the primary cause of the increase in postindustrial OA. The aim of this study is to determine if activity level affects the likelihood of developing OA. One’s occupation can be used as a proxy for activity level to better understand the prevalence of OA in different occupations requiring varying metabolic demands. The hypothesis is that individuals with lower activity levels will be more likely to have knee OA.
Methods
Convenience sampling was conducted of all available individuals with known occupation (n=567) from the William M. Bass Donated Skeletal Collection at The University of Tennessee. All donors were adults (21-80 years-old) of primarily European descent who lived and died during the late 20th century, comprising 373 males and 194 females.
A macromorphoscopic examination of the left and right femoral condyles, patellae, and tibial condyles was conducted to evaluate for signs of osteoarthritis. Osteoarthritis in the medial and lateral femorotibial and femoropatellar compartments was diagnosed by the presence of eburnation, a visually distinct, reflective, and glistening surface produced by bone-on-bone contact during joint articulation. The presence of eburnation was scored as either being present or absent. The sex, age-at-death, weight, stature, and occupation were drawn from the donor records. Activity level in each occupation was quantified using metabolic equivalent (MET) values, or the ratio of the work metabolic rate to the resting metabolic rate, as obtained from the National Cancer Institute. BMI was calculated from height and weight data in donor records. To avoid falsely diagnosing eburnation, individuals with postmortem damage, non-OA pathological changes, traumatic injury, and comminuted femorotibial or femoropatellar compartments were excluded from the sample.
A binomial logistic regression analysis was conducted to assess the effects of sex, age, activity level, and BMI on the likelihood that individuals have OA. A receiver operating characteristic (ROC) curve analysis was performed to assess the sensitivity and specificity of using MET value for predicting OA. Negative and positive predictive values were calculated to further assess model performance. All statistical analyses were performed in SPSS v22.0 with α = 0.05.
Results
Prevalence of knee OA in the sample was found to be at 15.3%. Individuals with and without OA have an average MET value of 2.90 and 2.60, respectively. The logistic regression model explained 8.1% (Nagelkerke R2) of the variance in OA, and correctly classified 82.4% of cases. The model had high specificity (0.997), low sensitivity (0.0128), low positive predictive value (0.5), and moderate negative predictive value (0.825). Age (p=0.098) and sex (p=0.087) do not affect the likelihood of OA whereas MET value (p=0.002) and BMI (p=0.004) have a statistically significant effect on OA. Increasing MET value and BMI is associated with an increased likelihood of OA. The ROC curve suggests MET value is not a reliable indicator of OA (area under the curve = 0.588, p=0.009).
Conclusion
This is the first study to use occupation and MET values as a proxy for activity level to investigate the effect of activity level on the presence of knee OA. In this sample, more active individuals with higher BMI are more likely to have OA compared to less active individuals with lower BMI. Some limitations of this study include the observational nature of the research design and a relatively small, homogenous sample predominately composed of males and individuals without OA. Future research will expand the sample size with individuals from different populations and include living individuals with clinical data.
An increasing number of medical schools are incorporating ultrasonography in the curriculum to su... more An increasing number of medical schools are incorporating ultrasonography in the curriculum to supplement student understanding of anatomy, with undefined success. This study aimed to evaluate current literature and assess whether ultrasound-assisted learning helps students gain anatomical knowledge. A systematic review following PRISMA guidelines returned 10 titles which were analyzed using the AQUA Tool. Students typically have a positive perception towards using ultrasound in learning anatomy, but there is limited evidence to show that ultrasound provides undergraduate medical students with a greater knowledge of anatomy. Further, well-designed educational research is needed to discern if teaching anatomy with ultrasound is advisable.
INTRODUCTION. The deltoid tubercle of the clavicle is a reliable surgical landmark for central ve... more INTRODUCTION. The deltoid tubercle of the clavicle is a reliable surgical landmark for central vein cannulation. This study is the first to investigate the location and size of the deltoid tubercle in a large sample with known demographics to explain observed variation as well as provide operational definitions of landmarks. METHODS. A Microscribe® G2X digitizer was used to register seven, 3D landmarks from 672 left and right clavicles (356 individuals aged 21 years or older) in the William M. Bass Donated Skeletal Collection. Interlandmark distances from the coordinate data were calculated to measure tubercle projection and location. A MANCOVA was run to test the effects of sex and side on projection and location when accounting for stature, weight, and age. Landmark data were subjected to a generalized Procrustes analysis and then a principal components analysis was conducted. Data were analyzed in MorphoJ v1.06d and SPSS v22.0. SUMMARY. Twelve individuals had no observable tubercle. The tubercle was located between 19 and 45% of the distance from the acromial end and ranged from 0.0 to 5.2 mm in height. The MANCOVA indicated age and stature affected tubercle projection only whereas sex affected both tubercle projection and location. Weight and side had no effect. Morphometric analyses revealed curvature and length of the clavicle explained 45% percent of shape variation with location and the degree of projection explaining an additional 20%. CONCLUSIONS. The deltoid tubercle varies in location depending on the sex of an individual. This variability may impact a clinician's ability to locate the subclavian vein with palpability potentially being affected by the age and stature of the patient. Some individuals may not have a palpable tubercle. Appreciating normal variability will help to improve clinical practice. (Sponsored by the Basic Science Fellowship Award, Lincoln Memorial University-DeBusk College of Osteopathic Medicine.)
Proceedings of the American Academy of Forensic Sciences, 2018
After attending this presentation, attendees will appreciate the utility of cranial base landmark... more After attending this presentation, attendees will appreciate the utility of cranial base landmarks in identifying human skeletal remains.
This presentation will impact the forensic science community by providing an alternative metric method for estimating ancestry from fragmentary crania.
The cranium is one of the most informative and widely used areas of the human skeleton in establishing the sex and ancestry of human remains. Standard methods of cranial morphometrics in forensic anthropology include the use of landmarks and features on the ectocranial surface of the vault and the face.1 These methods largely require intact crania. In a forensic setting, the cranium is often damaged and the traditionally used landmarks are obscured or destroyed.2 When fragmentary or unable to be reconstructed, the cranium is often not used for identification purposes in these cases.3-5 As a result, potentially valuable information contained within the remaining unexamined portions of the cranium is discarded. For example, in the case of fatal fires, the cranium is often deemed unusable because the typically evaluated areas for anthropological analysis (vault, face, mandible) are damaged or missing. The cranial base, however, is protected by the neck musculature, and oftentimes present with fragmentary remains. The cranial base is a relatively underused region of the cranium in forensic anthropological analysis, and is only recently being rigorously evaluated for its utility in prediction of ancestry and sex.6-9 This project tests the hypothesis that that there are differences in cranial base shape between American White and Black individuals by comparing cranial base landmark data with standard ectocranial landmark data.
