Finite element analysis of Neanderthal and early Homo sapiens maxillary central incisor

Neanderthal anterior teeth are very large and have a distinctive morphology characterized by robust 'shovel-shaped' crowns. These features are frequently seen as adaptive responses in dissipating heavy mechanical loads resulting from masticatory and non-masticatory activities. Although the long-standing debate surrounding this hypothesis has played a central role in paleoanthropology, is still unclear if Neanderthal anterior teeth can resist high mechanical loads or not. A novel way to answer this question is to use a multidisciplinary approach that considers together tooth architecture, dental wear and jaw movements. The aim of this study is to functionally reposition the teeth of Le Moustier 1 (a Neanderthal adolescent) and Qafzeh 9 (an early Homo sapiens adolescent) derived from wear facet mapping, occlusal fingerprint analysis and physical dental restoration methods. The restored dental arches are then used to perform finite element analysis on the left central maxillary incisor during edge-to-edge occlusion. The results show stress distribution differences between Le Moustier 1 and Qafzeh 9, with the former displaying higher tensile stress in enamel around the lingual fossa but lower concentration of stress in the lingual aspect of the root surface. These results seem to suggest that the presence of labial convexity, lingual tubercle and of a large root surface in Le Moustier 1 incisor helps in dissipating mechanical stress. The absence of these dental features in Qafzeh 9 is compensated by the presence of a thicker enamel, which helps in reducing the stress in the tooth crown.

Entheseal variation and locomotor behavior during growth

Entheses are acknowledged as skeletal markers capable of revealing several biological and behavioral aspects of past individuals and populations. However, entheseal changes (ECs) of juvenile individuals have not yet been studied with a systematic approach. This contribution aims at investigating the morphological changes occurring at the femoral insertion of the gluteus maximus and tibial origin of the soleus muscles to highlight a potential link between the morphological features of those entheses and skeletal maturity in relation to sex, age, and locomotor developmental patterns. The sample consisted of 119 skeletons (age-at-death: 0-30 years) belonging to the Documented Human Skeletal Collection of the Certosa Cemetery (Bologna, Italy). The entheseal variation during the last stages of skeletal maturation in young adults was assessed using existing recording standards. A recording protocol for each enthesis was developed for immature individuals to subdivide the morphological variability into discrete categories. Univariate, bivariate, and multivariate statistical analyses were performed to investigate the variation of entheseal morphologies and measurements in relation to bone metrics, degree of epiphyseal closure, sex, age, and locomotor developmental patterns. A statistically significant relationship was observed between ECs morphological patterns and age for both entheses, while sexual differences were negligible. A relationship between ECs morphological pattern and locomotor milestones emerged only for the gluteus maximus. Even though further testing is needed on other documented skeletal collections, our protocol could be usefully applied in forensic and archaeological fields and serving as important reference for evolutionary investigations.

Morphological and evolutionary insights into the keystone element of the human foot's medial longitudinal arch

The evolution of the medial longitudinal arch (MLA) is one of the most impactful adaptations in the hominin foot that emerged with bipedalism. When and how it evolved in the human lineage is still unresolved. Complicating the issue, clinical definitions of flatfoot in living Homo sapiens have not reached a consensus. Here we digitally investigate the navicular morphology of H. sapiens (living, archaeological, and fossil), great apes, and fossil hominins and its correlation with the MLA. A distinctive navicular shape characterises living H. sapiens with adult acquired flexible flatfoot, while the congenital flexible flatfoot exhibits a 'normal' navicular shape. All H. sapiens groups differentiate from great apes independently from variations in the MLA, likely because of bipedalism. Most australopith, H. naledi, and H. floresiensis navicular shapes are closer to those of great apes, which is inconsistent with a human-like MLA and instead might suggest a certain degree of arboreality. Navicular shape of OH 8 and fossil H. sapiens falls within the normal living H. sapiens spectrum of variation of the MLA (including congenital flexible flatfoot and individuals with a well-developed MLA). At the same time, H. neanderthalensis seem to be characterised by a different expression of the MLA.

New insights on Celtic migration in Hungary and Italy through the analysis of non-metric dental traits

The Iron Age is characterized by an extended interweaving of movements by Celts in Europe. Several waves of Celts from Western and Central Europe migrated southeast and west from the core area of the La Téne culture (between Bourgogne and Bohemia). Through the analysis of non-metric dental traits, this work aims to understand the biological relationship among Celtic groups arrived in Italy and the Carpathian Basin, as well as between local populations and Celtic newcomers. A total of 10 non-metric dental traits were analyzed to evaluate biological affinities among Celts (Sopron-Krautacker and Pilismarót-Basaharc) and Scythians-related populations from Hungary (Tápiószele), Celts from continental Europe (Switzerland and Austria), two Iron Age Etruscan-Celtic sites from northern Italy (Monterenzio Vecchio and Monte Bibele), 13 Iron Age central-southern Italic necropolises, and the northern Italian Bronze Age necropolis of Scalvinetto. Strontium isotopes were measured on individuals from the necropolis of Monte Bibele to infer their local or non-local origin. Results highlight the existence of statistically significant differences between Celts and autochthonous Italian groups. Celtic groups from Hungary and Italy (i.e., non-local individuals of Monterenzio Vecchio and Monte Bibele) share a similar biological background, supporting the historical records mentioning a common origin for Celts migrated to the eastern and southern borders of today's Europe. The presence of a supposed Steppean ancestry both in Celts from Hungary and Celts from northern Italy corroborates the hypothesis of the existence of a westward migration of individuals and genes from the Steppe towards northern Italy during the Bronze and Iron Age, which contributed to the biological variability of pre-Celtic and later Celtic populations, respectively. Conversely, individuals from central-southern Italy show an autochthonous pre-Iron Age background. Lastly, this work supports the existence of Celtic migratory routes in northern Italy, as shown by biological and cultural admixture between Celts and Italics living together.

Hydrogen sulfide and sulfaceutic or sulfanutraceutic agents: Classification, differences and relevance in preclinical and clinical studies

Hydrogen sulfide (H2S) has been extensively studied as a signal molecule in the body for the past 30 years. Researchers have conducted studies using both natural and synthetic sources of H2S, known as H2S donors, which have different characteristics in terms of how they release H2S. These donors can be inorganic salts or have various organic structures. In recent years, certain types of sulfur compounds found naturally in foods have been characterized as H2S donors and explored for their potential health benefits. These compounds are referred to as "sulfanutraceuticals," a term that combines "nutrition" and "pharmaceutical". It is used to describe products derived from food sources that offer additional health advantages. By introducing the terms "sulfaceuticals" and "sulfanutraceuticals," we categorize sulfur-containing substances based on their origin and their use in both preclinical and clinical research, as well as in dietary supplements.

On the traces of lost identities: chronological, anthropological and taphonomic analyses of the Late Neolithic/Early Eneolithic fragmented and commingled human remains from the Farneto rock shelter (Bologna, northern Italy)

The present study examines the prehistoric human skeletal remains retrieved starting from the 1920s in the deposit of the Farneto rock shelter, situated in the area of the 'Parco dei Gessi Bolognesi e Calanchi dell'Abbadessa' (San Lazzaro di Savena, Bologna, northern Italy). An exact dating and a reliable interpretation of the assemblage had not been reached so far because of the lack of contextual data useful for dating purposes, the inaccurate recovery procedures of the remains and their state of preservation. In fact, the skeletal remains from the Farneto rock shelter are highly fragmented and commingled, whereas reliable information about their original position and their recovery procedures are not available. Despite these difficulties, radiocarbon analyses allowed the precise dating of the remains to a final phase of the Neolithic and an early phase of the Eneolithic period in Emilia Romagna (northern Italy). The study of the assemblage enabled to clarify the use of the context for funerary purposes. Moreover, the anthropological and taphonomic analyses of the skeletal remains shed light on the biological profile of the individuals and on some events that occurred after their death. In particular, the analysis of perimortem lesions highlighted the existence of intentional interventions related to corpse treatment, referable to dismembering/disarticulation and scarnification, i.e. cleaning of bones from soft tissues. Finally, the comparison with other Italian and European Neo/Eneolithic funerary contexts enabled a better understanding of these complex ritual practices.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s12520-023-01727-2.

Morphologies in-between: The impact of the first steps on the human talus

OBJECTIVE

The development of bipedalism is a very complex activity that contributes to shaping the anatomy of the foot. The talus, which starts ossifying in utero, may account for the developing stages from the late gestational phase onwards. Here, we explore the early development of the talus in both its internal and external morphology to broaden the knowledge of the anatomical changes that occur during early development.

MATERIALS AND METHODS

The sample consists of high-resolution microCT scans of 28 modern juvenile tali (from 36 prenatal weeks to 2 years), from a broad chronological range from the Late Roman period to the 20th century. We applied geometric morphometric and whole-bone trabecular analysis to investigate the early talar morphological changes.

RESULTS

In the youngest group (<6 postnatal months), the immature external shell is accompanied by an isotropic internal structure, with thin and densely packed trabeculae. After the initial attempts of locomotion, bone volume fraction decreases, while anisotropy and trabecular thickness increase. These internal changes correspond to the maturation of the external shell, which is now more defined and shows the development of the articular surfaces.

DISCUSSION

The internal and external morphology of the human talus reflects the diverse load on the foot during the initial phases of the bipedal locomotion, with the youngest group potentially reflecting the lack of readiness of the human talus to bear forces and perform bipedal walking. These results highlight the link between mechanical loading and bone development in the human talus during the acquisition of bipedalism, providing new insight into the early phases of talar development.

Human talar ontogeny: Insights from morphological and trabecular changes during postnatal growth

Objectives

The study of the development of human bipedalism can provide a unique perspective on the evolution of morphology and behavior across species. To generate new knowledge of these mechanisms, we analyze changes in both internal and external morphology of the growing human talus in a sample of modern human juveniles using an innovative approach.

Materials and Methods

The sample consists of high‐resolution microCT scans of 70 modern juvenile tali, aged between 8 postnatal weeks and 10 years old, from a broad chronological range from Middle/Late Neolithic, that is, between 4800 and 4500 BCE, to the 20th century. We applied geometric morphometric and whole‐bone trabecular analysis (bone volume fraction, degree of anisotropy, trabecular number, thickness, and spacing) to all specimens to identify changes in the external and internal morphology during growth. Morphometric maps were also generated.

