Machine learning-based Sr isoscape of southern Sardinia: A tool for bio-geographic studies at the Phoenician-Punic site of Nora.

Since prehistoric times, the island of Sardinia-in the western Mediterranean-has played a leading role in the dynamics of human population and mobility, in the circulation of raw materials and artefacts, idioms and customs, of technologies and ideas that have enriched the biological, linguistic and cultural heritage of local groups. For the Phoenician and Punic periods (from the 9th to the 3rd centuries BCE), the ancient site of Nora-in southern Sardinia-represents an emblematic case in the study of migratory phenomena that occurred on the Island from the Iron Age until the Roman conquest. Despite the importance of exploring (and characterising) such movements from a wider bio-cultural perspective, the application of bio-geochemical tools for geographical provenance to the ancient skeletal populations of Sardinia is yet scarce. The present work is the first step towards filling this gap with the development of the first isoscape of southern Sardinia using new bioavailable Sr isotope data and a machine-learning approach. From a geolithological point of view, Sardinia is rather heterogeneous and requires detailed studies to correctly assess the distribution of the isotopic signature of bioavailable Sr. The random forest model employed here to construct the Sr isoscape uses several external environmental and geological variables. The most important predictors are related to age and bedrock type, with additional input from local soil properties. A 10-fold cross-validation gives a mean square error of 0.0008 and an R-squared of 0.81, so the model correctly predicts the 87Sr/86Sr ratio of unknown areas. By using a Bayesian provenance assignment workflow, we tested the isoscape here produced to determine the geographic origin and the mobility of archaeological and modern fauna collected from the Phoenician-Punic site of Nora and the surrounding Pula Plain. Our results indicate that archaeological sheep and goats (87Sr/86Sr < 0.7090) are compatible with areas close to Nora and Pula Plain, in agreement with archaeological evidence of pastoralism in those areas. Modern wild and domesticated fauna (87Sr/86Sr > 0.7090) show compatibility with several natural and anthropogenic locations in southern Sardinia, as expected based on modern species distribution data. Finally, we discuss the large Sr isotopic variability of the Nora baseline, where human mobility studies of human cremated and inhumed individuals are currently underway.

Early exploitation of Neapolitan pozzolan (pulvis puteolana) in the Roman theatre of Aquileia, Northern Italy.

The paper reports the results of the analyses on mortar-based materials from the Roman theatre of Aquileia (Friuli Venezia Giulia, Northern Italy), recently dated between the mid-1st Century BCE and the mid-1st Century CE. Samples were characterized by Polarized Light Microscopy on thin sections (PLM), Scanning Electron Microscopy with Energy Dispersive Spectroscopy (SEM-EDS) and Quantitative Phase Analysis by X-Ray Powder Diffraction (QPA-XRPD). Pyroclastic aggregates (mainly pumices and scattered tuffs), incompatible with the regional geology, were found in two samples from the preparation layers of the ground floor of the building. Their provenance was determined by means of QPA-XRPD, SEM-EDS, X-Ray Fluorescence (XRF) and Laser-Ablation Inductively-Coupled-Plasma Mass-Spectrometry (LA-ICP-MS). Mineralogical and geochemical analyses demonstrated their provenance from the Bay of Naples, thus recognizing them as pulvis puteolana, a type of pozzolanic aggregate outcropping around the modern town of Pozzuoli and prescribed by Vitruvius (De Architectura, 2.6.1) in mortar-based materials to strengthen masonries and produce hydraulic concrete for harbor piers. This evidence represents the oldest analytically-established case of pulvis puteolana exploitation in Northern Italy up to now, and an early use of the material out of Campania adapted for civil constructions in a non-strictly maritime-related environment. Indeed, the theatre was built in the low-lying Aquileia's deltaic plain, prone to water infiltrations that are typical in lagoon-like environments. The data highlight the craftsmen's resilience in adapting and reinterpreting the traditional use of the Neapolitan volcanic materials to deal with the geomorphological challenges of Aquileia's lowland.

Who was buried with Nestor's Cup? Macroscopic and microscopic analyses of the cremated remains from Tomb 168 (second half of the 8th century BCE, Pithekoussai, Ischia Island, Italy).

Cremation 168 from the second half of the 8th century BCE (Pithekoussai's necropolis, Ischia Island, Italy), better known as the Tomb of Nestor's Cup, is widely considered as one of the most intriguing discoveries in the Mediterranean Pre-Classic archaeology. A drinking cup, from which the Tomb's name derives, bears one of the earliest surviving examples of written Greek, representing the oldest Homeric poetry ever recovered. According to previous osteological analyses, the Cup is associated with the cremated remains of a juvenile, aged approximately 10-14 years at death. Since then, a vast body of literature has attempted to explain the unique association between the exceptionality of the grave good complex, the symposiac and erotic evocation of the Nestor's Cup inscription with the young age of the individual buried with it. This paper reconsiders previous assessments of the remains by combining gross morphology with qualitative histology and histomorphometric analyses of the burnt bone fragments. This work reveals the commingled nature of the bone assemblage, identifying for the first time, more than one human individual mixed with faunal remains. These outcomes dramatically change previous reconstructions of the cremation deposit, rewriting the answer to the question: who was buried with Nestor's Cup?.

