Condensed tannins fed to dairy goats: effects on digestibility, milk production, blood parameters, methane emission, and energy and nitrogen balances

Condensed tannins (CT) are plant polyphenols that can affect feed digestibility and are potentially able to reduce enteric methane emissions in ruminants. In this in vivo trial with 8 lactating goats, we investigated the effects of 4 levels of inclusion of a commercial CT extract from quebracho (0, 2, 4, 6% on DM basis; C, Q2, Q4, Q6, respectively). The experimental design was a repeated 4 × 4 Latin square with 28-d periods (24 d of diet adaptation and 4 d of sample collection) using metabolic cages and 4 open circuit respiration chambers. The inclusion of CT in the diets did not affect the dry matter intake (DMI) but caused a linear decrease in diet digestibility, with reductions up to -11% for dry matter (DM), -21% for crude protein (CP), -23% for neutral detergent fiber (aNDFom), and -13% for gross energy, when comparing the Q6 and C diets. However, ruminal total volatile fatty acids (VFA) concentration was not affected by CT, although there were changes in VFA proportions. Milk yield (g/d) was highest for Q4 (3371) and lowest for Q6 (3066). In terms of milk composition, CT induced a linear reduction of fat and CP concentrations. The reduction in CP digestibility resulted in a linear reduction in the milk urea level, up to -37% with Q6. Positively, CT linearly reduced the somatic cells count expressed as linear score. The feed efficiency was linearly decreased by CT inclusion. Furthermore, a shift from urinary to fecal nitrogen excretion was observed with CT. The retained nitrogen was always negative (on average -1.93 g/d). The methane yield (on average 19.2 g CH4/kg DMI) was linearly reduced by CT inclusion, up to -18% with Q6. Regarding the CH4 intensity, CT induced a linear reduction when expressed per kg of milk, but not per kg of fat and protein corrected milk. Moreover, the CH4 production per kg of digestible aNDFom was linearly increased by CT. The metabolizable energy intake (MEI) was not affected by the treatments, but the metabolizability (q = MEI/gross energy intake) was reduced as CT inclusion increased. From the results of the present study, it turned out that CT have a negative impact on feed digestibility and feed use efficiency. Condensed tannins can lower CH4 emissions from ruminants; however, the main mechanism of action is likely the decrease in feed digestibility. Furthermore, CT did not improve the N use efficiency. According to these findings, the positive environmental impacts of CT are only related to the shift from urinary to fecal N excretion.

Evaluation of Intergovernmental Panel on Climate Change (IPCC) equations to predict enteric methane emission from lactating cows fed Mediterranean diets

The study aimed to evaluate Intergovernmental Panel on Climate Change (IPCC) Tier 2 (2006 and 2019) to predict enteric CH4 emissions from lactating cows fed Mediterranean diets. The effects of the CH4 conversion factor (Ym; CH4 energy loss as a percentage of gross energy intake) and digestible energy (DE) of the diet were evaluated as model predictors. A data set was created using individual observations derived from 3 in vivo studies on lactating dairy cows housed in respiration chambers and fed diets typical of the Mediterranean region based on silages and hays. Five models using different Ym and DE were evaluated following a Tier 2 approach: (1) average values of Ym (6.5%) and DE (70%) from IPCC (2006); (2) average value of Ym (5.7%) and DE (70.0%) from IPCC (2019; 1YM); (3) Ym = 5.7% and DE measured in vivo (1YMIV); (4) Ym = 5.7 or 6.0%, depending on dietary NDF, and DE = 70% (2YM); and (5) Ym = 5.7 or 6.0%, depending on dietary NDF, and DE measured in vivo (2YMIV). Finally, a Tier 2 model for Mediterranean diets (MED) was derived from the Italian data set (Ym = 5.58%; DE = 69.9% for silage-based diets and 64.8% for hay-based diets) and validated on an independent data set of cows fed Mediterranean diets. The most accurate models tested were 2YMIV, 2YM, and 1YMIV with predictions of 384, 377, and 377 (g of CH4/d), respectively, versus the in vivo value of 381. The most precise model was 1YM (slope bias = 1.88%; r = 0.63). Overall, 1YM showed the highest concordance correlation coefficient value (0.579), followed by 1YMIV (0.569). Cross-validation on an independent data set of cows fed Mediterranean diets (corn silage and alfalfa hay) resulted in concordance correlation coefficient of 0.492 and 0.485 for 1YM and MED, respectively. The prediction of MED (397) was more accurate than 1YM (405) in comparison with the corresponding in vivo value of 396 g of CH4/d. The results of this study showed that the average values proposed by IPCC (2019) can adequately predict CH4 emissions from cows fed typical Mediterranean diets. However, the use of specific factors for the Mediterranean area, such as DE, improved the accuracy of the models.