A total of 73 landmarks of the endocranial and ectocranial surfaces were registered using a MicroScribe® G2X portable coordinate measuring machine from 245 adult crania in the Hamann-Todd Human Osteological Collection and the WM Bass Donated Collection. Landmarks were divided into four subsets: endobasicranial (18 landmarks), ectobasicranial (18 landmarks), all basicranial (36 landmarks), and ectocranial (43 landmarks). The first three subsets include uncommon landmarks while the ectocranial set includes landmarks commonly used in a FORDSIC10 analysis. First, landmarks were subjected to a generalized Procrustes analysis to bring them to a common coordinate system. Second, a discriminant function analysis with cross-validation was performed to assess the efficacy of landmark subsets in accurately classifying the crania. Finally, sensitivity, specificity, negative predictive value, and positive predictive value were calculated to further assess individual model performance. All analyses were performed in MorphoJ v1.06d11 with α = 0.05.
All discriminant models show statistically significant differences in mean landmark configuration between ancestral groups (p < 0.001). The ectocranial subset has the highest classification rate of 88.6% followed by ectobasicranium (82.0%), basicranium (78.8%), and endobasicranium (77.9%). Overall, the models have higher specificity (range 83.9-91.6%) than sensitivity (range 67.3-83.3%) and are able to more accurately classify White individuals than Black individuals. Positive predictive values have a range of 71.6-85.2% and negative predictive values have a range of 79.6-90.4% with the ectocranial set performing best.
Overall, landmark configurations show a longer and narrower base in the Black sample compared to the White sample. The most anterior cranial base landmark, the foramen cecum, is displaced posteriorly in White crania, and the internal occipital protuberance is displaced anteriorly, resulting in a shorter cranium in White compared to Black crania. The paired landmarks, including the stylomastoid foramen, endasterion, and jugular foramen, as well as the sigmoid sulcus point, which is the intersection between the posterior lip of the sigmoid sulcus and the occipitomastoid suture, all are more laterally displaced in White crania relative to Black.
These findings suggest that both midline and paired landmarks in the cranial base are useful in estimating ancestry, as corroborating evidence or especially in cases when the more commonly used areas of the cranium are not available for analysis. Although traditional ectocranial landmarks provide the highest classificatory rate, basicranial landmarks from the ectocranial and/or endocranial surfaces can be used to estimate ancestry and contribute to the construction of the biological profile. Forensic anthropologists should consider recording basicranial landmark coordinates when analyzing fragmentary cranial remains.
Keywords: Ancestry estimation, Cranial base, Geometric morphometrics
References:
1 Langley NR, Jantz LM, Ousley SD, Jantz RL, Milner G. Data collection procedures for forensic skeletal material 2.0. The University of Tennessee Knoxville, 2016: https://fac.utk.edu/wp-content/uploads/2016/03/DCP20_webversion.pdf.
2 Schmidt CW, Symes SA. The Analysis of Burned Human Remains, Second Edition. Academic Press: London 2015.
3 Berryman HE, Symes SA. Recognizing gunshot and blunt cranial trauma through fracture interpretation. IN: Forensic Osteology: Advances in the Identification of Human Remains, Second edition. Charles C. Thomas: Springfiled, IL 1998.
4 Holland TD. Race determination of fragmentary crania by analysis of the cranial base. J Forensic Sci 1986a;31:719-725.
5 Holland TD. Sex determination of fragmentary crania by analysis of the cranial base. Am J Phys Anthropol 1986b;70:203-208.
6 McKeown AH, Wescott DJ. Sex and ancestry estimation from landmarks of the cranial base. Proc Am Acad of Forensic Sci 2010;16:375.
7 Kolatorowicz A, Mason KA, Brienzi VL, Nawrocki SP. Assessing the efficacy of basicranial angle to determine ancestry. Proc Am Acad For Sciences 2013;19:416.
8 Siegel N. The use of the endocranial base in the estimation of ancestry. Proc Am Acad For Sciences 2013; 19:449.
9 Bruner E, Ripani M. A quantitative and descriptive approach to morphological variation of the endobasicranial base in modern humans. Am J Phys Anthropol 2008;137:30-40.
10 Jantz RL, Ousley SD. FORDISC 3.0: Personal Computer Forensic Discriminant Functions. University of Tennessee, Knoxville, TN 2005.
11 Klingenberg CP. MORPHOJ: an integrated software package for geometric morphometrics. Mol Eco Resour 2011;11:353-357.
INTRODUCTION. There are various multimedia applications for anatomy education. However, many appl... more INTRODUCTION. There are various multimedia applications for anatomy education. However, many applications lack three-dimensional (3D) images and some even compromise accuracy. Furthermore, few applications include 3D study aids produced directly from anatomical donors. Photogrammetry utilizes photography to determine distances between objects and is an underutilized technology in anatomy education. Photogrammetry coupled with computer software can use two-dimensional images captured by a still camera to create 3D digital models. The software uses overlapping images to tie points together in order to generate a 3D model. RESOURCES. A protocol for photography of human anatomical models/specimens and subsequent digital construction of 3D models was developed using a Nikon® D7100 HDSLR camera and Agisoft PhotoScan© software. DESCRIPTION. This novel study aims to utilize photogrammetry to produce 3D models for anatomy education and to digitally curate specimens. SIGNIFICANCE. The resulting models can offer students the convenience of study from satellite locations, which would give students the option to study anatomy in a variety of settings as well as the ability to minimize distractions. They could also lessen and possibly phase out wait time to study in a cluttered model room or anatomy lab by directly affecting the number of students present. Additionally, anatomical specimens or whole body donors that cannot be permanently curated may be electronically recorded for future study. Finally, the relative cost effectiveness and portability of a photogrammetry setup make it a practical and viable option compared to other 3D model producing devices, such as laser scanners or medical imaging equipment. Future work will entail creating a repository of digital models and implementing them in anatomy classes.
