Diets, stress, and disease in the Etruscan society: Isotope analysis and infantile skeletal palaeopathology from Pontecagnano (Campania, southern Italy, 730-580 BCE).

Susceptibility to morbidity and mortality is increased in early life, yet proactive measures, such as breastfeeding and weaning practices, can be taken through specific investments from parents and wider society. The extent to which such biosocialcultural investment was achieved within 1st millennium BCE Etruscan society, of whom little written sources are available, is unkown. This research investigates life histories in non-adults and adults from Pontecagnano (southern Italy, 730-580 BCE) in order to track cross-sectional and longitudinal breastfeeding and weaning patterns and to characterize the diet more broadly. Stable carbon and nitrogen isotope analysis of incrementally-sampled deciduous and permanent dentine (n = 15), bulk bone collagen (n = 38), and tooth enamel bioapatite (n = 21) reveal the diet was largely based on C3 staple crops with marginal contributions of animal protein. Millet was found to play a role for maternal diet and trajectories of breastfeeding and feeding for some infants and children at the site. The combination of multiple isotope systems and tissues demonstrates exclusive breastfeeding was pursued until 0.6 years, followed by progressive introduction of proteanocius supplementary foods during weaning that lasted between approximately 0.7 and 2.6 years. The combination of biochemical data with macroscopic skeletal lesions of infantile metabolic diseases and physiological stress markers showed high δ15Ndentine in the months prior to death consistent with the isotopic pattern of opposing covariance.

Infantile scurvy as a consequence of agricultural intensification in the 1st millennium BCE Etruria Campana.

The 1st millennium BCE in Italy was a time of agricultural intensification of staple cereal production which shaped sociocultural, political, and economic spheres of pre-Roman groups. The lifeways and foodways of the Etruscans, the greatest civilization in western Europe before Roman hegemony, are traditionally inferred from secondary written sources, funerary archaeology, archaeobotany, and zooarchaeology. However, no direct data extrapolated from the study of human skeletal remains are available to evaluate the extent to which agricultural intensification and decreased dietary diversity impacted health and the expression of skeletal indicators of metabolic disease. Macroscopic and radiological analyses were conducted on an archaeological skeletal sample of non-adults (n = 29) recovered from Pontecagnano (southern Italy) dating to the Orientalizing period (730-580 BCE). This allowed us to identify five cases of scorbutic non-adults and to assign diagnostic values to skeletal lesions of scurvy that have not been previously described in the literature. The onset of scurvy in the examined sample is related to the increased reliance of Etruscans on crops lacking vitamin C in this period of agricultural intensification. The skeletal expression of scurvy varied among the non-adults, with differences in location and disease severity; these were interpreted considering the age-at-death of the individuals coupled with feeding behaviors and interindividual variability.

A case of secondary hypertrophic osteoarthropathy from medieval Tuscany (central Italy, 10th-12th centuries CE).

OBJECTIVES: This study aims to provide a detailed evaluation of a case of secondary hypertrophic osteoarthropathy (HOA) and to explore insights into the presence and consequences of disease in medieval rural Italy. MATERIALS: The skeleton of a male (US 4405) with an estimated age at death of 51-69 years excavated from the medieval rural site of Pieve di Pava (Siena, Italy). METHODS: Macroscopic and radiological (x-ray, CT) analyses were performed. RESULTS: Symmetrical extensive periosteal new bone formation on the diaphyseal and metaphyseal regions of this individual's long bones; the lower limbs were more extensively and severely affected than the upper limbs and the distal segments were more severely altered in comparison to the proximal ones. CONCLUSIONS: The macroscopic and radiological features are highly consistent with a diagnosis of secondary HOA. SIGNIFICANCE: The excellent state of preservation allowed the evaluation of rarely noted skeletal manifestations of HOA and provided insight into aspects of rural life in medieval Italy. LIMITATIONS: Molecular analysis was not successful in sequencing the aDNA of tuberculosis, therefore the underlying primary cause of secondary HOA, whether pulmonary or extrapulmonary, remains obscure in this case. SUGGESTION FOR THE FUTURE RESEARCH: It is advisable to regularly revisit the data available from osteoarchaeological collections in order to identify further cases of HOA, along with to further investigate the known cases to search for the underlying primary disease.

Solitary osteochondromas in paleo-oncology: A case report from 4th-century BCE Pontecagnano (southern Italy).

