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OBJECTIVES: To evaluate the effect of a coaching intervention compared with control on physical activity and falls rate at 12 months in community-dwelling people aged 60+ years. DESIGN: Cluster randomised controlled trial. SETTING: Community-dwelling older people. PARTICIPANTS: 72 clusters (605 participants): 37 clusters (290 participants) randomised to the intervention and 35 (315 participants) to control. INTERVENTION: Intervention group received written information, fall risk assessment and prevention advice by a physiotherapist, activity tracker and telephone-based coaching from a physiotherapist focused on safe physical activity. Control group received written information and telephone-based dietary coaching. Both groups received up to 19 sessions of telephone coaching over 12 months. OUTCOMES: The co-primary outcomes were device-measured physical activity expressed in counts per minute at 12 months and falls rate over 12 months. Secondary outcomes included the proportion of fallers, device-measured daily steps and moderate-to-vigorous physical activity (MVPA), self-reported hours per week of physical activity, body mass index, eating habits, goal attainment, mobility-related confidence, quality of life, fear of falling, risk-taking behaviour, mood, well-being and disability. RESULTS: The mean age of participants was 74 (SD 8) years, and 70% (n=425) were women. There was no significant effect of the intervention on device-measured physical activity counts per minute (mean difference 5 counts/min/day, 95% CI -21 to 31), or falls at 12 months (0.71 falls/person/year in intervention group and 0.87 falls/person/year in control group; incidence rate ratio 0.86, 95% CI 0.65 to 1.14). The intervention had a positive significant effect on device-measured daily steps and MVPA, and self-reported hours per week of walking, well-being, quality of life, and disability. No significant between-group differences were identified in other secondary outcomes. CONCLUSION: A physical activity and fall prevention programme including fall risk assessment and prevention advice, plus telephone-based health coaching, did not lead to significant differences in physical activity counts per minute or falls rate at 12 months. However, this programme improved other physical activity measures (ie, daily steps, MVPA, hours per week of walking), overall well-being, quality of life and disability. TRIAL REGISTRATION NUMBER: ACTRN12615001190594.
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Vida Independiente , Tutoría , Humanos , Femenino , Anciano , Masculino , Calidad de Vida , Miedo , Ejercicio FísicoRESUMEN
Stream confluences are important components of fluvial networks. Hydraulic forces meeting at stream confluences often produce changes in streambed morphology and sediment distribution. These changes often increase habitat heterogeneity relative to upstream and downstream locations, which have led some to identify them as biological hotspots. Despite their potential ecological importance, there are relatively few empirical studies documenting ecological patterns upstream and downstream of confluences. We have produced a publicly available dataset of stream confluences and associated watershed attributes for the conterminous USA. The dataset includes 1,085,629 stream confluences and 383 attributes for each confluence organized into 15 dataset tables for both tributary and mainstem upstream catchments and watersheds. Themes in the dataset include hydrology (e.g., stream order), land cover, land cover change, geology (e.g., calcium content of underlying lithosphere), physical condition (e.g., precipitation), measures of ecological integrity, and stressors (e.g., impaired streams). Additionally, we used measures of ecological integrity to assess the condition of the stream confluences. Aside from a generally positive east-to-west gradient in ecological condition, we found that approximately one-third of the confluences had markedly contrasting ecological conditions between mainstem and tributary, catchment and watershed, or both. The dataset should support many, multifaceted studies of stream confluence ecology.