In vivo confocal microscopy study of corneal nerve alterations in children and youths with Type 1 diabetes.

OBJECTIVE: To determine whether children and youths with Type 1 diabetes (T1D) have early alterations of the corneal subbasal nerve plexus detectable with in vivo confocal microscopy (IVCM) and to investigate the role of longitudinally measured major risk factors for diabetes complications associated with these alterations. METHODS: One hundred and fifty children and youths with T1D and 51 age-matched controls were enrolled and underwent IVCM. Corneal nerve fiber length (CNFL), corneal nerve fiber density (CNFD), corneal nerve branch density (CNBD), corneal fiber total branch density (CTBD), and corneal fiber fractal dimension (CNFrD) were measured. Risk factors for diabetes complications (blood pressure, BMI, HbA1c, lipoproteins, urinary albumin-creatinine ratio) were recorded at IVCM and longitudinally since T1D onset. Unpaired t-test was used to compare variables between the groups. Multiple regression models were calculated using IVCM parameters as dependent variables and risk factors as independent variables. RESULTS: All IVCM parameters, except CTBD, were significantly lower in the T1D patients. Glycometabolic control (HbA1c, visit-to-visit HbA1c variability, and mean HbA1c), and blood pressure were inversely correlated with IVCM parameters. Multiple regression showed that part of the variability in CNFL, CNFD, CTBD, and CNFraD was explained by HbA1c, blood pressure percentiles and age at IVCM examination, independent of diabetes duration, BMI percentile and LDL cholesterol. Comparable results were obtained using the mean value of risk factors measured longitudinally since T1D onset. CONCLUSIONS: Early signs of corneal nerve degeneration were found in children and youths with T1D. Glycometabolic control and blood pressure were the major risk factors for these alterations.

Femtosecond Laser-Assisted Big-Bubble Deep Anterior Lamellar Keratoplasty.

PURPOSE: To determine whether type 1 big-bubble (BB) formation is influenced by the sequence of incisions created with the Victus femtosecond laser (FSL) enabled with software version 3.4 (SV 3.4) during deep anterior lamellar keratoplasty (DALK). MATERIALS AND METHODS: Consecutive FSL-assisted DALK BB procedures were performed on 20 human donor corneas: 10 shaped by tunnel incision followed by lamellar incision (tunnel-lamellar group, TL) and 10 in the reverse order (lamellar-tunnel group, LT). The BB type was assessed by evaluating dynamic air movement during air inflation; bubble diameter and floor thickness were measured by anterior segment optical coherence tomography. RESULTS: Overall, a type 1 BB formed in 85% of eyes: 100% in the TL group and 70% in the LT group. In the LT group, a type 2 BB formed in 2 corneas and one cornea was perforated during cannula insertion. Type 1 BB was achieved after one attempt in 90% of eyes in the TL group and in 57% in the LT group. CONCLUSION: Shaping the tunnel before rather than after lamellar incision may be more effective for obtaining a type 1 BB by air injection.

In Vivo Confocal Microscopy of the Corneal-Conjunctival Transition in the Evaluation of Epithelial Renewal after SLET.

Examination of the corneal surface by in vivo confocal microscopy (IVCM) allows for objective identification of corneal and conjunctival cell phenotypes to evaluate different epithelialization patterns. Detection of a corneal-conjunctival epithelial transition could be considered as a sign of restored epithelial function following simple limbal epithelial transplantation (SLET). This is a prospective, interventional case series. We assessed patients with limbal stem cell deficiency (LSCD) by IVCM, preoperatively and at monthly intervals following SLET. Sectors in the central and peripheral cornea were scanned. Immediately upon detection of multi-layered cells with the epithelial phenotype in the central cornea and confirmation of epithelial transition in all corneal sectors, the decision for keratoplasty was taken. Ten patients were enrolled. After SLET, epithelial phenotype in the central cornea and an epithelial transition were identified within six and nine months in seven and one patients, respectively. One patient was a partial success and one failed. Five patients underwent keratoplasty, with stable results up to 12 months. Identification of the epithelial transition zone by IVCM permits assessment of the efficacy of SLET, enabling subsequent planning of keratoplasty for visual rehabilitation. The stability of the corneal surface following keratoplasty confirms that the renewal of the corneal epithelium was effectively retained.

