Bioengineering the Vascularized Endocrine Pancreas: A Fine-Tuned Interplay Between Vascularization, Extracellular-Matrix-Based Scaffold Architecture, and Insulin-Producing Cells

Intrahepatic islet transplantation is a promising β-cell replacement strategy for the treatment of type 1 diabetes. Instant blood-mediated inflammatory reactions, acute inflammatory storm, and graft revascularization delay limit islet engraftment in the peri-transplant phase, hampering the success rate of the procedure. Growing evidence has demonstrated that islet engraftment efficiency may take advantage of several bioengineering approaches aimed to recreate both vascular and endocrine compartments either ex vivo or in vivo. To this end, endocrine pancreas bioengineering is an emerging field in β-cell replacement, which might provide endocrine cells with all the building blocks (vascularization, ECM composition, or micro/macro-architecture) useful for their successful engraftment and function in vivo. Studies on reshaping either the endocrine cellular composition or the islet microenvironment have been largely performed, focusing on a single building block element, without, however, grasping that their synergistic effect is indispensable for correct endocrine function. Herein, the review focuses on the minimum building blocks that an ideal vascularized endocrine scaffold should have to resemble the endocrine niche architecture, composition, and function to foster functional connections between the vascular and endocrine compartments. Additionally, this review highlights the possibility of designing bioengineered scaffolds integrating alternative endocrine sources to overcome donor organ shortages and the possibility of combining novel immune-preserving strategies for long-term graft function.

520 A possible easy way to predict response to cardiac resynchronization therapy: the role of QRS index

Several studies have evaluated the role of QRS duration or QRS narrowing as predictor of response to cardiac resynchronization therapy (CRT) in order to reduce non-responders. However, their results have been conflicting. The aim of our study was to determine the association between the relative change in QRS narrowing index (QI) and clinical outcome and prognosis in patients who underwent CRT implantation. We included 115 patients in whom a CRT device was implanted in accordance with current guidelines. Baseline clinical variables, echocardiographic parameters, and pharmacological therapies were included. QRS duration before and after CRT implantation and QI [(pre implant QRS duration—QRS duration during CRT)/pre implant QRS duration × 100] were measured. After 6 months, a significant improvement in all echocardiographic parameters was observed. In 103 (90%) patients, LVESV decreased by 10% or more. QI was significantly related to reverse remodelling (r = +0.19; 95% CI: 0.006–0.35, P = 0.049). The cut-off value of QI that predicted best LV reverse remodelling after 6 months of CRT was 12.25% (sensitivity = 65.5%, specificity = 75%, area under the curve = 0.737, P = 0.001). An improvement in their HF clinical composite score at 12 months was found in 23 patients (21%). Considering the improvement in NYHA class, of the 73 patients with QI > 12.25%, 34 (46.5%) had a reduced NYHA class at 12 months post implantation. A statistically significant difference was found between patients with a QI < 12.25%, and those with a QI > 12.25%, in terms of NYHA class worsening (P 0.04). Also a statistically significant difference was found between the mean of the QI of patients who died from cardiovascular causes and patients who died of other causes. We have also investigated the possible sex differences related to QI; women with QI > 12.25% had a statistically significant greater improvement in LVEF at follow-up than men with QI > 12.25% (P 0.03). Patients with a larger decrease in QRSd after CRT initiation showed greater echocardiographic reverse remodelling and better outcome from death or cardiovascular hospitalization. Even if larger studies are needed, QI seems to be an easy-to-measure variable that could be used or evaluated to predict CRT response.

Evaluation of Surgical and Functional Outcomes of Supracri- coid Laryngectomy and Rehabilitation Protocols

Abstract

Laryngeal squamous cell carcinoma (LSCC) is the most common malignant neoplasms of the head and neck. Several treatment options exist for LSCC according to cancer location and stage at diagnosis; proposed treatments include surgery alone or in combination with chemotherapy and radiotherapy. In selected LSCC cases in the T2-T4 staging, supracricoid laryngectomy (SCL) is an organ-sparing surgical approach aimed at preserving the main laryngeal functions that has been proposed as an alternative to total laryngectomy. Rehabilitation for swallowing and respiratory functions plays a central role after SCL; functional outcomes after SCL may significantly vary among different centers but they are generally satisfactory when oncological radicality has been obtained and the rehabilitation protocol starts promptly. In this clinical review, we analyzed functional outcomes for swallowing and voice rehabilitation in patients after SCL, as well as the optimal SCL surgical technique, post-operative complications and comparison with total laryngectomy or radio-chemotherapy protocols.

Impact of COVID-19 pandemic on otolaryngology, ophthalmology and dental clinical activity and future perspectives

OBJECTIVE

Since the COVID-19 outbreak, otolaryngologists, ophthalmologists and dentists have been severely affected, both for the transmission routes and for the diagnostical and therapeutic procedures typical of these disciplines.

MATERIALS AND METHODS

In this article, we discuss the transmission routes, the potential risk of contagion for patients and healthcare providers during procedures, and comment on the changes that will affect head and neck clinical practice in the future of outpatient and surgical activities.

RESULTS

Otolaryngologists, ophthalmologists and dentists are at high risk for infection contagion and spread because they perform diagnostic and therapeutic procedures that generate aerosol and droplets thus facilitating virus transmission. Furthermore, examination involves close doctor-patient contact and otolaryngologists and dentists have to remove patient's protective devices during the visit.