Clinical Anatomy, Dec 6, 2016
INTRODUCTION. The posterior deep temporal nerve traverses the roof of the infratemporal fossa to ... more INTRODUCTION. The posterior deep temporal nerve traverses the roof of the infratemporal fossa to innervate the posterior temporalis muscle and may lie within a bony groove or canal. The presence and depth of the groove has clinical implications for nerve entrapment or obstruction in patients undergoing nerve blocks. This study aims to document the heretofore unknown prevalence and variation of the groove in modern American populations as well as to investigate the association with basicranial shape. METHODS. The groove was observed in 227 adult male and female skulls of African American and European American ancestry. Depth and shape of the groove was scored bilaterally on an ordinal scale. An observer error study was conducted to establish the reliability of the scoring system. Basicranial angle of 143 crania was calculated using interlandmark distances of three cranial landmarks (nasion, sella, basion) acquired via a Microscribe® G2X digitizer. Sixteen preserved adult cadavers were examined to discern relationships of the groove and nerve with surrounding muscle and connective tissue. SUMMARY. Raters had moderate to strong agreement in scoring the groove (p<0.003). Some form of the groove is present in 83% of individuals with the right side being deeper (p=0.04). There is a significant difference in basicranial angle between ancestral groups (p=0.02), but the angle is not significantly correlated with groove score (p>0.49). There is no difference in groove score according to ancestry (p>0.14) or sex (p>0.34). The nerve was found to travel through lateral pterygoid muscle and, when in a groove, covered by a band of connective tissue. CONCLUSION. The posterior deep temporal nerve groove is a common variant and, if presenting as a deep groove or canal, should be considered by clinicians when assessing functional deficits and providing treatment. Further geometric morphometric analysis of basicranial morphology may explain variation in this feature.
The repeatability, precision, and validity of anthropometric landmarks has been assessed in the c... more The repeatability, precision, and validity of anthropometric landmarks has been assessed in the context of the ectocranium, but few studies have examined the reproducibility of endocranial landmarks. This is due in part to the difficulty in accessing these landmarks. To evaluate the repeatability of registering endocranial landmarks with a digitizer, nineteen homologous landmarks (9 Type I, 10 Type II, 7 unpaired, 12 paired) defining the endocranial base were selected for analysis. Three observers digitized 15 anatomical specimens with a coordinate measuring machine over four measurement rounds with at least four days separating each round (180 configurations total). Significant effects on shape due to individual observer and digitization were found after a Procrustes fit of the coordinate data and subsequent Procrustes ANOVA (p < 0.0001). Observer error was 2.52 times greater than digitizing error and the smallest level of biological variation was 3.64 times greater than observer error. Patterns of variation in the levels of measurement error were explored with a principal components analysis of the covariance matrices for observer and digitization variables. The greatest shape changes were seen in anterior frontal, posterior frontal, and internal occipital protuberance landmarks, all Type II. This study is not a measure of individual landmark location; rather, it examines the effect of individual landmarks on mean shape. Thus, data collected from multiple observers of the endobasicranium may be combined into a single data set for further analyses and hypothesis testing of shape variation and covariance of landmarks, such as assessing patterns of modularity.
Morphological integration as a theoretical framework for understanding evolutionary processes and... more Morphological integration as a theoretical framework for understanding evolutionary processes and explaining specific changes in complex structures has guided research over the last six decades. The modules that interact, or do not interact, with one another must be explicitly defined within the context of the research question. As such, definitions may vary greatly from one study to another. In this study, four commonly defined patterns of modularity in the modern human cranium were tested based on 1) functional demands, 2) developmental origin, 3) special sensation, and 4) the basicranium as a separate module. Three-dimensional coordinate data of 120 endocranial and ectocranial landmarks from 388 anatomically modern adult humans were subjected to generalized Procrustes analysis and then areas of shape variation were identified via principal components analysis of shape coordinates. Calculating the multi-set RV coefficients for hypothesized partitions and comparing them to random partitions of the landmark configuration revealed that the cranium is more integrated when considering functional demands of cranial components (RVM = 0.1831, p = 0.0000) or sensory fields (RVM = 0.1868, p = 0.0994) and is less modular when considering developmental fields (RVM = 0.3422, p = 0.0036) or the basicranium (RVM = 0.3458, p = 0.0001). Depending on how one defines cranial modules, results may be quite different and not comparable across studies. This study highlights differences among theoretical bases of morphological integration. The findings can be used in clinical applications for surgical treatment of craniofacial-related disorders and injuries as well as evaluating models of human evolution.
Anthropological field schools offer a unique opportunity to gain practical experience in applying... more Anthropological field schools offer a unique opportunity to gain practical experience in applying the methods and techniques used by professional anthropologists in the field and the laboratory. Assessing student performance in field-based courses poses different sets of challenges compared to a traditional classroom setting. An innovative model for student evaluation, combining rapid assessment processes with content analysis, can be effectively applied to address the experiential nature of these programs. Forensic anthropology, archeology, and osteology field schools may not have a formal evaluation process other than students devoting sufficient time to complete required activities. This time factor is then translated into a letter grade or certificate of completion. Still, participants may not have acquired essential skills by completing the program despite in-depth, practical study. This newly offered method focuses on quantitative data and statistical hypothesis testing to formally determine if students increased their knowledge base and skill set as a result of the field school learning experience. Qualitative work produced by the students through hands-on, team and problem-based activities can then be transformed into binary variables to allow for quantitative analysis. This method demonstrates that students exhibit significant differences in multiple knowledge and skill areas gained upon completion of the field course. Instructors can use this information to verify that students have walked away from the program as a better-trained anthropologist. This method can also be used to further refine course design and instructional strategies, as well as gain new insights to understand how students engage with instructors, classmates, and Anthropology.
The applicability of FORDISC in resolving issues of sex assessment in an historic population was ... more The applicability of FORDISC in resolving issues of sex assessment in an historic population was addressed by analyzing forty crania of unknown sex originating from a late 19th to early 20th century Italian ossuary. Fifty-six measurements were taken from each individual, entered into FORDSIC 3.1, and compared to the Forensic Databank and the Howells database to identify patterns of similarity to reference populations and determine the sex of individuals. We hypothesized the study sample would be more similar to the American White reference populations due to shared ancestry, most individuals in the study sample would be atypical of the reference populations, and that the majority of the individuals are female, based on visual assessment. Not including prior knowledge of the sample’s origin, FORDISC classified 67.5% of the sample as White while the remaining individuals were classified in multiple ancestry/sex groups. Posterior and typicality probabilities ranged from 0.177 to 1.000 and 0.011 to 0.993, respectively, with models providing 49.6-95.2% correct classification. Including prior knowledge of the sample’s origin classified 70% of the sample as female and 30% as male. Only five crania were classified differently as pertains to sex when limiting comparison to the White samples in the historic and modern reference populations. All craniometric classifications were largely concordant with non-metric assessments of sex, suggesting that craniometric assessments may serve as verification for non-metric sex determination. One may apply FORDISC to an historic sample if familiar with levels of sexual dimorphism in the local population and proceeding with (statistical) caution.
