Melatonin Enhances Neural Differentiation of Adipose-Derived Mesenchymal Stem Cells.

Adipose-derived mesenchymal stem cells (ASCs) are adult multipotent stem cells, able to differentiate toward neural elements other than cells of mesodermal lineage. The aim of this research was to test ASC neural differentiation using melatonin combined with conditioned media (CM) from glial cells. Isolated from the lipoaspirate of healthy donors, ASCs were expanded in a basal growth medium before undergoing neural differentiation procedures. For this purpose, CM obtained from olfactory ensheathing cells and from Schwann cells were used. In some samples, 1 µM of melatonin was added. After 1 and 7 days of culture, cells were studied using immunocytochemistry and flow cytometry to evaluate neural marker expression (Nestin, MAP2, Synapsin I, GFAP) under different conditions. The results confirmed that a successful neural differentiation was achieved by glial CM, whereas the addition of melatonin alone did not induce appreciable changes. When melatonin was combined with CM, ASC neural differentiation was enhanced, as demonstrated by a further improvement of neuronal marker expression, whereas glial differentiation was attenuated. A dynamic modulation was also observed, testing the expression of melatonin receptors. In conclusion, our data suggest that melatonin's neurogenic differentiation ability can be usefully exploited to obtain neuronal-like differentiated ASCs for potential therapeutic strategies.

Prophylactic venous Supercharging in DIEP Flap Surgery: A Retrospective Dual-Center Study.

BACKGROUND: DIEP flap is nowadays considered the gold standard in breast reconstruction. However, venous congestion is still a leading cause of free flap failure. Despite the conspicuous articles regarding the use of a secondary venous anastomosis, there is a lack in the literature regarding the prophylactic use of a secondary venous route to reduce the incidence of complications during breast reconstruction. METHODS: A double-center retrospective study based on women undergoing DIEP breast reconstruction was conducted, dividing patients into case group(DIEP flaps with double venous anastomosis) and control group(DIEP flaps with single venous anastomosis). Demographic and surgical data and complications were compared and statistically analyzed and a reconstructive algorithm was proposed to improve the flap insetting. RESULTS: 154 patients were included in the study, divided into Case group(74 patients) and control group(80 patients). Median age at the time of surgery was 49,09 years (range 29 -68), slightly lower in Group 1 when compared to Group 2. Mean BMI was 25,52 kg/m2(range 21,09-29,37), in particular 25,47 kg/m2 (range 23,44 -28,63) in Group 1 and 25,58 kg/m2(range 21,09-29,37) in Group 2. No statistical differences were found between groups in terms of BMI and smoking and comorbidities history. Average operative times were 272,16 minutes in Group 1 (range 221 - 328) and 272,34 minutes in Group 2(range 221-327), with no significant difference between groups, as well as ischemia times(44,4 minutes in Group 1 (range 38 - 56) and 49,12 minutes in Group 2(range 41- 67). Statistical analysis showed a reduction in short term complications and a statistically significant reduction for take-backs in the comparison of two groups. CONCLUSIONS: Our study suggests that venous supercharging of DIEP flap by performing dual venous anastomosis can be routinely and safely done prophylactically, and thus not only after intraoperative assessment of venous congestion, in order to avoid flap venous congestion and rates of re-exploration.