Results

During the first year of life, the talus has an immature and globular shape, with a dense, compact, and rather isotropic trabecular architecture, with numerous trabeculae packed closely together. This pattern changes while children acquire a more mature gait, and the talus tends to have a lower bone volume fraction, a higher anisotropy, and a more mature shape.

Discussion

The changes in talar internal and external morphologies reflect the different loading patterns experienced during growth, gradually shifting from an “unspecialized” morphology to a more complex one, following the development of bipedal gait. Our research shows that talar plasticity, even though genetically driven, may show mechanical influences and contribute to tracking the main locomotor milestones.

Transcriptional regulation and drug resistance in Mycobacterium tuberculosis

Bacterial drug resistance is one of the major challenges to present and future human health, as the continuous selection of multidrug resistant bacteria poses at serious risk the possibility to treat infectious diseases in the near future. One of the infection at higher risk to become incurable is tuberculosis, due to the few drugs available in the market against Mycobacterium tuberculosis. Drug resistance in this species is usually due to point mutations in the drug target or in proteins required to activate prodrugs. However, another interesting and underexplored aspect of bacterial physiology with important impact on drug susceptibility is represented by the changes in transcriptional regulation following drug exposure. The main regulators involved in this phenomenon in M. tuberculosis are the sigma factors, and regulators belonging to the WhiB, GntR, XRE, Mar and TetR families. Better understanding the impact of these regulators in survival to drug treatment might contribute to identify new drug targets and/or to design new strategies of intervention.

Direct evidence that late Neanderthal occupation precedes a technological shift in southwestern Italy

OBJECTIVES

During the middle-to-upper Paleolithic transition (50,000 and 40,000 years ago), interaction between Neanderthals and Homo sapiens varied across Europe. In southern Italy, the association between Homo sapiens fossils and non-Mousterian material culture, as well as the mode and tempo of Neanderthal demise, are still vividly debated. In this research, we focus on the study of two human teeth by using 3D geometric morphometric approaches for a reliable taxonomical attribution as well as obtaining new radiometric dates on the archeological sequence.

MATERIAL AND METHODS

This work presents two lower deciduous molars uncovered at Roccia San Sebastiano (Mondragone-Caserta, Italy), stratigraphically associated with Mousterian (RSS1) and Uluzzian (RSS2) artifacts. To obtain a probabilistic attribution of the two RSS teeth to each reference taxa group composed of Neanderthals and Homo sapiens, we performed and compared the performance of three supervised learning algorithms (flexible discriminant analysis, multiadaptive regression splines, and random forest) on both crown and cervical outlines obtained by virtual morphometric methods.

RESULTS

We show that RSS1, whose Mousterian context appears more recent than 44,800-44,230 cal BP, can be attributed to a Neanderthal, while RSS2, found in an Uluzzian context that we dated to 42,640-42,380 cal BP, is attributed to Homo sapiens.

DISCUSSION

This site yields the most recent direct evidence for a Neanderthal presence in southern Italy and confirms a later shift to upper Paleolithic technology in southwestern Italy compared to the earliest Uluzzian evidence at Grotta del Cavallo (Puglia, Italy).

Comparability of skeletal fibulae surfaces generated by different source scanning (dual-energy CT scan vs. high resolution laser scanning) and 3D geometric morphometric validation

This work aims to test accuracy and comparability of 3D models of human skeletal fibulae generated by clinical CT and laser scanner virtual acquisitions. Mesh topology, segmentation and smoothing protocols were tested to assess variation among meshes generated with different scanning methods and procedures, and to evaluate meshes‐interchangeability in 3D geometric morphometric analysis. A sample of 13 left human fibulae were scanned separately with Revolution Discovery CT dual energy (0.625 mm resolution) and ARTEC Space Spider 3D structured light laser scanner (0.1 mm resolution). Different segmentation methods, including half‐maximum height (HMH) and MIA‐clustering protocols, were compared to their high‐resolution standard generated with laser‐scanner by calculating topological surface deviations. Different smoothing algorithms were also evaluated, such as Laplacian and Taubin smoothing. A total of 142 semilandmarks were used to capture the shape of both proximal and distal fibular epiphyses. After Generalized Procrustes superimposition, the Procrustes coordinates of the proximal and distal fibular epiphyses were used separately to assess variation due to scanning methods and the operator error. Smoothing algorithms at low iteration do not provide significant variation among reconstructions, but segmentation protocol may influence final mesh quality (0.09–0.24 mm). Mean deviation among CT‐generated meshes that were segmented with MIA‐clustering protocol, and laser scanner‐generated ones, is optimal (0.42 mm, ranging 0.35–0.56 mm). Principal component analysis reveals that homologous samples scanned with the two methods cluster together for both the proximal and distal fibular epiphyses. Similarly, Procrustes ANOVA reveals no shape differences between scanning methods and replicates, and only 1.38–1.43% of shape variation is due to scanning device. Topological similarities support the comparability of CT‐ and laser scanner‐generated meshes and validate its simultaneous use in shape analysis with potential clinical relevance. We precautionarily suggest that dedicated trials should be performed in each study when merging different data sources prior to analyses.

Impact of SARS-CoV-2 on dentistry: a review of literature

OBJECTIVE

SARS-CoV-2 is a new Coronavirus identified as the cause of Coronavirus disease in 2019 (COVID-19). The epidemic spread in China and beyond its borders, involving 114 countries with more than 5 million dead. On March 11, the WHO declared the spread of SARS-CoV-2 to be a pandemic and encouraged nations to adopt harsh restrictive measures. Therefore, patients more and more often turn to dental offices only for emergencies. Healthcare professionals, including dentists, are at high infectious risk. In fact, the closeness to the oral cavity and nasopharynx and the use of drills or ultrasonic devices that cause aerosol release, make dental professions at high risk of bacterial and viral infections. The way patients are treated has changed. In fact, it should be mandatory to carry out a pre-treatment telephone triage and the use of mouthwashes to reduce bacterial load. In the current pandemic, it is necessary to adopt specific safety protocols that can protect dental operators as well as limit the spread of the virus. The purpose of this review is to present an overview on ways to reduce the risk of SARS-CoV-2 contagion in dentistry by focusing on the immediate situation as well as by looking towards the future.

MATERIALS AND METHODS

To reach the review purpose, we selected a series of studies using keywords "COVID-19" OR "SARS-CoV-2" in association with "dentistry" AND "safety protocols" AND "healthcare procedures" AND "individual protection dispositive" AND "air transmission" AND "droplet". We selected papers exclusively in English language, up to 1st January 2022.

RESULTS

During future phases of the pandemic, everywhere in the World, it is necessary to impose all dentistry team both a serological screening and the vaccination, as already established for all health staff in Italy.

CONCLUSIONS

For own safety, it is an important for the whole dentistry category constantly update the devices and the protocols adopted, as well as monitoring the real infectious threats, which may occur.

Frailty assessment in an unselected population admitted to an intensive cardiac care unit

Background

Although interest in frailty has expanded among cardiology experts over the past 2 decades, its integration, as part of cardiovascular disease management, is still lacking, above all in the acute cardiac care setting. The Clinical Frailty Scale (CFS) is a brief guided tool to assess frailty in hospital settings without specialist equipment.

Purpose

Our objective was to test the performance of the CFS in an older, unselected population, admitted to an Intensive Cardiac Care Unit (ICCU) during the year 2019.

Methods

The study sample included 431 patients ≥65 years old, admitted to an ICCU of a tertiary cardiac center in Italy. The CFS ranged from “very fit: 1” to “terminally ill: 9”, but it was considered present at a score ≥5. Our primary endpoint was defined by a combination of severe complications requiring critical care and in-hospital death. The data were collected from the hospital discharge summary and the electronic chart records.

Results

158 patients (36.7%) were frail. These individuals had greater comorbidity and higher in-hospital mortality (Table 1). After a multivariable logistic regression analysis, 4 predictors were identified: signs of congestive heart failure (OR: 8.51, 95% Confidence Interval-CI: 4.63–14.6; p&lt;0,001), systolic blood pressure (OR per 1 mmHg increasing: 0.98, 95% CI: 0.97–0.99; p&lt;0,001), smoking habit (OR: 0.49, 95% CI: 0.22–1.11; p=0.09) and the CFS ≥5 (OR: 1.86, 95% CI: 1.08–3.23: p=0,026).

Conclusions

The CFS is a simple guided frailty tool that may enhance outcome prediction in the acute cardiac care setting. These findings merit evaluation in larger cohorts of unselected patients.

Funding Acknowledgement

Type of funding sources: None.

The cranial biomechanics and feeding performance of Homo floresiensis

Homo floresiensis is a small-bodied hominin from Flores, Indonesia, that exhibits plesiomorphic dentognathic features, including large premolars and a robust mandible, aspects of which have been considered australopith-like. However, relative to australopith species, H. floresiensis exhibits reduced molar size and a cranium with diminutive midfacial dimensions similar to those of later Homo, suggesting a reduction in the frequency of forceful biting behaviours. Our study uses finite-element analysis to examine the feeding biomechanics of the H. floresiensis cranium. We simulate premolar (P³) and molar (M²) biting in a finite-element model (FEM) of the H. floresiensis holotype cranium (LB1) and compare the mechanical results with FEMs of chimpanzees, modern humans and a sample of australopiths (MH1, Sts 5, OH5). With few exceptions, strain magnitudes in LB1 resemble elevated levels observed in modern Homo. Our analysis of LB1 suggests that H. floresiensis could produce bite forces with high mechanical efficiency, but was subject to tensile jaw joint reaction forces during molar biting, which perhaps constrained maximum postcanine bite force production. The inferred feeding biomechanics of H. floresiensis closely resemble modern humans, suggesting that this pattern may have been present in the last common ancestor of Homo sapiens and H. floresiensis.