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Conference Presentations by Adam Kolatorowicz
While most kidneys are supplied by a single renal artery at the level of the L2 vertebral body, findings of supernumerary renal vessels are a common occurrence. The origin, number, and path of these vessels are highly variable. Cephalad ascent of the embryonic kidney during development results in the obliteration of existing vessels as new vasculature is established. Failure of degeneration of the supporting vasculature during this ascension can result in blood supply variations. Literature shows a wide variation in the incidence of ‘all type’ supernumerary renal vessels ranging from 7-76% of cadaveric and CT-scan specimens. This larger category of supernumerary renal vessels can be categorized based on the type of accessory renal vasculature found, variations in attachment site into the renal parenchyma, total number of accessory vessels, and course taken from either the abdominal aorta or the IVC. Incidences of bilateral accessory renal arteries are approximately 10% of cases. This case report adds to the existing literature of uncommon supernumerary renal vessels with bilateral inferior pole arteries.
Case Description:
The routine dissection of a 78-year-old female, formalin-fixed, whole body donor resulted in the incidental finding of bilateral renal vascular variations. Dissection had been completed during a first-year medical school anatomy course with only minor cleaning of the kidneys and surrounding vasculature. Further investigation of this donor revealed, in addition to classically found hilar vessels, an extra renal artery on the right starting slightly above the bifurcation of the abdominal aorta traveling anterior to the ureter before inserting into the inferior pole of the kidney. On the left, two accessory renal vessels were found inserting into the inferior pole of the kidney. Disrupted by previous dissection, visualization suggested an additional renal artery departing the abdominal aorta slightly above the bifurcation as well as an additional renal vein traveling to the inferior vena cava.
Discussion:
Understanding renal vasculature variations is vital as it influences urological procedures, renal transplantation, and other surgical procedures involving the retroperitoneum. When transplant teams must deal with multiple renal vessels, the Warm Ischemia Time (WIT) increases which has been shown to alter the ability and time for reperfusion following transplant, as well as varied outcomes in organ function upon reperfusion. As the number of supernumerary renal vessels increases, this WIT increases causing delays which can further impact transplant success. Additionally, the path of these accessory renal vessels over the pelvi-ureteric junction (PUJ) can cause issues in a patient as well. Studies demonstrate the effect of alterations in pressure in the renal pelvis in patients with accessory vessels that cross the PUJ compared to those without this crossing. Evidence of increased renal pelvis pressure was found in these patients with crossing vessels as well as increased incidence of PUJ obstruction.
Conclusion:
Detailed documentation of renal vasculature variations and associated medical implications is essential for anatomists and physicians. Further investigation into incidence and impact of these variations is recommended to broaden understanding, reduce risk of complications during medical interventions, and mitigate adverse outcomes.
Objective: The primary aim of this study was to provide continuity to the current literature on the needle thoracostomy. To accomplish this, the current study examines the extent of research regarding needle thoracostomy, summarizes the findings of prior research, and identifies gaps in existing literature.
Design/Methods: A scoping review was conducted using a modified version of the Arksey and O’ Malley framework. Inclusion and exclusion criteria were predetermined, along with a precise, working definition of the procedure. A search was conducted in six online databases to identify all studies relating to needle thoracostomy. Full text review was completed on 103 articles. The articles were assessed for relevance and categorized by two independent reviewers.
Results: The search yielded 60 relevant articles. After review, the articles were categorized into six common themes: placement site, needle length, procedural complications, provider training, pediatric studies, and miscellaneous. A broad, succinct review of current literature regarding needle thoracostomy could inform much needed changes in standard of practice and provide multiple avenues of future research.
Conclusion: This review illustrates that the location of needle thoracostomy and length of the needle used have been thoroughly researched. In addition, current literature has proposed multiple training modalities on the procedure in an attempt to increase provider confidence and competency. Specialized devices created to perform a needle thoracostomy have also been proposed more recently. However, there has been relatively little research done on the complications of the procedure and how the procedure should be adjusted for pediatric patients.
Impact: A broad, succinct review of current literature regarding needle thoracostomy could inform much needed changes in standard of practice and provide multiple avenues of future research.
INTRODUCTION. The splenic artery is well known for its conspicuously tortuous path, often having many loops, turns, and even elaborate coils. Previous hypotheses suggest that the coiled nature of the artery accommodates the expansion of the stomach, the movement of the diaphragm, is a result of higher blood pressure, or even the result of vascular disease. Pathologically tortuous vessels are more likely to experience aneurysm. The purpose of this study is to quantify splenic artery tortuosity and identify explanatory and confounding factors. METHODS. One hundred thirty-one formalin-fixed donors were dissected to expose the splenic artery from its origin on the celiac trunk to its branching prior to entering the spleen (63 females, 68 males, aged 50-101 years). Vessel tortuosity, vessel diameter, vessel wall thickness, and splenic volume were measured with spreading calipers. Presence, extent and calcification of atheroma was visually observed. Sex, age of death, and cause of death were abstracted from donor records. Correlations between variables were calculated to explore potential relationships. ANCOVA was used to examine variable effect magnitude on tortuosity. All analyses were performed with α = 0.05 in SPSS v26. SUMMARY. The average tortuosity index is 1.80 (1.00-4.08) and 51.1% of the sample had atheromas. No significant associations exist between tortuosity and the other parameters. The general linear model shows that vessel thickness, splenic volume, and presence of atheroma influence tortuosity, explaining 0.5%, 15.1%, and 7.1% of the variation in tortuosity, respectively. All other variables have no effect. CONCLUSIONS. Results suggest that vascular health and biomechanical factors influence tortuosity. Atherosclerotic plaques would alter blood flow dynamics, vessel dimensions, and vessel wall microstructure. An incidental finding of marked splenic artery tortuosity in a patient could indicate systemic vascular disease that warrants further investigation.
Osteoarthritis (OA) is largely viewed as a chronic disease that is both inevitable and difficult to manage. Lifespan has markedly increased worldwide over the last hundred years and it is thought that the increase in lifespan has led to an increase in the prevalence of chronic diseases. The joints of the body experience more degeneration than in previous generations, thereby increasing the likelihood that an individual acquires OA in their lifetime. In addition to increased lifespan, obesity is a major risk factor for OA. The increased weight load placed on the knee joint, and the increased tissue adiposity, which leads to meta-inflammation via adipokines and pro-inflammatory cytokines, deteriorates the structural integrity of bone and cartilage in the joint. However, recent research comparing knee OA in preindustrial and postindustrial skeletons has shown that its increased prevalence in the modern era is not due to obesity and increased lifespan as conventionally assumed. Arguably, the largely worldwide decrease in physical activity may be the primary cause of the increase in postindustrial OA. The aim of this study is to determine if activity level affects the likelihood of developing OA. One’s occupation can be used as a proxy for activity level to better understand the prevalence of OA in different occupations requiring varying metabolic demands. The hypothesis is that individuals with lower activity levels will be more likely to have knee OA.
