Impact of geometry and viewing angle on classification accuracy of 2D based analysis of dysmorphic faces

Digital image analysis of faces has been demonstrated to be effective in a small number of syndromes. In this paper we investigate several aspects that help bringing these methods closer to clinical application. First, we investigate the impact of increasing the number of syndromes from 10 to 14 as compared to an earlier study. Second, we include a side-view pose into the analysis and third, we scrutinize the effect of geometry information. Picture analysis uses a Gabor wavelet transform, standardization of landmark coordinates and subsequent statistical analysis. We can demonstrate that classification accuracy drops from 76% for 10 syndromes to 70% for 14 syndromes for frontal images. Including side-views achieves an accuracy of 76% again. Geometry performs excellently with 85% for combined poses. Combination of wavelets and geometry for both poses increases accuracy to 93%. In conclusion, a larger number of syndromes can be handled effectively by means of image analysis.     

Perthes' or Perthes' resembling disease in 13-month-old boy

Onset of Perthes' disease is reported frequently from the age of 2 years. Latest publications showed cases with onset of this disease in infancy at ages of 17 and 18 months. We report the case of a 13-month-old boy, who presented with left-sided limping. Radiological examination showed reduced height and fragmentation of the femoral head. Magnetic resonance imaging showed the typical signs of an avascular necrosis. Follow-up was done after 3, 7 and 15 months. Plain radiography showed the femoral head in a state of reparation. This is the youngest documented case of Legg-Calvé-Perthes' disease and is discussed under consideration of the current literature.     

Lack of effect on bone healing of injectable BMP-2 augmented hyaluronic acid

Introduction

Autologous bone graft is the gold standard for the filling of large osseous defects. Because of its limited supply and complications such as pain, bleeding or infection, the development of alternative bone substitutes has been the subject of several studies. In clinical practice, the most commonly used bone substitutes are calcium phosphates like hydroxyapatite or tricalcium phosphate. With the aim to improve the osseointegration of these materials, growth factors such as bone morphogenetic protein-2 (BMP-2) have been added. Preferably, an injectable bone substitute should be made available. Hyaluronic acid is a component of the extracellular matrix of many tissues, including bone. We examined the bone regenerative effect of commercially available, injectable hyaluronic acid (Hyalart^®) with and without addition of bone morphogenetic protein-2 (BMP-2).

Materials and methods

Trepanation defects of 9.4 mm diameter in the intercondylar groove of sheep femora were filled with pure and augmented (200 μg BMP-2) hyaluronic acid. As controls, empty defects and defects treated with autologous bone graft harvested from the contralateral side were used. After 3 months, the defects were analysed by fluorescence microscopy after intravital fluorescence staining, contact microradiography, histology and histomorphometry.

Results

Treatment of the defects with loaded and unloaded hyaluronic acid resulted in a significant lack of bone formation inside the defects. Untreated defects showed an amount of 5.1% newly formed bone, and defects treated with autologous bone graft revealed a bone content of 20%. The difference between both groups was statistically significant (P < 0.05). Furthermore, there was neither a remarkable effect in the periphery of the defects nor ectopic bone formation.

Conclusion

The application of the used injectable hyaluronic acid (Hyalart®) with and without BMP-2 is not advantageous as sole bone substitute for the filling of osseous defects.

     

How to store autologous bone graft perioperatively: an in vitro study

INTRODUCTION: Autologous bone graft is the golden standard for bone grafting, but little is known about the influence of various preservation techniques used during surgery immediately following harvest on the osseous structures and graft vitality. Several studies focussed on the optimal treatment of the bone during harvest and implantation, but only few examined the intraoperative storage conditions on the back table. The aim of our study was to examine the influence of various intraoperative preservation techniques on human cancellous bone at different points to optimize the storage during surgery. MATERIALS AND METHODS: Cancellous bone was harvested during hip arthroplasty and stored for 2 and 4 h under dry conditions, inside a swab moistened with saline solution or in saline solution, 5% glucose solution or culture medium. After the storage period, the bone was cultured and examined 7 days after the first cells grew out in one of these groups. Following the identification of the cells as osteoblast-like cells, the cultures were analysed by fluorescence staining, cell count and the XTT-test. RESULTS: Fluorescence staining revealed no avital cells in all groups. Dry storage of the bone led to significantly lower cell metabolism after 2 h compared to saline solution and 5% glucose solution. The same was true after 4 h dry storage compared to the moistened swab, and glucose and culture medium. Cell count was significantly lower after 2 h of dry storage compared to saline solution and culture medium. CONCLUSIONS: Perioperative storage of cancellous bone under dry conditions should be avoided. The bone graft should be stored in saline or 5% glucose solution or a moistened swab.     

Validierung der deutschen Version der regionalen Schmerzskala zur Diagnose des Fibromyalgiesyndroms

Objective

Use of the American College of Rheumatology classification criteria for the clinical diagnosis of fibromyalgia syndrome (FMS) is under debate. The Regional Pain Scale (RPS) had been developed for the diagnosis of FMS in clinical practice and in survey settings (survey criteria of FMS). So far a German version has not been validated.

Methods

A total of 216 patients with FMS, 53 with active rheumatoid arthritis (RA) and 60 with depressive disorder, recruited from clinical institutions completed the RPS. Forty-three patients with FMS filled in the RPS within 8 weeks a second time.

Results

The intraclass coefficient of FMS diagnosis after 8 weeks was 0.78 (test-retest reliability). The 7-day interval of pain was criticized by physicians. The absence of some articular pain regions was criticized by patients (face validity). The concordance of FMS diagnoses to survey and ACR criteria was 84.7% (±1.1); 45.3% of the patients with RA and 38.3% of the patients with depressive disorder met the survey criteria of FMS (discriminant validity).

Conclusion

The RPS has good reliability and convergent validity, but limited discriminant validity. The RPS is suited as a screening instrument for the diagnosis of FMS in clinical practice.