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Rationale: Atrial fibrillation (AF) is the most common cardiac arrhythmia and is associated with increased morbidity, especially stroke and heart failure. There is also increasing awareness that atrial fibrillation is a major cause of embolic events which in 75% of cases are complicated by cerebrovascular accidents. Patient concerns: A 50-year-old woman with mitral bioprosthesis under warfarin for nonvalvular atrial fibrillation was referred to our Coronary Intensive Care Unit due to acute myocardial infarction without evidence of significant coronary artery stenosis. Diagnoses: Cardiovascular examination showed an irregular pulse and a grade II diastolic murmur was audible at the apical area. The patient underwent coronary angiography showing absence of obstructive coronary artery disease. We decided to replace Warfarin with direct oral anticoagulants as anticoagulant therapy. Interventions: Transoesophageal echocardiography revealed a thrombus in left atrial appendage that was treated by replacing warfarin with an oral direct thrombin inhibitor. Outcomes: At 2-month follow-up, the therapy showed to be effective for thrombus resolution. Lessons: Our case demonstrated how AF has high risk of thromboembolic complications, not only in terms of stroke but also of myocardial infarction and death. The use of direct oral anticoagulants in AF patients with bioprosthetic heart valves is still debated due to an unclear definition of “nonvalvular” AF.

Patients with Down syndrome (DS) present delays in motor development, showing a unique pattern of locomotion in clinical settings. Hippotherapy (HBR) is a field of rehabilitation therapy to achieve physical, social, and psychological well-being through therapeutic horse riding, providing a new stimulus related to gait and may helping balance and postural control [1], [2]. Herein, we have enrolled fifteen male individuals affected by DS, aged from 19 to 36 years old. All patients were vaccinated for tetanus and previously screened for any contraindications to practice HBR. The HBR protocol included a six-months period of horseback riding exercise, performed weekly. Before, during and after the study period, functional mobility, strength and performance in balance were assessed by Time Up and Go Test (TUG), 30s Chair-Stand-Test (30CST), MRC-scale and the Berg-Balance-Scale (BBS). Furthermore, the OPTO-Gait for dynamic analysis and the Diasu Ultrasensor systems for static analysis were applied at the same timepoints, in order to assess the HBR effects on movement reaction time, muscle activation, functional mobility, muscle strength and balance in DS. In conclusion, we provided objective clinical data on the role of HBR to determine a functional improvement on gait speed, rhythm, width, bilateral symmetry, gross motor function and balance in DS., Italian Journal of Anatomy and Embryology, Vol. 122, No. 1 (Supplement) 2017

Sarcoglycans are transmembrane glycoproteins which play a key role in maintaining sarcolemma stabilization during muscle contraction. Several studies have demonstrated that this complex is not muscle specific and that it is also expressed in epithelial tissues as gingival, breast and prostatic epithelia. In the present study we investigated sarcoglycans expression in the epithelia of digestive and respiratory tracts. We performed immunofluorescence reactions using antibody against a-, b-, g-, d-, e- and z-sarcoglycans and against mucin 4 and 16. Mucins are a superfamily of proteins which serve to protect the underlying epithelia against a wide range of injuries (bacteria, virus, parasites, toxins, pH). This protection leads to coordinate cell proliferation, differentiation and apoptosis among other cellular responses; in fact, mucins are promising biomarkers and therapeutic targets in cancer and inflammatory diseases. Our results show the expression of sarcoglycans in the basal, lateral, and apical epithelial cell’s surface; moreover, sarcoglycans show to colocalize with mucins in the cell’s apical surface of bronchi and bronchioles, stomach and intestine but no apical localization has been detected in the esophageal epithelium. These results support the role of sarcoglycans in cell-cell and cell-matrix interaction. Moreover, the colocalization between sarcoglycans and mucins at apical level of epithelia which have high mucosecretory activity suggest that sarcoglycans could interact with mucus, maybe involving in maintainig omeostasis of gastro enteric epithelia. It will be necessary to demonstrate the hypothetical correlation between sarcoglycans and the maintaining epithelial homeostasis., Italian Journal of Anatomy and Embryology, Vol. 121, No. 1 (Supplement) 2016