Multimodality imaging of the ischemic right ventricle: an overview and proposal of a diagnostic algorithm

Right ventricular (RV) involvement is frequently detected in patients presenting with acute left ventricular myocardial infarction. The ischemic right ventricle carries a dismal outcome by predisposing the heart to arrhythmic events and mechanical or hemodynamic complications. A comprehensive RV evaluation by multimodality imaging could guide clinical practice but has always been a conundrum for the imagers. Two-dimensional echocardiography is the best first-line tool due to its availability of bedside capabilities. More advanced imaging techniques provide a more comprehensive evaluation of the complex RV geometry but are mostly reserved for the post-acute setting. Three-dimensional echocardiography has improved the evaluation of RV volumes and function. The recent application of speckle-tracking echocardiography to the right ventricle appears promising, allowing the earlier detection of subtle RV dysfunction. Cardiac magnetic resonance imaging is considered the gold standard for the RV assessment. Cardiac multidetector computed tomography could be a reliable alternative. The aim of this review is to focus on the growing importance of multimodality imaging of the ischemic right ventricle and to propose a diagnostic algorithm, in order to reach a comprehensive assessment of this too frequently neglected chamber.

Exploring directional and fluctuating asymmetry in the human palate during growth

Objectives

Palate morphology is constantly changing throughout an individual's lifespan, yet its asymmetry during growth is still little understood. In this research, we focus on the study of palate morphology by using 3D geometric morphometric approaches to observe changes at different stages of life, and to quantify the impact of directional and fluctuating asymmetry on different areas at different growth stages.

Materials and Methods

The sample consists of 183 individuals (1–72 years) from two identified human skeletal collections of 19th and early 20th Century Italian contexts. A 3D‐template of 41 (semi)landmarks was applied on digital palate models to observe morphological variation during growth.

Results

Asymmetrical components of the morphological structure appears multidirectional on the entire palate surface in individuals <2 years old and become oriented (opposite bilateral direction) between 2 and 6 years of age. Specifically, directional asymmetry differentially impacts palate morphology at different stages of growth. Both the anterior and posterior palate are affected by mild alterations in the first year of life, while between 2 and 6 years asymmetry is segregated in the anterior area, and moderate asymmetry affects the entire palatal surface up to 12 years of age. Our results show that stability of the masticatory system seems to be reached around 13–35 years first by females and then males. From 36 years on both sexes show similar asymmetry on the anterior area. Regarding fluctuating asymmetry, inter‐individual variability is mostly visible up to 12 years of age, after which only directional trends can be clearly observed at a group level.

Discussion

Morphological structure appears instable during the first year of life and acquires an opposite asymmetric bilateral direction between 2 and 6 years of age. This condition has been also documented in adults; when paired with vertical alteration, anterior/posterior asymmetry seems to characterize palate morphology, which is probably due to mechanical factors during the lifespan. Fluctuating asymmetry is predominant in the first period of life due to a plausible relationship with the strength of morphological instability of the masticatory system. Directional asymmetry, on the other hand, shows that the patterning of group‐level morphological change might be explained as a functional response to differential inputs (physiological forces, nutritive and non‐nutritive habits, para‐masticatory activity as well as the development of speech) in different growth stages. This research has implications with respect to medical and evolutionary fields. In medicine, palate morphology should be considered when planning orthodontic and surgical procedures as it could affect the outcome. As far as an evolutionary perspective is concerned the dominance of directional asymmetries in the masticatory system could provide information on dietary and cultural habits as well as pathological conditions in our ancestors.

Unveiling an odd fate after death: The isolated Eneolithic cranium discovered in the Marcel Loubens Cave (Bologna, Northern Italy)

An isolated human cranium, dated to the early Eneolithic period, was discovered in 2015 at the top of a vertical shaft in the natural Marcel Loubens gypsum Cave (Bologna area, northern Italy). No other anthropological or archaeological remains were found inside the cave. In other caves of the same area anthropic and funerary use are attested from prehistory to more recent periods. We focused on investigating the circumstances surrounding the death of this individual, since the cranium shows signs of some lesions that appear to be the results of a perimortem manipulation probably carried out to remove soft tissues. Anthropological analyses revealed that the cranium belonged to a young woman. We analysed the taphonomic features and geological context to understand how and why the cranium ended up (accidentally or intentionally) in the cave. The analyses of both the sediments accumulated inside the cranium and the incrustations and pigmentation covering its outer surface suggested that it fell into the cave, drawn by a flow of water and mud, likely from the edges of a doline. The accidental nature of the event is also seemingly confirmed by some post-mortem lesions on the cranium. The comparison with other Eneolithic archaeological sites in northern Italy made it possible to interpret the find as likely being from a funerary or ritual context, in which corpse dismemberment (in particular the displacement of crania) was practiced.

Oral microbiota and vitamin D impact on oropharyngeal squamous cell carcinogenesis: a narrative literature review

An emerging body of research is revealing the microbiota pivotal involvement in determining the health or disease state of several human niches, and that of vitamin D also in extra-skeletal regions. Nevertheless, much of the oral microbiota and vitamin D reciprocal impact in oropharyngeal squamous cell carcinogenesis (OPSCC) is still mostly unknown. On this premise, starting from an in-depth scientific bibliographic analysis, this narrative literature review aims to show a detailed view of the state of the art on their contribution in the pathogenesis of this cancer type. Significant differences in the oral microbiota species quantity and quality have been detected in OPSCC-affected patients; in particular, mainly high-risk human papillomaviruses (HR-HPVs), Fusobacterium nucleatum, Porphyromonas gingivalis, Pseudomonas aeruginosa, and Candida spp. seem to be highly represented. Vitamin D prevents and fights infections promoted by the above identified pathogens, thus confirming its homeostatic function on the microbiota balance. However, its antimicrobial and antitumoral actions, well-described for the gut, have not been fully documented for the oropharynx yet. Deeper investigations of the mechanisms that link vitamin D levels, oral microbial diversity and inflammatory processes will lead to a better definition of OPSCC risk factors for the optimization of specific prevention and treatment strategies.

Taxonomic differences in deciduous lower first molar crown outlines of Homo sapiens and Homo neanderthalensis

Recent studies have demonstrated that the outline shapes of deciduous upper and lower second molars and the deciduous upper first molar are useful for diagnosing hominin taxa-especially Homo neanderthalensis and Homo sapiens. Building on these studies, we use geometric morphometric methods to assess the taxonomic significance of the crown outline of the lower first deciduous molar (dm₁). We test whether the crown shape of the dm₁ distinguishes H. neanderthalensis from H. sapiens and explore whether dm₁ crown shape can be used to accurately assign individuals to taxa. Our fossil sample includes 3 early H. sapiens, 7 Upper Paleolithic H. sapiens, and 13 H. neanderthalensis individuals. Our recent human sample includes 103 individuals from Africa, Australia, Europe, South America, and South Asia. Our results indicate that H. neanderthalensis dm₁s cluster fairly tightly and separate well from those of Upper Paleolithic H. sapiens. However, we also found that the range of shapes in the recent human sample completely overlaps the ranges of all fossil samples. Consequently, results of the quadratic discriminant analysis based on the first 8 principal components (PCs) representing more than 90% of the variation were mixed. Lower dm1s were correctly classified in 87.3% of the individuals; the combined H. sapiens sample had greater success (90.2%) in assigning individuals than did the H. neanderthalensis sample (61.5%). When the analysis was run removing the highly variable recent human sample, accuracy increased to 84.6% for H. neanderthalensis, and 57.1% of Upper Paleolithic H. sapiens were classified correctly by using the first 4 PCs (70.3%). We conclude that caution is warranted when assigning isolated dm₁ crowns to taxa; while an assignment to H. neanderthalensis has a high probability of being correct, assignment to Upper Paleolithic H. sapiens is less certain.

The study of the lower limb entheses in the Neanderthal sample from El Sidrón (Asturias, Spain): How much musculoskeletal variability did Neanderthals accumulate?

Entheses have rarely been systematically studied in the field of human evolution. However, the investigation of their morphological variability (e.g., robusticity) could provide new insight into their evolutionary significance in the European Neanderthal populations. The aim of this work is to study the entheses and joint features of the lower limbs of El Sidrón Neanderthals (Spain; 49 ka), using standardized scoring methods developed on modern samples. Paleobiology, growth, and development of both juveniles and adults from El Sidrón are studied and compared with those of Krapina Neanderthals (Croatia, 130 ka) and extant humans. The morphological patterns of the gluteus maximus and vastus intermedius entheses in El Sidrón, Krapina, and modern humans differ from one another. Both Neanderthal groups show a definite enthesis design for the gluteus maximus, with little intrapopulation variability with respect to modern humans, who are characterized by a wider range of morphological variability. The gluteus maximus enthesis in the El Sidrón sample shows the osseous features of fibrous entheses, as in modern humans, whereas the Krapina sample shows the aspects of fibrocartilaginous ones. The morphology and anatomical pattern of this enthesis has already been established during growth in all three human groups. One of two and three of five adult femurs from El Sidrón and from Krapina, respectively, show the imprint of the vastus intermedius, which is absent among juveniles from those Neanderthal samples and in modern samples. The scant intrapopulation and the high interpopulation variability in the two Neanderthal samples is likely due to a long-term history of small, isolated populations with high levels of inbreeding, who also lived in different ecological conditions. The comparison of different anatomical entheseal patterns (fibrous vs. fibrocartilaginous) in the Neanderthals and modern humans provides additional elements in the discussion of their functional and genetic origin.

Exploring sexual dimorphism of the modern human talus through geometric morphometric methods

Sex determination is a pivotal step in forensic and bioarchaeological fields. Generally, scholars focus on metric or qualitative morphological features, but in the last few years several contributions have applied geometric-morphometric (GM) techniques to overcome limitations of traditional approaches. In this study, we explore sexual dimorphism in modern human tali from three early 20th century populations (Sassari and Bologna, Italy; New York, USA) at intra- and interspecific population levels using geometric morphometric (GM) methods. Statistical analyses were performed using shape, form, and size variables. Our results do not show significant differences in shape between males and females, either considering the pooled sample or the individual populations. Differences in talar morphology due to sexual dimorphism are mainly related to allometry, i.e. size-related changes of morphological traits. Discriminant function analysis using form space Principal Components and centroid size correctly classify between 87.7% and 97.2% of the individuals. The result is similar using the pooled sample or the individual population, except for a diminished outcome for the New York group (from 73.9% to 78.2%). Finally, a talus from the Bologna sample (not included in the previous analysis) with known sex was selected to run a virtual resection, followed by two digital reconstructions based on the mean shape of both the pooled sample and the Bologna sample, respectively. The reconstructed talus was correctly classified with a Ppost between 99.9% and 100%, demonstrating that GM is a valuable tool to cope with fragmentary tali, which is a common occurrence in forensic and bioarchaeological contexts.