Methods
Convenience sampling was conducted of all available individuals with known occupation (n=567) from the William M. Bass Donated Skeletal Collection at The University of Tennessee. All donors were adults (21-80 years-old) of primarily European descent who lived and died during the late 20th century, comprising 373 males and 194 females.
A macromorphoscopic examination of the left and right femoral condyles, patellae, and tibial condyles was conducted to evaluate for signs of osteoarthritis. Osteoarthritis in the medial and lateral femorotibial and femoropatellar compartments was diagnosed by the presence of eburnation, a visually distinct, reflective, and glistening surface produced by bone-on-bone contact during joint articulation. The presence of eburnation was scored as either being present or absent. The sex, age-at-death, weight, stature, and occupation were drawn from the donor records. Activity level in each occupation was quantified using metabolic equivalent (MET) values, or the ratio of the work metabolic rate to the resting metabolic rate, as obtained from the National Cancer Institute. BMI was calculated from height and weight data in donor records. To avoid falsely diagnosing eburnation, individuals with postmortem damage, non-OA pathological changes, traumatic injury, and comminuted femorotibial or femoropatellar compartments were excluded from the sample.
A binomial logistic regression analysis was conducted to assess the effects of sex, age, activity level, and BMI on the likelihood that individuals have OA. A receiver operating characteristic (ROC) curve analysis was performed to assess the sensitivity and specificity of using MET value for predicting OA. Negative and positive predictive values were calculated to further assess model performance. All statistical analyses were performed in SPSS v22.0 with α = 0.05.
Results
Prevalence of knee OA in the sample was found to be at 15.3%. Individuals with and without OA have an average MET value of 2.90 and 2.60, respectively. The logistic regression model explained 8.1% (Nagelkerke R2) of the variance in OA, and correctly classified 82.4% of cases. The model had high specificity (0.997), low sensitivity (0.0128), low positive predictive value (0.5), and moderate negative predictive value (0.825). Age (p=0.098) and sex (p=0.087) do not affect the likelihood of OA whereas MET value (p=0.002) and BMI (p=0.004) have a statistically significant effect on OA. Increasing MET value and BMI is associated with an increased likelihood of OA. The ROC curve suggests MET value is not a reliable indicator of OA (area under the curve = 0.588, p=0.009).
Conclusion
This is the first study to use occupation and MET values as a proxy for activity level to investigate the effect of activity level on the presence of knee OA. In this sample, more active individuals with higher BMI are more likely to have OA compared to less active individuals with lower BMI. Some limitations of this study include the observational nature of the research design and a relatively small, homogenous sample predominately composed of males and individuals without OA. Future research will expand the sample size with individuals from different populations and include living individuals with clinical data.
This presentation will impact the forensic science community by providing an alternative metric method for estimating ancestry from fragmentary crania.
The cranium is one of the most informative and widely used areas of the human skeleton in establishing the sex and ancestry of human remains. Standard methods of cranial morphometrics in forensic anthropology include the use of landmarks and features on the ectocranial surface of the vault and the face.1 These methods largely require intact crania. In a forensic setting, the cranium is often damaged and the traditionally used landmarks are obscured or destroyed.2 When fragmentary or unable to be reconstructed, the cranium is often not used for identification purposes in these cases.3-5 As a result, potentially valuable information contained within the remaining unexamined portions of the cranium is discarded. For example, in the case of fatal fires, the cranium is often deemed unusable because the typically evaluated areas for anthropological analysis (vault, face, mandible) are damaged or missing. The cranial base, however, is protected by the neck musculature, and oftentimes present with fragmentary remains. The cranial base is a relatively underused region of the cranium in forensic anthropological analysis, and is only recently being rigorously evaluated for its utility in prediction of ancestry and sex.6-9 This project tests the hypothesis that that there are differences in cranial base shape between American White and Black individuals by comparing cranial base landmark data with standard ectocranial landmark data.
A total of 73 landmarks of the endocranial and ectocranial surfaces were registered using a MicroScribe® G2X portable coordinate measuring machine from 245 adult crania in the Hamann-Todd Human Osteological Collection and the WM Bass Donated Collection. Landmarks were divided into four subsets: endobasicranial (18 landmarks), ectobasicranial (18 landmarks), all basicranial (36 landmarks), and ectocranial (43 landmarks). The first three subsets include uncommon landmarks while the ectocranial set includes landmarks commonly used in a FORDSIC10 analysis. First, landmarks were subjected to a generalized Procrustes analysis to bring them to a common coordinate system. Second, a discriminant function analysis with cross-validation was performed to assess the efficacy of landmark subsets in accurately classifying the crania. Finally, sensitivity, specificity, negative predictive value, and positive predictive value were calculated to further assess individual model performance. All analyses were performed in MorphoJ v1.06d11 with α = 0.05.
All discriminant models show statistically significant differences in mean landmark configuration between ancestral groups (p < 0.001). The ectocranial subset has the highest classification rate of 88.6% followed by ectobasicranium (82.0%), basicranium (78.8%), and endobasicranium (77.9%). Overall, the models have higher specificity (range 83.9-91.6%) than sensitivity (range 67.3-83.3%) and are able to more accurately classify White individuals than Black individuals. Positive predictive values have a range of 71.6-85.2% and negative predictive values have a range of 79.6-90.4% with the ectocranial set performing best.
Overall, landmark configurations show a longer and narrower base in the Black sample compared to the White sample. The most anterior cranial base landmark, the foramen cecum, is displaced posteriorly in White crania, and the internal occipital protuberance is displaced anteriorly, resulting in a shorter cranium in White compared to Black crania. The paired landmarks, including the stylomastoid foramen, endasterion, and jugular foramen, as well as the sigmoid sulcus point, which is the intersection between the posterior lip of the sigmoid sulcus and the occipitomastoid suture, all are more laterally displaced in White crania relative to Black.
