Antonio Di Meo

Long-term safety and tolerance of silicone and self-expandable airway stents: an experimental study

BACKGROUND A variety of respiratory stents are currently available, but the ideal airway prosthesis seems far from being recognized. The objective of this study was to verify safety and long-term effect on the bronchial wall of three different types of airway stents. METHODS Twelve healthy adult sheep were divided in three groups, scheduled to receive: (1) bare self-expandable metallic stents (Gianturco); (2) silicone stents (Dumon); and (3) covered self-expandable synthetic stents (Polyflex). Insertions were performed through a rigid bronchoscope under general anesthesia. Chest roentgenogram was performed 1 and 6 months after surgery, and flexible bronchoscopy after 6 months. Twelve months postoperatively, the animals were killed and a postmortem examination was carried out. RESULTS All Polyflex stents migrated during the observation period; one late migration was observed in the Dumon group. Microscopic study showed: (1) Gianturco stents: full-thickness perforation of the bronchial wall covered by a thick layer of a chronic inflammatory infiltrate. Infection by Candida at the bottom of some ulcerations; (2) Dumon stents: mild bronchial inflammation (squamous metaplasia, submucosal inflammatory infiltrates; granuloma-like infiltrates). In case of displacement, no significant changes of the previously stented bronchus occurred; and (3) Polyflex stents: no changes of the previously stented bronchi. CONCLUSIONS Gianturco stents proved unsafe in the long term, owing to the risk of severe airway wall damage. The Polyflex stent is well tolerated but presents a high migration rate. Silicone stents show several limitations but appear to be well tolerated by the host mucosa.

Ultrasonographic findings in 38 horses with septic arthritis/tenosynovitis.

Septic arthritis/tenosynovitis in the horse can have life-threatening consequences. The purpose of this cross-sectional retrospective study was to describe ultrasound characteristics of septic arthritis/tenosynovitis in a group of horses. Diagnosis of septic arthritis/tenosynovitis was based on historical and clinical findings as well as the results of the synovial fluid analysis and/or positive synovial culture. Ultrasonographic findings recorded were degree of joint/sheath effusion, degree of synovial membrane thickening, echogenicity of the synovial fluid, and presence of hyperechogenic spots and fibrinous loculations. Ultrasonographic findings were tested for dependence on the cause of sepsis, time between admission and beginning of clinical signs, and the white blood cell counts in the synovial fluid. Thirty-eight horses with confirmed septic arthritis/tenosynovitis of 43 joints/sheaths were included. Degree of effusion was marked in 81.4% of cases, mild in 16.3%, and absent in 2.3%. Synovial thickening was mild in 30.9% of cases and moderate/severe in 69.1%. Synovial fluid was anechogenic in 45.2% of cases and echogenic in 54.8%. Hyperechogenic spots were identified in 32.5% of structures and fibrinous loculations in 64.3%. Relationships between the degree of synovial effusion, degree of the synovial thickening, presence of fibrinous loculations, and the time between admission and beginning of clinical signs were identified, as well as between the presence of fibrinous loculations and the cause of sepsis (P ≤ 0.05). Findings indicated that ultrasonographic findings of septic arthritis/tenosynovitis may vary in horses, and may be influenced by time between admission and beginning of clinical signs.

Intraperitoneal injection of microencapsulated Sertoli cells restores muscle morphology and performance in dystrophic mice.

Duchenne muscular dystrophy (DMD) is a genetic disease characterized by progressive muscle degeneration leading to impaired locomotion, respiratory failure and premature death. In DMD patients, inflammatory events secondary to dystrophin mutation play a major role in the progression of the pathology. Sertoli cells (SeC) have been largely used to protect xenogeneic engraftments or induce trophic effects thanks to their ability to secrete trophic, antiinflammatory, and immunomodulatory factors. Here we have purified SeC from specific pathogen-free (SPF)-certified neonatal pigs, and embedded them into clinical grade alginate microcapsules. We show that a single intraperitoneal injection of microencapsulated SPF SeC (SeC-MC) in an experimental model of DMD can rescue muscle morphology and performance in the absence of pharmacologic immunosuppressive treatments. Once i.p. injected, SeC-MC act as a drug delivery system that modulates the inflammatory response in muscle tissue, and upregulates the expression of the dystrophin paralogue, utrophin in muscles through systemic release of heregulin-β1, thus promoting sarcolemma stability. Analyses performed five months after single injection show high biocompatibility and long-term efficacy of SeC-MC. Our results might open new avenues for the treatment of patients with DMD and related diseases.