P1288 Male gender and left atrial volume index predict non valvular atrial fibrillation recurrence. The NeAfi echo registry

Background

In non-valvular atrial fibrillation (AF) patients, risk stratification scores such as CHA2DS2VASc and HASBLED allow the prediction of thromboembolic and bleeding risks, respectively. However, no risk score for the prediction of AF recurrence has been yet validated.

Purpose

To evaluate the mayor anthropometric and echocardiographic determinants of AF recurrence in non-valvular paroxysmal AF patients at 1 year follow-up.

Methods

Among 395 consecutive adult patients with non valvular AF enrolled in the Neapolitan Atrial Fibrillation (NeAfi) Echo registry, 177 (F/M = 87/90, age = 66.5± 11.9 years) had paroxismal AF and underwent 1-year follow-up. Fifteen patients had AF recurrence. Anthropometric parameters and blood pressure (BP) were recorded and CHA2DS2VASc and HASBLED scores were calculated. At baseline, patients underwent a comprehensive echo-Doppler exam, including quantification of left atrial (LA) size measurements, peak atrial longitudinal strain (PALS) and left ventricular (LV) global longitudinal strain (GLS). Binary logistic regression analysis was used to establish a mathematical model of the relationship between the variables and AF recurrence. The covariates for regression analysis were chosen as potential confounding factors based on their significance in independent T test analyses for continuous variables of chi-square for dichotomous variables, or on their biological plausibility.

Results

AF recurrence was higher in male than in female patients (14.4 vs 2.3%, p = 0.008). Patients with AF recurrence had similar body mass index, systolic and diastolic BP and heart rate compared to those without. The two groups were similar for LV end-systolic and end-diastolic volumes, ejection fraction, LV mass index, diastolic indexes, pulmonary artery systolic pressure and GLS. LA diameter (p = 0.235) and PALS (p = 0.375) were also similar between the two groups, whereas LA volume index (LAVi) was greater in patients experiencing AF recurrence (45.5 ± 15.7 vs. 36.7 ± 10.4 ml/m², p = 0.003). Binomial multiple regression analysis model explained 25% (Nagelkerke R²) of the variance in AF recurrence and correctly classified 95.0% of cases. Males were 8.9 times more likely to exhibit AF recurrence than females (p = 0.04). Greater LAVi was associated with an increased likelihood of exhibiting AF recurrence (OR = 1.07, p = 0.03), whereas CHA2DS2VASc &gt;1 in men and &gt;2 in women, HASBLED &gt;3 and greater LA diameter or lower PALS did not add significant information to the model.

Conclusions

Male gender and, with a lower extent, LAVi appear to be major determinants of AF recurrence in non-valvular paroxysmal AF. The quantification of PALS does not seem to add valuable information in the prediction of recurrent AF.

433 Independent impact of metabolic syndrome on left ventricular longitudinal dysfunction in type 2 diabetes mellitus

Background

The risk of cardiovascular (CV) disease in type 2 diabetes mellitus (T2DM) is highly heterogeneous and an adequate risk stratification is needed. CV risk mainly depends on concomitant risk factors, combined in the metabolic syndrome (MetS). Echocardiography is an useful tool for diagnosis of cardiac organ damage and CV risk stratification in T2DM.

Purpose

To investigate the effects of MetS on left ventricular (LV) structure and function in patients with T2DM with normal LV ejection fraction (LVEF) and without overt coronary artery disease (CAD) and heart failure symptoms/signs.

Methods

We prospectively recruited 384 consecutive, uncomplicated T2DM patients. All patients underwent clinical exam, blood sampling and complete echo-Doppler exam, including determination of 2D-echo derived global longitudinal strain (GLS). LV mass index ≥45 g/m^2.7 in women and ≥49 g/m^2.7 in men was used to characterize LV hypertrophy. LV longitudinal dysfunction was assumed for GLS &lt; 20% in absolute values. LV diastolic dysfunction was identified according to 2016 ASE/EACVI recommendations. MetS was defined according to NCEP-ATP III criteria. Significant CAD including previous myocardial infarction, LV systolic dysfunction (= LVEF &lt;50%), hemodinamically significant valvular heart disease, primary cardiomyopathies, permanent atrial fibrillation, glomerular filtration rate &lt;30 ml/min and inadequate echo images were exclusion criteria. The study population was divided according to presence of MetS.

Results

66% of the patients (254/384) met the criteria for MetS diagnosis. They had comparable age and heart rate with controls. Diabetic patients with MetS had higher glycated haemoglobin (HbA1c) (7.2 ± 1.3 vs. 6.9 ± 1.0%, p = 0.023) and uric acid (5.5 ± 1.4 vs. 4.9 ± 1.3 mg/dl, p = 0.001) than those without, and lower glomerular filtration rate (69.5 ± 15.0 vs 74.0 ± 12,1 ml/min, p = 0.004). MetS patients showed a higher LV mass index (p &lt; 0.0001) and a greater prevalence of both LV hypertrophy (31.9 vs 12.5%, p &lt; 0.0001) and diastolic dysfunction (52.6 vs. 32.8%, p = 0.007) (Figure). T2DM patients with MetS also had lower GLS (20.6 ± 2.1 vs. 21.9 ± 2.2%, p = 0.001), with a greater prevalence of LV longitudinal dysfunction (38.2 vs. 24.7%, p = 0.049) (Figure). After adjusting for age, T2DM duration, sex, HbA1c, uric acid, LV mass index and LV diastolic dysfunction by a multiple regression analysis in the pooled population, GLS reduction was independently associated with MetS (β coefficient = -0.184, p &lt; 0.02) and LV mass index (β= -0.94, p = 0.04).

Conclusion

In patients with T2DM, the presence of MetS induces a greater prevalence not only of LV hypertrophy and diastolic dysfunction but also of LV longitudinal deformation impairment. GLS reduction in diabetic patients is associated with MetS independently of confounders including glycemic control and diabetic duration.

Abstract 433 Figure. Rate of LV alterations according to MetS

P291 Additional value of myocardial work in detecting subclinical systolic dysfunction in patients with bicuspid aortic valve and left ventricular hypertrophy

Background

An impairment of speckle tracking derived left ventricular (LV) global longitudinal strain (GLS) has been observed in patients with bicuspid aortic valve (BAV) and referred to abnormalities of aortic elasticity properties. The impact of LV mass on myocardial deformation has still not been investigated. This issue can be now better addressed by myocardial work software, which incorporates both deformation and hemodynamic load in the analysis.

Aim of the study

To analyse the impact of both deformation and strain derived myocardial work in BAV patients with and without LV hypertrophy (LVH).

Methods

Sixty-five patients with BAV underwent a comprehensive echo exam, including speckle tracking derived calculation of GLS (in absolute value). Parameters of myocardial work such as global work index (GWI), global constructive work (GCW) global wasted work (GWW) and global work efficiency (GWE) were measured according to standardized procedures. Patients with reduced LV ejection fraction and with more than mild aortic stenosis and/or regurgitation were excluded. Other exclusion criteria included coronary artery disease, concomitant valvular heart disease, heart failure, primary cardiomyopathies, permanent and/or persistent atrial fibrillation and inadequate echo images. BAV patients were divided according to presence of LVH: 10 with LVH (LV mass index &gt;47 g/m^2.7 in women and &gt;50 g/m^2.7 in men) and 55 without LVH.

Results

The two groups were comparable for sex, age and heart rate whereas systolic blood pressure (p = 0.006) and pulse pressure (p = 0.002) were higher in patients with LVH, who also had higher relative diastolic wall thickness (p &lt; 0.02). No significant difference in ejection fraction (p = 0.56), transmitral E/A ratio (p = 0.504) and E/e" (p = 0.311) was found between the two groups. GLS (19.1 ± 2.5 in LVH group and. 20.0 ± 2.4% in patients without LVH, p = 0.290), GWI (p = 0.356) and GCW (p = 0.396) did not differ significantly whereas GWW was higher (119.5 ± 72.9 vs. 72.3 ± 38.7 mmHg%, p = 0.003) and GWE lower (94.4 ± 3.0 vs. 92.2 ± 1.6%, p = 0.007) in BAV patients with LVH (Figure). In the pooled population, LV mass index was related with GWW (r = 0.26, p = 0.03) and GWE (r=-0.30, p &lt; 0.01) but not with GLS (r=-0.22, p = 0.08). The relation between GWE and LV mass index remained significant even after adjusting for pulse pressure (partial r=-0.28, p &lt; 0.02).

Conclusion

In patients with BAV, LVH plays a detrimental effect on LV systolic function which cannot be identified by ejection fraction and GLS assessment but is unmasked by the application of myocardial work. In presence of LVH, the wasted work of BAV patients is increased and myocardial efficiency is substantially reduced, it being negatively related to LV mass even after adjusting for a raw index of aortic stiffness such as pulse pressure.

Abstract P291 Figure. GLS, GWW and GWE according to LVH

1033 Prominent longitudinal strain involvement of left ventricular basal segments in native hypertensive patients without clear-cut hypertrophy

Background

Left ventricular (LV) global longitudinal strain (GLS) is able to detect an early subclinical dysfunction and it has been demonstrated to be a prognosticator in arterial hypertension. Information of regional longitudinal strain (LS) pattern has not been investigated in this clinical setting.

Purpose

We analyzed regional LV patterns of LS and base-to-apex behaviour of LS in newly diagnosed and never-treated hypertensive patients (HTN) without clear-cut LV hypertrophy (LVH).

Methods

166 HTN (M/F = 107/59; age 43.9 ± 14.3 years, blood pressure [BP] = 146.5± 10.7/90.1 ± 7.5 mmHg) and a control group of 94 healthy subjects (M/F = 58/36; age 41.2 ± 15.0 years) underwent standard echo-Doppler exam, including speckle tracking quantification of regional LS and GLS (considered in absolute values). The average LS of six basal (BLS), six middle (MLS), and six apical (ALS) segments and relative regional strain ratio - RRSR = [ALS/(BLS + MLS)] - were also computed. Exclusion criteria were LVH (LV mass index ≥45 g/m^2.7 in females and ≥49 g/m^2.7 in males), diabetes mellitus, coronary artery disease, overt heart failure, hemodynamically significant valve heart disease, primary cardiomyopathies, atrial fibrillation and inadequate echo imaging.