These findings suggest that both midline and paired landmarks in the cranial base are useful in estimating ancestry, as corroborating evidence or especially in cases when the more commonly used areas of the cranium are not available for analysis. Although traditional ectocranial landmarks provide the highest classificatory rate, basicranial landmarks from the ectocranial and/or endocranial surfaces can be used to estimate ancestry and contribute to the construction of the biological profile. Forensic anthropologists should consider recording basicranial landmark coordinates when analyzing fragmentary cranial remains.
Keywords: Ancestry estimation, Cranial base, Geometric morphometrics
References:
1 Langley NR, Jantz LM, Ousley SD, Jantz RL, Milner G. Data collection procedures for forensic skeletal material 2.0. The University of Tennessee Knoxville, 2016: https://fac.utk.edu/wp-content/uploads/2016/03/DCP20_webversion.pdf.
2 Schmidt CW, Symes SA. The Analysis of Burned Human Remains, Second Edition. Academic Press: London 2015.
3 Berryman HE, Symes SA. Recognizing gunshot and blunt cranial trauma through fracture interpretation. IN: Forensic Osteology: Advances in the Identification of Human Remains, Second edition. Charles C. Thomas: Springfiled, IL 1998.
4 Holland TD. Race determination of fragmentary crania by analysis of the cranial base. J Forensic Sci 1986a;31:719-725.
5 Holland TD. Sex determination of fragmentary crania by analysis of the cranial base. Am J Phys Anthropol 1986b;70:203-208.
6 McKeown AH, Wescott DJ. Sex and ancestry estimation from landmarks of the cranial base. Proc Am Acad of Forensic Sci 2010;16:375.
7 Kolatorowicz A, Mason KA, Brienzi VL, Nawrocki SP. Assessing the efficacy of basicranial angle to determine ancestry. Proc Am Acad For Sciences 2013;19:416.
8 Siegel N. The use of the endocranial base in the estimation of ancestry. Proc Am Acad For Sciences 2013; 19:449.
9 Bruner E, Ripani M. A quantitative and descriptive approach to morphological variation of the endobasicranial base in modern humans. Am J Phys Anthropol 2008;137:30-40.
10 Jantz RL, Ousley SD. FORDISC 3.0: Personal Computer Forensic Discriminant Functions. University of Tennessee, Knoxville, TN 2005.
11 Klingenberg CP. MORPHOJ: an integrated software package for geometric morphometrics. Mol Eco Resour 2011;11:353-357.
While most kidneys are supplied by a single renal artery at the level of the L2 vertebral body, findings of supernumerary renal vessels are a common occurrence. The origin, number, and path of these vessels are highly variable. Cephalad ascent of the embryonic kidney during development results in the obliteration of existing vessels as new vasculature is established. Failure of degeneration of the supporting vasculature during this ascension can result in blood supply variations. Literature shows a wide variation in the incidence of ‘all type’ supernumerary renal vessels ranging from 7-76% of cadaveric and CT-scan specimens. This larger category of supernumerary renal vessels can be categorized based on the type of accessory renal vasculature found, variations in attachment site into the renal parenchyma, total number of accessory vessels, and course taken from either the abdominal aorta or the IVC. Incidences of bilateral accessory renal arteries are approximately 10% of cases. This case report adds to the existing literature of uncommon supernumerary renal vessels with bilateral inferior pole arteries.
Case Description:
The routine dissection of a 78-year-old female, formalin-fixed, whole body donor resulted in the incidental finding of bilateral renal vascular variations. Dissection had been completed during a first-year medical school anatomy course with only minor cleaning of the kidneys and surrounding vasculature. Further investigation of this donor revealed, in addition to classically found hilar vessels, an extra renal artery on the right starting slightly above the bifurcation of the abdominal aorta traveling anterior to the ureter before inserting into the inferior pole of the kidney. On the left, two accessory renal vessels were found inserting into the inferior pole of the kidney. Disrupted by previous dissection, visualization suggested an additional renal artery departing the abdominal aorta slightly above the bifurcation as well as an additional renal vein traveling to the inferior vena cava.
Discussion:
Understanding renal vasculature variations is vital as it influences urological procedures, renal transplantation, and other surgical procedures involving the retroperitoneum. When transplant teams must deal with multiple renal vessels, the Warm Ischemia Time (WIT) increases which has been shown to alter the ability and time for reperfusion following transplant, as well as varied outcomes in organ function upon reperfusion. As the number of supernumerary renal vessels increases, this WIT increases causing delays which can further impact transplant success. Additionally, the path of these accessory renal vessels over the pelvi-ureteric junction (PUJ) can cause issues in a patient as well. Studies demonstrate the effect of alterations in pressure in the renal pelvis in patients with accessory vessels that cross the PUJ compared to those without this crossing. Evidence of increased renal pelvis pressure was found in these patients with crossing vessels as well as increased incidence of PUJ obstruction.
Conclusion:
Detailed documentation of renal vasculature variations and associated medical implications is essential for anatomists and physicians. Further investigation into incidence and impact of these variations is recommended to broaden understanding, reduce risk of complications during medical interventions, and mitigate adverse outcomes.
Objective: The primary aim of this study was to provide continuity to the current literature on the needle thoracostomy. To accomplish this, the current study examines the extent of research regarding needle thoracostomy, summarizes the findings of prior research, and identifies gaps in existing literature.
Design/Methods: A scoping review was conducted using a modified version of the Arksey and O’ Malley framework. Inclusion and exclusion criteria were predetermined, along with a precise, working definition of the procedure. A search was conducted in six online databases to identify all studies relating to needle thoracostomy. Full text review was completed on 103 articles. The articles were assessed for relevance and categorized by two independent reviewers.
Results: The search yielded 60 relevant articles. After review, the articles were categorized into six common themes: placement site, needle length, procedural complications, provider training, pediatric studies, and miscellaneous. A broad, succinct review of current literature regarding needle thoracostomy could inform much needed changes in standard of practice and provide multiple avenues of future research.
Conclusion: This review illustrates that the location of needle thoracostomy and length of the needle used have been thoroughly researched. In addition, current literature has proposed multiple training modalities on the procedure in an attempt to increase provider confidence and competency. Specialized devices created to perform a needle thoracostomy have also been proposed more recently. However, there has been relatively little research done on the complications of the procedure and how the procedure should be adjusted for pediatric patients.
Impact: A broad, succinct review of current literature regarding needle thoracostomy could inform much needed changes in standard of practice and provide multiple avenues of future research.