OBJECTIVE: This study presents a new case of solitary osteochondroma (SOC) identified on the proximal tibia of a 4th-century BCE individual from Pontecagnano (Salerno, Italy) with an aim to contribute to differential diagnosis of bone tumors in archeological contexts. MATERIALS: Paleopathological assessment of a male individual with an estimated age-at death of 45.9-62.9 years brought to light during the archaeological excavations in the funerary sector of 'Sica de Concillis' within the necropolis of Pontecagnano. METHODS: Macroscopic and radiographic analyses were performed for diagnostic purposes. RESULTS: The proximal portion of the right tibia exhibited a large exophytic bone formation extending from the anteromedial to the posteromedial portion of the diaphysis. The x-ray confirmed the lesion being characterized by regular trabecular bone tissue with cortico-medullary continuity. CONCLUSIONS: The lesion observed is diagnostic of sessile SOC, a neoplasm that must have had aesthetic and, possibly, neurovascular complications due to its large size. SIGNIFICANCE: By offering a detailed description of a case of tibial osteochondroma and discussing the possible complications the individual might have experienced during life, this study highlights the role and importance of benign bone tumors in paleo-oncology. LIMITATIONS: Histological analysis was not carried out in order to preserve the integrity of the affected tibia. SUGGESTIONS FOR FURTHER RESEARCH: More attention should be devoted to benign tumors in paleopathology as their occurrence and manifestations in the past will lead to a better understanding of their impacts on the quality of life of affected individuals and to greater knowledge of their natural history.

Contextualizing bilateral asymmetry and gender: A multivariate approach to femoral cross-sectional geometry at rural Medieval Pieve di Pava, Italy.

OBJECTIVES: Our objective was to identify the relationship between biocultural factors of sex-gender and age and patterns of femoral cross-sectional geometry with historical evidence about labor and activity from an archeological skeletal sample excavated from the rural Medieval site Pieve di Pava. MATERIALS AND METHODS: The study site, Pieve di Pava, was a rural parish cemetery in Tuscany with osteoarcheological remains from the 7th to 12th centuries. Cross-sectional geometric analysis of femora from 110 individuals dated to the 10th-12th centuries were used to examine trends in bone quantity, shape, and bending strength between age and sex groups, as well as in clusters identified through Hierarchical Cluster Analysis (HCA). RESULTS: Overall, our study sample showed remarkable heterogeneity and our cluster analysis revealed a complex underlying structure, indicating that divisions of labor did not follow a strict gender binary in our sample. We found high levels of bilateral asymmetry in our sample in multiple cross-sectional areas for a significant proportion of the population. We found minimal differences between age groups or sex. DISCUSSION: Our results suggest that males and females had varied experiences of labor and work during their lives that did not reflect the strict binary gender roles sometimes documented for medieval Europe. One important axis of difference is the direction and magnitude of bilateral asymmetry observed in our femur sample, which is associated with divergent trends in section moduli and bone area measures.

Exploring activity-induced dental modifications in medieval Pieve di Pava (central Italy, 10th-12th centuries AD).

OBJECTIVE: This study aims to investigate the following aspects: i) presence of activity-induced dental modifications (AIDMs) in a medieval population from Pieve di Pava (Siena, central Italy); ii) sex-specific and age-specific distribution of AIDMs in the sample; iii) potential correlations between AIDMs and the tradi tional activities and cultural habits of rural communities in medieval Italy. DESIGN: The permanent teeth of 204 individuals buried at Pieve di Pava (10th-12th centuries AD) were systematically examined in order to assess the distribution of five types of AIDM, i.e. lingual surface attrition of the maxillary anterior teeth (LSAMAT), excessive occlusal load, grooving, notching, and chipping. RESULTS: Prevalence rates of LSAMAT, excessive occlusal load and grooving were low, whereas higher frequencies were recorded for the other types of AIDMs. Prevalence was higher in the male subsample for all the modifications recorded. Overall, the frequencies of AIDMs increased with age. CONCLUSIONS: The very low prevalence of LSAMAT was thought to be connected to leatherworking in the sample under study, while excessive occlusal load was interpreted as evidence that hard materials requiring preliminary chewing and softening were not regularly processed with teeth. The unique case of interproximal grooving in an old male individual may reflect the use of a toothpick for therapeutic purpose. Conversely, the very high prevalence of notching and chipping was taken as indicative of the processing of wool fibers. The sex-specific distribution of these AIDMs suggests that males performed activities involving the use of teeth more frequently than females.

Paleopathology of Endocranial Lesions: A Possible Case of a Middle Meningeal Artery Aneurysm in an Etruscan Child from Pontecagnano (Southern Italy).