Results

The two groups were comparable for sex, age, heart rate and LV ejection fraction (EF). Body mass index (BMI), systolic (SBP), diastolic (DBP) and mean BP (MBP) (all p &lt; 0.0001), LV mass index (p = 0.03), relative wall thickness (RWT) (p &lt; 0.02) and E/e’ ratio (p &lt; 0.01) were higher, and GLS lower (21.6 ± 2.0 vs. 22.2 ± 2.1%, p &lt; 0.02) in HTN. By analyzing regional LS, BLS (18.2 ± 2.1% vs. 19.2 ± 2.1%, p &lt; 0.0001) and MLS (20.7 ± 2.0 vs. 21.4 ± 2.1%, p = 0.007) resulted significantly lower in HTN, without significant difference in ALS (26.0 ± 3.6 vs. 25.9 ± 3.8%, p = 0.98). Accordingly, RRSR was higher in HTN (0.67 ± 0.09 vs. 0.64 ± 0.09, p &lt; 0.01). Even after excluding patients with LV concentric remodeling (RWT &gt; 0.42) (n = 34), BLS (p &lt; 0.0001) and MLS (p &lt; 0.002) were again lower and RRSR (p &lt; 0.01) higher in HTN than in controls. In the pooled population, BLS negatively correlated with SBP (r=-0.22), DBP (r=-0.25) and MBP (r=-0.26) (Figure) (all p &lt; 0.0001). By a multiple linear regression analysis, after adjusting for age, sex, BMI and RWT, the association between BLS and MBP remained significant (β coefficient=-0.23, p &lt; 0.0001), with an additional significant impact of male sex (β=-0.33, p &lt; 0.0001) (cumulative R²=0.18, SEE = 1.9%, p &lt; 0.0001).

Conclusions

Besides normal LV EF, GLS is lower in HTN. LS dysfunction involves basal and, with a lower extent, middle myocardial segments, with a compensation of apical segments. RRSR appears to be significantly higher in HTN. These results are even confirmed in hypertensive patients with normal LV geometry. The association of BLS and BP appears to be independent on several confounders. Regional LS pattern might be useful to detect very early LV systolic abnormalities in arterial hypertension.

Abstract 1033 Figure. Relation between MBP and BLS

P1782 Left ventricular deformation proprieties in aortic coarctation: insights from multilayer strain imaging

Background

Patients with coarctation of the aorta (CoA) have proven impaired left ventricular (LV) myocardial deformation that will persist even after successful transcatheter intervention compared to normal controls. However, little is known about layer specific contraction in this clinical setting.

Purpose

To investigate multi-layer longitudinal strain in patients with repaired CoA, compared with a control group of healthy subjects.

Methods

In a case-control study, 13 CoA patients (F/M = 9/4, age = 15.1 ± 4.4 years) and 13 healthy age- and sex-matched controls, underwent a complete echocardiogram, including speckle tracking assessment for quantification of LV transmural global longitudinal strain (GLS), subendocardial longitudinal strain (LSsubendo), subepicardial longitudinal strain (LSsubepi), and myocardial longitudinal strain gradient (LSsubendo - LSsubpepi).

Results

CoA patients had similar blood pressure, heart rate, and body surface area in comparison with healthy controls. The two groups did not differ for ejection fraction and LV diastolic indices. Increased maximal gradient (&gt;20 mmHg) in descending aorta was found in 9 (69.2%) CoA patients. In CoA population, 5 (38.5%) had LV concentric remodeling (RWT &gt; 0.42) and 2 (15.4%) LV hypertrophy (Z score &gt;2.0). LV mass index (92.4 ± 31.1 vs. 60.9 ± 12.5 g/m^2.7, p = 0.002), septal wall thickness (8.7 ± 2.0 vs 6.6 ± 0.9 mm p = 0.002), posterior wall thickness (8.2 ± 1.7 vs. 6.6 ± 1.4 mm, p = 0.02) and RWT (0.38 ± 0.06 vs. 0.27 ± 0.08, p &lt; 0.001) were greater in CoA patients. By multi-layer deformation analysis, GLS (21.2 ± 1.9 vs. 22.9 ± 1.4%, p &lt; 0.01), LSsubepi (19.3 ± 1.6 vs. 21.0 ± 1.6%, p &lt; 0.01), LSsubendo (22.9 ± 1.8 vs. 25.4 ± 1.9%, p = 0.003) and longitudinal strain gradient (3.6 ± 1.1 vs. 4.7 ± 1.1, p &lt; 0.02) were lower in CoA patients than in healthy controls. Separate sub-analyses in patients without LV hypertrophy, substantially confirmed the same results: GLS 20.9 ± 1.6 vs. 22.8 ± 0.9%, p = 0.004; LSsubepi 19.0 ± 1.4 vs. 21.1 ± 1.3%, p = 0.004; and LSsubendo 22.4 ± 1.2 vs. 25.3 ± 1.4%, p &lt; 0.0001; strain gradient 3.4 ± 1.0 vs. 4.6 ± 1.1, p = 0.02. Notably, LSsubepi (18.6 ± 1.4 vs. 20.6 ± 1.0%, p = 0.03) and, with greater significance, LSsubendo (22.1 ± 1.1 vs. 24.7 ± 1.8%, p &lt; 0.0001) were lower in CoA patients with increased aortic gradient versus those without significant gradient increase.

Conclusions

In CoA patients, layer specific strain imaging highlights an impairment of LV longitudinal deformation, which mainly involves LSsubendo and causes reduction of longitudinal strain gradient. This preferential impairment of subendocardium is particularly evident in patients with residual aortic gradient and is independent of LV hypertrophy.

Abstract P1782 Figure. Multilayer strain in CoA vs. controls

P678 Late gadolinium enhancement cardiac magnetic resonance and layer-specific longitudinal strain in treatment naive Anderson Fabry disease

Background

In Anderson-Fabry disease (AFD), the accumulation of glycosphingolipids in cardiomyocytes causes inflammation, hypertrophy and interstitial fibrosis which is first limited to the mid-myocardial layers, then spreads to transmural fibrosis. Speckle tracking echocardiography allows the estimation of layer-specific strain, differentiating longitudinal strain (LS) at subendocardium and subepicardium (LSsubendo and LSsubepi, respectively).

Purpose

To investigate the matching of functional and structural abnormalities in newly diagnosed, never treated AFD patients by comparing multi-layer LS and late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR).

Methods

Twenty newly diagnosed, never treated AFD patients (age = 37 ± 13 years; F/M =10/10) and 20 healthy controls, matched for age and sex, underwent comprehensive evaluation of target organs and a standard echo-Doppler exam, including assessment of relative diastolic wall thickness (RWT) and left ventricular mass index (LVMI). Left ventricular hypertrophy (LVH) was defined as LVMi &gt; 47 g/m^2.7 in women and &gt;50 g/m^2.7 in men. Speckle tracking echocardiography derived left ventricular transmural global longitudinal strain (GLS), LSsubendo, LSsubepi and LS gradient (LSsubendo - LSsubpepi) were also determined. CMR sequences including assessment of LGE were also performed.

Results

AFD patients had normal renal function and comparable body mass index, blood pressure, heart rate, ejection fraction and diastolic indices with healthy controls. LVMi (p = 0.006) and RWT (p &lt; 0.02) were greater in AFD patients than in controls. GLS (p = 0.006), LSsubendo (p = 0.005) and LSsubepi (p &lt; 0.001) were lower in AFD patients. By CMR, only four patients (F/M = 3/1), 3 with LVH (75%), exhibited focal LGE, always localized in the midwall. LGE was detected at basal lateral wall in three patients and at the septal insertional points with the right ventricle in the remaining one. AFD patients with LGE had higher LVMi than those without LGE (47.2 ± 11.0 vs. 34.5 ± 11.6 g/m^2.7, p = 0.04). There was no correspondence of LGE with both regional LS and layer specific LS impairment (Figure). However, AFD patients with LGE had higher LS gradient compared to those without LGE (5.8 ± 0.65 vs. 4.8 ± 0.66, p &lt; 0.02).

Conclusions

Treatment naïve AFD patients show a reduction of longitudinal deformation, which involves both subendocardial and subepicardial layers. Patients with LGE present higher LV mass and increased LS gradient, without a correspondence of LGE with both regional and layer specific LS impairment. Accordingly, this impairment might due to myocardial inflammation occurring in the early disease stages more than to myocardial fibrosis itself.

Abstract P678 Figure. Multilayer bull"s eye and LGE-CMR in AFD

P753 Impact of transcatheter aortic valve implantation on concomitant mitral regurgitation in patients with severe aortic stenosis

Background

Severe aortic stenosis (AS) and functional mitral regurgitation (MR) frequently coexist. There is no consensus about the optimal therapeutic strategy for patients with combined valve disease. Evidence has shown that double valve surgery is associated with high complication rates and mortality, whereas MR severity may improve after transcatheter aortic valve implantation (TAVI).

Purpose

Aim of our study was to evaluate hemodynamic parameters and cardiac function in patients with severe AS and concomitant MR undergoing TAVI.

Methods

We prospectively enrolled consecutive TAVI patients with concomitant MR. Exclusion criteria were primary cardiomyopathies, prior valve surgery, permanent atrial fibrillation and inadequate echocardiographic imaging. Echo-Doppler assessment, including global longitudinal strain (GLS) and peak atrial longitudinal strain (PALS) (absolute value), was performed before TAVI and after 1-3 months. MR grading was assessed according to quantitative methods (vena contracta and/or PISA). Changes (Δ) of the main echo parameters before and after intervention were computed. On the basis of MR grading changes, the study population was divided in two groups: no improvement in MR grading (NIMR) and improvement in MR grading (IMR).