INTRODUCTION. The splenic artery is well known for its conspicuously tortuous path, often having many loops, turns, and even elaborate coils. Previous hypotheses suggest that the coiled nature of the artery accommodates the expansion of the stomach, the movement of the diaphragm, is a result of higher blood pressure, or even the result of vascular disease. Pathologically tortuous vessels are more likely to experience aneurysm. The purpose of this study is to quantify splenic artery tortuosity and identify explanatory and confounding factors. METHODS. One hundred thirty-one formalin-fixed donors were dissected to expose the splenic artery from its origin on the celiac trunk to its branching prior to entering the spleen (63 females, 68 males, aged 50-101 years). Vessel tortuosity, vessel diameter, vessel wall thickness, and splenic volume were measured with spreading calipers. Presence, extent and calcification of atheroma was visually observed. Sex, age of death, and cause of death were abstracted from donor records. Correlations between variables were calculated to explore potential relationships. ANCOVA was used to examine variable effect magnitude on tortuosity. All analyses were performed with α = 0.05 in SPSS v26. SUMMARY. The average tortuosity index is 1.80 (1.00-4.08) and 51.1% of the sample had atheromas. No significant associations exist between tortuosity and the other parameters. The general linear model shows that vessel thickness, splenic volume, and presence of atheroma influence tortuosity, explaining 0.5%, 15.1%, and 7.1% of the variation in tortuosity, respectively. All other variables have no effect. CONCLUSIONS. Results suggest that vascular health and biomechanical factors influence tortuosity. Atherosclerotic plaques would alter blood flow dynamics, vessel dimensions, and vessel wall microstructure. An incidental finding of marked splenic artery tortuosity in a patient could indicate systemic vascular disease that warrants further investigation.
Osteoarthritis (OA) is largely viewed as a chronic disease that is both inevitable and difficult to manage. Lifespan has markedly increased worldwide over the last hundred years and it is thought that the increase in lifespan has led to an increase in the prevalence of chronic diseases. The joints of the body experience more degeneration than in previous generations, thereby increasing the likelihood that an individual acquires OA in their lifetime. In addition to increased lifespan, obesity is a major risk factor for OA. The increased weight load placed on the knee joint, and the increased tissue adiposity, which leads to meta-inflammation via adipokines and pro-inflammatory cytokines, deteriorates the structural integrity of bone and cartilage in the joint. However, recent research comparing knee OA in preindustrial and postindustrial skeletons has shown that its increased prevalence in the modern era is not due to obesity and increased lifespan as conventionally assumed. Arguably, the largely worldwide decrease in physical activity may be the primary cause of the increase in postindustrial OA. The aim of this study is to determine if activity level affects the likelihood of developing OA. One’s occupation can be used as a proxy for activity level to better understand the prevalence of OA in different occupations requiring varying metabolic demands. The hypothesis is that individuals with lower activity levels will be more likely to have knee OA.
Methods
Convenience sampling was conducted of all available individuals with known occupation (n=567) from the William M. Bass Donated Skeletal Collection at The University of Tennessee. All donors were adults (21-80 years-old) of primarily European descent who lived and died during the late 20th century, comprising 373 males and 194 females.
A macromorphoscopic examination of the left and right femoral condyles, patellae, and tibial condyles was conducted to evaluate for signs of osteoarthritis. Osteoarthritis in the medial and lateral femorotibial and femoropatellar compartments was diagnosed by the presence of eburnation, a visually distinct, reflective, and glistening surface produced by bone-on-bone contact during joint articulation. The presence of eburnation was scored as either being present or absent. The sex, age-at-death, weight, stature, and occupation were drawn from the donor records. Activity level in each occupation was quantified using metabolic equivalent (MET) values, or the ratio of the work metabolic rate to the resting metabolic rate, as obtained from the National Cancer Institute. BMI was calculated from height and weight data in donor records. To avoid falsely diagnosing eburnation, individuals with postmortem damage, non-OA pathological changes, traumatic injury, and comminuted femorotibial or femoropatellar compartments were excluded from the sample.
A binomial logistic regression analysis was conducted to assess the effects of sex, age, activity level, and BMI on the likelihood that individuals have OA. A receiver operating characteristic (ROC) curve analysis was performed to assess the sensitivity and specificity of using MET value for predicting OA. Negative and positive predictive values were calculated to further assess model performance. All statistical analyses were performed in SPSS v22.0 with α = 0.05.
Results
Prevalence of knee OA in the sample was found to be at 15.3%. Individuals with and without OA have an average MET value of 2.90 and 2.60, respectively. The logistic regression model explained 8.1% (Nagelkerke R2) of the variance in OA, and correctly classified 82.4% of cases. The model had high specificity (0.997), low sensitivity (0.0128), low positive predictive value (0.5), and moderate negative predictive value (0.825). Age (p=0.098) and sex (p=0.087) do not affect the likelihood of OA whereas MET value (p=0.002) and BMI (p=0.004) have a statistically significant effect on OA. Increasing MET value and BMI is associated with an increased likelihood of OA. The ROC curve suggests MET value is not a reliable indicator of OA (area under the curve = 0.588, p=0.009).
Conclusion
This is the first study to use occupation and MET values as a proxy for activity level to investigate the effect of activity level on the presence of knee OA. In this sample, more active individuals with higher BMI are more likely to have OA compared to less active individuals with lower BMI. Some limitations of this study include the observational nature of the research design and a relatively small, homogenous sample predominately composed of males and individuals without OA. Future research will expand the sample size with individuals from different populations and include living individuals with clinical data.
This presentation will impact the forensic science community by providing an alternative metric method for estimating ancestry from fragmentary crania.
The cranium is one of the most informative and widely used areas of the human skeleton in establishing the sex and ancestry of human remains. Standard methods of cranial morphometrics in forensic anthropology include the use of landmarks and features on the ectocranial surface of the vault and the face.1 These methods largely require intact crania. In a forensic setting, the cranium is often damaged and the traditionally used landmarks are obscured or destroyed.2 When fragmentary or unable to be reconstructed, the cranium is often not used for identification purposes in these cases.3-5 As a result, potentially valuable information contained within the remaining unexamined portions of the cranium is discarded. For example, in the case of fatal fires, the cranium is often deemed unusable because the typically evaluated areas for anthropological analysis (vault, face, mandible) are damaged or missing. The cranial base, however, is protected by the neck musculature, and oftentimes present with fragmentary remains. The cranial base is a relatively underused region of the cranium in forensic anthropological analysis, and is only recently being rigorously evaluated for its utility in prediction of ancestry and sex.6-9 This project tests the hypothesis that that there are differences in cranial base shape between American White and Black individuals by comparing cranial base landmark data with standard ectocranial landmark data.