Milk production, methane emissions, nitrogen, and energy balance of cows fed diets based on different forage systems

Eight lactating Italian Friesian cows were housed in individual respiration chambers in a repeated Latin square design to determine their dry matter intake (DMI) and their milk and methane production, as well as to collect the total feces and urine to determine the N and energy balances. Four diets, based on the following forages (% of dry matter, DM), were tested: corn silage (CS, 49.3), alfalfa silage (AS, 26.8), wheat silage (WS, 20.0), and a typical hay-based Parmigiano Reggiano cheese production diet (PR, 25.3 of both alfalfa and Italian ryegrass hay). The greatest DMI was observed for cows fed PR (23.4 vs. 20.7 kg/d, the average of the other 3 diets). The DM digestibility was lower for PR (64.5 vs. 71.7%, the average of the other diets). The highest ash-free neutral detergent fiber digestibility values were obtained for CS (50.7%) and AS (47.4%). In the present study, no differences in milk production were observed between diets, although PR showed a higher milk yield trend. The highest milk urea N concentration (mg/dL) was found for the cows fed the WS diet (13.8), and the lowest was observed for the cows fed AS (9.24). The highest milk urea N concentration for the cows fed WS was also correlated with the highest urinary N excretion (g/d), which was found for the cows fed that same diet (189 vs. 147 on average for the other diets). The protein digestibility was higher for the cows fed the CS and WS diets (on average 68.5%) than for the cows fed AS and PR (on average 57.0%); dietary soybean inclusion was higher for CS and WS than for AS and PR. The rumen fermentation pattern was affected by the diet; the cows fed the PR diet showed a higher rumen pH and decreased propionate production than those fed CS, due to the lower nonfiber carbohydrate content and higher ash-free neutral detergent fiber content of the PR diet than the CS diet. Feeding cows with PR diet increased the acetate:propionate ratio in comparison with the CS diet (3.30 vs. 2.44 for PR and CS, respectively). Cows fed the PR diet produced a greater daily amount of methane and had a greater methane energy loss (% of digestible energy intake) than those fed the CS diet (413 vs. 378 g/d and 8.67 vs. 7.70%), but no differences were observed when methane was expressed as grams per kilogram of DMI or grams per kilogram of milk. The PR diet resulted in a smaller net energy for lactation content than the CS diet (1.36 vs. 1.70 Mcal/kg of DM for the PR and CS diets, respectively). Overall, our research suggests that a satisfactory milk production can be attained by including different high-quality forages in balanced diets without any negative effect on milk production or on the methane emissions per kilogram of milk.

AB0525 NATURAL HISTORY OF CRYOGLOBULINEMIA FROM 2000 TO 2018 FROM THE LABORATORY POINT OF VIEW: AN ANALYSIS OF CRYOGLOBULIN CHARACTERISTICS IN A SINGLE CENTER

Background:

Big data refers to large amounts of information. With today’s ever-improving technologies created by the automation and digitization, it becomes easier to convert data into relevant information, which can be used to provide better patient management, especially when it occurs a rare condition such as cryoglobulinemia (CRG).

CRG is due to an immunoglobulins (Ig) that precipitate at low temperatures. There are 3 types of CRG: type I: monoclonal Ig; type II: monoclonal Ig + polyclonal Ig; type III: 2 polyclonal Ig.

Objectives:

The aim of this study was to analyse the available data coming to the Department of Laboratory Medicine of Modena to describe the population of patients suffering of CRG.