CONCLUSIONS

Special attention to prevention protocols for diagnostic and therapeutic procedures and the use of protective equipment is of utmost importance to limit contagion and prevent a new virus spread in the near future.

Obstructive sleep apnea syndrome in the pediatric age: the role of the anesthesiologist

OBJECTIVE

Childhood obstructive sleep disordered breathing (SDB) is a sleep-related upper airway obstruction that degrades sleep quality, ventilation and/or oxygenation; obstructive sleep apnea syndrome (OSAS) is one of the most common causes of SDB in children. The aim of this review is to evaluate the role of the anesthesiologist in pediatric OSAS.

MATERIALS AND METHODS

A literature review has been performed on the following topics: clinical aspects of pediatric OSAS, preoperative investigations including questionnaires, clinical parameters, laboratory polysomnography and home sleep apnea testing, anesthesiologic preoperative management, anesthesiologic perioperative management, anesthesiologic postoperative management including postoperative analgesia, postoperative nausea and vomiting (PONV), and post-tonsillectomy bleeding.

RESULTS

OSAS in children is a distinct disorder from the condition that occurs in adults; adenoidectomy and tonsillectomy are the first line of therapy in these patients. Even if these surgical procedures are frequently performed, they represent a great challenge for surgeons and anesthesiologists and are associated with a substantially increased risk of morbidity and mortality.

CONCLUSIONS

The role of the anesthesiologist is pediatric OSAS is crucial before, during and after surgery, as pediatric patients are at higher risk of preoperative, perioperative and postoperative adverse events including airway obstruction, PONV, and bleeding.

Innate Immunity Mediated Inflammation and Beta Cell Function: Neighbors or Enemies?

Type 1 diabetes (T1D) is still considered a huge burden because the available treatments are not effective in preventing the onset or progression of the disease. Recently, the idea that diabetes is an autoimmune disease mediated exclusively by T cells has been reshaped. In fact, T cells are not the only players with an active role in beta cell destruction. Macrophages and neutrophils, which physiologically reside in pancreatic tissue, can also participate in tissue homeostasis and damage by promoting innate immune responses and modulating inflammation. During the development of the pancreatic islet inflammation there is a strong interplay of both adaptive and innate immune cells, and the presence of innate immune cells has been demonstrated both in exocrine and endocrine pancreatic compartments during the earliest stages of insulitis. Innate immune cell populations secrete cytokines, which must be considered both as physiological and pathological mediators. In fact, it has been demonstrated that cytokines could regulate directly and indirectly insulin secretion and, simultaneously, trigger inflammatory reaction. Indeed, cytokines pathways could represent targets both to improve glucose metabolism and to prevent autoimmune damage. Concordantly, the combination of immunomodulatory strategies against both innate and adaptive immunity should be tested in the next future, as they can be more efficient to prevent or delay islet damage and T1D onset.

Percutaneous treatment of traumatic talus extrusion: a case report

Background and aim of work: Total traumatic extrusion of talus with interruption of all ligaments (missing talus) is a very rare injury. We represent the case of a 44-years-old male who reported total extrusion of talus and Lisfranc dislocation after a motorbike accident. This rare injury has a wide choice of treatment but usually there is not a successful functional restore. Methods: We decided to treat the patient with an immediate reimplantation of extruded talus using 3 Kirschner wires and antibiotic therapy. We performed a temporary fixation of talus with calcaneus, tibia and scaphoid. Results: Usually, this kind of injuries are treated with a tibiocalcaneal arthrodesis and show common complications such as avascular necrosis and infection. Against our expectations we managed to treat successfully our patient. Conclusions: After 5 years of follow up the patient reported good clinical outcomes without performing arthrodesis and recording major complications. (www.actabiomedica.it)

Clinical changes in "true" hobnail hemangioma during menstruation

Hobnail hemangioma (HH) was known in the past as targetoid hemosiderotic hemangioma (THH). We present a case that meets the criteria of HH in a 34-year-old woman. The lesion presented as a reddish papule on her left hip. It changed periodically during menstruation and the changes included. The biopsy showed the characteristics of a typical HH with moderate iron deposits. Immunohistochemical staining failed to demonstrate either estrogen or progesterone receptors (Fig. 1, Ref. 15). Full Text (Free, PDF) www.bmj.sk.

Thrombus in right atrium in two infants successfully treated with tissue plasminogen activator

The widespread use of central venous catheters in children has increased thrombotic complications that warrant thrombolytic therapy. We report the cases of two infants, aged four and two months, with a mobile thrombus in the right atrium treated with recombinant tissue-plasminogen-activator (rt-PA) infused by a central venous catheter. Clot dissolution was obtained in both patients in eight and 44 hours, respectively. One patient presented mild respiratory distress probably from a pulmonary microembolism that disappeared in a few days. Both had minor bleeding from venipuncture sites, but no major hemorrhage.

Aberrant left pulmonary artery with tracheal stenosis without vascular sling

We report a case of abnormal origin of the left pulmonary artery from the right pulmonary artery, associated with tracheal stenosis but with no vascular sling. This is the first such case, to our knowledge, without vascular sling.

First human isolate of Leptospira interrogans as serovar bratislava in Italy

A strain of Leptospira interrogans was isolated from a patient suffering from leptospirosis and was typed by the Cross Agglutination Absorption test using monoclonal antibodies prepared against different serovars of the Australis serogroup. This newly isolated strain belonged to serovar bratislava. It is the first reported isolation from man, in Italy, of Leptospira bratislava, thus supporting the emerging role of this serovar in human leptospirosis.