A new bi-layered scaffold for osteochondral tissue regeneration: In vitro and in vivo preclinical investigations.

Current treatments for acute or degenerative chondral and osteochondral lesions are in need of improvement, as these types of injuries lead to disability and worsen the quality of life in a high percentage of patients. The aim of this study was to develop a new bi-layered scaffold for osteochondral tissue regeneration through a "biomimetic" and "bioinspired" approach. For chondral regeneration, the scaffold was realized with an organic compound (type I collagen), while for the regeneration of the subchondral layer, bioactive magnesium-doped hydroxyapatite (Mg/HA) crystals were co-precipitated with the organic component of the scaffold. The entire scaffold structure was stabilized with a cross-linking agent, highly reactive bis-epoxyde (1,4-butanediol diglycidyl ether - BDDGE 1wt%). The developed scaffold was then characterized for its physico-chemical characteristics. Its structure and adhesion strength between the integrated layers were investigated. At the same time, in vitro cell culture studies were carried out to examine the ability of chondral and bone scaffold layers to separately support adhesion, proliferation and differentiation of human mesenchymal stem cells (hMSCs) into chondrocytes and osteoblasts, respectively. Moreover, an in vivo study with nude mice, transplanted with osteochondral scaffolds plain or engineered with undifferentiated hMSCs, was also set up with 4 and 8-week time points. The results showed that chondral and bone scaffold layers represented biocompatible scaffolds able to sustain hMSCs attachment and proliferation. Moreover, the association of scaffold stimuli and differentiation medium, induced hMSCs chondrogenic and osteogenic differentiation and deposition of extracellular matrix (ECM). The ectopic implantation of the engineered osteochondral scaffolds indicated that hMSCs were able to colonize the osteochondral scaffold in depth. The scaffold appeared permissive to tissue growth and penetration, ensuring the diffusion of nutrients and oxygen, as also suggested by the presence of a neo-angiogenesis process, especially at 4weeks. Moreover, the in vivo results further confirmed the great potential of the scaffold in tissue engineering, as it was able to support the initial formation of new bone and chondral tissue, confirming the importance of combined and innovative strategies to improve the available therapeutic strategies for chondral and osteochondral regeneration.

Nose muscular dynamics: the tip trigonum.

In 1995, the senior author (E.E.F.) published an article in which he described the musculus digastricus septi nasi labialis. In the article presented here, work carried out by anatomists and other researchers who, over the last two centuries, studied nose muscular dynamics is described. The present study is based on Gray's Anatomy, which, in 1858, first described the nasal tip muscles, along with the other nasal muscles. Later works not only used different terminology for these muscles but also ignored some, creating tremendous confusion. The study presented here provides an update of the exact terms, location, insertions, and muscle functions of the muscles of the nose. Each nose muscle is described with regard to the two portions able to produce separate contractions. In this study, the term "dual function" is used and characterizes the nasal mimetic muscles that do not have well-defined fascia. Therefore, there is doubt about the existence of a real nasal superficial muscle aponeurotic system. The musculus myrtiformis seems to have a dual function, inserting in the canine fosse and in the periosteum of the central incisors, forming two portions-one to the septum and the other to the nostril-each of which has specific functions. This study has been based on research in physiognomy, the science of expression. With regard to the basis for nose expressions, common anatomical research is excluded because it provides a different view of the dynamics studied to date. The term trigonum musculare apicis nasi defines the interaction of the musculi compressor narium minor and dilator naris anterior, connecting with the columellar bundle of the musculus digastricus and levering the nasal spine. This muscular trigone creates circular concentric and eccentric movements of the nasal tip.

The nasal tip: a new dynamic structure.

In my study of patients consulting for facial profile imperfections, I have found a pathology that is related neither to the osseous nor to the cartilaginous structure, since it is an individual entity corresponding to a defined muscular activity. I detected and described the morphology of a digastric muscle (m. digastricus nasi-septi labialis) that links the nose to the upper lip with a columellar portion originating in the nasal tip and a labial portion, both joined in the center by an intermediate tendon functioning as a pulley, which is inserted in the anterior nasal spine. These muscular portions may function either independently or synchronously. The imperfection will appear according to the predominance of one or the other, or both, and the contracture of the two muscular portions. In this paper a didactic classification is established as septum 0, I, II, or III according to the levels of seriousness.

