Sensationalism and speaking to the public: Scientific rigour and interdisciplinary collaborations in palaeopathology.

OBJECTIVES: In this brief communication we discuss issues concerning scientific rigour in palaeopathological publications, particularly studies published in clinical or general science journals, that employ skeletal analysis to elucidate the lives and deaths of historical figures or interpret "mysterious" assemblages or burials. We highlight the relationship between poor methodological rigour and lack of interdisciplinary communication, and discuss how this can result in scientifically weak, sensational narratives being presented to the public. CONCLUSIONS: Although most high profile publications involving analysis of archaeological human remains are methodologically sound and well interpreted, others have suffered from poor scientific rigour stemming from an apparent lack of awareness of anthropological methods and ethics. When these publications are highlighted by the press, sensationalistic narratives are perpetuated which may reflect poorly on our discipline and give the public unrealistic expectations about our work. SUGGESTIONS FOR FUTURE RESEARCH: We suggest that best practice in high-profile paleopathological research include recruitment of a range of authors and reviewers from clinical sciences, anthropology, and the humanities, consideration of the ethical issues surrounding retrospective diagnosis, and transparency with the press in regards to the limitations inherent in this kind of work.

Cone-Beam Computed Tomography vs. Multi-Slice Computed Tomography in paleoimaging: where we stand.

Paleopathology and anthropology are fields of research which have benefited from the use of diagnostic imaging since its introduction in the clinical setting. The deriving discipline, that is, paleoimaging, has effectively employed several diagnostic techniques. However, while Multi-Slice Computed Tomography (MSCT) has found its role in paleoimaging, Cone-Beam Computed Tomography (CBCT), despite its several advantages with regard to MSCT, is still struggling to find a clear position in this field. The aim of our study is to evaluate the possible advantages CBCT could bring to paleoimaging. We describe the characteristics and role of CBCT in clinical applications, in forensic and legal medicine, and in paleopathology. We report the study of an ancient mandible by means of CBCT and MSCT, in order to compare the quality of the images in terms of spatial resolution. CBCT allows to obtain good quality images of mineralized tissues. Moreover, the possibility of imaging metallic manufacts makes the technique suitable for the study not only of bony remains, but also of museum and archaeological artifacts. Our study highlights the strengths of CBCT as a valid imaging technique for the study of ancient bone remains and manufacts. A revision of the current uses of CBCT is provided and gives insights into the possible role it can cover in bioarchaeological studies. Further evaluation is needed in terms of possible applications of this technique to paleopathology. We strongly encourage the use of CBCT in paleoimaging, and suggest a broader application of the technique to the study of archaeological samples.

A recording form for differential diagnosis of arthropathies.

The present study is focused on a group of arthropathies that may have very similar bone manifestations (rheumatoid arthritis, ankylosing spondylitis, reactive arthritis, psoriatic arthritis, osteoarthritis and diffuse idiopathic skeletal hyperostosis), which makes it more difficult to diagnose them in human remains from archaeological contexts. A stepwise recording form was designed in order to improve the identification and differential diagnosis of these pathological conditions in bone remains, particularly in joint manifestations of the spine, pelvis, hands, feet and other limb joints. This recording form was applied in the analysis of two medieval individuals from the Basque Country (Spain) who presented very severe arthropathic manifestations. The use of this recording form allowed the researchers the diagnosis of ankylosing spondylitis in one of them and diffuse idiopathic skeletal hyperostosis in the other.

Reestablishing rigor in archaeological parasitology.

Archaeological parasitology originated in the mid-twentieth century with interdisciplinary teams of specialists directed by archaeologists. The goals of such studies were detailed analyses of dietary, medicinal, and environmental factors that shaped the patterns of infection. By the 1970s, a cadre of unique coprolite analysts was trained to analyze macroscopic and microscopic remains for integrated reconstructions of the cultural determinants of parasitism. During these first phases of research, diagnostic rigor was maintained by direct training of specialists in parasitology and archaeology sub-disciplines including archaeobotany and archaeopalynology. Near the end of the twentieth century, however, "paleoparasitology" was defined as a separate field focusing on defining parasite distribution through time and space. Ironically, this focus resulted in an increase in misdiagnosis, especially prominent after 2000. Paleoparasitology does not explicitly include other specialized studies in it research design. Thus, dietary, environmental and medicinal inferences have been neglected or lost as samples were destroyed solely for the purpose of parasitological analysis. Without ancillary archaeological studies, paleoparasitology runs the risk of separation from archaeological context, thereby reducing its value to the archaeologists who recover samples for analysis.