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The 2016 National Land Cover Database (NLCD) product suite (available on www.mrlc.gov), includes Landsat-based, 30 m resolution products over the conterminous (CONUS) United States (U.S.) for land cover, urban imperviousness, and tree, shrub, herbaceous and bare ground fractional percentages. The release of NLCD 2016 provides important new information on land change patterns across CONUS from 2001 to 2016. For land cover, seven epochs were concurrently generated for years 2001, 2004, 2006, 2008, 2011, 2013, and 2016. Products reveal that land cover change is significant across most land cover classes and time periods. The land cover product was validated using existing reference data from the legacy NLCD 2011 accuracy assessment, applied to the 2011 epoch of the NLCD 2016 product line. The legacy and new NLCD 2011 overall accuracies were 82% and 83%, respectively, (standard error (SE) was 0.5%), demonstrating a small but significant increase in overall accuracy. Between 2001 and 2016, the CONUS landscape experienced significant change, with almost 8% of the landscape having experienced a land cover change at least once during this period. Nearly 50% of that change involves forest, driven by change agents of harvest, fire, disease and pests that resulted in an overall forest decline, including increasing fragmentation and loss of interior forest. Agricultural change represented 15.9% of the change, with total agricultural spatial extent showing only a slight increase of 4778 km2, however there was a substantial decline (7.94%) in pasture/hay during this time, transitioning mostly to cultivated crop. Water and wetland change comprised 15.2% of change and represent highly dynamic land cover classes from epoch to epoch, heavily influenced by precipitation. Grass and shrub change comprise 14.5% of the total change, with most change resulting from fire. Developed change was the most persistent and permanent land change increase adding almost 29,000 km2 over 15 years (5.6% of total CONUS change), with southern states exhibiting expansion much faster than most of the northern states. Temporal rates of developed change increased in 2001-2006 at twice the rate of 2011-2016, reflecting a slowdown in CONUS economic activity. Future NLCD plans include increasing monitoring frequency, reducing latency time between satellite imaging and product delivery, improving accuracy and expanding the variety of products available in an integrated database.
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Accuracy assessment is a standard protocol of National Land Cover Database (NLCD) mapping. Here we report agreement statistics between map and reference labels for NLCD 2011, which includes land cover for ca. 2001, ca. 2006, and ca. 2011. The two main objectives were assessment of agreement between map and reference labels for the three, single-date NLCD land cover products at Level II and Level I of the classification hierarchy, and agreement for 17 land cover change reporting themes based on Level I classes (e.g., forest loss; forest gain; forest, no change) for three change periods (2001-2006, 2006-2011, and 2001-2011). The single-date overall accuracies were 82%, 83%, and 83% at Level II and 88%, 89%, and 89% at Level I for 2011, 2006, and 2001, respectively. Many class-specific user's accuracies met or exceeded a previously established nominal accuracy benchmark of 85%. Overall accuracies for 2006 and 2001 land cover components of NLCD 2011 were approximately 4% higher (at Level II and Level I) than the overall accuracies for the same components of NLCD 2006. The high Level I overall, user's, and producer's accuracies for the single-date eras in NLCD 2011 did not translate into high class-specific user's and producer's accuracies for many of the 17 change reporting themes. User's accuracies were high for the no change reporting themes, commonly exceeding 85%, but were typically much lower for the reporting themes that represented change. Only forest loss, forest gain, and urban gain had user's accuracies that exceeded 70%. Lower user's accuracies for the other change reporting themes may be attributable to the difficulty in determining the context of grass (e.g., open urban, grassland, agriculture) and between the components of the forest-shrubland-grassland gradient at either the mapping phase, reference label assignment phase, or both. NLCD 2011 user's accuracies for forest loss, forest gain, and urban gain compare favorably with results from other land cover change accuracy assessments.
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BACKGROUND: A prospective analysis of the effect of autologous adipose derived mesenchymal stem cell (MSC) therapy in the treatment of an osteochondral defect of the knee with early progressive osteoarthritis following unsuccessful surgical intervention of osteochondritis dissecans (OCD). CASE PRESENTATION: After failed conventional management of OCD a patient undergoes intra-articular MSC therapy. Patient outcome measures included the Numeric Pain Rating Scale (NPRS), the Western Ontario and McMaster Universities Arthritis Index (WOMAC) and the Knee Injury and Osteoarthritis Outcome Score (KOOS). Structural outcome was assessed using MRI with the novel technique of T2 mapping used to indicate cartilage quality. Following MSC therapy the patient reported improvement in pain and function as measured by NPRS, WOMAC and KOOS. Repeat MRI analysis showed regeneration of cartilage. MRI T2 mapping indicated hyaline like cartilage regrowth. CONCLUSION: In this report, the use of MSCs, after unsuccessful conventional OCD management, resulted in structural, functional and pain improvement. These results highlight the need to further study the regenerative potential of MSC therapy. TRIAL REGISTRATION: Australian and New Zealand Clinical Trial Registry Number - ACTRN12615000258550 (Date registered 19/03/2015 - retrospectively registered).