Methods:

Data from the Modena Labs network were extracted by means of the software “Pagoda”, for statistical purposes, directly connected to the Laboratories Information System (LIS). Considered time period 2000-2018

Results:

The analysed samples were 28,847, 4901 (17%) of which positive to the cryoglobulins (CR) detection. The typing positive CR were 4190 (85%): type 1 7.8 %, type II 48.54% and type III 43.8% The positive samples belonged to 2528 patients. Patients were 1563 (62%) women, average age 66±16, and 965 (38%) men, average age 62±16. (female/male ratio = 1.62) No statistically significant difference regarding sex and age between the 3 types. The cryoglobulinemia phenomenon is quite complex and the typing of monoclonal, polyclonal components of the Ig classes and chains has made it possible to identify 41 possible combinationsOut of 115 patients with Type 1 cryoglobulin, 73% had a monoclonal IgM and 36% monoclonal IgG; 11.2% both monoclonal IgG and IgM. The к light chain was the most frequent: 55,6% IgM-k and 23,4% IgG-k vs 29% IgM-λ and 18.2% IgG-λ. Two patients had an IgA-k cryoglobulin.

Patients with Type 2 cryo were 781: monoclonal IgM-k 587 (75.1 %), 126 IgM-λ (16.1 %), 52 IgG-k (6.6 %), IgG-λ (5%), 1 IgA-λ; 2.8% had both IgG and IgM. Out of 1204 patients with Type 3 cryo, 74.8% had both polyclonal IgG and IgM, 13,8% had isolated IgM or IgG (9%); 4.8 % IgG-IgA-IgM together, both IgG and IgA in only 0,5% of patients. Almost the 50% (1255) of the patients had a diagnosis supporting the request of CR:

HCV, 604 (48%); chronic hepatitis, 177 (14%); rheumatologic disorder, 107 (9%); autoimmune diseases, 83 (7%), nephropathy, 80 (7%); others, 204 (15%).

Genotyped HCV+ patients were 290 (48%), with the following results: 1b, 136 (47%); 2a/2c, 65 (22%); 3a, 26 (9%); others 63 (22%).

Conclusion:

The data show that CRG is a pathology which affects the elderly and especially women, as in autoimmune and rheumatological diseases. The predominant CRG type is the III and the most frequently related pathology to the request for CR is HCV+ and chronic hepatitis. The most common HCV genotype are 1b and 2a/2c The cryoglobulinemia phenomenon is complex and laboratory typing is intriguing.

Starting from this preliminary descriptive study, it will be possible, with the available data, to perform elaborations that allow to relate CRG with the diagnosis and verify the effect of therapy.

Big Data methods’ application represents an undeniable resource for public institutions when carrying out strategic decision-making processes.

Disclosure of Interests:

None declared

Digestibility and metabolic utilization of diets containing whole-ear corn silage and their effects on growth and slaughter traits of heavy pigs

The aim was to evaluate 2 levels of dietary inclusion of chopped whole-ear corn silage (WECS) on energy and nutrient utilization, growth, and slaughter performances of heavy pigs. Two in vivo experiments were conducted to determine digestibility and metabolic utilization of WECS using 18 barrows weighing 118 ± 8 kg BW on average, metabolic cages and respiration chambers (Exp. 1), and the effect of WECS on the growth performance and carcass traits on 42 barrows from 90 to 170 kg BW (Exp. 2). In both experiments, pigs were fed 3 experimental diets: a control diet (CON) containing cereal meals, extracted soybean meal, and wheat bran (80%, 9%, and 8% of DM, respectively) and 2 diets containing 15% (15WECS) or 30% WECS (30WECS) on a DM basis in place of wheat bran and corn meal. The diets were prepared daily by mixing the WECS to a suitable compound feed. Feed intake was always restricted to allow a daily DMI of 7.2% BW(0.75) in Exp. 1 and from 8.0% to 6.5% BW(0.75) in Exp. 2. Diets had similar NDF contents (15.2% to 15.8% of DM), and WECS inclusion resulted in a slight reduction in CP content (from 14.0% to 13.6% of DM) and a considerable decrease in P content (from 0.47% to 0.30% of DM). Digestibility of OM, CP, and fat was similar among diets, whereas P digestibility was lower (P < 0.05) for the 30WECS diet (33.5%) in comparison with the CON and 15WECS diets (45.5% and 44.1%, respectively). Nitrogen lost in feces and urine and N retained were not different among diets, whereas P retained decreased with the increase of WECS (5.4, 3.7, and 2.2 g/d for the CON, 15WECS, and 30WECS diets, respectively; P < 0.05). No difference among diets was observed for energy balance. The WECS contained 13.48 MJ ME and 9.39 MJ NE/kg DM. In Exp. 2, feed intake was not depressed by WECS inclusion, and the ADG for the whole experiment was not different among dietary treatments (from 737 to 774 g/d). Fecal pH was lower (P < 0.05) for the WECS diets than the control diet (7.10 and 7.00 vs. 7.40) and for the sampling at 150 kg BW than that at 130 and 110 kg BW (6.96 vs. 7.29 and 7.24). At slaughter, lean percentage in the carcass was lower in the 30WECS diet than those of the other 2 diets (46.8% vs. 48.3% and 48.6%, P = 0.05). The overall experimental data obtained in both trials indicate that substitution of wheat bran and corn meal for WECS (up to 30% of DM) does not affect, with the exception of P utilization and carcass leanness, energy and nutrient utilization and performance of heavy pigs in the last phase of growing.

