A Message from the Editor-in-Chief.

A Message from the Editor-in-Chief This issue of Acta medica Lituanica is the result of further evolution: from now on, our journal is being published by the Vilnius University Press. Probably you noted changed design, but most changes are within the system of submission and publishing. All they serve the main goal - wider and more effective dissemination of knowledge. Vilnius University Press is the academic community owned publishing platform - it means that academics play a key role in dissemination of results of their research. This enables also more effective implementation of academic freedom, more innovations, more transparency. Finally, it also means more Open Science. Publications in our journal are and will be freely accessible and free of article processing charges. This is already the second issue that was formed at the time of extreme challenges for biomedical community due to the global COVID-19 pandemic. Many of us found ourselves at the frontline dealing with this critical situation and fulfilling our duty to society. This issue starts with a review paper dedicated to the problem No.1; some more are under review. Another paper is dealing with professional burnout - not a minor problem for health professionals nowadays. Other research papers and case studies remind us about life before and (let's hope) after the pandemic. Finally, I want to thank our reviewers who sacrificed their time evaluating manuscripts: Sigita Aidietiene Vidmantas Alekna Karolis Azukaitis Valdas Banys Ausra Berzanskyte Zana Bumbuliene Jolanta Dadoniene Gyte Damuleviciene Edvardas Danila Audrius Dulskas Milda Endziniene Egle Ereminiene Zymantas Jagelavicius Ligita Jancoriene Ricardas Janilionis Augustina Jankauskiene Dalius Jatuzis Tomas Kacergius Vytautas Kasiulevicius Jacek Kubica Vaidutis Kucinskas Zita Kucinskiene Limas Kupcinskas Sigita Lesinskiene Mieczyslaw Litwin Ruta Mameniskiene Ruta Nadisauskiene Alvydas Navickas Janina Petkeviciene Narunas Porvaneckas Tomas Poskus Dainius Puras Ruta Sargautyte Jurate Sipylaite Povilas Sladkevicius Eugenijus Stratilatovas Arunas Strumila Rasa Strupaite-Sileikiene Virgilijus Tarutis Vytautas Tutkus Albertas Ulys Vincas Urbonas Algirdas Utkus Birute Vaisnyte Respectfully, Prof. Dr Rimantas Jankauskas, Editor-in-Chief Acta medica Lituanica.

An association between adult lifespan and stature in preindustrial Lithuanian populations: Analysis of skeletons.

The aim of this study was to test the null hypothesis that no relationship between maximal living stature and adult lifespan had existed in prehistoric and historic Lithuanian populations. The sample analyzed consisted of 1713 skeletons of adult individuals who died between the 2nd century CE and the beginning of the 19th century CE, collected from 118 archaeological sites located in the current territory of Lithuania. A cumulative logit model was applied to model ordinal age-related changes in the auricular surface and the pubic symphysis (measures of lifespan) as a function of maximal length of femur (an indicator of maximal living stature), sex, burial site and its chronology as a proxy for the place of residence and period. The lack of strong association between adult lifespan and femur length was observed for males and females, various periods and places of residence. However, the results failed to reject convincingly the hypothesis that no relationship between these two variables had existed in preindustrial Lithuanian populations. In addition to concerns regarding sampling and measurement errors, heterogeneous frailty in early life and resulting selective mortality may partly explain the results obtained.

MEPROCS framework for Craniofacial Superimposition: Validation study.

Craniofacial Superimposition (CFS) involves the process of overlaying a skull with a number of ante-mortem images of an individual and the analysis of their morphological correspondence. The lack of unified working protocols and the absence of commonly accepted standards, led to contradictory consensus regarding its reliability. One of the more important aims of 'New Methodologies and Protocols of Forensic Identification by Craniofacial Superimposition (MEPROCS)' project was to propose a common framework for CFS, what can be considered the first international standard in the field. The framework aimed to serve as a roadmap for avoiding particular assumptions that could bias the process. At the same time, it provides some empirical support to certain practices, technological means, and morphological criteria expected to facilitate the application of the CFS task and to improve its reliability. In order to confirm the utility and potential benefits of the framework use, there is a need to empirically evaluate it in CFS identification scenarios as close as possible to the reality. Thus, the purpose of this study is to validate the CFS framework developed. For that aim 12 participants were asked to report about a variable number of CFS following all the recommendations of the framework. The results are analysed and discussed according to the framework understanding and fulfilment, the participants' performance, and the correlation between expected decisions and those given by the participants. In view of the quantitative results and qualitative examination criteria we can conclude that those who follow the MEPROCS recommendations improve their performance.

Study on the performance of different craniofacial superimposition approaches (II): Best practices proposal.