A middle meningeal artery (MMA) aneurysm is a type of intracranial aneurysm that has been rarely documented and is not completely understood in clinical medicine and especially in pediatrics, because juvenile cases have been extremely uncommon. Vascular conditions have occasionally been diagnosed in osteoarchaeological remains, providing evidence of their occurrence in previous eras. In the present report, we have described a lesion that was highly consistent with a case of an MMA aneurysm observed in an Etruscan child, whose remains had been exhumed during archaeological excavations in the necropolis of Pontecagnano (Salerno, southern Italy). The remains date back to the seventh to sixth century BC. Macroscopic and radiological examinations revealed an oval depression in the endocranial area corresponding to the parietal branch of the right MMA. The localized thinning of the bone and the absence of a bone reaction were compatible with a long-lasting compression of vascular origin highly consistent with an MMA aneurysm. Primary malignant bone tumors, bone metastasis, benign neoplastic conditions, and other non-neoplastic conditions, including calvarial venous malformations, eosinophilic granuloma, and sarcoidosis, could be excluded from the differential diagnosis, although the occurrence of other pathologies, such as dural arteriovenous fistulas, could not be rejected. Although it was not possible to definitely establish whether the MMA aneurysm was symptomatic, it could not be ruled out that rupture and subsequent extradural hemorrhage and/or intracranial hemorrhage could have caused the death of the child. From a paleopathological viewpoint, the case illustrated provides an interesting historical perspective on a rare neurovascular disorder that continues to be debated in modern clinical research.

Maxillary sinusitis as a respiratory health indicator: a bioarchaeological investigation into medieval central Italy.

OBJECTIVE: This study aims to assess chronic maxillary sinusitis in an osteoarchaeological sample from the medieval rural site of Pieve di Pava (central Italy), to investigate triggers responsible for sinus inflammation, and to compare prevalence rates with coeval European rural sites. MATERIALS: The analysis focused on 145 10th-12th-century adults with at least one preserved maxillary sinus. METHODS: Sinusitis-related lesions were observed macroscopically and microscopically. Alveolar pathologies of the maxillary posterior dentition were recorded to investigate the impact of odontogenic sinusitis. RESULTS: Maxillary sinusitis was observed in 23.4% of the individuals (n = 34), with similar frequencies in both sexes and bilateral sinusitis appearing more frequently than unilateral sinusitis. An association of alveolar lesions with sinusitis was found in 38.2% of cases. CONCLUSIONS: Compared to coeval rural sites in Northern Europe, Pieve di Pava shows the lowest prevalence of maxillary sinusitis, likely reflecting a greater amount of time spent outdoors. Despite the small size of the sample, odontogenic sinusitis cannot be ruled out. SIGNIFICANCE: This is the first Italian study to investigate maxillary sinusitis and to focus on the Mediterranean area, contributing to the understanding of this condition as a health indicator in ancient populations. LIMITATIONS: Research limitations include preservation issues affecting the number of observable sinuses, the non-homogenous age distribution of the sample, and the impact of inclusion and methodological criteria on the comparability of results. SUGGESTIONS FOR FURTHER RESEARCH: Further investigations into odontogenic sinusitis and the microscopic examination of dental calculus may provide new data on the pathogenesis of sinusitis.

A possible case of juvenile idiopathic arthritis from Renaissance Lucca (Tuscany, central Italy).

OBJECTIVE: The skeletal remains of a young individual (Guinigi US 1278) are described and a differential diagnosis is performed to determine the potential etiology of bone alterations. MATERIALS: Archaeological excavations conducted at the private funerary chapel of the upper class members of the Guinigi family (14th-17th centuries AD) of Lucca (Tuscany, central Italy) brought to light the fragmented human skeletal remains of a young individual (Guinigi US 1278) with pathological osseous modifications. METHODS: Morphological and radiological analyses were followed by differential diagnosis. RESULTS: Guinigi US 1278 was a non-adult aged 16-20 years, who exhibited florid skeletal alterations in the form of vertebral fusion and extensive subchondral bone changes of the small and large joints of the appendicular skeleton. The severity of the resorptive process in the peripheral joints, as well as vertebral fusion, indicates a long-standing inflammatory process. CONCLUSIONS: The features and the distribution of the skeletal lesions of Guinigi US 1278 are highly consistent with a form of juvenile idiopathic arthritis (JIA), leading to irreversible phenomena such as subchondral erosive lesions and axial ankylosis, with impairment of the gait and neck movements. SIGNIFICANCE: While abundant clinical literature on JIA is available, paleopathological studies are scarce. The possible case of JIA from Lucca provides a direct opportunity to examine the chronic course of rheumatic disease in young individuals in the absence of appropriate medical therapies in the antiquity. SUGGESTIONS FOR FURTHER RESEARCH: Future molecular analyses might be able to identify specific alleles of the HLA region responsible for JIA subtypes.