[The new magnetic therapy TAMMEF in the treatment of simple shoulder pain]

AIMS

Numerous studies have demonstrated the utility of extremely low frequencies (ELF) electromagnetic fields in the treatment of pain. Moreover, the effects of these fields seems to depend on their respective codes (frequency, intensity, waveform). In our study we want to assess the effects of the TAMMEF (Therapeutic Application of a Musically Modulated Electromagnetic Field) system, whose field is piloted by a musical signal and its parameters (frequency, intensity, waveform) are modified in time, randomly varying within the respective ranges, so that all possible codes can occur during a single application.

PATIENTS AND METHODS

Sixty subjects, affected by shoulder periarthritis were enrolled in the study and randomly divided into three groups of 20 patients each: A exposed to TAMMEF, B exposed to ELF, C exposed to a simulated field. All subjects underwent a cycle of 15 daily sessions of 30 minutes each and a clinical examination upon enrollment, after 7 days of therapy, at the end of the cycle and at a follow-up 30 days later.

RESULTS

All the patients of groups A and B completed the therapy without the appearance of side effects: they presented a significant improvement of the subjective pain and the functional limitation, which remained stable at the follow-up examination. In group C, there was no improvement of the pain symptoms or articular functionality.

CONCLUSIONS

This study suggests that the TAMMEF system is efficacious in the control of pain symptoms and in the reduction of functional limitation in patients with shoulder periarthritis. Moreover, the effects of the TAMMEF system cover those produced by the ELF field.

[Preliminary results of the effects of electromagnetic fields ELF and TAMMEF on human lymphocytes: evaluation of some biological parameters]

AIMS

The Authors have evaluated the effects of low frequency electromagnetic fields on human peripheral blood lymphocytes metabolism.

MATERIALS AND METHODS

It has been assayed total proteins and the activities of some purine metabolism enzymes after exposure of the cells to sinusoidal ELF fields (100 Hz frequency) or to the new TAMMEF system fields, characterized by variable frequency, intensity and shape of wave.

RESULTS

The protein lymphocytes content, increased after both treatments. Instead, the enzyme activities did not vary, with the exception of Myokinase activity, which, respect to the control, increased after ELF field treatment, and slightly decreased after TAMMEF treatment. This preliminary result was interpreted as a variation of the cellular electric charge stability, stimulated by ELF fields, which induce the Myokinase to increase its rate, to rearrange the correct equilibrium, while the TAMMEF field were useless to maintain the cellular electric charge at normal levels.

CONCLUSIONS

We interpreted these preliminary results as follow: the ELF fields influence the cellular electric charge stability, so that the cells must increase MK activity to restore the correct equilibrium, while TAMMEF fields are useful to maintain and regulate cellular electric charge. The results obtained by this preliminary study opens interesting prospective to be further investigated.

Effect of Chestnut Tannin on Fermentation Quality, Proteolysis, and Protein Rumen Degradability of Alfalfa Silage

Two experiments were conducted on alfalfa to investigate the effects of the addition of commercial chestnut hydrolyzable tannin at ensiling on 1) silage fermentation quality in lab-scale silos and protein degradation in the rumen, and 2) silage fermentation quality and proteolysis in bale silages. Wilted alfalfa was prepared with 4 tannin levels (0, 2, 4, and 6% on a dry matter (DM) basis; T0, T1, T2, T3, respectively) and ensiled in lab-scale silos. Silages (33% DM) were analyzed for fermentation quality, protein rumen degradability in situ, and organic matter digestibility in vitro through gas production after 120 d of conservation. Wilted alfalfa containing 0 and 4% tannin (T0 and T2) was harvested at 40% DM (wilting level I) and 53% DM (wilting level II) for bale (600 mm diameter) silage. Silages were analyzed for fermentation quality after 78 d of conservation. All the silages were well fermented with no butyric acid. Lab-scale silages showed reductions in ammonia, nonprotein nitrogen (NPN) and DM losses in T2 and T3 treatments, while the fermentation acid profiles were unaffected. In experiment 1, the untreated silage (T0) had the highest protein degradability after being incubated in the rumen. The addition of tannin reduced crude protein ruminal disappearance in a dose-dependent manner. However, the tannin reduced the organic matter digestibility by 5.1% for all of the tannin addition levels. The tannin positively affected the silage quality in the round bale silages, in particular reducing ammonia and NPN in the lowest wilting level. In both experiments, T2 treatment reduced proteolysis without any influence of DM on the binding reaction and reduced the NPN by 15% in comparison to the control.

