Isolating Pediatric Mesenchymal Stem Cells with Enhanced Expansion and Differentiation Capabilities

Mesenchymal stem cells/marrow stromal cells (MSCs) are attractive for applications ranging from research and development to use in clinical therapeutics. However, the most commonly studied MSCs, adult bone marrow MSCs (A-MSCs), are limited by significant donor variation resulting in inconsistent expansion rates and multilineage differentiation capabilities. We have recently obtained permission to isolate pediatric MSCs (P-MSCs) from surplus iliac crest bone chips. Here, we developed a simple and easily replicable isolation protocol yielding P-MSCs, which adhere to MSC defining guidelines. After confirming immunophenotypic marker expression, we compared expansion rates, senescence, morphology, and trilineage differentiation of P-MSCs to A-MSCs for multiple donors. We found P-MSCs have faster in vitro replication, consistently show significantly lower senescence, and are capable of more reproducible multilineage differentiation than A-MSCs. We, therefore, believe P-MSCs are a promising candidate for use in research applications and potentially as part of an allogeneic therapeutic treatment

A Call from the Graafschap Consistory Was Made to the Rev. Helkius de Cock Who Lived in the Netherlands

A call from the Graafschap Consistory was made to the Rev. Helkius de Cock who lived in the Netherlands. The writer of the document said that Rev. Albertus C. Van Raalte did not sign the call for some unknown reason. Elders who signed were H. Strabbing, H. Schrotenboer, J. Rutgers, and Steven Lukas; and deacons, J. F. van Anrooy and M. Naeijghe document also included responses to the seven questions which de Cock had asked about Graafschap, its environs, the state of the parsonage, etchttps://digitalcommons.hope.edu/vrp_1850s/1209/thumbnail.jp

A Call Was Extended by the Reformed Church of Graafschap, Michigan, to the Rev. A. G. De Waal, Pastor of the Seceded Congregations at Axel, Zaamslag, and Ten Neusden

A was call extended by the Reformed Church of Graafschap, Michigan, to the Rev. A. G. de Waal, pastor of the Seceded congregations at Axel, Zaamslag, and ten Neusden. He received 32 of the 43 votes cast. The congregation consisted of 51 families. There was a parsonage with five acres of land. The call was signed by the elders, H. Strabbing, A. J. Neerken, and Pieter Boven, and deacons, G. F. van Anrooy and M. Noeije.https://digitalcommons.hope.edu/vrp_1850s/1221/thumbnail.jp

Virtual reality exposure before elective day care surgery to reduce anxiety and pain in children: A randomised controlled trial

BACKGROUNDPre-operative anxiety in children is very common and is associated with adverse outcomes.OBJECTIVEThe aim of this study was to investigate if virtual reality exposure (VRE) as a preparation tool for elective day care surgery in children is associated with lower levels of anxiety, pain and emergence delirium compared with a control group receiving care as usual (CAU).DESIGNA randomised controlled single-blind trial.SETTINGA single university children's hospital in the Netherlands from March 2017 to October 2018.PATIENTSTwo-hundred children, 4 to 12 years old, undergoing elective day care surgery under general anaesthesia.INTERVENTIONOn the day of surgery, children receiving VRE were exposed to a realistic child-friendly immersive virtual version of the operating theatre, so that they could get accustomed to the environment and general anaesthesia procedures.MAIN OUTCOME MEASURESThe primary outcome was anxiety during induction of anaesthesia (modified Yale Preoperative Anxiety Scale, mYPAS). Secondary outcomes were self-reported anxiety, self-reported and observed pain, emergence delirium, need for rescue analgesia (morphine) and parental anxiety.RESULTSA total of 191 children were included in the analysis. During induction of anaesthesia, mYPAS levels (median [IQR] were similar in VRE, 40.0 [28.3 to 58.3] and CAU, 38.3 [28.3 to 53.3]; P=0.862). No differences between groups were found in self-reported anxiety, pain, emergence delirium or parental anxiety. However, after adenoidectomy/tonsillectomy, children in the VRE condition needed rescue analgesia significantly less often (55.0%) than in the CAU condition (95.7%) (P=0.002).CONCLUSIONIn children undergoing elective day care surgery, VRE did not have a beneficial effect on anxiety, pain, emergence delirium or parental anxiety. However, after more painful surgery, children in the VRE group needed rescue analgesia significantly less often, a clinically important finding because of the side effects associated with analgesic drugs. Options for future research are to include children with higher levels of anxiety and pain and to examine the timing and duration of VRE

Predicting Intense Levels of Child Anxiety During Anesthesia Induction at Hospital Arrival

In children, intense levels of anxiety during anesthetic induction are associated with a higher risk of pain, poor recovery, and emergence delirium. Therefore, it is important to identify these high-risk children at hospital arrival. The current study examined internalizing behavior (Child Behavior Checklist, CBCL) and state anxiety measures (modified Yale Preoperative Anxiety Scale, mYPAS, and State Trait Anxiety Inventory for Children, STAIC) at hospital arrival as predictors of anxiety during induction of anesthesia. One hundred children (aged 4 to 12 years) undergoing elective daycare surgery were included. The STAIC and mYPAS at hospital arrival were significant predictors of anxiety during induction, whereas CBCL was not. The STAIC state form at hospital arrival was the strongest predictor and could be used to identify children who will experience intense levels of anxiety during anesthetic induction, with sufficient to good diagnostic accuracy. Using the STAIC at hospital arrival allows targeted interventions to reduce anxiety in children