Digital data recording and interpretational standards in mummy science.

Beginning during the late19th century, paleoimaging has played an ever-expanding role in mummy science. Increasingly during the 21st century, digital radiographic data collected through imaging efforts have become significant. The rapid influx of imaging data raises questions regarding standardized approaches to both acquisition and interpretation. Reports using digital data presented without contextual considerations commonly lead to interpretational errors. Digital data recording and interpretation require rigorous methodology and standards in order to achieve reproducibility, accuracy and minimization of inter- and intra-observer error. Researchers applying paleoimaging methods in bioarchaeological research must understand the significant limitations inherent in data collection and interpretation from various digital data recording methods. Currently, vast amounts of digital data are being archived, allowing greater potential for hypothesis-based research and informed diagnosis by consensus. Digital databases hold great potential in preparing both radiologists and bioarchaeologists in the appropriate application and interpretation of digital data.

Introduction: Scientific rigor in paleopathology.

This introductory chapter to the Special Issue on "Scientific Rigor in Paleopathology" serves to orient and introduce the chapters that follow through a detailed consideration of paleopathology as a 21st century intellectual field. In this vein, we first make the significant point that paleopathology is a profoundly interdisciplinary endeavor, encompassing aspects of the biomedical science, the humanities, and the social sciences. Thus, we suggest that no one practitioner can personally command the range of skills necessary for a 21st century paleopathologist. To maintain rigor in differential diagnosis, we emphasize collaborations and consider key concepts that illustrate the basic knowledge from each of these fields that any paleopathologist should command. We then address the manner in which disease diagnosis should proceed as a scientific endeavor. To illustrate scientific rigor in differential diagnosis, we present two case studies drawn from 1970s contributions by Cook and by Buikstra. Finally, we introduce Chapters 2-6, which address differential diagnosis in contexts ranging from specific conditions (scurvy, trepanation) to broader field-wide considerations (paleoparasitology, historical paleopathology, imaging, animal paleopathology).

[Tutankhamun: evidence-based paleopathology versus "curse of the pharaoh"]. / Tutanchamun: Evidenzbasierte Paleopathologie vs. "Fluch des Pharao".

AIMS: Several speculations exist regarding possible diseases of the juvenile Pharaoh Tutankhamun. In this review published paleopathological findings and artificial alterations as well as suggestions regarding underlying diseases were characterized. MATERIAL AND METHODS: A selective search of the literature was carried out in the PubMed data base in an arbitrary time interval from 1960 to 2013 (search terms: Tutankhamun, Pharaoh, paleopathology and mummy) and additional supplementary literature. RESULTS: Many artificial changes were a result of embalming and the examinations which have been performed since exhumation in 1922. Evidenced pathologies are craniofacial dysmorphia, bilateral alterations of the feet, malarial disease and an acute traumatic fracture of the knee. The cause of the knee fracture could no longer be reconstructed. Other trauma (e.g. skull fractures) or familial transmission of an eighteenth dynasty syndrome could not be confirmed. CONCLUSION: In addition to many artificial post-mortem alterations, chronic and acute diseases could be verified in Tutankhamun, although the underlying causes are partially unknown.

Evidence based palaeopathology: meta-analysis of Pubmed-listed scientific studies on pre-Columbian, South American mummies.

The aim of this study was to review all Pubmed(®)-listed palaeopathological studies performed on pre-Columbian South American mummies. A total of 61 studies were found (1977-2005). Review criteria included e.g. method of examination, method of mummification, palaeopathological diagnoses and individual age of mummies as well as dating, which ranged from 7500 to 500 years BP, mainly (if reported) originating from the Chiribaya and Chinchorro cultures. The average age of the 99 individually reported mummies was about 25 years. Only six studies included computed tomography, thirteen studies used classical radiography as an examination method. Three studies analysed parasite related diseases, especially caused by Trypanosoma cruzi. Among all of the reported infectious diseases (n=9), there were seven studies presenting cases of tuberculosis. The results were also compared inter-culturally. In 61 studies (37 epidemiological and 24 case reports) more than 6400 mummified individuals were analysed. By contrast, meta-analytic data for ancient Egyptian mummies (Zweifel et al., 2009) included about 3000 analysed individuals in 131 studies (85 case reports and 46 epidemiological studies). In general, ancient Egyptian mummies were shown to be intentionally mummified, whereas the Pre-Columbian American mummies showed a great diversity of spontaneous mummification. However, ritualistic mummification methods were also practised (n=2). This study's results shall assist to improve evidence-based research in palaeopathology.