Bisphosphonates are a category of drugs that are commonly used in dentistry and orthopedics to treatment of several bone disorders. The two most potent and widely used nitrogen-containing BPs are zoledronate and alendronate, which inhibit the intracellular mevalonate pathway. In recent years it has been observed Biphosphonate-associated osteonecrosis of the jaws which is a real complication of intravenous biphosphonates therapy in patients with cancer or osteoporosis. In our previous studies, performed on rat model, we observed mandibular bone characteristics after long term of low dose zoledronate treatment without tooth extraction or trauma; results showed several areas of bone with empty osteocyte lacunae, absence of matrix and presence of unorganized fibrillar structures but no spontaneous bone exposure has been observed. In the present study we have treated 20 rats with intraperitoneal injections of zoledronate at the lower dose for three times a week. After 30 days of treatment we applied trauma on mandibular bone by application of screw. Specimens were analysed by histological staining, immunofluorescence techniques and scanning electron microscopy. Our results show that the bone area of screw application is characterized of empty osteocyte lacunae, empty Volkmann’and Havers’canals and some inflammatory cells. Although the presence of small necrotic areas no bone exposure has been observed after low dose zoledronate treatment and trauma application. These results suggest us that the bisphosphonates-associated osteonecrosis of jaw is strictly correlated to drug’s dose. It will be necessary to perform the same study using the highest dose of drugs., Italian Journal of Anatomy and Embryology, Vol. 121, No. 1 (Supplement) 2016

The objective of our study is to explore the feasibility and utility of Diffusion Tensor Imaging (DTI) in the non invasive evaluation of any lesion [1] in Head and Neck structure. We would reach a verified and certified step of Virtual biopsy. Ten patients with different histological lesions were recruited for this study. Morphological and diffusion weighted images were acquired with a 3T scanner during last 3 months. Probabilistic tensor-based tractography reconstruction of any lesions was performed and mean fractional anisotropy (FA) values for everyone were extracted [2]. The results showed that the Diffusion Tensor Imaging (DTI) was able to identify the lesion geometrical morphology and diffusion microstructural changes. The patient with a benign lesion reported a significant improvement in ADC mean values. We have evidence that pushes us to continue with this method. We are at the beginning of this work. We had to recruits more patients to get meaningfully significant data., Italian Journal of Anatomy and Embryology, Vol. 122, No. 1 (Supplement) 2017

Crossbite is a lateral misalignment of the dental arches. Subjects with unilateral posterior crossbite exhibit different kinematics of the mandible during mastication when chewing on the affected side, resulting in an increased frequency of reverse chewing cycles; moreover, the masseter of the affected side results less active than the counterpart (Piancino et al., 2006). An our immunofluorescence study on masseter muscle of crossbite patients has shown that in the affected side there is a lower expression of muscle specific integrins than the counterpart (Cutroneo et al., 2012). So, we hypothesized that integrins could be correlated with contraction activity in mastication, maybe promoting the production of new muscle fibers. Another our tractography study on crossbite patients has shown an increment of muscle fibers number in non affected side. On this basis in the present work we investigated the number of satellite cells in masseter muscle of crossbite patients, both in affected and non affected side. Since the existence of a bidirectional signaling between integrins and sarcoglycans we have also investigated the expression of the sarcoglycan subcomplex. Results show that the number of satellite cells in non affected side is higher than affected side. Moreover, in according with our previous results about integrins, even the sarcoglycan sub-complex show to be less expressed in the affected side than the counterpart. These data support that in non affected masseter muscle a new fibers production activity takes place which, in turns, determines a muscular hyperplasia. Based on our results, the myogenesis in masseter muscle could be regulated by sarcoglycan and integrin protein systems., Italian Journal of Anatomy and Embryology, Vol 119, No 1 (Supplement) 2014

Myocardial Infarction (MI) is an ischemic heart disease representing one of the main causes of death for acute cardiac pathologies. Two important consequences of MI are left ventricular (LV) aneurysm and pseudo-aneurysm. The aim of the present study is to highlight anatomical and functional changes in LV undergoing post-ischemic remodeling by means of three dimensional-Magnetic Resonance Imaging (MRI) and three dimensional-Computed Tomography (CT), which are useful techniques for the diagnosis and evaluation of accurate clinical and surgical approaches. In this way the surgeon can evaluate pro and counter of the classical approach or the parachute implant with possible promotion of mininvasive surgery [1]. Although to date MI consequences can be assessed with bidimensional technique (e.g. echocardiography and ventriculography), we want to suggest the use of three dimensional Direct Volume Rendering (DVR), which is a direct technique for visualizing primitive volumes without any intermediate conversion of the volume data to surface presentation [2]. DVR allows to better discriminate between aneurysm and pseudoaneurysm and to do a better evaluation of inclusion and exclusion criteria for the implant of a parachute device., Italian Journal of Anatomy and Embryology, Vol. 120, No. 1 (Supplement) 2015

