Smaller long bone cross-sectional size in people who died of tuberculosis: Insights on frailty factors from a 19th and early 20th century Finnish population

A severe case of bilateral humerus varus deformity from the Middle Bronze age necropolis of Olmo di Nogara, Northeast Italy. The contribution of biomechanical analysis to paleopathological study

OBJECTIVE

To gain insights on possible impairment of a Middle Bronze Age individual with bilateral humerus varus buried with a sword in Northeastern Italy.

MATERIALS

A skeleton of a 40-50-year-old male from Olmo di Nogara (Italy) compared to other males from the same necropolis and to Neolithic and Iron Age samples from Italy.

METHODS

Macroscopic/X-rays analysis for pathological diagnosis and cross-sectional geometric analysis.

RESULTS

Both humeri of the individual appear short with destruction of the humeral heads, showing severe osteoarthrosis and flattening of the scapular glenoid cavities. The individual showed appreciable humeral bilateral asymmetry; there is no evidence for sustained immobilization.

CONCLUSIONS

The pathological modifications suggest a diagnosis of bilateral humeral varism probably following an injury at birth. The individual's life was likely not significantly affected, as evidence suggests that he remained active and possibly used weapons.

SIGNIFICANCE

Biomechanical analyses provided a useful tool to reconstruct the life of the subject within the community, showing that this individual's apparent upper limb abnormalities did not exempt him from a role as a warrior and highlighting the importance of the warrior identity in this Bronze Age society.

LIMITATIONS

The complex interaction between epiphyseal damage and shortening of the humerus makes it difficult to assess activity patterns. Only severe impairment leading to long-term immobilization can be excluded for this individual.

SUGGESTIONS FOR FURTHER RESEARCH

Cross-sectional geometry may be used in other cases of humerus varus or bone dysplasia to investigate functional impairment.

Exploring adolescence as a key life history stage in bioarchaeology

Adolescence is a unique period in the life history of an individual. It is characterized by a myriad of changes that bioarchaeologists are only just coming to appreciate, related to sexual maturation, linear growth, immunological transformation, and emotional and cognitive development. New methods allow us to measure this age of transition through the stages of the adolescent growth, as a proxy for the physical development associated with sexual maturation (puberty). This review outlines ways bioarchaeologists may draw on research developments from the fields of human biology, evolutionary theory and neurobiology to advance a more holistic approach to the study of adolescence in the past. It considers current theoretical and analytical approaches to highlight the research potential of this critical stage of life history. This synthesis integrates the most recent research in the medical sciences concerned with body and brain development, and outlines the biological processes involved with sexual and physical maturation of the adolescent. The goal of this review is to help inform potentially rewarding areas of research that bioarchaeologists can contribute to and draw from, as well as the challenges and limitations, theoretical and methodological questions, and ways in which we can develop the study of adolescence in the discipline going forward.

Quantifying cortical bone in fragmentary archeological second metacarpals

OBJECTIVES

Skeletal variation in cortical bone thickness is an indicator of bone quality and health in archeological populations. Second metacarpal radiogrammetry, which measures cortical thickness at the shaft midpoint, is traditionally used to evaluate bone loss in bioarcheological and some clinical contexts. However fragmentary elements are regularly omitted because the midpoint cannot be determined. This methodological limitation reduces sample sizes and biases them against individuals prone to fracture, such as older individuals with low bone mass. This study introduces a new technique for measuring cortical bone in second metacarpals, the "Region of Interest" (ROI) method, which quantifies bone in archeological remains with less-than-ideal preservation while accounting for cortical heterogeneity.

MATERIALS AND METHODS

The ROI method was adapted from digital X-ray radiogrammetry (DXR), a clinical method used to estimate bone mineral density, and tested using second metacarpals from Middenbeemster, Netherlands, a 19th century known age and sex skeletal collection. The ROI method quantifies cortical bone area within a 1.9 cm-long, mid-diaphyseal region, standardized for body size differences using total area (CAI_ROI ). CAI_ROI values were compared to traditional radiogrammetric cortical indices (CI) to assess the method's ability to identify age-related bone loss.

RESULTS

CAI_ROI values have high intra- and interobserver replicability and are strongly and significantly correlated with CI values for both males (r[n = 39] = 0.906, p = 0.000) and females (r[n = 58] = 0.925, p = 0.000).