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Cartílago Articular/diagnóstico por imagen , Trasplante de Células Madre Mesenquimatosas/métodos , Osteoartritis de la Rodilla/diagnóstico por imagen , Osteoartritis de la Rodilla/terapia , Osteocondritis Disecante/diagnóstico por imagen , Osteocondritis Disecante/terapia , Adulto , Artralgia/diagnóstico por imagen , Artralgia/etiología , Artralgia/terapia , Humanos , Masculino , Osteoartritis de la Rodilla/complicaciones , Osteocondritis Disecante/complicaciones , Trasplante Autólogo/métodos , Resultado del TratamientoRESUMEN
Landscape context is an important factor in restoration ecology, but the use of landscape context for site prioritization has not been as fully developed. We used morphological image processing to identify candidate ecological restoration areas based on their proximity to existing natural vegetation. We identified 1,102,720 candidate ecological restoration areas across the continental United States. Candidate ecological restoration areas were concentrated in the Great Plains and eastern United States. We populated the database of candidate ecological restoration areas with 17 attributes related to site content and context, including factors such as soil fertility and roads (site content), and number and area of potentially conjoined vegetated regions (site context) to facilitate its use for site prioritization. We demonstrate the utility of the database in the state of North Carolina, U.S.A. for a restoration objective related to restoration of water quality (mandated by the U.S. Clean Water Act), wetlands, and forest. The database will be made publicly available on the U.S. Environmental Protection Agency's EnviroAtlas website (http://enviroatlas.epa.gov) for stakeholders interested in ecological restoration.
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The landscape mosaic model quantifies and maps the spatial juxtaposition of different land uses. It provides a landscape perspective of anthropic threats posed by agriculture and urban development, and the spatial-temporal shifting of the landscape mosaic indicates landscapes where anthropic intensity has changed. We use the U.S. Geological Survey provided National Land Cover Database (NLCD) for the years 2001 and 2021 to derive the landscape mosaic at five analysis scales. To improve earlier implementations of the model, we introduce the heatmap, a flexible scheme providing more thematic reporting opportunities and allowing for better quantitative summary reporting across analysis scales as well as for temporal trends. The results are exemplified at regional scale for the Atlanta metropolitan area. We use the improved model to investigate the land cover context over time and at different analysis scales and show how custom color tables detail different thematic features of the landscape mosaic, including the degree and change of anthropic intensity. We conclude with a discussion of potential applications in ecology, landscape planning, and restoration to illustrate the benefits of the revised landscape mosaic model. All assessment tools are now available in open-source software packages.
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Modelos Teóricos , Conservación de los Recursos Naturales/métodos , Agricultura/métodos , Humanos , EcosistemaRESUMEN
Objectives: To assess the safety and efficacy of an allogeneic adipose-derived mesenchymal stem cell preparation (MAG200) in the treatment of knee osteoarthritis over 12 months. Design: A single-centre, double-blind, ascending dose, randomised controlled trial. 40 participants with moderate knee osteoarthritis were randomised to receive a single intra-articular injection of MAG200 (dose cohorts:10, 20, 50, 100 â× â106 âcells) or placebo. Primary objectives were safety and efficacy according to a compound responder analysis of minimal clinically important difference in pain (numerical pain rating scale [NPRS]) and function (Knee Injury and Osteoarthritis Outcome Score - Function in Daily Living subscale [KOOSADL]) at month 12. Secondary efficacy outcomes included changes from baseline in patient reported outcome measures and evaluation of disease-modification using quantitative MRI. Results: Treatment was well tolerated with no treatment-related serious adverse events. MAG200 cohorts reported a greater proportion of responders than placebo and demonstrated clinical and statistically significant improvement in pain and clinically relevant improvement in all KOOS subscales. MAG200 demonstrated a reproducible treatment effect over placebo, which was clinically relevant for pain in the 10 â× â106 dose cohort (mean difference NPRS:-2.25[95%CI:-4.47,-0.03, p â= â0.0468]) and for function in the 20 â× â106 and 100 â× â106 dose cohorts (mean difference KOOSADL:10.12[95%CI:-1.51,21.76, p â= â0.0863] and 10.81[95%CI:-1.42,23.04, p â= â0.0810] respectively). A trend in disease-modification was observed with improvement in total knee cartilage volume in MAG200 10, 20, and 100 â× â106 dose cohorts, with progression of osteoarthritis in placebo, though this was not statistically significant. No clear dose response was observed. Conclusion: This early-phase study provides supportive safety and efficacy evidence to progress MAG200 to later-stage trial development. Trial registration: ACTRN12617001095358/ACTRN12621000622808.