Results

Of 49 included patients (M/F = 20/29, age 80.7 ± 5.6 years), 23 had mild MR and 26 moderate to severe MR before TAVI. After the procedure, MR grading improved in 11 (IMR) and remained stable in 38 (NIMR) patients. The two groups were comparable for sex, age, body mass index, blood pressure and heart rate. After TAVI, both groups showed an improvement in GLS (17.8 ± 4.7 to 20.1 ± 4.4%, p &lt; 0.0001 and 16.8 ± 3.8 to 19.0 ± 3.1%, p &lt; 0.01, in NIMR and IMR respectively) and in PALS (20.4 ± 7.4 to 24.2 ± 7.3%, p &lt; 0.0001 in NIMR and 19.5 ± 4.5 to 26.7 ± 6.1%, p &lt; 0.001, in NIMR and IMR respectively), without significant changes in ejection fraction (p = 0.12). Only in IMR group, a significant decrease of systolic pulmonary arterial pressure (sPAP) (45.5 ± 10.6 to 36.3 ± 6.9 mmHg, p &lt; 0.001) and left atrial volume index (54.9 ± 14.8 to 48.9 ± 13.3 ml/m², p &lt; 0.01) was observed after TAVI. Changes of sPAP (ΔsPAP) (9.1 ± 6.4 vs. -0.07 ± 6.7, p &lt; 0.0001) was higher and ΔPALS (-7.2 ± 5.1 vs. -3.8 ± 4.3, p &lt; 0.03) lower in IMR compared with NIMR group (Figure). By a multiple linear regression analysis performed in the pooled population, after adjusting for ΔPALS, Δ aortic valve area and ΔGLS, the association between ΔsPAP and MR grading improvement remained significant (beta = 0.53, p &lt; 0.001) (cumulative R²=0.31, SEE = 6.9 mmHg, p = 0.007).

Conclusion

Afterload reduction following TAVI may induce hemodynamic changes determining also a reduction in MR severity. This mechanism implies a reduction in left atrial pressure, whose PALS is a reliable marker, and a consequent reduction of post-capillary pulmonary hypertension. The association between MR improvement and ΔsPAP reduction is independent on echocardiographic confounders.

Abstract P753 Figure. ΔsPAP and ΔPALS in NIMR and IMR

P814 Independent association of body mass index and left atrial strain in patients with non valvular atrial fibrillation. The NeAfib-Echo registry

Background

Overweight and obesity are related to the risk of new-onset atrial fibrillation (AF). Peak atrial longitudinal strain (PALS) is an advanced echocardiographic parameter of left atrial (LA) function with a recognized diagnostic and prognostic role in both the general population and AF.

Purpose

To investigate the impact of body mass index (BMI) on LA function by utilizing standard and advanced echocardiography in patients with non-valvular AF.

Methods

In the NeAfib-Echo registry, 395 consecutive adult patients with non-valvular AF (F/M: 175/220; mean age 70.6 ± 11 years, BMI: 27.8 ± 5.6 kg/m²) were enrolled. 215 patients (54.1%) had permanent/persistent AF (prAF) and 178 (45.9%) had paroxysmal AF (pxAF). Anthropometric parameters and blood pressure (BP) were recorded and CHA2DS2VASc score was calculated. Patients underwent a complete echo-Doppler exam, including determination of PALS and left ventricular (LV) global longitudinal strain (GLS) (both reported in absolute values). The overall population was divided according to BMI tertiles: first tertile &lt;25.3 Kg/m² (n = 127); second tertile 25.3-29 Kg/m² (n = 137); third tertile &gt; 29.3 Kg/m² (n = 130).

Results

No significant difference of sex prevalence, age, systolic BP and heart rate was found among the three BMI tertiles, whereas diastolic BP was higher in the third tertile (p &lt; 0.001). CHA2DS2VASc score did not significantly differ among tertiles. In the pooled population LV mass index (LVMi) (p = 0.001) progressively increased from the first to the third tertile (p &lt; 0.001), whereas LA volume index, LV ejection fraction (EF), GLS and E/e" ratio were not significantly different among the three groups. PALS was lower in third tertile (14.3 ± 8.2%) versus both the first (19.0 ± 11.5%) and the second tertile (17.7 ± 10.6%) (p &lt; 0.002). In separate sub-analyses according to AF type, PALS was significantly lower in the first than the third tertile in the PxAF group (p &lt; 0.01) but not in patients with PrAF (p = 0.158). In the pooled population PALS was significantly related with BMI (r= -0.17, p &lt; 0.001) (Figure) but also with age, heart rate, LVMi, LV EF, GLS, E/e’ ratio and pulmonary artery systolic pressure (PAPS). By a multilinear regression analysis, after adjusting for CHA2DS2VASc score, LV mass index, LV EF, E/e’ ratio and PAPs, BMI remained independently associated with PALS (standardized β coefficient = -0.127, p &lt; 0.02) (cumulative R² =0.41, SEE = 8.5%, p &lt; 0.0001).

Conclusions

In patients with non valvular AF, overweight and obesity exert a detrimental effect on LA function as testified by the gradual PALS reduction with the increase of BMI tertiles. BMI is associated with PALS independently of several confounders including CHA2DS2VASc. Besides CHA2DS2VASc score, BMI could be considered as an additional factor for evaluating cardiovascular risk in non valvular AF.

Abstract P814 Figure. Relation between BMI and PALS

P1404 Additional power of automated longitudinal strain during dobutamine stress echo for detecting inducible ischemia in left anterior descending artery stenosis

Background

Dobutamine stress echo (DSE) is a sensitive but subjective test of inducible ischemia. Speckle tracking allows now a quantitative assessment of regional wall motion, even during DSE.

Purpose

To investigate the feasibility and accuracy of global and regional longitudinal strain during DSE to detect significant CAD.

Methods

This is a prospective, observational study, including 88 patients undergoing DSE for suspected CAD. Thirthy-three patients with negative DSE were excluded from analysis. The remaining 50 patients (82% males, mean age 66.3 ± 8.2 years) with positive DSE underwent subsequent invasive coronary angiography (CA). Besides visual regional wall motion score index (WMSI), global longitudinal strain (GLS) and regional longitudinal strain (RLS) were determined at rest, at peak stress and at early recovery by a dedicated software (Automated Function Imaging) incorporated in a quoad-screen of the echo machine and activated by automatic quantification. Obstructive CAD was defined as &gt;70% stenosis or intermediate stenosis combined with fractional flow reserve &lt;0.80.

Results

The feasibility of DES regional longitudinal strain was 100% (n = 50/50) in the pooled population. Fifteen patients did not show coronary stenosis whereas obstructive CAD was detected in 35 patients (12 with multi-vessel disease). Among these patients, 18 patients had left anterior descending artery (LAD) stenosis, 18 left circumflex coronary artery (LCX) stenosis and 15 right coronary artery (RCA) stenosis. GLS reduction at peak stress (k = 0.253, p = 0.037) and WMSI increase at peak stress (k = 0.217, p = 0.04) showed mild but significant agreement with CA for detecting significant coronary stenosis, whereas the agreement of GLS at recovery (k=-0.087, p = 0.518) was poor. When single lesion territory was considered, GLS at peak stress (17.4 ± 5.5 vs 20.5 ± 4.4%, p = 0.034) and LAD longitudinal strain (= average of 8 myocardial segments: middle and apical posterior septum, basal, middle and apical anterior septum, basal, middle and apical anterior wall) at peak stress showed significantly lower values in the obstructed LAD regions than the territories perfused by non-obstructed coronary arteries (17.1 ± 7.6 vs 21.6 ± 5.5% p = 0.021). Conversely, in presence of significant LCX or RCA stenosis, visual regional wall motion of LCX and RCA territories were higher at peak stress (WMSI LCX = 1.80 ± 0.65 in presence of LCX stenosis vs. 1.38 ± 0.44 in absence of stenosis, p &lt; 0.01; WMSI RCA = 1.89 ± 0.52 in presence of RCA stenosis vs. 1.42 ± 0.42 in absence of stenosis, p = 0.002), but RLS at peak stress showed a trend to increase, without achieving the statistical significance (RLS RCA: p = 0.128, RLS LCX: p = 0.103).

Conclusion

AFI-based strain quantitative analysis appears to be highly feasible during DSE. It appears also to be more accurate than the visual wall motion for the detection of myocardial ischemia in presence of LAD while the accuracy is suboptimal in patients with LCX and RCA stenosis.

P658 Impact of hyperuricemia on left ventricular longitudinal systolic function in uncomplicated hypertensive patients

Background

Hyperuricemia has been reported to accelerate the occurrence and worsening of cardiovascular disease, being a risk factor for coronary heart disease and cardiac mortality. Elevated uric acid (UA) is also associated with left ventricular (LV) hypertrophy and with LV diastolic dysfunction. The effect of hyperuricemia (HU) on LV systolic function is still unclear.

Purpose

Aim of our study was to evaluate the impact of elevated UA serum levels on LV systolic function, also evaluating longitudinal deformation, in a population of hypertensive patients.

Methods

We enrolled 160 treated hypertensive patients (M/F = 104/56, age 58.2 ± 13.3 years, blood pressure = 136.7 ± 16.8/81.3 ± 10.9 mmHg), who underwent standard echo-Doppler exam, including speckle tracking quantification of global longitudinal strain (GLS, considered in absolute value). HU was defined as UA≥7 mg/dL and the study population was divided in two groups: patients with (n = 63) and without (n = 97) HU. Exclusion criteria were coronary artery disease, overt heart failure, hemodynamically significant valve heart disease, primary cardiomyopathies, permanent atrial fibrillation and inadequate echo imaging.

Results

The two groups were comparable for sex prevalence, blood pressure and heart rate. Patients with HU were older and had higher body mass index (BMI) (both p &lt; 0.0001). Prevalence of diabetes mellitus was higher in the group of patients with HU than in patients with normal UA (69% vs. 12% p &lt; 0.0001). Fasting glycaemia was higher (p &lt; 0.0001) and glomerular filtration rate (GFR) lower in HU hypertensives (both p &lt; 0.0001). LV mass index (LVMi) was higher in patients with HU (p &lt; 0.0001). Among diastolic parameters, transmitral E/A ratio (p &lt; 0.0001) was lower, whereas E/e’ ratio (p &lt; 0.0001), E velocity deceleration time and left atrial volume index (both p &lt; 0.001) were higher in HU hypertensives. GLS resulted to be lower in patients with HU (20.8 ± 1.5 vs. 22.3 ± 2.2%, p &lt; 0.0001). LV ejection fraction, despite still in normal range values, was also slightly lower in comparison with controls (60.6 ± 4.0 vs. 62.2 ± 3.9%, p &lt; 0.01). Serum UA levels resulted to be negatively correlated with GLS (r=-0.28, p &lt; 0.0001) (Figure), but not with ejection fraction. By a multiple linear regression analysis performed in the pooled hypertensive population, after adjusting for age, BMI, GFR, fasting glycaemia and LVMi, the association between UA levels and GLS remained significant (standardized beta coefficient =-0.25, p &lt; 0.01), besides the significant impact of age (beta=-0.19 , p &lt; 0.05).

