The obstetrical dilemma hypothesis (ODH) proposes an evolutionary trade-off between obstetric requirements and locomotor performance. However, whether external pelvic breadth measures influence walking energetics during human growth remains poorly understood. This study quantified gross walking energy expenditure (WalkingEE) in juveniles and examined whether external pelvic breadth measures influence locomotor energetics during growth. Twenty-eight healthy children and adolescents (8-17 years) completed treadmill walking trials at randomized speeds (2-6 km/h). Gross WalkingEE (kcal/24 h) was measured by indirect calorimetry, and anthropometric variables included body mass (BM), height, femur length, tibia length, bi-iliac breadth (BIL), and bi-trochanteric breadth (BITR). Forward stepwise multiple linear regression identified BM, walking speed, and BIL as the only significant predictors of WalkingEE (R[2] = 0.89, *p < 0.0001). BM and walking speed were positively associated with energy expenditure, whereas BIL showed a significant negative association, accounting for 43%, 31.5%, and -25.5% of the explained effect, respectively. These findings indicate that greater bi-iliac breadth is associated with lower walking energy expenditure during growth. Moreover, the fact that bi-trochanteric breadth was not retained in the final model, despite being used as a proxy more closely associated with obstetric dimensions, suggests that locomotor energetics and obstetric function may be at least partly independent. Overall, our findings are consistent with a more dynamic interpretation of the obstetrical dilemma hypothesis and provide new empirical support for the view that the human pelvis is a functionally modular structure shaped by multiple selective pressures.

Background and Objectives: The association between spinal and pelvic alignment significantly impacts sagittal balance in adults. This study, that is retrospective, aims to investigate sagittal alignment anatomy of the pelvis and spine in juvenile idiopathic scoliosis (JIS) and adolescent idiopathic scoliosis (AIS) patients. Materials and Methods: We evaluated nine sagittal parameters from lateral radiographs of 100 JIS and AIS patients, including thoracic kyphosis (TKA), lumbar lordosis (LLA), pelvic tilt (PTA), pelvic incidence (PIA), spinosacral (SSA), sacral slope (SSLA), C7 tilt angles (C7-TA), sagittal vertical axis length (SVAL), and odontoid process hip axis angle (OPHAA) using the ImageJ program. Participants were classified based on their coronal curve group. Analysis of variance compared parameters between curve groups, and Pearson coefficients assessed the relationship between all parameters (p < 0.05). Results: Female participants had an average age of 13.4, and male participants had an average age of 13.0. Female participants had an average scoliosis degree of 19.3, while male participants had 15.2. PIA, PTA, SSLA, and SSA values were significantly higher in women participants than in men participants (p < 0.05). Additionally, PIA, PTA, SSLA, SSA, and OPHAA values were significantly lower in participants with a lower scoliosis degree (p < 0.05). We observed a moderately positive association between LLA and TKA, PIA, SSA, and C7-TA. There was also a moderate positive association between spinopelvic alignment parameters and the degree of scoliosis in participants. Conclusions: Easily measured values such as PIA, PTA, SSLA, SSA, and OPHAA may be related to severity of vertebral column deformities in patients, making them valuable for monitoring scoliosis patients.