CONCLUSION

The ROI method complements traditional radiogrammetry analyses and provides a reliable way to quantify cortical bone in incomplete second metacarpals, thereby maximizing sample sizes, allowing patterns in bone acquisition and loss to be more comprehensively depicted in archeological assemblages.

Severe skeletal lesions, osteopenia and growth deficit in a child with pulmonary tuberculosis (mid-20th century, Portugal)

OBJECTIVE

This case-study provides a summary of skeletal lesions seen in a case of diagnosed juvenile pulmonary tuberculosis with extensive multifocal bony lesions.

MATERIALS

Skeleton of a 9-year-old girl who died in the 1940s in Lisbon, Portugal. The remains of this individual are part of the Lisbon skeletal reference collection curated at the National Museum of Natural History and Science.

METHODS

Lesions and paleopathological conditions were identified and documented through macroscopic, radiographic, computed tomographic, and mammographic analysis.

RESULTS

The skeleton shows a variety of lytic lesions on the ribs and thoracic vertebrae including complete destruction of the bodies and fusion of the vertebral arches of four vertebrae, kyphosis, and scoliosis. Further pathological conditions were identified, including bone erosion, premature fusion of the left femoral head and greater trochanter, and abnormal size and shape changes to the lower limbs including loss of bone mass and stunting of the long bones.

CONCLUSIONS

Skeletal lesions are indicative of spondylitis, Pott's disease, and prolonged bedrest.

SIGNIFICANCE

This case is one of the few examples of confirmed juvenile pulmonary tuberculosis with skeletal lesions prior to the antibiotic era. As such, it provides a reference for the skeletal abnormalities which may be observed in archaeological tuberculosis cases.

LIMITATIONS

Pulmonary tuberculosis was recorded as cause of death, however there is no documentation to know the length of illness period or the existence of any comorbidities.

SUGGESTIONS FOR FURTHER RESEARCH

Consideration of multi-focal lesions is recommended when analyzing individuals with suspected tuberculosis.

Insights on patterns of developmental disturbances from the analysis of linear enamel hypoplasia in a Neolithic sample from Liguria (northwestern Italy)

OBJECTIVE

To assess developmental disturbances through the analysis of linear enamel hypoplasia (LEH) frequency and to infer environmental stress and life history within Neolithic communities from Liguria (Italy).

MATERIALS

43 unworn/minimally worn permanent anterior teeth of 13 individuals recovered from nearby caves and dated to c. 4800-4400 cal. BCE.

METHODS

LEH defects were identified with high-resolution macrophotos of dental replicas, age at LEH was calculated via perikymata counts. LEH defects matched between two or more teeth were considered as systemic disturbances. LEH frequency by age classes was analyzed via GLZ and Friedman ANOVA.

RESULTS

Number of matched defects per individual range between 2-12. The mean LEH per individual was highest in the 2.5-2.99 age category, with a significant increase relative to earlier growth stages, followed by a decline.

CONCLUSION

LEH may reflect life-history in the local ecology of Neolithic Liguria, where several individuals with osteoarticular tuberculosis have been recorded. Disease burden may have triggered developmental disturbances around the time of weaning. Age at first defect was negatively correlated with age at death and positively with the total number of defects, suggesting that early stress may have affected survivorship.

SIGNIFICANCE

The study contributes to the reconstruction of ecological pressures among Neolithic people of Liguria, and informs on environmental challenges during the Neolithic adaptive expansion.

LIMITATIONS

The visual examination of macrophotos is prone to observer error; mid-crown tends to display more visible LEH due to tooth architecture.

SUGGESTIONS FOR FURTHER RESEARCH

Apply different quantitative methods to examine severity and duration of disturbances.

Environmental correlates of growth patterns in Neolithic Liguria (northwestern Italy)

OBJECTIVE

This study evaluates patterns of human growth in the Neolithic to make inferences about environmental correlates of developmental disturbances.

MATERIALS

33 children/adolescents from the Neolithic of Liguria (Italy), 29 of which date between 4,800-4,400 cal BCE.

METHODS

Neolithic patterns of growth are compared with a modern sample (the Denver Growth Study; DGS). Dental development was used to determine age at death. Proxies for postcranial maturation are femoral length and proportion of mean adult femoral length attained.

RESULTS

Ligurian children show growth faltering compared to DGS, especially between 4 and 9 years of age. Between 1 and 2 years, and in later childhood and adolescence, values are more similar or higher than DGS, when using the proportion of adult femoral length attained.