Radiographic evaluation of changes in the proximal phalanx of Thoroughbreds in race training

OBJECTIVE To evaluate changes in the cortical bone of the proximal phalanx of the fore-limbs of Thoroughbreds in response to training. ANIMALS Twenty-seven 2-year-old Thoroughbreds (20 females, 2 males, and 5 geldings). PROCEDURES Horses were principally in training for races in a straight line and in a clockwise direction. Lateromedial and dorsopalmar radiographic views of each metacarpophalangeal joint were obtained before the horses started training and 1 year after starting exercise and racing. Width of the dorsal, palmar, lateral, and medial cortex and the width and thickness of the medulla were measured. Ratios (rather than absolute values) were used to remove the effect of differences in bone size among horses. RESULTS 10 horses were lost from the study. Radiographs were obtained for 17 horses 1 year after starting training (9 horses raced in a clockwise direction, and 8 raced in clockwise and counterclockwise directions). There was no difference between the cortical bone in the right and left forelimbs at the start of the study. After training for 1 year, the palmar cortex in the right forelimb was significantly thicker than that in the left forelimb. CONCLUSIONS AND CLINICAL RELEVANCE The strain patterns, biomechanics of rapid exercise, and type of training most probably determined differences in the adaptive responses of the proximal phalanx. The data reported here can be used in the evaluation of weight-bearing distribution along the proximal phalanx and evaluation of the relationship between exercise and bone remodelling of the proximal phalanx.

Effects of intraperitoneal injection of microencapsulated Sertoli cells on chronic and presymptomatic dystrophic mice.

We report data about the effects of intraperitoneal (i.p.) injection of specific pathogen-free (SPF) porcine Sertoli cells (SeC) encapsulated into clinical grade alginate-based microcapsules (SeC-MC) on muscles of chronic and presymptomatic dystrophic, mdx mice. Mdx mouse is the best characterized animal model of Duchenne muscular dystrophy (DMD), an X-linked lethal myopathy due to mutation in the gene of dystrophin, which is crucial for myofiber integrity during muscle contraction. Our data show that three weeks after i.p. injection of SeC-MC significantly reduced adipose and fibrous tissue deposition, reduced macrophage infiltrate, and reduced numbers of damaged myofibers are found in muscles of 12-month-old mdx mice, which reproduce chronic DMD conditions. Compared with muscles of mock-treated mdx mice muscles of SeC-MC-treated mice show upregulation of the dystrophin paralogue, utrophin which is localized to the periphery of myofibers. Moreover, our data show that i.p. injection of SeC-MC into presymptomatic, 2-week-old mdx mice, although not fully preventing myofiber degeneration, results in protection against myofiber necrosis and muscle inflammation. Extensive discussion of these data can be found in Ref. [1].

Heart rate and blood pressure variations after transvascular patent ductus arteriosus occlusion in dogs

The objective of the study was to retrospectively analyse the cardiovascular effects that occurs following the transvascular occlusion of patent ductus arteriosus in dogs. Sixteen anaesthesia records were included. Variables were recorded at the time of placing the arterial introducer, occlusion of the ductus, and from 5 to 60min thereafter, including, among the other, heart rate, systolic, diastolic and mean arterial blood pressure. The maximal percentage variation of the aforementioned physiological parameters within 60min of occlusion, compared with the values recorded at the introducer placing, was calculated. The time at which maximal variation occurred was also computed. Correlations between maximal percentage variation of physiological parameters and the diameter of the ductus and systolic and diastolic flow velocity through it were evaluated with linear regression analysis. Heart rate decreased after occlusion of the ductus with a mean maximal percentage variation of 41.0±14.8% after 21.2±13.7min. Mean and diastolic arterial blood pressure increased after occlusion with a mean maximal percentage variation of 30.6±18.1 and 55.4±27.1% after 19.6±12.1 and 15.7±10.8min, respectively. Mean arterial blood pressure variation had a significant and moderate inverse correlation with diastolic and systolic flow velocity through the ductus. Transvascular patent ductus arteriosus occlusion in anaesthetised dogs causes a significant reduction in heart rate and an increase in diastolic and mean blood arterial pressure within 20min of closure of the ductus.