[On statistical evaluation of efficacy for dichotomous test result]

Today in our country multivariate statistical analysis in health science are not very widespread, they are used only in few selected health center. So I will try to elucidate some multidimensional procedure to evaluate dichotomous results in diagnostic test. Anyway, someone can take a further advantage to apply these techniques to complex therapeutic treatments. New technologies make possible everyone to process data by means of the multivariate methodology, so I propose tested techniques like logistic regression combined with area under the ROC (Receiver Operating Characteristic) curve.

Myasthenia gravis self-administered questionnaire: development of regional domains

The objective was to develop regional domains from the Myasthenia Gravis Questionnaire (MGQ) to better assess generalised, bulbar and ocular involvement in patients with myasthenia gravis (MG) and to evaluate their responsiveness. Some items from the MGQ were aggregated into 3 domains: bulbar, generalised and ocular. The study was carried out at the Institute of Neurology, EMG Service, Universita Cattolica, Rome, and the Department of Neurology, University Hospital, Modena, Italy. Ninety-three MG patients were prospectively enrolled in two neurological departments; furthermore, outcome after treatment was studied in 23 patients to evaluate responsiveness. Disease severity was scored according to a modified version of the Osserman classification and MGQ. The questionnaire appeared more sensitive than clinical examination and history to assess bulbar and ocular involvement. For example, according to the bulbar domain, 67 patients experienced bulbar symptoms whereas on clinical examination 51 of 67 were completely normal in the bulbar region. The MGQ domains appeared reliable and sensitive. Results of global MG score (GMG) and of domains appeared reliable. Domains were able to better assess the functional involvement of anatomical regions than main GMG, clinical examination and history.

[Day surgery in breast reconstructive surgery: our experience]

Breast cancer is the most common tumour in Italy in the female population, counting for about 40000 new cases every year. The psychological aspects of breast mutilation and the social and economic implications are receiving increasing attention. Despite of the diffusion of screening programs to detect pre-clinical breast cancers, 30% of patients still undergo radical interventions. Therefore, many women present serious limitations of their social-life that can lead to severe depression since, in occidental countries, the biological function of the breast is less considered than its primary role of femininity and sexuality. The gold-standard is to conceal oncological radicality and aesthetic preservation. The Authors present their experience analysing the techniques employed.

[Posterior mediastinum neoplasms: a case of schwannoma]

The Authors report the case of a 33-year-old male affected with an asymptomatic schwannoma of the posterior mediastinum, and review the relevant Literature, discussing the difficulties in making the differential diagnosis of the posterior mediastinum lesions, particularly in the pre-clinical phase. Neurogenic tumors represent about 75 percent of all tumors of mediastinum and about one third of all tumors of the mediastinum. They can originate from the peripheral nervous system group, from the sympathetic nervous system group or, in rare cases, from the vagus nerve. In adult patients, they are usually found by chance during radiographic examination of the thorax, and they are usually asymptomatic and benign. During preoperative evaluation, a magnetic resonance examination of rachis should be done to exclude the possibility of intraspinal involvement. If there are no contraindications, the treatment of choice should be surgical resection by means of thoracoscopy or thoracotomy, when size and location of the tumors allow it in order to prevent malignant evolution.

[Therapeutic strategies in neoplasms of the distal bile duct and the Vater's ampulla]

Malignant periampullary and ampullary tumors represent an anatomic and clinical entity of complex surgical approach due to the difficulty in setting out an early diagnosis, for the back of symptoms at early stages. The Authors at the Department of Surgery and Medical Technology Applications "F. Durante", University of Rome "La Sapienza", since 1990 to 2001 observed 19 cases. The results of surgical treatment of these tumors are here reported. By the analysis of the cases it is evident that long-term survival if mainly conditioned by prompt diagnosis stage of the tumor, and patient status before the operation.

