Harmonization and standardization of nucleus pulposus cell extraction and culture methods

Background In vitro studies using nucleus pulposus (NP) cells are commonly used to investigate disc cell biology and pathogenesis, or to aid in the development of new therapies. However, lab-to-lab variability jeopardizes the much-needed progress in the field. Here, an international group of spine scientists collaborated to standardize extraction and expansion techniques for NP cells to reduce variability, improve comparability between labs and improve utilization of funding and resources. Methods The most commonly applied methods for NP cell extraction, expansion, and re-differentiation were identified using a questionnaire to research groups worldwide. NP cell extraction methods from rat, rabbit, pig, dog, cow, and human NP tissue were experimentally assessed. Expansion and re-differentiation media and techniques were also investigated. Results Recommended protocols are provided for extraction, expansion, and re-differentiation of NP cells from common species utilized for NP cell culture. Conclusions This international, multilab and multispecies study identified cell extraction methods for greater cell yield and fewer gene expression changes by applying species-specific pronase usage, 60–100 U/ml collagenase for shorter durations. Recommendations for NP cell expansion, passage number, and many factors driving successful cell culture in different species are also addressed to support harmonization, rigor, and cross-lab comparisons on NP cells worldwide

Risk factors for bile duct injury in laparoscopic cholecystectomy: analysis of 49 cases

Forty-nine bile duct injuries, representing 0.8 per cent of 6076 laparoscopic cholecystectomies performed in the Netherlands in 1990-1992, were reviewed. The aim of the study was to classify the injuries according to severity, to identify possible risk factors contributing to the aetiology of such injuries and to correlate these with the severity of the injury. On the basis of operative findings, bile duct injuries were classified from minor (classes I-IIIa) to extensive with loss of bile duct tissue (IIIb) or localization in the liver hilum (IV). Of 49 injuries, there were 11 in class I, six in class II, ten in class IIIa, 18 in class IIIb and four in class IV. In 16 patients the injury was detected during laparoscopic cholecystectomy and the procedure converted to laparotomy. The duct injury was minor (class I-IIIa) in 14 of these 16 patients. In 20 of the 33 patients in whom identification of the injury was delayed to a second or third operation, more severe types of injury (classes IIIb and IV) were observed. Delayed detection was associated with greater severity (P = 0.002). Of eight patients with histologically proven acute cholecystitis at cholecystectomy, seven suffered severe injury (class IIIb or IV). Surgical experience with laparoscopic cholecystectomy was an important factor in the incidence of bile duct injur

Laparoscopic cholecystectomy in a surgical training programme

OBJECTIVE: To assess the impact of the introduction of the laparoscopic cholecystectomy on surgical training, and the outcome of laparoscopic cholecystectomies performed by residents compared with those of surgeons. DESIGN: Retrospective analysis. SETTING: University hospital, The Netherlands. SUBJECTS: 943 Patients who underwent cholecystectomies from January 1987-December 1993 by residents and surgeons. In 527 patients the cholecystectomy was open and in 416 laparoscopic. MAIN OUTCOME MEASURES: The percentage of cholecystectomies done by residents in the period 1987-1993. The outcome of laparoscopic cholecystectomies done by surgeons and residents in terms of duration of operation, conversion rate, postoperative complications, and hospital stay. RESULTS: Before the laparoscopic era about 70% of all cholecystectomies were done by residents. After its introduction in 1990, the residents did 38% of the laparoscopic cholecystectomies in 1991, 39% in 1992, and 64% in 1993. There were no differences in outcome of laparoscopic cholecystectomy in terms of duration of operation, conversion rate, postoperative complications and hospital stay between surgeons and residents. CONCLUSIONS: The introduction of laparoscopic cholecystectomy caused a temporary decline in the number of cholecystectomies done by residents. Laparoscopic cholecystectomy was integrated as a standard surgical procedure in the residents' training programme within two years of its introduction. The outcome of laparoscopic cholecystectomies done by supervised residents and surgeons was similar, and so laparoscopic cholecystectomy should be part of residents' trainin