Intraoperative ureteral dilation through smooth muscle relaxation is of interest for improving upper urinary tract access during retrograde intrarenal surgery. Porcine ureters are widely used translational models due to their anatomical similarities to humans; however, the distribution of receptors essential for pharmacological feasibility studies has not been fully characterized. This ex vivo study defines the regional expression of adrenergic and muscarinic receptors throughout the porcine ureter. Ureters from juvenile female Yorkshire swine (n = 4) were segmented into renal pelvis, proximal, middle, distal, and bladder cuff regions. Immunohistochemical (IHC) and histomorphometric analyses evaluated protein expression of α- and β-adrenergic receptor subtypes and muscarinic (M) subtypes. Quantitative-PCR assessed mRNA expression across ureteral regions; statistical analyses were performed using the Kruskal-Wallis test (IHC) and the Friedman test (qPCR), with Dunn's post hoc correction (P < 0.05). IHC demonstrated uniform distribution of α-, β-, M3, and M5 subtypes (P > 0.05). M1 expression was significantly higher in distal and bladder cuff regions versus proximal ureter (P = 0.0262), while M2 was elevated in the renal pelvis (P = 0.0134). All subtypes showed lower proximal immunoreactivity, and M4 was scantily detected. Most receptors are localized to the urothelium, except M3, which was also present in smooth muscle. qPCR confirmed expression of all receptor families except M4, with no regional differences in α-adrenergic or muscarinic transcripts. β-2 expression exceeded β-3 (P = 0.0439), and β-adrenergic transcripts were significantly higher than muscarinic (P = 0.0429). These results provide essential biological context for advancing translational research on the ureter.NEW & NOTEWORTHY This study provides the first comprehensive quantitative characterization of adrenergic and muscarinic receptor distribution throughout the porcine ureter using qPCR and immunohistochemistry. Novel findings include the first quantification of all β-adrenoceptor subtypes, revealing β-2 dominance (74% of β-receptors, 54% of total transcripts), and detection of M1 muscarinic receptor mRNA. α-1a/1d codominance mirrors human ureters. Predominant urothelial receptor localization suggests epithelial smooth muscle signaling. These data strengthen the understanding of porcine ureteral physiology for clinical and translational studies.

Drimolen Main Quarry (the primary excavation within the Drimolen paleocave system in Gauteng Province, South Africa) dates to ~2 Ma and has yielded abundant hominin remains. Most craniodental specimens are attributed to Paranthropus robustus, but the collection also includes a cranial vault of Homo aff. erectus and teeth with early Homo affinities. Here we catalog isolated postcranial specimens recovered between 1994 and 2015 and contribute formal descriptions along with comparative and functional analyses to provide further information on the paleobiology of the Drimolen hominins. Twenty-eight fossil specimens are cataloged, although two previously considered as possibly hominin are formally removed from that status. Like the craniodental assemblage, the postcrania include a high proportion of juveniles and subadults. Upper limb elements include an adult distal humerus (DNH 32), ulnar fragment (DNH 109, previously described), three fetal/perinatal humeri, three fetal/perinatal radius fragments, and nine manual phalanges. Lower limb elements include two fetal/perinatal tibiae, hallucal metatarsal, and nonhallucal pedal proximal phalanx. Vertebral and pelvic material include an adult lumbar centrum, a partial pelvis (DNH 43, previously described), and infant thoracic and lumbar neural arches (DNH 150 a and b). DNH 32 and DNH 43 can be attributed to P. robustus with some confidence while DNH 150a and b can possibly be associated with the DNH 134 juvenile cranium attributed to Homo aff. erectus. Although most other specimens probably belong to P. robustus, taxonomic attribution is challenging given Drimolen's mixed assemblage. Functional analyses indicate small-bodied hominins committed to terrestrial bipedality. However, the first metatarsal evinces a tight tarsometatarsal joint curvature possibly suggesting increased hallucal divergence in that individual. These results might reflect taxonomic variation or evolutionary mosaicism of the postcrania.