Multiple osteomata from medieval Tuscany, Italy (ca. 10th-12th AD).

OBJECTIVE: To explore the possible etiology of multiple osteomata on a skull and long bones from an individual from a medieval site in Tuscany, Italy. MATERIALS: Human skeletal remains dating to the 10th-12th century AD from the parish church of S. Pietro in Pava, in the province of Siena (Tuscany, Central Italy). METHODS: Macroscopic and imaging analyses (Cone Beam Computed Tomography). RESULTS: Nine round-shaped new bone formations are observed on a female individual aged 40-50 years. The lesions have a smooth surface and range from 2.2-6 mm in diameter. CONCLUSIONS: Cone Beam Computed Tomography confirmed that the lesions were composed of compact bone. Macroscopic and radiological features suggest the presence of nonsyndromic multiple osteomata. SIGNIFICANCE: Single cranial osteomata are commonly observed in osteoarchaeological remains, but multiple osteomata are rare and might assist in our understanding of neoplastic conditions in the past. LIMITATIONS: The lack of soft tissues prevents the diagnosis of complex disorders, such as the Gardner syndrome, which is characterised by multiple osteomata and polyposis of the colon. SUGGESTIONS FOR FURTHER RESEARCH: Careful investigation and reporting of all neoplastic lesions in ancient human remains in order to increase our knowledge about the etiology in past human populations.

Carpals and epiphyses of radius and ulna as age indicators using longitudinal data: a Bayesian approach.

The aim of this study is to develop a new formula for age estimation in a longitudinal study of a sample from the radiological collection of wrist bones of growing infants, children, and adolescents recorded at the Burlington Growth Centre. A sample of 82 individuals (43 boys and 39 girls), aged between 3 and 16 years, were analyzed with a total of 623 X-rays of left hand-wrist bones by measuring the area of carpal bones and epiphyses of the ulna and radius (Bo) and carpal area (Ca). The intra-class correlation coefficient (ICC) and its 95% confidence interval were used to evaluate intra-observer agreement. Hierarchical Bayesian calibration has been adopted to exceed the bias deriving from the classical regression approach used for age estimation in forensic disciplines, since it tends to overestimate or underestimate the age of the individuals. Calibration distributions of the dataset obtained by the evaluation of BoCa (the ratio of Bo and Ca) suggested mean absolute errors (MAE) of 1.07 and 1.34 years in boys and girls, respectively. The mean interquartile range (MIQR) was 1.7 and 2.42 years in boys and girls, respectively. The respective bias of the estimates was ßERR = - 0.025 and - 0.074. Furthermore, a correspondence between different BoCa values and estimated age with its standard deviation (SD) was calculated for boys and girls, respectively. In conclusion, the Bayesian calibration method appears to be suitable for assessing both age and its distribution in subadults, according to hand-wrist maturity. Furthermore, it can easily incorporate other age predictors, obtaining a distribution of the subjects with multivariate predictors.

Multiple myeloma in paleopathology: A critical review.

This paper provides a critical literature review concerning paleopathological evidence of multiple myeloma discovered both in the Old and in the New World. A critical assessment of the bioarchaeological and paleopathological documentary sources permitted to identify a total of 25 ascertained cases of multiple myeloma from different geographical areas in the world ranging from Prehistoric times up to the Contemporary age. The distribution of multiple myeloma findings in past times shows that the majority of cases have been discovered in the Old World (n = 18) and extend back to the Middle Ages, while the evidences in the New World (n = 7) seems to date back to the pre-Columbian era. The demographic profile suggests a sex ratio of 1.3:1, while 91.7% of affected individuals (n = 24) are adults. This critical review also discusses the diagnostic criteria and methodological issues commonly attempted in paleo-oncological research, with particular regard to the differential diagnosis of multiple myeloma. As such, the main focus of this work is to present a comprehensive and exhaustive scrutiny of the skeletal manifestations identified as multiple myeloma in order to improve the accuracy of diagnoses within the field of paleopathology.

Linear Cutting Trepanation in Italy: A Unique Case from Hellenistic Sicily (Third Century BC).