Craniofacial superimposition, although existing for one century, is still a controversial technique within the scientific community. Objective and unbiased validation studies over a significant number of cases are required to establish a more solid picture on the reliability. However, there is lack of protocols and standards in the application of the technique leading to contradictory information concerning reliability. Instead of following a uniform methodology, every expert tends to apply his own approach to the problem, based on the available technology and deep knowledge on human craniofacial anatomy, soft tissues, and their relationships. The aim of this study was to assess the reliability of different craniofacial superimposition methodologies and the corresponding technical approaches to this type of identification. With all the data generated, some of the most representative experts in craniofacial identification joined in a discussion intended to identify and agree on the most important issues that have to be considered to properly employ the craniofacial superimposition technique. As a consequence, the consortium has produced the current manuscript, which can be considered the first standard in the field; including good and bad practices, sources of error and uncertainties, technological requirements and desirable features, and finally a common scale for the craniofacial matching evaluation. Such a document is intended to be part of a more complete framework for craniofacial superimposition, to be developed during the FP7-founded project MEPROCS, which will favour and standardize its proper application.

Evidence of probable tuberculosis in Lithuanian mummies.

Tuberculosis has affected Europe for millennia and continues to be a burden upon modern society. It is estimated that one-third of the world's population is infected with Mycobacterium tuberculosis, the causative agent of this condition. Despite the introduction of control strategies, the disease continues to be one of the most common causes of death globally. Within the framework of the Lithuanian Mummy Project, seven spontaneously mummified human bodies from a church crypt in Vilnius, dating from the 18th and 19th century, were CT-scanned to assess the presence of tuberculosis or other lung diseases. We encountered pulmonary lesions suggestive of cases of pulmonary tuberculosis. In addition, one case might have been affected by extra-pulmonary tuberculosis. This report replicates the image findings from previous studies on ancient mummies that provided evidence of tuberculosis in soft tissues, thus helping reconstruct the history of this disease over time.

Study on the performance of different craniofacial superimposition approaches (I).

As part of the scientific tasks coordinated throughout The 'New Methodologies and Protocols of Forensic Identification by Craniofacial Superimposition (MEPROCS)' project, the current study aims to analyse the performance of a diverse set of CFS methodologies and the corresponding technical approaches when dealing with a common dataset of real-world cases. Thus, a multiple-lab study on craniofacial superimposition has been carried out for the first time. In particular, 26 participants from 17 different institutions in 13 countries were asked to deal with 14 identification scenarios, some of them involving the comparison of multiple candidates and unknown skulls. In total, 60 craniofacial superimposition problems divided in two set of females and males. Each participant follow her/his own methodology and employed her/his particular technological means. For each single case they were asked to report the final identification decision (either positive or negative) along with the rationale supporting the decision and at least one image illustrating the overlay/superimposition outcome. This study is expected to provide important insights to better understand the most convenient characteristics of every method included in this study.

Genetic discontinuity between local hunter-gatherers and central Europe's first farmers.

After the domestication of animals and crops in the Near East some 11,000 years ago, farming had reached much of central Europe by 7500 years before the present. The extent to which these early European farmers were immigrants or descendants of resident hunter-gatherers who had adopted farming has been widely debated. We compared new mitochondrial DNA (mtDNA) sequences from late European hunter-gatherer skeletons with those from early farmers and from modern Europeans. We find large genetic differences between all three groups that cannot be explained by population continuity alone. Most (82%) of the ancient hunter-gatherers share mtDNA types that are relatively rare in central Europeans today. Together, these analyses provide persuasive evidence that the first farmers were not the descendants of local hunter-gatherers but immigrated into central Europe at the onset of the Neolithic.

Factors affecting the variation in the adult temporomandibular joint of archaeological human populations.

To elucidate factors that may affect the variation in the bony components of temporomandibular joint (TMJ), a preliminary study was conducted on the temporal articular surface of the TMJ of 30 skulls from Iron Age and medieval populations from Lithuania and a mixed Neolithic and Bronze Age population from the Central Elbe-Saale region (CESR). Using three-dimensional (3D) photos of the skulls, length and width measurements of the TMJ were obtained and compared with external skull measurements. Distinct, random variation between the TMJ values from opposite sides of the cranium were identified as fluctuating asymmetry. ANOVA results suggest significant differences in the length of the TMJ between the population of the CESR and the two Lithuanian populations, but not between the two Lithuanian populations. Environmental factors, including geography, may be responsible for the variation in the TMJ form.

Incremental lines of dental cementum in biological age estimation.