Cenegermin in Pediatric Neurotrophic Keratopathy.

PURPOSE: We report a case of neurotrophic keratopathy (NK) arising after surgery for rhabdomyosarcoma of the jaw successfully treated with Cenegermin eye drops (Oxervate; Dompé Farmaceutici, Milan, Italy) in a 3-year-old boy. METHODS: At the age of 1 year, the boy underwent surgery for rhabdomyosarcoma of the jaw, followed by radiotherapy. Subsequent NK was initially treated with preservative-free artificial tears, topical combination of dexamethasone 0.1% and netilmicin 0.3% (Netildex; Sifi, Catania, Italy), and moxifloxacin 0.5% (Vigamox; Alcon, Fort Worth, TX), followed by 10 cycles of a topical eye biopolymer containing a poly-carboxymethyl glucose sulfate solution (Cacicol; Theà, Clermont-Ferrand, France) and 4 amniotic membrane transplantations. Keratopathy was recalcitrant to therapy and tissue transplant. Therapy was switched to Cenegermin eye drops 6 times daily for 8 weeks. RESULTS: Complete healing of the corneal epithelium was achieved at 3 weeks into treatment. CONCLUSIONS: Cenegermin was effective in restoring corneal integrity in this pediatric patient with NK.

Small-incision lenticule addition in ex vivo model of ectatic human corneas.

PURPOSE: To investigate the feasibility of intrastromal lenticule insertion to restore corneal shape in a model of ectatic human cornea. METHODS: For this experimental ex vivo study on 34 human corneas unsuitable for transplantation, 17 corneas were thinned by decentralized posterior excimer laser ablation to 200 µm thickness and 6.5 mm diameter and then inflated up to 100 mm Hg to expose the ectasias (recipient corneas). Pachimetry and topography were obtained. Stromal lenticules of the same diameter and thickness as the ectasias were shaped with a femtosecond laser from the remaining 17 donor corneas. An intrastromal pocket was created with femtosecond laser within the ectatic recipient corneas and the donor lenticule was inserted inside it. Changes in corneal architecture and profile were evaluated by means of corneal topography and anterior segment optical coherence tomography. RESULTS: All stromal lenticules were successfully implanted. Tomography confirmed regularity of the lenticule profile within the stromal pocket. Corneal thickness was significantly increased after the procedure (P < 0.0001). Maximal posterior elevation from the best-fitted toric ellipsoid was significantly reduced (P < 0.0001). Significant flattening of posterior K1 and K2 was also obtained (P = 0.041 and P = 0.004, respectively). Anterior and posterior astigmatism, anterior and posterior asphericity, and spherical aberration did not differ significantly after the procedure. CONCLUSIONS: Femtosecond laser-assisted stromal lenticule addition is feasible for restoring corneal thickness to an ectatic area and for regularizing posterior corneal elevation. The technique opens new perspectives for the treatment of corneal ectasias.

Quality of vision, patient satisfaction and long-term visual function after bilateral implantation of a low addition multifocal intraocular lens.

PURPOSE: The aim of the current study was to compare the quality of vision, contrast sensitivity and patient satisfaction with a biaspheric, segmented, rotationally asymmetric IOL (Lentis Comfort LS-313 MF 15-Oculentis GmbH, Berlin, Germany) as opposed to those of a monofocal IOL. METHODS: This prospective single-blind comparative study included two groups of patients affected by bilateral senile cataract who underwent lens extraction and IOL implantation. The first group received a bilateral implantation of a monofocal IOL, and the second group received a bilateral implantation of the Comfort IOL. Twelve months after surgery uncorrected and corrected visual acuity at different distances (30, 50, 70 cm and 4 m), defocus curve and contrast sensitivity were assessed. Patient's satisfaction and spectacle independence were evaluated by mean of the NEI RQL-42 questionnaire. RESULTS: No significant differences were found between the groups in terms of near vision. The group of patients implanted with a Comfort IOL obtained the best results at intermediate distances (50 and 70 cm P < .001). Both groups showed an excellent uncorrected distance visual acuity (4 m). No statistically significant differences were found in terms of corrected near, intermediate and distance visual acuity. Concerning contrast sensitivity, no statistically significant differences between the groups were observed at any cycles per degree. The NEI RQL-42 questionnaire showed statistically significant differences between the group for "near vision" (P = .015), "dependence on correction" (P = .048) and "suboptimal correction" (P < .001) subscales. CONCLUSION: Our findings indicated that the Comfort IOL +1.5 D provides a good intermediate spectacle independence together with a high quality of vision, with a low amount of subjective symptoms and a contrast sensitivity similar to those obtained with a monofocal IOL.