Pelvic visceromotor functions such as micturition are regulated by coordinated autonomic and somatic motor pathways from the central nervous system. The parasympathetic system induces detrusor muscle contraction while the somatic system facilitates relaxation of the external urethral sphincter, ensuring synchronized and efficient bladder emptying during the voiding process. This study explores the relationship between Barrington's nucleus corticotropin-releasing hormone (CRH)-ergic projections and the formation of perineural nets (PNNs) among spinal motoneurons, particularly parasympathetic preganglionic neurons in the intermediolateral nucleus (IML) and Onuf's nucleus during the maturation of the neural circuitry controlling pelvic visceromotor functions. Immunohistochemical analysis revealed CRH expression commenced at postnatal Day 5 (P5) in both the IML and Onuf's nucleus, progressively increasing with age. By P60, CRH expression in Onuf's nucleus showed significant sexual dimorphism, higher in males than in females. In contrast, PNN formation exhibited distinct sex-dependent temporal patterns: Males showed earlier formation in the IML at P25, while females exhibited earlier PNN appearance in Onuf's nucleus at P25. Notably, delayed and reduced formation of PNN compared to somatic motoneurons in previous studies suggests an extended period of synaptic plasticity. This finding suggests a potentially longer and more effective recovery period for pelvic visceromotor system compared to the locomotor system. Furthermore, the observed sex difference in CRH expression and PNN formation in Onuf's nucleus may indicate the involvement of sex hormones. These results contribute to understanding the mechanism and treatment approaches tailored to age, sex, and the recovery of specific function such as micturition following spinal cord injury.

Background: Scurvy is an uncommon and often underrecognized disease. However, conditions associated with a restrictive and/or selective diet and inadequate absorption still pose a high risk for developing vitamin C deficiency. Musculoskeletal symptoms are among the most characteristic manifestations of scurvy, often requiring radiological investigations. Objective: This study aims to describe the radiological signs of scurvy on pelvic magnetic resonance imaging (MRI) in children presenting with musculoskeletal symptoms and to highlight features that may help differentiate it from other conditions with similar presentations. Methods: We conducted a retrospective study including children admitted for musculoskeletal symptoms requiring a pelvic MRI and who were subsequently diagnosed with scurvy. Demographic, clinical, laboratory, and radiological data were extracted from electronic medical records. Results: We identified ten patients with a median age at disease onset of 45 months (range 17-133 months) admitted between 2016 and 2022. All ten patients included in the study were male. All had at least one of the following symptoms: limping, pain in the lower limbs, or refusal to walk, in addition to gum bleeding (7/10), hypertrophic gums (5/10), purpura (3/10), irritability (3/10), and fever (2/10). In all patients, pelvic MRI showed a bilateral, patchy, abnormal, water-like signal intensity pattern in the sacroiliac area. Sacroiliitis was detected in three children and hip effusion in another child. Seven out of these ten patients had a previous pelvis X-ray that was negative. Conclusions: In scurvy, the pelvis is often prematurely affected, with bone marrow accumulating water and joints showing inflammatory changes, particularly at the hips and sacroiliac joints. Due to its ability to assess soft tissues and its high sensitivity to water content, MRI is the ideal imaging tool to assess these changes. In contrast, plain radiography is less sensitive and specific and may be uninformative in the early stages of the disease.

The case report depicts a 16-year-old female, who presented with complaints of an abdominal mass extending up to the xiphisternum. A CECT of the abdomen and pelvis showed a large right ovarian mass, solid cystic in consistency with raised alfa-fetoprotein. The patient underwent a right salpingo-oophorectomy. The frozen section histopathology showed a Sex cord-stromal tumor. The fertility-sparing staging surgery was performed, considering the young age of the patient. The final histopathology with immunohistochemistry revealed it to be a case of Gynandroblastoma [Sertoli Leydig cell component is intermediate to poorly differentiated (80%) + Juvenile Granulosa Cell Tumour (20%)]. The final FIGO stage was stage IA, grade 3. The patient was given adjuvant chemotherapy (4 cycles of BEP). NGS analysis showed a mutation in the DICER1 gene. The follow-up at 12 months post-treatment of the patient is recurrence-free with serum tumor marker AFP within the normal range.

