Tenogenically induced allogeneic mesenchymal stem cells for the treatment of proximal suspensory ligament desmitis in a horse

Suspensory ligament injuries are a common injury in sport horses, especially in competing dressage horses. Because of the poor healing of chronic recalcitrant tendon injuries, this represents a major problem in the rehabilitation of sport horses and often compromises the return to the initial performance level. Stem cells are considered as a novel treatment for different pathologies in horses and humans. Autologous mesenchymal stem cells (MSCs) are well known for their use in the treatment of tendinopathies; however, recent studies report a safe use of allogeneic MSCs for different orthopedic applications in horses. Moreover, it has been reported that pre-differentiation of MSCs prior to injection might result in improved clinical outcomes. For all these reasons, the present case report describes the use of allogeneic tenogenically induced peripheral blood-derived MSCs for the treatment of a proximal suspensory ligament injury. During conservative management for 4 months, the horse demonstrated no improvement of a right front lameness with a Grade 2/5 on the American Association of Equine Practitioners (AAEP) scale and a clear hypo-echoic area detectable in 30% of the cross sectional area. From 4 weeks after treatment, the lameness reduced to an AAEP Grade 1/5 and a clear filling of the lesion could be noticed on ultrasound. At 12 weeks (T-4) after the first injection, a second intra-lesional injection with allogeneic tenogenically induced MSCs and platelet rich plasma was given and at 4 weeks after the second injection (T-5), the horse trotted sound under all circumstances with a close to total fiber alignment. The horse went back to previous performance level at 32 weeks after the first regenerative therapy and is currently still doing so (i.e., 20 weeks later or 1 year after the first stem cell treatment). In conclusion, the present case report demonstrated a positive evolution of proximal suspensory ligament desmitis after treatment with allogeneic tenogenically induced MSCs

The genetic architecture of the human cerebral cortex

The cerebral cortex underlies our complex cognitive capabilities, yet little is known about the specific genetic loci that influence human cortical structure. To identify genetic variants that affect cortical structure, we conducted a genome-wide association meta-analysis of brain magnetic resonance imaging data from 51,665 individuals. We analyzed the surface area and average thickness of the whole cortex and 34 regions with known functional specializations. We identified 199 significant loci and found significant enrichment for loci influencing total surface area within regulatory elements that are active during prenatal cortical development, supporting the radial unit hypothesis. Loci that affect regional surface area cluster near genes in Wnt signaling pathways, which influence progenitor expansion and areal identity. Variation in cortical structure is genetically correlated with cognitive function, Parkinson's disease, insomnia, depression, neuroticism, and attention deficit hyperactivity disorder

Reduced nurse working time and surgical productivity and economics

dWorking time reduction is an issue in many sectors of the economy of several countries. In the health care sector, this reduction is mostly felt in regions with a shortage of personnel. In The Netherlands, this is the operating theater suite. We designed this study to evaluate the effects of a policy reduction in working time from 38 to 36 h/wk on the performance of the operating theater suite. The study describes the policy process and its context. For retrospective before-and-after analyses of various performance variables, multivariate linear regression techniques were used. A 4% decrease to a 36-h work week was implemented in our hospital during a period of shortage of personnel in the labor market. This resulted in a 2% decrease in the number of surgical operations performed. The expected increased demand for nursing personnel is reflected in larger wages and the introduction of additional benefits. Additionally, the introduction of a 36-h work week and the 4-day working schedule was accompanied by an increase in absenteeism. Taken together, this resulted in an increase in nursing costs per average operation of 20%. This means that a small reduction in working time during a period of labor shortage can cause an important decrease in surgical productivity. In our hospital, this was accompanied by an increase in sick leave, resulting in a substantial increase of nursing costs per operatio

Computed tomographic myelography for assessment of the cervical spinal cord in ataxic warmblood horses : 26 cases (2015-2017)