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The conservation value of natural vegetation is degraded by proximity to anthropogenic land uses. Previous global assessments focused primarily on the amount of land protected or converted to anthropogenic uses, and on forest vegetation. Comparative assessments of extant vegetation in terms of proximity to anthropogenic land uses are needed to better inform conservation planning. We conducted a novel comparative survey of global forest and grass-shrub vegetation at risk of degradation owing to proximity of anthropogenic land uses. Using a global land cover map, risks were classified according to direct adjacency with anthropogenic land cover (adjacency risk), occurrence in anthropogenic neighborhoods (neighborhood risk), or either (combined risk). The survey results for adjacency risk and combined risk were summarized by ecoregions and biomes. Adjacency risk threatens 22 percent of global grass-shrub and 12 percent of forest vegetation, contributing to combined risk which threatens 31 percent of grass-shrub and 20 percent of forest vegetation. Of 743 ecoregions examined, adjacency risk threatens at least 50 percent of grass-shrub vegetation in 224 ecoregions compared to only 124 ecoregions for forest. The conservation threats posed by proximity to anthropogenic land cover are higher for grass-shrub vegetation than for forest vegetation.
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Conservación de los Recursos Naturales , Actividades Humanas , Poaceae , Árboles , EcosistemaRESUMEN
Objective: To evaluate the long-term safety and efficacy of adipose-derived mesenchymal stem cell (ADMSC) therapy in the treatment of knee osteoarthritis (OA). Methods: 329 participants with knee OA underwent intra-articular ADMSC therapy. Participants were followed up for 24 months and were separated based on radiological OA grade. Results: Treatment was well tolerated with no related serious adverse events. All participant groups reported clinically and statistically significant pain improvement. Clinical outcome was not influenced by patients' age or BMI. Conclusion: ADMSC therapy is an effective, safe and long-lasting treatment option for knee OA with the potential to delay total joint replacement. In addition to the observed clinical benefits, ADMSC therapy promises to reduce the global economic burden of OA. Trial registration number: ACTRN12617000638336.
The aim of this study was to assess the benefit of stem cell therapy in the treatment of mild to severe knee osteoarthritis. A total of 329 study participants with painful knee osteoarthritis undertook stem cell therapy and were followed up for two years. Stem cell therapy was well tolerated and safe. Significant pain and functional improvement were observed in all of the participant groups including those with severe bone-on-bone osteoarthritis. Participants' age and weight did not influence the clinical outcome. This study shows that stem cell therapy is an effective, safe and long-lasting treatment for knee osteoarthritis and greatly reduces knee pain and improves the function of the knee. Stem cell therapy may delay or prevent knee replacement surgery and result in significant global health and economic benefit.