Conclusions

In hypertensive patients with multiple cardiovascular risk factors, the presence of HU is associated with LV diastolic and systolic dysfunction. Serum UA levels and GLS resulted independently associated even after adjusting for several clinical and echo confounders. Acid uric might be considered as an independent marker of early LV dysfunction, able to identify hypertensive patients at increased risk for heart failure.

Abstract P658 Figure. Relation between uric acid and GLS

P297 Left atrial volume index is the best predictor of post-capillary pulmonary hypertension in patients with pure mitral valve stenosis

Background

Mitral stenosis (MS) is characterized by a reduced mitral valve area (MVA) and an increased transmitral pressure gradient, with direct consequences on left atrial (LA) remodelling and pulmonary arterial systolic pressure (PASP). Post-capillary pulmonary hypertension (PH) has a main impact on the outcome in patients with MS.

Purpose

To evaluate determinants of post-capillary PH in patients with pure MS by using a combined approach of standard and advanced echocardiography.

Methods

From January 2018 to January 2019, 52 consecutive patients with MS were enrolled. Concomitant hemodynamically significant valve heart disease, primary PH, coronary artery and congenital heart diseases, primary cardiomyopathies, prosthetic valves and permanent/persistent atrial fibrillation were exclusion criteria. Twenty-three "pure" MS were selected (age: 63.9 ± 11.6 years, F/M= 17/6). Twenty-three healthy controls, matched by age and sex, were recruited as the control group. All participants underwent a complete echocardiographic examination, including determination of left ventricular ejection fraction (LVEF), speckle tracking derived global longitudinal strain (GLS, in absolute values), LA volume index (LAVi) and PASP. MS severity was assessed by continuous wave Doppler derived mean transmitral pressure gradient (MPG), pressure half time (PHT) and functional mitral valve area (MVA). Data were analysed offline by a dedicated workstation.

Results

No significant difference of body mass index, systolic and diastolic blood pressure was found between the two groups, while heart rate was higher in MR (p &lt; 0.0001). In the pooled MS population, MPG was 5.7 ± 2.4 mmHg, PHT 127.7 ± 26.9 msec and MVA 1.76 ± 0.36 cm². Twelve patients (52.1%) had mild MS, 10 (43.5%) moderate MS and one (4.3%) severe MS. Patients with MS had larger LA volumes (LAVi = 45.0 ± 12.7 vs. 28.3 ± 7.3 ml/m², p &lt; 0.0001), higher PASP (36.4 ± 8.9 vs. 30.4 ± 6.7 mmHg, p &lt; 0.01), lower LVEF (58.5 ± 6.1 vs. 66.0 ± 3.5%. p &lt; 0.0001) and lower GLS (18.8 ± 4.6 vs. 21.7 ± 2.5%, p &lt; 0.01) than the healthy controls. By analyzing the MS group, LAVi had a significant univariate relation with MPG degree (r = 0.69, p &lt; 0.002). PASP correlated with LAVi (r = 0.60, p = 0.003) and MPG (r = 0.51, p &lt; 0.01) but not with PHT (r = 0.28, p = 0.54) and functional MVA (r=-0.31, p = 0.33). By a multlinear regression analysis, including heart rate, MPG, LVEF and GLS as potential determinants, LAVi (standardized beta coefficient =0.65, p= &lt;0.02) and GLS (beta =-0.62, p = 0.03) were both independently associated with PASP degree, whereas the association of MPG and PASP was not significant (cumulative R²=0.47, SEE = 5.9 mmHg, p &lt; 0.01) in the MS group.

Conclusions

In patients with pure MS, by using a multi-parametric echocardiographic approach, LA dilation appears to be the best predictor of post-capillary PH, independent on the magnitude of LV systolic dysfunction and valvular disease severity. Particular care should be devoted to determine LA size in this clinical setting.

Abstract P297 Figure. Relation between LAVi and PASP in MS

The influence of mobility strategy on the modern human talus

OBJECTIVES

The primate talus is known to have a shape that varies according to differences in locomotion and substrate use. While the modern human talus is morphologically specialized for bipedal walking, relatively little is known on how its morphology varies in relation to cultural and environmental differences across time. Here we compare tali of modern human populations with different subsistence economies and lifestyles to explore how cultural practices and environmental factors influence external talar shape.

MATERIALS AND METHODS

The sample consists of digital models of 142 tali from 11 archaeological and post-industrial modern human groups. Talar morphology was investigated through 3D (semi)landmark based geometric morphometric methods.

RESULTS

Our results show distinct differences between highly mobile hunter-gatherers and more sedentary groups belonging to a mixed post-agricultural/industrial background. Hunter-gatherers exhibit a more "flexible" talar shape, everted posture, and a more robust and medially oriented talar neck/head, which we interpret as reflecting long-distance walking strictly performed barefoot, or wearing minimalistic footwear, along uneven ground. The talus of the post-industrial population exhibits a "stable" profile, neutral posture, and a less robust and orthogonally oriented talar neck/head, which we interpret as a consequence of sedentary lifestyle and use of stiff footwear.

DISCUSSION

We suggest that talar morphological variation is related to the adoption of constraining footwear in post-industrial society, which reduces ankle range of motion. This contrasts with hunter-gatherers, where talar shape shows a more flexible profile, likely resulting from a lack of footwear while traversing uneven terrain. We conclude that modern human tali vary with differences in locomotor and cultural behavior.

P2775Evaluation of right ventricular function in patients with idiopathic and non-idiopathic interstitial pulmonary fibrosis: a speckle tracking echocardiography study

Background

Pulmonary fibrosis (PF) is a heterogeneous group of diffuse parenchymal lung diseases, including idiopathic PF (IPF), which is the most frequent type in adults, and non-IPF. The impairment of right ventricular (RV) myocardial function of PF patients is not fully elucidated.

Purpose

To identify RV alterations in patients with interstitial PF and to evaluate possible differences between IPF and non-IPF by a combined assessment with standard and advanced echocardiography.

Methods

We enrolled 61 patients affected by interstitial PF (F/M: 16/45; age 67.9±8.1 years). 33 patients had IPF fibrosis and 28 non-IPF (bronchiolitis obliterans-organizing pneumonia and nonspecific interstitial pneumonia/fibrosis). Patients with coronary artery disease, overt heart failure, primary cardiomyopathies, other forms of diffuse parenchymal lung disease, history of pulmonary embolism and primary pulmonary hypertension were excluded. PF diagnosis was made by chest radiography, spirometry and chest high-resolution computed tomography. Lung cumulative damage was evaluated by diffusion capacity of the lung for carbon monoxide (DLco). Anthropometric parameters and blood pressure (BP) were recorded. All patients underwent a complete standard and advanced echo-Doppler exam including assessment of RV structure and function. RV global longitudinal strain (RVGLS), septal and lateral longitudinal strain (SLS and LLS respectively), were estimated by speckle tracking echocardiography (all strains were reported in absolute values).

Results

No significant difference was found in sex prevalence, systolic and diastolic BP and heart rate between the two groups, whereas IPF patients were older (65.2±8.1 vs. 70.1±7.6 years, p<0.01) than non-IPF. There was no difference in DLco between IPF and non-IPF patients. The two groups had similar left ventricular (LV) mass index, LV E/A ratio and E/e' ratio, and LV ejection fraction. RV diameters, tricuspid annulus plane systolic excursion (TAPSE) and pulmonary systolic artery pressure (PAPs) were not significantly different between the two groups, whereas IPF patients had lower RV GLS (20.2±3.1 vs. 23.0±3.6%, p=0.006), SLS (17.4±3.4 vs. 20.5±4.7%, p<0.01) and LLS (22.6±4.5 vs. 25.8±4.7%, p<0.02) compared to non-IPF patients. In the pooled population, DLco was related to RV GLS (r=0.51, p=0.004) and SLS (r=0.47, p<0.01), but not with age (p=0.121), TAPSE (p=0.532), and PAPs (p=0.875). In separate sub-analyses according to PF type, DLco was related to RVGLS in patients with IPF (r=0.52, p=0.03), but not in patients with non-IPF (r=0.41, p=0.16).

Conclusion

In patients with PF, RV systolic myocardial dysfunction is detectable by speckle tracking but not with standard echocardiography. In patients with IPF, RV dysfunction is associated with the degree of lung disease damage, as assessed by DLco.

Enamel peptides reveal the sex of the Late Antique 'Lovers of Modena'

Recent work has disclosed the critical role played by enamel peptides in sex classification of old skeletal remains. In particular, protein AMELY (amelogenin isoform Y) is present in the enamel dental tissue of male individuals only, while AMELX (isoform X) can be found in both sexes. AMELY can be easily detected by LC-MS/MS in the ion extracted chromatograms of the SM(ox)IRPPY peptide (monoisotopic [M + 2 H]+2 mass = 440.2233 m/z). In this paper, we exploited the dimorphic features of the amelogenin protein to determine the sex of the so-called 'Lovers of Modena', two Late Antique individuals whose skeletons were intentionally buried hand-in-hand. Upon discovery, mass media had immediately assumed they were a male-female couple, even if bad preservation of the bones did not allow an effective sex classification. We were able to extract proteins from the dental enamel of both individuals (~1600 years old) and to confidently classify them as males. Results were compared to 14 modern and archaeological control samples, confirming the reliability of the ion chromatogram method for sex determination. Although we currently have no information on the actual relationship between the 'Lovers of Modena' (affective? Kin-based?), the discovery of two adult males intentionally buried hand-in-hand may have profound implications for our understanding of funerary practices in Late Antique Italy.

Multi-analytic study of a probable case of fibrous dysplasia (FD) from certosa monumental cemetery (Bologna, Italy)

OBJECTIVE

To evaluate, via a multidisciplinary approach, a distinctive paleopathological condition believed to be fibrous dysplasia, found on a 19th/20th century skeleton from Certosa Monumental Cemetery, Bologna, Italy.

MATERIALS

A skeletonized cranium and mandible recovered from an ossuary in 2014.

METHODS

Pathological alterations were analysed by radiological examination, dental macrowear, histopathological and genetic analyses.