A "giant" punch for reduction mammoplasty.

A new instrument, a kind of "giant" punch, is useful in Strömbeck's reduction mammoplasty. Its application makes the upper cylinder of tissue excision an easy maneuver. It also guarantees that even, symmetrical amounts of parenchyma will be removed from both sides. Its three sizes permit three different amounts of tissue removal for varying degrees of reduction or asymmetries.

Effects of physostigmine, scopolamine, and mecamylamine on the sleeping time induced by ketamine in the rat.

Male Sprague-Dawley rats weighing 116--241 g were injected i.p. with ketamine hydrochloride, 80 mg per kilo of body weight. Immediately after loss of righting reflex, scopolamine, physostigmine, and mecamylamine were administered i.p. to different groups of rats. Control animals received sterile saline by the same route. The ketamine-induced sleeping time was significantly prolonged by physostigmine and scopolamine, but not by mecamylamine. After the delayed injection of physostigmine, the ketamine sleeping time was longer. These results, although too preliminary for a mechanistic interpretation, suggest that multiple neurotransmitter systems, probably including the cholinergic system, are involved in the mechanism of action of ketamine-induced narcosis.

Ketamine as the sole anaesthetic agent for laparoscopic sterilization. The effects of premedication on the frequency of adverse clinical reactions.

Ketamine, as the sole anaesthetic agent, was assessed in a double-blind study of 135 female patients who underwent laparoscopic sterilization. The patients were allocated randomly to one of four groups according to the type (pentobarbitone or droperidol) and route (i.v. or i.m.) of premedication. In addition all the patients received hyoscine i.m. Neither pentobarbitone nor droperidol prevented adverse emergence reactions and the total frequency of dream-like activity. However, patients who received pentobarbitone i.v. did not recall unpleasant dream-like activity. Patients who received droperidol i.v. had the shortest recovery time after ketamine anaesthesia. There was a high incidence of visual disturbances in all groups. Droperidol protected against the initial increase of heart rate, and pentobarbitone against the increase in arterial systolic pressure associated with ketamine.

Surgical treatment of mammary ptosis without hypertrophy.

A new method of mastopexy is presented which we have used on 60 cases during 7 years, with the best results we have obtained. We believe it preserves the blood supply and sensation of the areola-nipple better than the other mastopexies we have tried, while producing breasts with excellent contour and position, and normal consistency.

Anaesthesia for dilatation, evacuation and curettage in outpatients: comparison of subanaesthetic doses of ketamine and sodium methohexitone-nitrous oxide anaesthesia.

Sub-dissociative doses of ketamine compared unfavourably with methohexitonenitrous oxide anaesthesia for dilatation, evacuation and curettage. We could not separate the desirable effects of analgesia and amnesia from the unwanted dream effects and visual disturbances. Although the time of clinical recovery was similar, the Trieger Motor Test revealed a delay in return to normal in both groups.

Postnatal effects of chemically induced intrauterine growth retardation on some hematological values in the rat.

The effects of artificially induced intrauterine growth retardation on hematological values of the rat are manifest only temporarily in the red blood cell number, the amount of hemoglobin, and the 2,3-DPG. These three elements reached normal levels after the fifth day of postnatal life. We believe that this temporary effect may be the consequence of the short-term effect of hydroxyurea (the drug used to produce intrauterine growth retardation) upon DNA synthesis in the hematopoietic system. The animals compensate for the low red cell number and low hemoglobin by raising the levels of 2,3-DPG brought about by the temporary anoxia.

Anesthesia for jejunoileal shunt: review of 88 cases.

Experience with 88 obese pateints undergoing jejunoileal shunt is reviewed, with emphasis on preoperative preparation and assessment, conduct of anesthesia, postoperative care, and anesthesia-related complications. There was no intraoperative mortality, and postoperative morbidity was minimal. The operation can be viewed as a short-term answer to the malignancy of massive obesity, since physiologic abnormalities are reversible; however, only hospitals that can provide full surgical, medical, endocrinologic, and anesthesia services, backed by modern ancillary investigative ability, should perform this operation.