Variation of musculoskeletal stress markers in the medieval population from Cedynia (Poland)--proposal of standardized scoring method application.

The objective of this paper is: (a) to present a rating scale for the evaluation of the musculoskeletal stress markers; (b) to analyze the medieval population from Cedynia in terms of the degree of expression and frequency of the musculoskeletal stress markers. The presented rating scale was developed based on the variability of the morphology of muscle attachment sites, observed in the skeletal material from Cedynia (102 males and 99 females). The scale encompasses 10 musculoskeletal stress markers located on the scapula, humerus, radius, femur and tibia. The system reflects three degrees (1, 2, 3) of complexity of the muscle attachment sites morphology. The analysis of asymmetry and sexual dimorphism of the musculoskeletal stress markers was made based on the chi2 (Pearson) statistics or chi2 statistics for 2 x 2 tables. Moderate degree (2) of muscle attachment site complexity is the most frequent degree of musculoskeletal stress markers development in the population from Cedynia. Low (1) and high (3) complexity of muscle attachment site are the most seldom observed categories. No statistically significant differences between the frequencies of the musculoskeletal stress markers on the bones of the right and left side of the skeleton were noted in females. Also in males the differences found were not statistically significant. Only in the case of deltoid tuberosity (H2) p = 0.052 oscillating around the threshold value may suggest existence of a statistically significant difference in the degree of expression of this stress marker on the bone of the right and left side of the skeleton. On the bones of the right side of the skeleton dimorphic differences were observed in the glenoid tuberosity (S2), bicipital groove (H1), pronator teres origin (R2), tibial tuberosity (T1), soleal crest (T2) and linea aspera (F2). On the bones of the left side of the skeleton dimorphic differences were noted for the bicipital groove (H1), pronator teres origin (R2) and glenoid tuberosity (S2).

[The School of Palaeopathology of Turin: from the histology of mummified tissues to the monitoring and programmed conservation of the mummies of the Egyptian Museum and the Anthropology Museum]. / La Scuola di Paleopatologia di Torino: dall'istologia dei tessuti mummificati al monitoraggio e alla conservazione programmata delle mummie del Museo Egizio e del Museo di Antropologia.

Scientific analyses, frequent revisions of historical collections and unsuitable preservation conditions in storage and display environments can cause damage to the anthropological patrimony. Therefore, there is an urgent need to establish criteria for the correct conservation of anthropological material according to a "standard of quality". Within the context of a broad and complex view of the protection of anthropological materials, the methodology followed by the research group is aimed at identifying a series of primary (diagnostic) and supportive (therapeutic) interactive processes. The final purpose of these processes is the programmed management of each specimen which is able to identify and control the activities necessary for conservation of the material.

Immunohistochemistry: a new outlook in histopaleopathology.

To date, rehydration techniques on mummified tissues as well as the methods for histological specimen preparation with standard basic stains and with histochemical techniques are commonly known and well established. The application of immunohistochemical techniques is a further development in the study of mummified tissues. Similarly to what is done on fresh and fixed tissues, reaction sensitivity and specificity must be guaranteed. While reaction sensitivity depends on serum quality and the detection method employed, specificity is guaranteed by serum quality but also by method standardisation. Method standardisation is the most serious problem in the study of mummified tissues. Mummified tissues have different antigen preservation characteristics, varying from subject to subject, and even within the same subject, depending on the topographic region and the site. These changes are due to different mummification methods and to subsequent environmental conditions in which the mummy was preserved. The Streptavidin-Biotin-Peroxidase Complex (SABC) technique guarantees excellent detection sensitivity. However, the method accuracy and reliability can be ensured only through a rigorous case by case examination with internal controls on structures in which the antigens we are looking for are surely expressed. Today, with these artifices (technique optimisation), cell differentiation phenotype markers can be detected which are useful in paleopathological studies and in the diagnosis of morphologically doubtful lesions.