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Trasplante de Células Madre Mesenquimatosas , Células Madre Mesenquimatosas , Osteoartritis de la Rodilla , Humanos , Inyecciones Intraarticulares , Osteoartritis de la Rodilla/terapia , Estudios Prospectivos , Resultado del TratamientoRESUMEN
INTRODUCTION: Paramedic duties include assessing, treating, and maneuvering patients in physically challenging environments. Whether clinical skills and patient care are affected by these occupational demands is unknown. High-fidelity simulation affords the opportunity to study this in a controlled setting. METHODS: Using a randomized crossover design, 11 regional paramedicine students and graduates (mean ± SD age = 23 ± 2 years) completed two, 20-minute high-fidelity simulations that included cardiopulmonary resuscitation (CPR) immediately after either an acute bout of occupational physical activity (OPA) or a rest period (REST). Heart rate, respiratory rate, and mean arterial pressure were measured throughout. Clinical performance was scored using the Global Rating Score and a patient care record. Measures of CPR efficacy were recorded in the manikin. RESULTS: There were no significant differences in Global Rating Score ( P = 0.07, ES = 0.03) or CPR efficacy between conditions. Patient care record accuracy was higher after the OPA versus REST simulations (mean ± SD = 61.8 ± 12.6% vs. 55.5 ± 12.0%, P = 0.03, ES = 0.5). Mean heart rate was higher during OPA simulations versus REST simulations (121 ± 14 vs. 84 ± 9 beats per minute, P < 0.01, ES = 3.1), as was mean respiratory rate (19 ± 3 vs. 16 ± 3 breaths per minute, P < 0.01, ES = 1.0). Mean arterial pressure was higher for OPA versus REST at simulation start (105 ± 11.3 vs. 95.8 ± 11.8 mm Hg, P = 0.01, Effect Size = 0.8), although not different after simulation. CONCLUSIONS: Paramedicine students including recent graduates performed as well, or better, in a simulated clinical scenario immediately after occupation-specific acute physical exertion compared with a REST, despite higher physiological exertion. Whether this is the case for more experienced but potentially less physically fit paramedics in the workforce warrants investigation.
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Técnicos Medios en Salud , Competencia Clínica , Enseñanza Mediante Simulación de Alta Fidelidad , Esfuerzo Físico , Estudiantes del Área de la Salud , Adulto , Técnicos Medios en Salud/educación , Reanimación Cardiopulmonar , Competencia Clínica/estadística & datos numéricos , Estudios Cruzados , Humanos , Maniquíes , Esfuerzo Físico/fisiología , Proyectos Piloto , Estudiantes del Área de la Salud/estadística & datos numéricos , Adulto JovenRESUMEN
Aim: To evaluate safety and efficacy of low dose autologous adipose-derived mesenchymal stem cells (ADMSCs) for treatment of disc degeneration resulting in low back pain (LBP). Methods: Nine participants with chronic LBP originating from single-level lumbar disc disease underwent intradiscal injection of 10 million ADMSCs with optional repetition after 6 months. Results: No unexpected or serious adverse events were recorded. Seven (78%) of participants reported reductions in pain 12 months after treatment. Five (56%) reported increased work capacity. Three (33%) reduced analgesic medication. Improvements in EQ-5D and Oswestry disability index results were observed. MRI demonstrated no further disc degeneration and improvements to annular fissures and disc protrusions. Conclusion: This study provides initial evidence of safety and efficacy of ADMSCs for discogenic LBP.
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BACKGROUND: This statistical analysis plan details the Coaching for Healthy AGEing (CHAnGE) trial analysis methodology. OBJECTIVE: To investigate the effect of a combined physical activity and fall prevention program on physical activity and falls compared to a healthy eating among people aged 60 years and over. METHODS: The CHAnGE trial is a pragmatic parallel-group cluster-randomised controlled trial with allocation concealment and blinded assessors. Clusters are allocated to either (1) a physical activity and fall prevention intervention or (2) to a healthy eating intervention. The primary outcomes are: objectively measured physical activity at 12 months post-randomisation, and self-reported falls throughout the 12-month trial period. Secondary outcomes include the proportion of participants reporting a fall, the proportion of participants meeting the Australian physical activity guidelines, body mass index, eating habits, mobility goal attainment, mobility-related confidence, quality of life, fear of falling, risk-taking behaviour, mood, well-being, self-reported physical activity, disability, and use of health and community services. ANALYSIS: We will follow the intention-to-treat principle. All analysis will allow for cluster randomisation using a generalised estimating equation approach. The between-group difference in the number of falls per person-year will be analysed using negative binomial regression models. For the continuously scored primary and secondary outcome measures, linear regression models adjusted for corresponding baseline scores will assess the effect of group allocation. Analyses will take into account cluster randomisation and will be adjusted for baseline scores. A subgroup analysis will assess differential effects of the intervention by baseline physical activity levels and history of falls.
