Ricostruzione della colonna anteriore dopo resezione tumorale: Utilizzo di gabbia in titanio/carbonio o innesto osseo allogenico armato in titanio?

Il rachide è stato suddiviso in tre colonne da Denis: anteriore e centrale comprendono la metà anteriore del corpo vertebrale, la metà posteriore e l’inizio dei peduncoli, mentre la colonna posteriore comprende l’arco e i peduncoli stessi. In caso di resezione o lesione della colonna anteriore e media è indicata la ricostruzione. Diverse tecniche e materiali possono essere usati per ricostruire il corpo vertebrale. Innesti vascolarizzati, autograft, allograft sono stati usati, così come impianti sintetici di titanio o materiale plastico come il PEEK (Poly etere etere ketone). Tutti questi materiali hanno vantaggi e svantaggi in termini di proprietà intrinseche, resistenza meccanica, modulo di elasticità, possibilità di trasmissione malattie, capacità di fondersi con l’osso ospite o meno. Le soluzioni più usate sono le cage in titanio o carbonio, il PMMA ( Poli methil metacrilato), gli innesti ossei massivi. Si è effettuato uno studio di coorte retrospettivo paragonando due gruppi di pazienti oncologici spinali trattati da due chirurghi esperti in un centro di riferimento, con vertebrectomia e ricostruzione della colonna anteriore: un gruppo con cage in carbonio o titanio, l’altro gruppo con allograft massivo armato di innesto autoplastico o mesh in titanio. Si sono confrontati i risultati in termini di cifosi segmenterai evolutiva, fusione ossea e qualità di vita del paziente. Il gruppo delle cage in carbonio / titanio ha avuto risultati leggermente migliori dal punto di vista biomeccanico ma non statisticamente significativo, mentre dal punto di vista della qualità di vita i risultati sono stati migliori nel gruppo allograft. Non ci sono stati fallimenti meccanici della colonna anteriore in entrambi i gruppi, con un Fu tra 12 e 60 mesi. Si sono paragonati anche i costi delle due tecniche. In conclusione l’allogar è una tecnica sicura ed efficace, con proprietà meccaniche solide, soprattutto se armato con autograft o mesi in titanio.

Asymmetric synthesis of benzylic and heterobenzylic amines

C2-Symmetrical, enantiopure 2,6-di[1-(1-aziridinyl)alkyl]pyridines (DIAZAPs) were prepared by a high-yielding, three-step sequence starting from 2,6-pyridinedicarbaldehyde and (S)-valinol or (S)-phenylglycinol. The new compounds were tested as ligands in palladium-catalyzed allylation of carbanions in different solvents. Almost quantitative yield and up to 99% enantiomeric excess were obtained in the reactions of the enolates derived from malonate, phenyl- and benzylmalonate dimethyl esters with 1,3-diphenyl-2-propenyl ethyl carbonate. Asymmetric synthesis of 2-(2-pyridyl)aziridines from chiral 2-pyridineimines bearing a stereogenic center at the nitrogen atom was development. The envisioned route involves the addition of chloromethyllithium to the imine derived from 2-pyridinealdehyde and (S)-valinol, protected as O-trimethylsilyl ether. The analogous reaction performed on the imine derived from (S)-valine methyl ester gave the product containing the aziridine ring as well as the α-chloro ketone group coming from the attack of chloromethyllithium to the ester function. Other stereogenic alkyl substituents at nitrogen gave less satisfactory results. Moreover, the aziridination protocol did not work on other aromatic imines, e.g. 3-pyridineimine and benzaldimine, which are not capable of bidentate chelation. The N-substituent could not be removed, but aziridine underwent ring-opening by attack of nitrogen, sulfur, and oxygen nucleophiles. Complete or prevalent regioselectivity was obtained using cerium trichloride heptahydrate as a catalyst. In some cases, the N-substituent could be removed by an oxidative protocol. The addition of organometallic (lithium, magnesium, zinc) reagents to 2-pyrroleimines derived from (S)-valinol and (S)-phenylglycinol gave the N-substituted-1-(2-pyrrolyl)alkylamines with high yields and diastereoselectivities. The (S,S)-diastereomers were useful intermediates for the preparation of enantiopure 1-[1-(2-pyrrolyl)alkyl]aziridines by routine cyclization of the β-aminoalcohol moiety and of (S)-N-benzoyl 1-[1-(2-pyrrolyl)alkyl]amines and their N-substituted derivatives by oxidative cleavage of the chiral auxiliary. 1-Allyl-2-pyrroleimines obtained from (S)-phenylglycinol and (S)-valinol underwent highly diastereoselective addition of allylmetal reagents, used in excess amounts, to give the corresponding secondary amines with concomitant allyl to 1-propenyl isomerisation of the 1-pyrrole substituent. Protection of the 2-aminoalcohol moiety as oxazolidinone, amide or Boc derivate followed by ring closing metathesis of the alkene groups gave the unsaturated bicyclic compound, whose hydrogenation afforded the indolizidine derivative as a mixture of separable diastereomers. The absolute configuration of the main diastereomer was assessed by X-ray crystallographic analysis.

Electrospun Polymeric Scaffolds with Enhanced Biomimetic Properties for Tissue Engineering Applications

This PhD Thesis is focused on the development of fibrous polymeric scaffolds for tissue engineering applications and on the improvement of scaffold biomimetic properties. Scaffolds were fabricated by electrospinning, which allows to obtain scaffolds made of polymeric micro or nanofibers. Biomimetism was enhanced by following two approaches: (1) the use of natural biopolymers, and (2) the modification of the fibers surface chemistry. Gelatin was chosen for its bioactive properties and cellular affinity, however it lacks in mechanical properties. This problem was overcome by adding poly(lactic acid) to the scaffold through co-electrospinning and mechanical properties of the composite constructs were assessed. Gelatin effectively improves cell growth and viability and worth noting, composite scaffolds of gelatin and poly(lactic acid) were more effective than a plain gelatin scaffold. Scaffolds made of pure collagen fibers were fabricated. Modification of collagen triple helix structure in electrospun collagen fibers was studied. Mechanical properties were evaluated before and after crosslinking. The crosslinking procedure was developed and optimized by using - for the first time on electrospun collagen fibers - the crosslinking reactant 1,4-butanediol diglycidyl ether, with good results in terms of fibers stabilization. Cell culture experiments showed good results in term of cell adhesion and morphology. The fiber surface chemistry of electrospun poly(lactic acid) scaffold was modified by plasma treatment. Plasma did not affect thermal and mechanical properties of the scaffold, while it greatly increased its hydrophilicity by the introduction of carboxyl groups at the fiber surface. This fiber functionalization enhanced the fibroblast cell viability and spreading. Surface modifications by chemical reactions were conducted on electrospun scaffolds made of a polysophorolipid. The aim was to introduce a biomolecule at the fiber surface. By developing a series of chemical reactions, one oligopeptide every three repeating units of polysophorolipid was grafted at the surface of electrospun fibers.