The aim of this study is to evaluate the use of counting incremental lines of dental root cementum for biological age determination, and to compare it with alternative methods. Two samples were taken: 51 teeth from 49 individuals of known age obtained at the Stomatological Clinic, Vilnius University, as well as the canine teeth from the remains of 48 individuals from the mass graves of Tuskulenai in Vilnius (inhumed 1944-47). In the latter sample, the chronological age of 43 individuals was known through personal identification. Undecalcified teeth were sectioned with the Leica SP 1600 microtome diamond saw, and incremental line count as a blind test was made on sections of 35 to 100 microns thickness. Incremental line count was possible in 82-86 percent of cases. The results of three independent counts showed that intra-observer bias has no significant impact. Biological age was estimated by adding incremental line number to the average age of tooth eruption. It was found that mean absolute error was 6.46 years for the 1st sample, 6.27 years for the 2nd sample, and in some cases exceeded 10 years. For the 2nd sample, the results were compared to those of other methods such as endocranial suture ossification, pubic symphysis morphology and the "combined" method of Nemeskéri. All four methods yield a similar correlation in regard to an individual's chronological age. The highest correlation was found for the combined method, and the lowest one for public symphysis morphology. All correlations had a similar standard error. Thus our assessment is less enthusiastic than in some past studies; it is suggested that the incremental lines rather have a similar use as other methods.

Paleopathological and molecular evidence of human bone tuberculosis in Iron Age Lithuania.

Skeletal remains of two individuals, showing lesions suggestive of bone tuberculosis, from the archaeological sites of Marvele and Sukioniai in Lithuania were analyzed at the DNA level. The diagnosis of bone tuberculosis was confirmed in the remains from Marvele by amplifiying a 245-bp fragment of a repetitive insertion element-like sequence (IS 6110) of Mycobacterium tuberculosis DNA. This is direct evidence for the presence of tuberculosis in Lithuania at the beginning of the first millennium AD. The individual from Sukioniai was found to be tuberculosis-negative. No PCR product was obtained for the 245-bp target sequence or for a smaller 123-bp DNA fragment specific for Mycobacterium tuberculosis. However, amplifiable ancient DNA appeared to be present in the examined specimen as was shown by the results of the DNA-based sex identification, which indicated, consistent with the bone morphology, a male individual.

Diseases in European historical populations and their effects on individuals and society.

Traditionally, populations are considered "historical" when first written evidences appear. Cultural development with all it's features--agricultural innovations and as a consequence--population growth, social specialisation and stratification, and finally--urbanisation trigger new environmental conditions, among them also in epidemiological situation, that have the feedback effects on the population and the individual. At this time only qualitative evaluations on many of questions can be presented. This paper is an attempt to synthesize available data on the following specific topics related to Medieval/Early Modern European population welfare: nutritional intake, malnutrition and famine; great epidemics and their consequences; spreading of specific infectious diseases (tuberculosis, syphilis, leprosy), which also had a great social resonance in those times, professional diseases. Considerations on their impact on demographical situation (life expectancy, birth rate), life quality and physical development and body build of an individual are also presented. Finally, possibilities for directional selection and impact on modern genetic diversity in Europe are discussed.

Educational technology transfer in newly independent states: developing a medical multimedia laboratory in Lithuania.

This paper discusses the development of an interactive multimedia computer laboratory within the Vilnius University Medical Faculty involving transfer of hardware and courseware developed in the USA. The contexts in which the laboratory was developed are described and factors helping and hindering successful technology transfer are identified. The future of the laboratory and its potential role in international distance education and information access are discussed. While this paper does not focus on international distance education in the traditional sense of offering courses or training from one or more source institutions to individuals off-site, it has implications for providing education internationally, especially in the Baltic and other newly independent states of the former USSR.

Clinical otosclerosis and auditory exostoses in ancient Europeans (investigation of Lithuanian paleoosteological samples).

The purpose of this investigation was to establish the incidence of clinical otosclerosis and auditory exostoses in Lithuanian paleopopulations. The total sample consists of 4080 skulls, dating from the Neolithic to the C17th-C18th A.D., investigated visually, under magnification and radiologically. Eight cases of clinical otosclerosis and 22 of auditory exostoses were identified. The general epidemiology of otosclerosis (0.19 +/- 0.08 per cent) was established to be similar to contemporary populations. This suggests that there are no new aetiological factors attributable to our modern society. Clear diminution of the incidence of auditory exostoses from the 1st to the 2nd millenium A.D. (3.46 +/- 0.76 per cent, against 0.06 +/- 0.04 per cent, p < 0.001) and definite sexual differences (males: 1.21 +/- 0.28 per cent; females: 0.17 +/- 0.10 per cent, p < 0.001) were also noted. In general, auditory exostoses were found much more frequently than in recent populations.

Odontometry of Lithuanian paleopopulations.

In 3443 teeth of 418 adults (224 males, 194 females) from Lithuanian crania of the 1st and 2nd millennia A.D., vestibulolingual (VL) and mesiodistal (MD) diameters of each tooth were measured on the right side. The samples showed a marked stability during the millennia, measurements being typical for a mesodontic population. Definite sexual dimorphism of teeth measurements was established. A method for sex estimation from dental measurements is proposed.