Novel Therapy for Acquired Tracheomalacia with a Tissue-Engineered Extraluminal Tracheal Splint and Autologous Mesenchymal-Derived Chondrocytes.

Introduction Acquired tracheomalacia (ATM) is characterized by a loss of structural strength of the tracheal framework, resulting in airway collapse during breathing. Near half of the patients undergoing prolonged invasive mechanical ventilation will suffer tracheal lesions. Treatment for ATM includes external splinting with rib grafts, prosthetic materials, and tracheal resection. Failure in the use of prosthetic materials has made reconsidering natural origin scaffolds and tissue engineering as a suitable alternative. Objective To restore adequate airway patency in an ovine model with surgically-induced ATM employing a tissue-engineered extraluminal tracheal splint (TE-ETS). Methods In the present prospective pilot study, tracheal rings were partially resected to induce airway collapse in 16 Suffolk sheep ( Ovis aries ). The TE-ETS was developed with autologous mesenchymal-derived chondrocytes and allogenic decellularized tracheal segments and was implanted above debilitated tracheal rings. The animals were followed-up at 8, 12, and 16 weeks and at 1-year postinsertion. Flexible tracheoscopies were performed at each stage. After sacrifice, a histopathological study of the trachea and the splint were performed. Results The TE-ETS prevented airway collapse for 16 weeks and up to 1-year postinsertion. Tracheoscopies revealed a noncollapsing airway during inspiration. Histopathological analyses showed the organization of mesenchymal-derived chondrocytes in lacunae, the proliferation of blood vessels, and recovery of epithelial tissue subjacent to the splint. Splints without autologous cells did not prevent airway collapse. Conclusion It is possible to treat acquired tracheomalacia with TE-ETS without further surgical removal since it undergoes physiological degradation. The present study supports the development of tissue-engineered tracheal substitutes for airway disease.

[Frecuencia de cardiopatías congénitas y adquiridas en 4,544 niños. Estudio basado en ecocardiografía]. / Frequency of 4,544 children with congenital and acquired heart disease. Echocardiographic study

Objective: To aim the incidence of congenital and acquired heart disease in our institution. Material and methods: A retrospective, transverse, descriptive and comparative study was conducted, from August 2001 to July 2011, in which we evaluated echocardiograms of patients between the ages of newborn to 18 years of age. They were grouped by heart disease. In the last statistical analysis, we obtained the frequency of occurrence and the proportional value of each cardiopathy. Results: In the last 10 years, we founded 4,544 patients with heart disease. The 14 most common cardiopathies represented 89% of the statistic. The congenital heart disease most frequent was persistent ductus arteriosus with 896 patients (19%), and the acquired heart disease most frequent was myocarditis with 116 patients (2.5%). The tetralogy of Fallot was most frequent congenital heart disease with cyanosis. Conclusions: The frequencies of congenital and acquired heart disease are different in difference geographic and ethnics areas.

Objetivo: Mostrar la frecuencia de las cardiopatías congénitas y adquiridas en nuestra institución. Material y métodos: Se realizó un estudio retrospectivo, transversal y descriptivo donde se revisaron las libretas de los estudios ecocardiográficos, realizados en pacientes cuyas edades fueron de recién nacidos a 18 años y se agruparon por tipos de cardiopatías. En el análisis estadístico obtuvimos la frecuencia de ocurrencia, el valor de la proporción de cada cardiopatía. Resultados: En los últimos 10 años ingresaron 4,544 pacientes con cardiopatía. Las 14 cardiopatías más frecuentes correspondieron al 89.21% de la estadística. La cardiopatía más frecuente fue la persistencia del conducto arterioso con 896 pacientes (19%) y la cardiopatía adquirida más frecuente fue la miocardiopatía, con 116 pacientes (2.5%). La tetralogía de Fallot fue la cardiopatía cianógena más frecuente, con 139 pacientes (3%), a diferencia de otros países. Conclusiones: La frecuencia de cardiopatías congénitas y adquiridas es variable en diferentes áreas étnicas y geográficas.

Novel Therapy for Acquired Tracheomalacia with a Tissue-Engineered Extraluminal Tracheal Splint and Autologous Mesenchymal-Derived Chondrocytes

Abstract Introduction Acquired tracheomalacia (ATM) is characterized by a loss of structural strength of the tracheal framework, resulting in airway collapse during breathing. Near half of the patients undergoing prolonged invasive mechanical ventilation will suffer tracheal lesions. Treatment for ATM includes external splinting with rib grafts, prosthetic materials, and tracheal resection. Failure in the use of prosthetic materials has made reconsidering natural origin scaffolds and tissue engineering as a suitable alternative. Objective To restore adequate airway patency in an ovine model with surgicallyinduced ATM employing a tissue-engineered extraluminal tracheal splint (TE-ETS). Methods In the present prospective pilot study, tracheal rings were partially resected to induce airway collapse in 16 Suffolk sheep (Ovis aries). The TE-ETS was developed with autologous mesenchymal-derived chondrocytes and allogenic decellularized tracheal segments and was implanted above debilitated tracheal rings. The animals were followed-up at 8, 12, and 16 weeks and at 1-year postinsertion. Flexible tracheoscopies were performed at each stage. After sacrifice, a histopathological study of the trachea and the splint were performed. Results The TE-ETS prevented airway collapse for 16 weeks and up to 1-year postinsertion. Tracheoscopies revealed a noncollapsing airway during inspiration. Histopathological analyses showed the organization of mesenchymal-derived chondrocytes in lacunae, the proliferation of blood vessels, and recovery of epithelial tissue subjacent to the splint. Splints without autologous cells did not prevent airway collapse. Conclusion It is possible to treat acquired tracheomalacia with TE-ETS without further surgical removal since it undergoes physiological degradation. The present study supports the development of tissue-engineered tracheal substitutes for airway disease.

Autologous subcutaneous adipose tissue transplants improve adipose tissue metabolism and reduce insulin resistance and fatty liver in diet-induced obesity rats.

Long-term dietary and pharmacological treatments for obesity have been questioned, particularly in individuals with severe obesity, so a new approach may involve adipose tissue transplants, particularly autologous transplants. Thus, the aim of this study was to evaluate the metabolic effects of autologous subcutaneous adipose tissue (SAT) transplants into two specific intraabdominal cavity sites (omental and retroperitoneal) after 90 days. The study was performed using two different diet-induced obesity (DIO) rat models: one using a high-fat diet (HFD) and the other using a high-carbohydrate diet (HCHD). Autologous SAT transplant reduced hypertrophic adipocytes, improved insulin sensitivity, reduced hepatic lipid content, and fasting serum-free fatty acids (FFAs) concentrations in the two DIO models. In addition, the reductions in FFAs and glycerol were accompanied by a greater reduction in lipolysis, assessed via the phosphorylation status of HSL, in the transplanted adipose tissue localized in the omentum compared with that localized in the retroperitoneal compartment. Therefore, the improvement in hepatic lipid content after autologous SAT transplant may be partially attributed to a reduction in lipolysis in the transplanted adipose tissue in the omentum due to the direct drainage of FFAs into the liver. The HCHD resulted in elevated fasting and postprandial serum insulin levels, which were dramatically reduced by the autologous SAT transplant. In conclusion, the specific intraabdominal localization of the autologous SAT transplant improved the carbohydrate and lipid metabolism of adipose tissue in obese rats and selectively corrected the metabolic parameters that are dependent on the type of diet used to generate the DIO model.