[Atrial fibrillation and hyperthyroidism: results after thyroidectomy]

Hyperthyroidism patients can develop atrial fibrillation (AF) with a frequency range between 10 and 25%. The Authors consider 256 hyperthyroid patients operated in their Department, from 1985 to 2001. Before and after surgery, thyroid examination, routine blood tests and common diagnostic evaluations were performed. The follow-up has been 12 months and during this period a L-Thyroxine (50-200 mg/die) therapy has been arranged. Before surgery 59 patients (23%) showed an AF associated with palpitations (76%), asthenia (66%), tremors (54%) and dyspnea (43%). The onset of AF was less than 1 months in 18% of cases, less than 3 months in 30% and chronic in remaining 52%. The 87% of patients was already pharmacologically treated. All the patients were treated with anticoagulants, with a INR value between 2 and 3. After the surgery, 47% of patients presented a restoration of the sinusal rhythm, while the 53% showed a stronger therapeutic responsiveness to specific antiarrhythmic therapy. Treatment of FA hyperthyroid patients with FA tends to normalize the function of the thyroid gland (euthyroidism). In our experience the restoring of sinusal rhythm usually develops in patients with 50 years of age (45 +/- 5 years), while in older patients AF tends to be resistant to treatment.

[Neurinoma of the brachial plexus: 2 case reports]

Neurinomas, also referred to as neurilemmomas and schwannomas, are rare benign tumours of the peripheral nerves. A small percentage of these lesions arise from the brachial plexus. The Authors report two cases of schwannoma arising from the brachial plexus. Such lesions, usually asymptomatic, may cause sensitivity alterations or, less frequently, motor deficits in the involved arm. Tumour enucleation, avoiding damage to any of the nervous fascicles, is the treatment of choice.

Effects of a nonforage diet on milk production, energy, and nitrogen metabolism in dairy goats throughout lactation

The objective of the experiment was to compare a silage-based control diet (C) with a nonforage diet (NF) in dairy goats throughout lactation in terms of animal performance and energy utilization. Eight Saanen goats were divided into two groups and fed C or NF, a commercial blend that included sunflower meal, cassava, coconut meal, and whole cottonseeds as the main ingredients that was characterized by a small particle size and a high crude protein content. In early, mid, and late lactation (44, 100, and 219 days in milk) the goats were individually tested for dry matter intake (DMI), digestibility, milk yield and composition, milk renneting properties, rumen and plasma parameters, and nitrogen and energy utilization (open circuit respiration chambers). During early and mid lactation, the NF fed goats had a very high DMI: 2946 and 2915 g/d, respectively. Nevertheless, milk yield was similar for the two treatments: 4369 vs. 4342 and 3882 vs. 3841 g/d for goats fed diets C and NF during the first and second periods, respectively. Milk fat content was not statistically different between the two diets. The protein content and rheological parameters of milk were similar for the two diets. Nonprotein nitrogen and urea levels in milk of goats fed NF were significantly higher than goats fed C. Ruminal ammonia and plasma urea nitrogen were also significantly increased by diet NF, due to its high protein content. Plasma glucose, beta-hydroxybutyrate, and nonesterified fatty acids and ruminal volatile fatty acids were not influenced by dietary treatment. Dietary NF significantly decreased energy digestibility (74.5 vs. 65.8%, on average for the lactation, for C and NF, respectively) and had a significantly lower metabolizability (metabolizable energy/intake energy; 66.6 vs 58.0%, on average); however, the efficiency of utilization of metabolizable energy was unaffected by the diet. In conclusion, goats were fed a nonforage diet during the entire lactation without detrimental effect on their health and productive performance.