Osteosclerotic bone diseases include more than 30 rare diseases characterized by excessive bone formation. The aim of this study is to compare the molecular pathogenesis and prognostic features of 12 different osteosclerotic diseases. Thirty-four patients from 23 families were included, 25 of whom were followed for a period of one to 22 years. Exome sequencing was performed in 20 families. Primary hypertrophic osteoarthropathy (PHOAR1/2) was found in 12 patients, followed by juvenile Paget's disease (JPD)-5 in five, craniometaphyseal dysplasia (CMD) and Camurati-Engelmann disease (CED) in four, Ghosal hematodiaphyseal dysplasia (GHDD) in three patients, sclerosteosis-1 in two patients, and ultra-rare diseases including trichothiodystrophy-1, prenatal Caffey disease, melorheosteosis, and Lenz-Majewski hyperostotic dwarfism in one patient each. Patients with CMD and sclerosteosis-1 had severe cranial sclerosis leading to facial dysmorphism. CMD was characterized by metaphyseal widening, radiolucency, and diaphyseal sclerosis of the long bones in early childhood and later developed Erlenmeyer flask deformity sparing the vertebrae and pelvis, whereas sclerosteosis-1 manifested as generalized sclerosis. CED and GHDD share bone pain, difficulty in walking, and diaphyseal sclerosis, with some patients also having bone marrow involvement. Interestingly, patients with CED and JPD-5 showed osteopenia in early childhood, followed by the development of osteosclerosis in late childhood. Clinical and radiologic findings improved over time in PHOAR1 patients, whereas they progressed in JPD-5 and trichothiodystrophy-1 patients. Intra- and interfamilial clinical differences were observed in CMD, CED, JPD-5, and GHDD. The knowledge gained about the natural history of osteosclerotic diseases will make an important contribution to their diagnosis and management.

The greater rhea (Rhea americana) is the largest bird in South America. It is flightless and cursorial, with a precocial postnatal development. This study aims to describe the postnatal morphological changes in the pelvic girdle of Rhea americana, focusing on ontogenetic scaling and gross anatomy to provide insight into the potential relationship between structure and function in cursorial birds. The pelves of 18 specimens representing four postnatal stages, were studied. Gross anatomical observations and staining methods were used to identify bone and cartilage, providing detailed information about qualitative morphological changes. Quantitative changes were assessed through linear regression analysis using pelvic linear dimensions and body mass to determine allometric growth patterns. The pelvic girdles of immature specimens are characterized by unfused bones, including the vertebrae synsacrales and the medial borders of the ilia, and small cartilaginous areas at the caudal end of the ilium, ischium, pubis, antitrochanter and tuberculum preacetabulare. These immature traits persisted until the most advanced juvenile stages were studied, indicating the slow postnatal growth typical of precocial birds. Similar to other precocial birds, the greater rhea exhibits large bone areas in its pelvic girdle, providing the mechanical strength necessary for locomotion from hatching. The pelvic dimensions showed a combined pattern of allometric and isometric growth related to hindlimb function and body support. The positive allometric growth of the ilium contributed to its increasing verticalization and narrowing, providing an increased dorsoventral surface area for the attachment of the powerful proximal hindlimb muscles. In contrast, the isometric growth of the intertrochanteric width helps in the uniform distribution of loading caused by body mass, providing adequate stability and support.

Enthesitis related arthritis (ERA) is a specific type of juvenile idiopathic arthritis (JIA) and ERA typically begins with enthesitis and peripheral arthritis in the lower extremities, progressing later in the disease to sacroiliitis and spinal involvement. The condition has a strong relationship with the HLA-B27 and primarily affects boys between the ages of 13 and 16 years. We describe an unusual presentation of ERA in a young boy with pubic pain and fever, describing its quintessential magnetic resonance imaging (MRI) findings. A child presented to the paediatric outpatient department with fever, insidious onset pubic pain and tenderness with associated leukocytosis and elevated inflammatory markers. MRI of the pelvis revealed bilateral symmetrical bone marrow edema involving the pubic symphysis and inferior pubic rami with para symphyseal edema involving bilateral obturator externus muscle and bilateral adductor longus muscle insertions suggestive of enthesitis of the pubic symphysis. MRI also showed sacroiliitis and enthesitis at other sites. HLA-B27 was positive. The patient responded well to a short course of steroids and maintained remission with tumour necrosis factor alpha inhibitors.