Scenario's voor lange termijn CO2 reductie in West-Europa

Abstract niet beschikbaarAn energy model for Western Europe has been constructed on the basis of the MARKAL model to analyse future development of CO2 emissions from Western Europe and the possibilities to limit these emissions with technological measures. This report describes two baseline scenarios for Western Europe for the period 1990 to 2050, which have clear differences in economic production orientation and assumptions with respect to criteria for making energy investment decisions. The differences in assumptions result in distinctly different baseline CO2 emissions, ranging from almost stable CO2 emissions to a continuous growth emissions. Several cases with a range of CO2 emission taxes were also calculated to identify cost-effective strategies for CO2 emission reduction and to assess the potential contribution of energy technologies and sectors to CO2 reduction. Energy efficiency improvements are shown to have the highest potential to contribute to CO2 emission reduction. Fossil fuel switching and nuclear energy are relatively cost-effective ways to reduce CO2 emissions. The contribution of renewables to CO2 reduction is relatively small with low CO2 taxes but is substantial with high CO2 tax levels.SG-NO

Evaluatie van de ebolapreparatie in Nederland (2014-2015)

Van 2014 tot 2016 was er een ebola-uitbraak in West-Afrika. Vanwege de kleine kans dat zich onder reizigers terugkerend uit West-Afrika besmettingsgevallen zouden voordoen, zijn in Nederland voorbereidingen getroffen. Het RIVM heeft voor medische professionals richtlijnen opgesteld hoe om te gaan met een patiënt met (verdenking van) ebola. Ook heeft het RIVM landelijke bijeenkomsten georganiseerd om de voorbereidingen onderling af te stemmen. Deze evaluatie gaat in op de manier waarop betrokkenen uit de curatieve zorg (ziekenhuizen, huisartsen en ambulances) en openbare gezondheidszorg (GGD'en en Centrum infectieziektebestrijding (CIb) van het RIVM) met elkaar hebben samengewerkt ten tijde van de eboladreiging. In het algemeen waren de betrokkenen tevreden over de onderlinge samenwerking. Wel bleek de aanpak in de verschillende regio's te verschillen. Zo verschilde per regio wie het initiatief nam voor de regionale afstemming: het UMC, de GGD of zij wachtten op landelijke instructies. Daarnaast was de regio-indeling niet altijd duidelijk omdat de regio-indeling voor verwijzingen van patiënten naar UMC's verschilt van de veiligheidsregio's waarbinnen voorbereiding op de opvang van eventuele ebolapatiënten (preparatie) plaatsvond. Ten slotte was er behoefte om de beschermende middelen en maatregelen, bedoeld om overdracht van het virus van de patiënt naar de zorgverlener te voorkomen, meer te standaardiseren. De betrokken partijen zouden hier graag meer landelijke sturing op zien, zodat er uniformiteit is in de voorbereiding en duidelijker is waar het initiatief moet liggen. De informatievoorziening door het CIb van het RIVM werd als adequaat beoordeeld. Men zou de landelijke bijeenkomsten graag willen uitbreiden om meer betrokkenen hieraan te kunnen laten deelnemen. Tot slot was er vanuit geïnterviewde medewerkers van de UMC's behoefte aan inzicht in de criteria op basis waarvan bestuurders van UMC's en het ministerie van VWS tot de keuze komen welke UMC's aangewezen worden voor langdurige behandeling van patiënten. Gewenste verbeterpunten zijn: een uniformere preparatie, de ontwikkeling van heldere criteria voor bestuurders van ziekenhuizen en zorgorganisaties voor centralisatie van opvang en behandeling van ebola patiënten, duidelijk ingedeelde regio's waarin ketenpartners samenwerken in de ebola preparatie, en een duidelijker rol voor het CIb bij de landelijke regie. Het CIb heeft inmiddels een Platform Preparatie Groep A-ziekten opgericht om deze verbeterpunten uit te werken met betrokkenen uit ziekenhuizen, ambulance, huisartsen, en GGD'en