In vitro reconstructed dermis implanted in human wounds: degradation studies of the HA-based supporting scaffold

The objective of the present study was to demonstrate the safety and efficacy of a dermal replacement for cutaneous wounds of diverse origin. Autologous fibroblasts were cultured in fleece scaffolds made from benzyl esters of hyaluronic acid and applied onto cutaneous lesions. The cases presented are (1) skin removal for multiple epithelioma and (2) chronic deep decubitus ulcer. Dermal-like tissue applied by the surgeon elicited no adverse reactions, and was fully integrated and well-vascularized by 1-3 weeks. In Case 1, the material was fully integrated after 1 week, and after 3 weeks an epidermal autograft was overlaid which showed good take with excellent integration observed after 4 weeks. At 12 months, skin demonstrated visual normo-elastic properties and no signs of excessive scarring. In Case 2, 2-3 weeks after the dermal implant was applied, the wound was invaded with granulation tissue and healing occurred by secondary intention. The ulcer was healed by 8 weeks, with the biomaterial completely resorbed and a complete re-epithelialization over the dermal-like tissue. These results suggest that autologous fibroblast culture in hyaluronan-derived scaffolds may be successfully grafted in diverse cutaneous pathologies and constitute a suitable bed for further epidermal implantation.

Use of dermal-like tissue in the management of chronic and acute full-thickness cutaneous wounds

This paper presents a dermal replacement technique for cutaneous wounds of diverse origin. An autologous tissue-engineered dermal-like structure was implanted in one patient with an acute surgical excision of a nevus and in another patient with a chronic post-traumatic ulcer. The dermal constructs were well integrated with the wound area, and, at 3 weeks, an epidermal covering was implanted. In both cases, 3 to 8 weeks after autografting, good integration of the transplanted epidermis with the surrounding native skin and a good take over the dermal-like tissue occurred. The use of this technology, despite its high cost, is increasing. Clinicians choose it because it helps heal critical wounds for which current therapies have failed.

Motor neuron disease and HIV-1 infection in a 30-year-old HIV-positive heroin abuser: a causal relationship?

Although human retroviruses seem plausible agents of motor neuron diseases, there are only few reports of patients infected by the human immunodeficiency virus, with documented motor neuron disorder. That retroviral infections may cause motor neuron pathology by various mechanisms in animals and humans is known. Neurological symptoms potentially attributed to damage of lower motor neurons are often described during the course of HIV-1 infection and AIDS, however, it is often difficult to establish whether the disorder is primarily affecting the perikarya of lower motor neurons, or whether it is due to a focal proximal axonopathy, or to a dying-back process. We report a 30-year-old heroin abuser, HIV-1 positive, who presented a rapidly progressive limb weakness, muscle wasting, and bulbar signs, in absence of sensory loss of cerebellar and pyramidal signs. Imaging studies were negative. CSF showed increased protein content, negative cytology, and no oligoclonal bands. Serum protein electrophoresis, urinary heavy metal, and viral researches were negative. CD4 cells were counted 340 mm3 with a CD4-CD8 ratio equal to 0.4. Electrophysiology showed acute and chronic neurogenic changes, confirmed by muscle biopsy. Conduction studies along motor and sensory nerves fell within normal range. Biopsy of sural nerve revealed mild myelinated and unmyelinated fiber loss, occasional degeneration and regeneration, unremarkable inflammation. Despite treatment with AZT, zalcitabine, and steroids, the patient died after 3-month illness. Neuropathology showed normal cortical cell Betz's, and hemispheric white matter. Brain stem motor nuclei (inferior olival, dorsal motor of the vagus, hypoglossal) showed atrophy and intracytoplasmatic lipofuscin accumulation. Vacuolization, central chromatolysis, and neuronophagia were rarely seen. As associated pathology, in the fourth ventricle there were two small subependymal foci of demyelination, with reactive astrocytes and vascular proliferation. A possible crucial role of the HIV-1 infection in the development and progression of our patient's illness is considered in view of the known altered immunity proved in MND and ALS cases.

Leptomeningeal carcinomatosis presenting as progressive multineuritis: clinical, pathologic, and MRI study

Two patients developed a persistent illness characterized clinically and electrophysiologically by asymmetric involvement of spinal roots, of cranial and peripheral nerves. In the first case the disease was not discovered clinically but only after autopsy. The primary neoplasm remained undetected at autopsy. There was profound infiltration of the leptomeninges by tumor cells with features of metastatic adenocarcinoma. In the second patient onset of neurological symptoms occurred 16 years after surgery for breast cancer, which may be reasonably considered the primary malignancy-CSF cytology was positive only in the second patient in whom Gd-DTPA MRI supported the diagnosis. Our cases demonstrate that diagnosis in leptomeningeal carcinomatosis may be a challenging clinical problem.

Methyl bromide induced neuropathy: a clinical, neurophysiological, and morphological study

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