The limbic system is a complex set of brain structures located on both sides of the thalamus, right under the cerebrum. It is not a separate system but a collection of structures from the telencephalon, diencephalon, and mesencephalon, including the hippocampus, amygdala, anterior thalamic nuclei, fornix, columns of fornix, mammillary body, septum pellucidum, habenular commissure, cingulate gyrus, parahippocampal gyrus, limbic cortex, pars of olfactory system and limbic midbrain areas. Nevertheless, recent studies showed that the definition of anatomical structures considered part of the limbic system is a controversial subject. Although the role of the cerebellum was traditionally considered mainly associated to motion control, it has been recently suggested a cerebellar involvement in emotions control, cognitive processes and social behavior. In this regard, we have previously demonstrated that the cerebellum is interconnected with the hippocampus [1]. In this work, a wider sample of normal subjects was examined by using probabilistic Constrained Spherical Deconvolution (CSD) tractography, which represents a method able to overcome many limitations of other Diffusion Tensor Imaging (DTI) techniques, providing more accurate data [2]. We found evidences in the human brain that the cerebellum is widely linked with limbic-related structures and provided a more reliable demonstration of direct cerebello-limbic pathways. In addition, we further extendend our analysis to the other limbic connections including uncinated fasciculus, cingulate fasciculus, inferior longitudinal fasciculus, anterior thalamic connections and fornix. Although these pathways have been already described in the tractographic literature we provided reconstruction and quantitative analysis, which could be potentially useful to explore pathological conditions damaging this system. Finally, the demonstration of the existence of cerebello-limbic connections could constitute an important step in the knowledge of the anatomic substrate of non-motor cerebellar functions., Italian Journal of Anatomy and Embryology, Vol. 120, No. 1 (Supplement) 2015

Chewing is one of the most important functional movement of the stomatognathic system. It ‘a highly coordinated neuromuscular motor function, characterized by mandibular movements with a fast and continuous adaptation of the modulation strength. The information resulting from the masticatory pattern, in fact, are important to diagnose the functional status of the patient, such as repeatability and variability of the mandibular movement, neuromuscular coordination between the right and left side, or the ability to adapt to the load during chewing a hard bolus. In the context of scientific research, there is a constant demand for new applications to take advantage of the more technologically advanced clinical information. In this perspective the anatomy is presented as a basis for the study and the ‘integration of medical imaging techniques aimed at creating a system of Cloud Computing, able to process and store data. In our study, we found patients with craniomandibular disorders and chewing. Patients underwent an MRI Philips Achieva 3T, at IRCSS “Neurolesi”. The protocol included a MRI, fMRI and DTI, then the data obtained were processed processed and finally stored. On this basis we observe as the multimodal integration of different imaging modalities allows for numerous clinical data that favor a proper diagnosis, which is useful for the planning of an effective therapy. In addition, the cloud computing system allows the sharin, Italian Journal of Anatomy and Embryology, Vol 119, No 1 (Supplement) 2014

In present study we adopted an innovative approach, integrating the “Diffusion Tensor Imaging tractography (DTI)” technique with navigated transcranial magnetic stimulation (nTMS). In this way it is possible to improve accuracy of motor fiber reconstruction by positioning the fiducial seeding from DTI reconstruction, over the motor areas localized by nTMS. This will allow a direct comparison between the density of the motor map obtained with nTMS with the related axonal density obtained with DTI. DTI uses anisotropic water diffusion like test to study in vivo white matter anatomy in order to reconstruct tri-dimensional fiber bundles improving the practical 1 mm. MRI scanning resolution. Therefore we used the appropriate acquisition and reconstruction DTI techniques in order to study local cerebral pathways. Related acquisition must be done following resonance protocol and varying the magnetic gradient, in order to have the following steps: DWI acquisition; tensor calculation; scalar maps; 3d visualization; fiducial seeding. DTI technique can exploit two different classes of fiber tracking algorithms: “deterministic” or “probabilistic” tracking higherorder integration schemes. The deterministic one, allows to calculate the directions of streamline propagation, and reveals only, presence or absence of a connection. On the other hand a probabilistic tracking approach is achieved: starting from a basic point, fibers are propagated multiple times through the tensor field while varying, in a stochastic way, the estimated fiber orientation along the traversed voxels. In addition nTMS is a newly evolving technique for in vivo investigating human motor system combining spatial information from high-resolution MRI with the functionality of non-invasive cortical stimulation. In this way it is possible to target motor areas more precisely obtaining a discrete motor maps of facial, hand and leg muscles. This innovative approach will indeed provide a new tool in neuroscience for an in vivo direct correlation between anatomical circuits and electrophysiological data., Italian Journal of Anatomy and Embryology, Vol 117, No 2 (Supplement) 2012

Italian Journal of Anatomy and Embryology, Vol 115, No 1/2 (Supplement) 2010