A total of 73 landmarks of the endocranial and ectocranial surfaces were registered using a MicroScribe® G2X portable coordinate measuring machine from 245 adult crania in the Hamann-Todd Human Osteological Collection and the WM Bass Donated Collection. Landmarks were divided into four subsets: endobasicranial (18 landmarks), ectobasicranial (18 landmarks), all basicranial (36 landmarks), and ectocranial (43 landmarks). The first three subsets include uncommon landmarks while the ectocranial set includes landmarks commonly used in a FORDSIC10 analysis. First, landmarks were subjected to a generalized Procrustes analysis to bring them to a common coordinate system. Second, a discriminant function analysis with cross-validation was performed to assess the efficacy of landmark subsets in accurately classifying the crania. Finally, sensitivity, specificity, negative predictive value, and positive predictive value were calculated to further assess individual model performance. All analyses were performed in MorphoJ v1.06d11 with α = 0.05.
All discriminant models show statistically significant differences in mean landmark configuration between ancestral groups (p < 0.001). The ectocranial subset has the highest classification rate of 88.6% followed by ectobasicranium (82.0%), basicranium (78.8%), and endobasicranium (77.9%). Overall, the models have higher specificity (range 83.9-91.6%) than sensitivity (range 67.3-83.3%) and are able to more accurately classify White individuals than Black individuals. Positive predictive values have a range of 71.6-85.2% and negative predictive values have a range of 79.6-90.4% with the ectocranial set performing best.
Overall, landmark configurations show a longer and narrower base in the Black sample compared to the White sample. The most anterior cranial base landmark, the foramen cecum, is displaced posteriorly in White crania, and the internal occipital protuberance is displaced anteriorly, resulting in a shorter cranium in White compared to Black crania. The paired landmarks, including the stylomastoid foramen, endasterion, and jugular foramen, as well as the sigmoid sulcus point, which is the intersection between the posterior lip of the sigmoid sulcus and the occipitomastoid suture, all are more laterally displaced in White crania relative to Black.
These findings suggest that both midline and paired landmarks in the cranial base are useful in estimating ancestry, as corroborating evidence or especially in cases when the more commonly used areas of the cranium are not available for analysis. Although traditional ectocranial landmarks provide the highest classificatory rate, basicranial landmarks from the ectocranial and/or endocranial surfaces can be used to estimate ancestry and contribute to the construction of the biological profile. Forensic anthropologists should consider recording basicranial landmark coordinates when analyzing fragmentary cranial remains.
Keywords: Ancestry estimation, Cranial base, Geometric morphometrics
References:
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This project examines patterns of phenotypic integration in modern human cranial morphology using geometric morphometric methods. It is theoretically based in the functional paradigm of craniofacial growth and morphological integration. The hypotheses being addressed are: 1) cranial form is influenced by secular trends, sex, and phylogenetic history of the population and 2) integration patterns wherein the basicranium is the keystone feature best explains the relationships among in cranial modules.
Geometric morphometric methods were used to collect and analyze three-dimensional coordinate data of 152 endocranial and ectocranial landmarks from 391 anatomically modern human crania. These crania are derived from temporally historic and recent groups in the United States spanning both sexes and across several ancestral groups. Landmark data were subjected to generalized Procrustes analysis and then areas of shape variation were identified via principal components analysis of shape coordinates. Discriminant function analysis and canonical variate analysis identified regions that can be used to separate groups. Temporal period, ancestry, and sex all have significant effects on mean shape. Age-at-death accounts for a small proportion of the total variation. Modern individuals have higher, narrower vaults with highly arched palates and historic individuals have short, wider vaults with shallower palates. The forehead, brow ridges, and cheek shape were closely associated with sexual dimorphism. Variation in both the vault and face allowed for separation of ancestral groups with concomitant inferior movement of the anterior basicranium in the median plane.
Three major hypotheses of modularity were tested based on functional demands of cranial modules, functional-developmental fields, and the basicranium. Comparing covariance structures of partitions of landmark subsets revealed that the cranium is more integrated when considering functional demands of cranial components origins of cranial components and is less modular when considering developmental origins. Special sensory modules are the most independent units in the cranium. Depending on the definition of cranial modules, results may be quite different and not comparable across studies.
This project integrates anthropology, evolutionary anatomy, and developmental biology. It makes a significant contribution to our understanding of integration patterns in the modern human cranium and highlights differences among theoretical frameworks of integration. The findings can be used for individual identification in medicolegal contexts and clinical applications for surgical treatment of craniofacial-related disorders and injuries. Future research will include examining patterns of morphological integration in non-human primates.
Sixty five cranial measurement were taken on 155 adult human crania from three different ancestral groups: (1) African American (n = 50), (2) European American (n = 50), and (3) Coyotero Apache (n = 55). The 65 measurements were broken up into four subsets for statistical analysis: (1) FD2 (1996), (2) Howells (1973), (3) Gill (1984), and (4) All Measurements. A predictive discriminant analysis with a forward stepwise methodology of p = 0.05 to enter and p = 0.15 to remove was run using the computer software package SPSS 13.0. The analysis produced 4 sets of discriminant function formulae. The classificatory power of each set of formulae was determined by comparing the hit-rate estimation (the percent correctly classified) of each of the subsets. First, the resubstitution rate was compared to the leave-one-out (LOO) rate for each subset and then both rates were compared across all subsets. The FD2 subset had a resubstitution rate of 90.3% and LOO rate of 85.8%. The Howells subset had a resubstitution rate of 92.9% and a LOO rate of 90.3%. The Gill subset had a resubstitution rate of 63.2% and a LOO rate of 61.9%. Finally, the All Measurements subset had a resubstitution rate of 95.5% and a LOO rate of 93.5%. The non-standard measurements of the All Measurements subset performed the best and the standard FD2 measurements performed third best. Non-standard measurements incorporated in the All Measurements formulae included frontal subtense, mid-orbital breadth, bistephanic breadth, bimaxillary breadth, and molar alveolar radius.
The formulae provided the best separation of the Apache group from the other two groups. Stepwise analysis showed that the use of more variables is not necessarily better, as not all of the variables were included in the final formulae. Only 12 of the 24 FD2 measurements, 12 of the 57 Howells measurements, 4 of the 6 Gill measurements, and 15 of the 65 All Measurements were used. Results show that the non-standard measurements can be useful for determining the ancestry of unknown human crania. These measurements could be especially useful for incomplete crania. It is suggested that biological anthropology laboratories purchase radiometers and coordinate calipers to record data that would be missed with spreading and sliding calipers. Standard measurements can be combined with non-standard measurements to produce more powerful discriminant function formulae for the determination of ancestry.