OBJECTIVE : To quantify the degree of dural compression and assess the association between site and direction of compression and articular process (AP) size and degree of dural compression with CT myelography. ANIMALS : 26 client-oriented horses with ataxia. PROCEDURES : Spinal cord-to-dura and AP-to-cross-sectional area of the C6 body ratios (APBRs) were calculated for each noncompressive site and site that had > 50% compression of the subarachnoid space. Site of maximum compression had the largest spinal cord-to-dura ratio. Fisher exact test and linear regression analyses were used to assess the association between site and direction of compression and mean or maximum APBR and spinal cord-to-dura ratio, respectively. RESULTS : Mean +/- SD spinal cord-to-dura ratio was 0.31 +/- 0.044 (range, 0.20 to 0.41) for noncompressive sites and 0.44 +/- 0.078 (0.29 to 0.60) for sites of maximum compression. Sites of maximum compression were intervertebral and extra-dural, most frequently at C6 through 7 (n = 10), followed by C3 through 4 (6). Thirteen horses had dorsolateral and lateral compression at the AP joints, secondary to AP (n = 7) or soft tissue proliferation (6). Site significantly affected direction of compression, and directions of compression from occiput through C4 were primarily ventral and lateral, whereas from C6 through T1 were primarily dorsal and dorsolateral. No linear relationship was identified between mean or maximum APBR and spinal cord-to-dura ratio. CONCLUSIONS AND CLINICAL RELEVANCE : CT myelography may be useful for examination of horses with suspected cervical compressive myelopathy. Degree of compression can be assessed quantitatively, and site of compression significantly affected direction of compression

Computed tomographic examination of the articular process joints of the cervical spine in warmblood horses : 86 cases (2015-2017)

OBJECTIVE To describe articular process joints (APJs) of the cervical spine in horses on the basis of CT and to determine whether abnormalities were associated with clinical signs. ANIMALS 86 client-owned warmblood horses. PROCEDURES Horses that underwent CT of the cervical spine between January 2015 and January 2017 were eligible for study inclusion. Medical records were reviewed for age, body weight, breed, sex, history, clinical signs, and CT findings. Horses were divided into 3 case groups and I control group on the basis of clinical signs. RESULTS 70 warmblood horses were cases, and 16 were controls. Abnormalities were more frequent from CS through TI and were severe in only horses from the case group. Narrowing of the intervertebral foramen was common in horses in the case group (85.7%), often owing to enlarged, misshaped articular processes, followed by degenerative changes, periarticular osteolysis, cyst-like lesions, and fragmentation. High articular process-to-vertebral body (C6) ratio (APBR) and high-grade narrowing of the intervertebral foramen and periarticular osteolysis were noted for horses with forelimb lameness or signs of cervical pain or stiffness. No association was identified between APBR and age or sex. An APBR > 1.5 was found in only horses in the case group, and 32.3% of APJs with APBRs > 1.5 did not have any degenerative changes and periarticular osteolysis. CONCLUSIONS AND CLINICAL RELEVANCE CT was useful to identify abnormalities of the APJs of the cervical spine. An association existed between CT findings and clinical signs. The APJs can be enlarged without concurrent degenerative changes

Intravenous application of allogenic peripheral blood-derived mesenchymal stem cells : a safety assessment in 291 equine recipients

It has been reported that mesenchymal stem cells (MSCs) have homing capacities and immunomodulating effects after an intravenous injection. However, transplanting MSCs in murine tail veins can result in pulmonary reactions and even death of the animals. Unfortunately, only a few intravenous MSC transplantations have been reported in large animal species and these were performed in a limited number of individuals. To assess the safety of MSC transplantations, a large study on 291 recipient horses is reported here. MSCs were isolated from the peripheral blood (PB) of a 4-year-old and 6-year-old donor horse after having tested their PB for a wide range of transmittable diseases. The MSC samples from both donor horses were characterized and resuspended in 1ml of Dulbecco's Modified Eagle Medium (DMEM) supplemented with 10% Dimethyl Sulfoxide (DMSO). After hand-thawing in the field, 291 horses with ages ranging from 3-months to 33-years were directly injected into their jugular vein. 281 horses (97%) received a single injection of a physiological dose of 0.2 x 10(6) MSCs, 5 horses (1.7%) were re-injected after approximately 6 weeks (using the same dose and donor cells) and a single superphysiological dose of 10(6) MSCs was administered to 5 horses as well. In total, 176 recipients were injected with MSCs from the 4-year-old donor and 115 recipients received MSCs from the 6-year-old donor. From all the injected horses (n=291) no acute clinical adverse effects were noticed. Apart from one horse that died of colic 7 months after the treatment, no deaths were registered and all the horses were monitored for 1 year after the injection. In conclusion, no adverse effects were noticed in 291 recipients after an intravenous injection of allogenic PB-derived MSCs. Nevertheless, further research is warranted in order to verify the immunogenic properties of these cells after allogenic transplantation into various (patho)physiological sites