Background and Objectives: Ankylosing spondylitis (AS) is a chronic progressive inflammatory process of the axial skeleton and sacroiliac joints (SIJ). Symptoms typically appear between the ages of 20 and 40, although there are also cases of juvenile-onset AS. This suggests that most patients with AS are of reproductive age at the time of diagnosis. The study aimed to identify differences in the shape of the sacroiliac joint depending on the type of birth (vaginal delivery (V/D) and the cesarean section(C/S) in patients with ankylosing spondylitis. Materials and Methods: On pelvis X-ray images of women n = 36 with AS and n = 34 in the control group, 12 landmarks were marked, and differences in SIJ shape between the study groups were assessed using generalized Procrustes Analysis. Results: The results showed that the anterior point of the SIJ had an enlarged shape in the V/D group compared with the C/S group, even in the control group. There was a difference between the mean right and left SIJ shapes of the AS group patients with V/D and the controls with C/S (p = 0.007 and p < 0.001). The superior part of the right SIJ tended to be enlarged in V/D-delivered AS patients, compared to the C/S control group. On the left side, the middle region of the SIJ was statistically enlarged in AS patients with V/D compared to the healthy C/S group. Conclusions: This study demonstrates that vaginal delivery is associated with increased sacroiliac joint (SIJ) enlargement in both healthy individuals and those with ankylosing spondylitis (AS). Our findings suggest that delivery type independently influences SIJ morphology, and cesarean section (C/S) may serve as a protective procedure for preserving SIJ shape in AS patients. These results underline the importance of individualized obstetric planning for AS patients to mitigate potential risks to SIJ morphology.

Fibroadenoma is a type of benign tumor that occurs in breast tissues, commonly in younger age groups. However, the presentation of the patient described below shows how the disease presents in various manners. A 52-year-old woman presented to the outpatient clinic with a unilateral, giant, left-sided fungating breast mass who was later admitted under the General Surgical team, at Salmaniya Medical Complex (SMC) for further corresponding diagnostic workup. A staging CT scan of the abdomen/pelvis and chest/thorax showed a left, large, heterogeneously enhancing, fungating breast lesion, involving most breast quadrants measuring around 17 × 12 cm with an unexpected hamartoma in the right breast. An incidental finding of leiomyoma was found on the left lateral border of the uterine cervix. Diagnosis of giant fibroadenoma was established only after the surgical management was completed. Management of this case was approached by multidisciplinary surgical teams. We are reporting this case to highlight the significance of the breast screening protocols, hence avoiding late and complicated presentations of the disease. This case report is one of few, which will help future researchers formulate precise guidelines dedicated to huge fibroadenomas.

Anthropologists have led the way in formulating techniques that reveal skeletal differences between males and females. Understanding of physical differences in the pelvis related to childbirth, hormonal impacts on bones, and extensive comparative studies have provided anthropologists with an array of traits and measurements that help them estimate sex using just bones. Forensic anthropologists and bioarcheologists are improving their ability to differentiate males and females by increasing research on a variety of postcranial bones and through the use of molecular data, especially new methods called proteomics, to identify sex in prepubescent juveniles. As remains from more cultures and time periods are studied, sex identification will continue to improve, because skeletal sex differences are in large part biologically determined. Yet, anthropologists have also been at the forefront of arguing that sex lies on a spectrum. Anthropologists who view sex as on a spectrum may deter sex identification progress; from their perspective, an individual of an undetermined sex may just be a nonbinary individual. Anthropologists who consider sex is on a spectrum are coming to this conclusion in part because they are looking for anatomical ideals, mistaking pathology for variation, and confusing independent variables with dependent variables. Nonetheless, anthropologists need to continue to improve sex identification techniques to reconstruct the past accurately, which may reveal less strict sex roles than previously presumed and help with the identification of crime victims. Forensic anthropologists should also increase their efforts to identify whether individuals have undergone medical procedures intended to change one's gender due to the current rise in transitioning individuals.