CONCLUSIONS

The pattern of growth in Ligurian Neolithic children may reflect a deprived and highly-infectious environment: three individuals show skeletal lesions consistent with tuberculosis. The relatively faster growth in infancy may result from the buffering provided by maternal milk. Older children and adolescents may exhibit catch-up growth.

SIGNIFICANCE

This study contributes to our understanding of Neolithic selective pressures and possible biocultural adaptive strategies.

LIMITATIONS

The cross-sectional nature of the data and the small sample size make it unclear whether the observed pattern is representative of the growth patterns in the living population. The possibility that adults are stunted undermines the interpretation of optimal growth in the first years.

SUGGESTIONS FOR FURTHER RESEARCH

Refine age estimates, increase sample size through the study of other bone elements.

Maintaining mobility after fracture: A biomechanical analysis of fracture consequences at the Roman Sites of Ancaster (UK) and Vagnari (Italy)

OBJECTIVE

This study uses biomechanical data from tibiae to investigate the functional consequences of lower limb fractures. Adults with malunited fractures are hypothesized to have experienced altered mobility, indicated by asymmetric tibial cross-sectional geometries (CSG).

MATERIALS

Ninety-three adults from Roman (1st to 4th centuries CE) Ancaster, UK and Vagnari, Italy (Ancaster n = 16 adults with lower limb fracture:53 without fracture; Vagnari n = 5:19) METHODS: Biplanar radiographs were used to quantify and compare tibial CSG properties and asymmetries between individuals with and without fractures to femora, tibiae, and/or fibulae. The amount of angulation, rotation, and overlap, indicative of linear deformity, were measured for each fracture. Individuals who loaded their fractured leg differently than their opposite, uninjured leg were identified using outlying amounts of CSG asymmetry.

RESULTS

Two Ancaster individuals had poorly aligned fractures. None of the Ancaster or Vagnari individuals with lower limb fractures had CSG properties or asymmetries outside the calculated normal ranges.

CONCLUSIONS

Regardless of how a fracture healed, individuals at Ancaster and Vagnari generally resumed mobility after trauma whenever possible.

SIGNIFICANCE

This research contributes information about injury recovery and suggests that resilient behaviors and persistent mobility may have been valued or required responses to fracture in the study communities. This work advises that impairment should not be inferred based solely on the appearance of lesions.

LIMITATIONS

Site, sex, and age patterns in injury recovery are not evaluated due to sample size limitations.

SUGGESTIONS FOR FURTHER RESEARCH

Biomechanical assessments of post-traumatic function in varied cultural contexts are advised in order to further characterize the impact that physical and social factors have on injury recovery.

Isoniazid-loaded chitosan/carbon nanotubes microspheres promote secondary wound healing of bone tuberculosis

Poor blood circulation makes it difficult for antitubercular drugs to achieve effective bactericidal concentration at tuberculose focus. The residual Mycobacterium tuberculosis around surgical wound would multiply, resulting in nonunion or sinus formation. Carbon nanotubes have strong tissue penetration and can cross many kinds of physiological barriers. Here, we constructed a chitosan/carbon nanotubes nanoparticles to control slow release of isoniazid. Transmission electron microscopy and nanoparticle tracking and analysis results showed that the diameter of chitosan/carbon nanotubes nanoparticles was between 150 and 250 nm. Chitosan/carbon nanotubes nanoparticles significantly prolonged the release time of isoniazid, and the release rate was more uniform, no sudden release was observed. In vitro experiments showed that chitosan/carbon nanotubes nanoparticles did not destroy biological function of isoniazid, but could reduce its cytotoxicity and inflammation. We further constructed animal model of tuberculous ulcer. The results showed that isoniazid/chitosan/carbon nanotubes nanoparticles promoted the healing of tuberculosis ulcer. Compared with isoniazid group and isoniazid/carbon nanotubes group, the area of wounds decreased by 94.6% and 89.8%, respectively. Immunohistochemistry showed that CD3+ and CD4+ T cell number decreased significantly in isoniazid/chitosan/carbon nanotubes group. In conclusion, we constructed a kind of isoniazid/chitosan/carbon nanotubes nanoparticles, which can significantly promote the healing of tuberculosis ulcer. Our study provided an effective way for the treatment of secondary wound healing of bone tuberculosis.