RESULT

The skeleton is believed to be an adult male. Differential diagnoses include Paget's disease, McCune-Albright syndrome, osteochondroma and osteosarcoma. The radiographic findings, along with the solitary nature of the lesions, are strong evidence for the diagnosis of fibrous dysplasia (FD). Genetic analysis further revealed a frequency of ˜1% of mutant alleles with the R201C substitution, one of the post-zygotic activating mutation frequently associated with FD.

CONCLUSIONS

The multi-analytical method employed suggests a diagnosis of monostotic form of FD. The diagnostic design incorporates multiple lines of evidence, including macroscopic, histopathological, and genetic analyses.

SIGNIFICANCE

Through the use of a multi-analytic approach, robust diagnoses can be offered. This case serves as one of the oldest examples of FD from an historical context. The genetic mutation detected, associated with FD, has not been previously reported in historical/ancient samples.

Implications on pathogenesis and risk of oral lichen planus neoplastic transformation: an ex-vivo retrospective immunohistochemical study

AIMS

To evaluate OPN, MCM7, Ki-67, p53, Bcl-2 and 53BP1 presence, together with the abnormal adaptive CD4 and CD8 T-cell response markers expression in a series of oral lichen planus (OLP) affected patients and assess their combined contribution for a more objective disease classification.

METHODS AND RESULTS

In this ex-vivo retrospective analysis, biopsy specimens from 28 adults with a clinical diagnosis of OLP at different progression degree (16 reticular, 2 plaque-like, 1 erosive and 9 mixed type) were collected. Sections were immunohistochemically investigated for the proinflammatory cytokine osteopontin (OPN), alpha-beta CD4 and CD8 positive T cells, DNA replication licensing factor (MCM7), proliferating cell marker (Ki-67), apoptotic and tumor antigen (p53), apoptosis modulator (Bcl-2) and cellular response regulator to double-strand breaks tumor suppressor p53-binding protein 1 expression. Statistical analysis revealed that 53BP1 is highly represented among the OLP study patients (p<0.05). Moreover, on the basis of the quantification results of the highly expressed parameters, two illness categories with different severity were evidenced. The classification hypothesis was confirmed by i) OLP lesion persistence, ii) the development of oral severe lesions in the patients belonging to high grade activity OLP group (HGA-OLPs) and iii) the ascertainment of the same evidence both in the oral squamous cell tumor controls (OSCC) and in HGA-OLP cases.

CONCLUSION

This study completes the scenario with respect to early detection, thanks to a more precise histological analysis, for rationalizing the clinical and histological findings toward a sharable international disease scoring system.

Three-dimensional echocardiographic evaluation of the right ventricle in patients with uncomplicated systemic lupus erythematosus

Our aim was to identify subclinical right ventricular (RV) alterations in systemic lupus erythematosus (SLE) by combining standard and three-dimensional echocardiography (3DE). Fifty SLE patients without concomitant cardiac disease and 50 healthy controls, matched for age and gender, were enrolled. Disease damage was evaluated by inflammatory markers and SLE damage index. All patients underwent an echo-Doppler examination with 3DE assessment of RV function, RV septal and lateral longitudinal strain. The two groups had comparable body mass index and blood pressure. RV transversal middle diameter and pulmonary arterial pressure were significantly higher in SLE compared to controls. By 3DE, RV end-systolic volume ( p = 0.037) was greater, whereas stroke volume ( p = 0.023), ejection fraction ( p < 0.0001) and septal and lateral longitudinal strain (both p < 0.0001) were lower in SLE. SLE damage index ≥ 1 was negatively associated with tricuspid annular plane systolic excursion (TAPSE) ( p < 0.002), tricuspid E/A ratio ( p = 0.003), RV ejection fraction ( p < 0.05), lateral longitudinal strain ( p < 0.0001) and septal longitudinal strain ( p = 0.04). By separate multivariate models, after adjusting for age, C reactive protein and proBNP, SLE damage index was independently associated with TAPSE ( p = 0.009) and RV lateral longitudinal strain ( p = 0.007). In conclusion, a subclinical RV systolic dysfunction is detectable in SLE by 3DE, RV lateral wall strain being a key parameter. RV dysfunction is associated with cumulative disease damage.

Human papillomavirus type 16 E6 and E7 oncoproteins interact with the nuclear p53-binding protein 1 in an in vitro reconstructed 3D epithelium: new insights for the virus-induced DNA damage response

Background

Despite vaccination and screening measures, anogenital cancer, mainly promoted by HPV16 oncoproteins, still represents the fourth tumor and the second cause of death among women.

Cell replication fidelity is the result of the host DNA damage response (DDR). Unlike many DNA viruses that promote their life cycle through the DDR inactivation, HR-HPVs encourage cells proliferation despite the DDR turned on. Why and how it occurs has been only partially elucidated.

During HPV16 infection, E6 links and degrades p53 via the binding to the E6AP LXXLL sequence; unfortunately, E6 direct role in the DDR response has not clearly identified yet.

Similarly, E7 increases DDR by competing with E2F1-pRb interaction, thus leading to the inactivation of pRb, and promotion, E2F1 mediated, of DDR genes translation, by binding to the pRb-like proteins CBP/p300 and p107, that also harbour LXXLL sequence, and via the interaction and activation of several DDR proteins.

Methods

To gain information regarding E6 and E7 contribution in DDR activation, we produced an in vitro 3D HPV16-E6E7 infected epithelium, already consolidated study model for HPVs, and validated it by assessing H&E staining and BrdU, HPV16 DNA, E6E7 proteins and γH2A.X/53BP1 double-strand break (DSBs) sensors expression; then we made an immuno-colocalization of E6 and E7 with cyclin E2 and B1.

Since 53BP1, like E6 and E7, also binds p53 and pRb, we supposed their possible direct binding. To explore this hypothesis, we performed a double immunofluorescence of E6 and E7 with 53BP1, a sequence analysis of 53BP1 within its BRCT2 domain and then an in situ PLA within CaSki, E6E7HPV16 NHEKs and the 3D model.

Results

The in vitro epithelium resembled the histology and the events typical of in vivo infected tissues. E6E7HPV16 were both expressed in basal and differentiated strata and induced H2A.X phosphorylation and 53BP1 increment into nuclear foci.

After highlighting E6 and E7 co-expression with 53BP1 and a LKVLL sequence within the 53BP1 BRCT2 domain, we demonstrated the bindings via the PLA technique.

Conclusions

Our results reinforce E6 and E7 role in cellular function control providing potentially new insights into the activity of this tumor virus.

The physiological linkage between molar inclination and dental macrowear pattern

OBJECTIVES

Exact symmetry and perfect balance between opposite jaw halves, as well as between antagonistic teeth, is not frequently observed in natural masticatory systems. Research results show that asymmetry in our body, skull, and jaws is often related to genetic, epigenetic, environmental and individual ontogenetic factors. Our study aims to provide evidence for a significant link between masticatory asymmetry and occlusal contact between antagonist teeth by testing the hypothesis that tooth inclination is one of the mechanisms driving distribution of wear in masticatory phases in addition to dietary and cultural habits.

MATERIALS AND METHODS

The present work investigates the relationship between dental macrowear patterns and tooth inclinations on a sample of complete maxillary and mandibular 3D models of dental arches from 19 young and adult Yuendumu Aboriginal individuals. The analysis was carried out on first molars (M1) from all quadrants. Occlusal Fingerprint Analysis was used for the quantification of macrowear patterns, and 2D cross-sectional geometric analysis was carried out to investigate asymmetry in dental arches.

RESULTS

The asymmetry is highly variable on both arches, and it is associated with differences in the inclination of upper M1 crowns. Each molar has variable inclination (buccal/lingual) which influence tooth to tooth contact, producing greater or lesser variation in wear pattern. Interindividual variability of morphological variation of the occlusal relationship has to be considered in macrowear analysis.

DISCUSSION

Our results suggest that overall asymmetry in the masticatory apparatus in modern humans affects occlusal contact areas between antagonist teeth influencing macrowear and chewing efficiency during ontogeny.

3D Printing of Thermo-Responsive Methylcellulose Hydrogels for Cell-Sheet Engineering

A possible strategy in regenerative medicine is cell-sheet engineering (CSE), i.e., developing smart cell culture surfaces from which to obtain intact cell sheets (CS). The main goal of this study was to develop 3D printing via extrusion-based bioprinting of methylcellulose (MC)-based hydrogels. Hydrogels were prepared by mixing MC powder in saline solutions (Na₂SO₄ and PBS). MC-based hydrogels were analyzed to investigate the rheological behavior and thus optimize the printing process parameters. Cells were tested in vitro on ring-shaped printed hydrogels; bulk MC hydrogels were used for comparison. In vitro tests used murine embryonic fibroblasts (NIH/3T3) and endothelial murine cells (MS1), and the resulting cell sheets were characterized analyzing cell viability and immunofluorescence. In terms of CS preparation, 3D printing proved to be an optimal approach to obtain ring-shaped CS. Cell orientation was observed for the ring-shaped CS and was confirmed by the degree of circularity of their nuclei: cell nuclei in ring-shaped CS were more elongated than those in sheets detached from bulk hydrogels. The 3D printing process appears adequate for the preparation of cell sheets of different shapes for the regeneration of complex tissues.

Aging resistance, mechanical properties and translucency of different yttria-stabilized zirconia ceramics for monolithic dental crown applications

OBJECTIVES

The dental market moves towards high-translucency monolithic zirconia dental crowns, which are usually placed either with - or without - a thin glaze layer. The microstructural features and the mechanical performances of these materials are still controversial, as well as their susceptibility to aging. This paper aims at studying these aspects in the current generation of zirconia dental crowns showing different degrees of translucency.

METHODS

Four different commercial zirconia materials were investigated, including one standard 'full-strength' 3Y-TZP and three grades with improved translucency. The microstructural features (phase composition and assemblage, grain size) were carefully studied, as well as mechanical properties (biaxial bending strength and indentation toughness), translucency and aging behavior (in autoclave at 134°C). Aging was conducted on crowns with and without glaze to better represent clinical uses.

RESULTS

Important differences are found in terms of microstructures among the materials in terms of cubic phase content and yttria in the tetragonal phase, leading to different optical, mechanical and aging resistance properties. We show that higher cubic phase content leads to better translucency and stability in water steam, but at the expense of strength and toughness. A compromise is always inevitable between translucency and aging resistance on one side and mechanical properties on the other side.

SIGNIFICANCE