During the archaeological excavations conducted in the Hellenistic necropolis discovered in Messina (Sicily, Italy) dating back to the 3rd century BC., a skeleton showing evidence of cranial traumas and surgical intervention was found. The skull, belonging to a young adult male, presented signs of 4 head injuries produced by both blunt and sharp-edged instruments. The first 2 lesions, located on the frontal bone, were produced by blunt blows and showed signs of long-term survival. The third lesion, located on the inferior portion of the right parietal, suggests a perimortem nonpenetrating linear cut likely caused by a blade instrument. Finally, a rectangular bone loss is visible on the left parietal bone, involving the full cranial thickness with well-delimited cutting edges and no sign of a reparative process. This injury can be interpreted as the result of a trepanation, performed with the technique defined as "linear cutting" and obtained through 4 linear incisions in parallel pairs intersecting at the right angles. The trepanation is likely related to the multiple head injuries exhibited by the patient, who unfortunately did not survive the surgical intervention. Trepanation in Italy has been largely attested since Prehistoric times, but the case from Messina represents the first evidence of neurosurgical intervention performed through the linear cutting technique in the Italian context and the second case in the whole of Europe. This technique might have been imported in Sicily during the Hellenistic period from the Near East, where it is clearly attested.

Paleopathological evidence of paranasal lesions: Two cases of frontal sinus osteomata from Imperial Rome.

The archaeological excavations carried out in 1999 in the Collatina necropolis of the Roman Imperial Age (1st-3rd centuries AD) (Rome, Italy) discovered the skeletal remains of two adult males with evidence of paranasal lesions. Both individuals showed postmortem damage in the frontal bone, through which it was possible to macroscopically detect an oblong new bone formation. In both specimens, radiological examination of the defects' morphology showed new pediculated-based bone formations. Radiology also confirmed the presence of benign osseous masses arising from the right frontal sinus and interpreted as osteomata. Their dimensions did not exceed 10 mm, so that mechanical complications and compression of the adjacent structures could be ruled out. The osteomata of paranasal sinuses are rarely reported in paleopathology, since they can be discovered only incidental to bone breakage or radiography. Hence, the evaluation of their occurrence in past populations represents an important challenge. The two cases presented here show direct and rare evidence of frontal sinus osteomata dating back to the Roman Imperial Age.

Trepanation to Treat a Head Wound: A Case of Neurosurgery from 13th-Century Tuscany.

During the archaeological excavations conducted in the 13th century cemetery of the Church of Sant'Agostino in Poggibonsi (Tuscany, Italy), a skull with evidence of neurosurgical intervention was brought to light. The skull, belonging to an adult male, shows two traumatic lesions produced by bladed instruments. The first lesion, located on the anterior part of the parietal bones, involved only the outer cranial table; bone remodeling indicates that the individual survived the injury for a long time. The second lesion, located on the frontal bone, involved all the thickness of the bone; the absence of reparative processes allows a diagnosis of peri mortem lesion. To treat this wound, the patient underwent surgical intervention. In fact, in correspondence to the lesion, an oval bone loss, with clean and well-defined cutting edges, can be interpreted as the result of a trepanation, probably performed to clean the wound and to remove any bone splinters. Half of the bone "rondella" was found in situ; it can be hypothesized that the surgeon decided to replace the bony piece to protect the brain. However, the surgical intervention failed, and the patient died soon afterwards. Trepanation for the treatment of cranial traumas is described by several medical classical and medieval authors, whose texts were available in the 13th century. This case represents rare Middle Ages evidence of neurosurgery used to treat a bone injury.

Accuracy of cut-off value by measurement of third molar index: Study of a Colombian sample.

The aim of this cross-sectional study was to test the accuracy of cut-off value of 0.08 by measurement of third molar index (I3M) in assessing legal adult age of 18 years in a sample of Colombian children and young adults. Digital orthopantomographs of 288 Colombian children and young adults (163 girls and 125 boys), aged between 13 and 22 years, were analysed. Concordance correlation coefficient (ρc) and κ statistics (Cohen's Kappa coefficient) showed that repeatability and reproducibility are high for both intra- and inter-observer error. κ statistics for intra- and inter-observer agreement in decision on adult or minor was 0.913 and 0.877, respectively. Age distribution gradually decreases as I3M increases in both girls and boys. For girls, the sensitivity test was 95.1% (95% CI 87.1%-95%) and specificity was 93.8% (95% CI 87.1%-98.8%). The proportion of correctly classified individuals was 95.1%. For boys, the sensitivity test was 91.7% (95% CI 85.1%-96.8%) and specificity was 90.6% (95% CI 82.1%-97.8%). The proportion of correctly classified individuals was 89.7%. The cut-off value of 0.08 is highly useful to determine if a subject is 18 years of age or older or not.