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Envejecimiento Saludable , Tutoría , Accidentes por Caídas/prevención & control , Anciano , Australia , Ejercicio Físico , Miedo , Humanos , Vida Independiente , Persona de Mediana Edad , Calidad de VidaRESUMEN
BACKGROUND: Intervention trials promoting physical activity among older people frequently report low and unrepresentative recruitment. Better understanding of reasons for participation can help improve recruitment. This study explored why participants enrolled in the Coaching for Healthy Ageing (CHAnGE) trial, including how their decision was influenced by recruitment strategies. CHAnGE was a cluster randomised controlled trial testing the effectiveness of a healthy ageing program targeting inactivity and falls. Seventy-two groups of people aged 60+ were recruited from community organisations via informal presentations by the health coaches. METHODS: We conducted a secondary thematic analysis of interview data from our wider qualitative evaluation in which 32 purposively sampled trial participants took part in semi-structured interviews about their experiences of CHAnGE. Data relating to recruitment and participation were analysed inductively to identify themes, then a coding framework comprising the core constructs from self-determination theory-autonomy, competence and relatedness-was used to explore if and how this theory fit with and helped to explain our data. RESULTS: Recruitment presentations promoted the CHAnGE intervention well in terms of addressing value expectations of structured support, different forms of accountability, credibility, achievability and, for some, a potential to enhance social relationships. Participation was motivated by the desire for improved health and decelerated ageing, altruism and curiosity. These factors related strongly to self-determination concepts of autonomy, competence and relatedness, but the intervention's demonstrated potential to support self-determination needs could be conveyed more effectively. CONCLUSIONS: Findings suggest that recruitment could have greater reach using: 1. Strengths-based messaging focusing on holistic gains, 2. Participant stories that highlight positive experiences, and 3. Peer support and information sharing to leverage altruism and curiosity. These theory-informed improvements will be used to increase participation in future trials, including people in hard-to-recruit groups. They may also inform other physical activity trials and community programs.
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Entrevistas como Asunto/métodos , Selección de Paciente , Participación de los Interesados/psicología , Anciano , Anciano de 80 o más Años , Envejecimiento , Altruismo , Australia , Ejercicio Físico/psicología , Ejercicio Físico/tendencias , Femenino , Personal de Salud/psicología , Envejecimiento Saludable , Humanos , Relaciones Interpersonales , Masculino , Persona de Mediana Edad , Motivación/ética , Autonomía Personal , Proyectos de Investigación/tendenciasRESUMEN
Tendinopathy is a common condition of both the athletic and general population and can be associated with significant pain and disability. The ability of mesenchymal stem cells (MSCs) to differentiate along a mesodermal cell lineage, including tenocytes, and secrete various bioactive regenerative and anti-inflammatory molecules has seen them considered as a future reparative therapy for tendinopathy. Preclinical trials with MSCs have shown promising positive functional and structural outcomes in several connective tissue related conditions. A 52-year-old male professional masters golfer presents with a clinical history of common extensor origin tendinopathy of the elbow. Subsequent formal ultrasound showed evidence of a large intrasubstance tear. The patient underwent intratendinous autologous adipose-derived MSC therapy in combination with autologous platelet-rich plasma. Following treatment, the patient reported progressive improvement as measured by the validated Numeric Pain Rating Scale and Patient-Rated Tennis Elbow Evaluation score. Repeat imaging showed successful regeneration of tendon-like tissue.
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Lesiones de Codo , Articulación del Codo , Tendinopatía del Codo , Plasma Rico en Plaquetas , Codo de Tenista , Traumatismos en Atletas , Articulación del Codo/diagnóstico por imagen , Tendinopatía del Codo/diagnóstico , Tendinopatía del Codo/etiología , Tendinopatía del Codo/terapia , Golf , Humanos , Masculino , Trasplante de Células Madre Mesenquimatosas/métodos , Células Madre Mesenquimatosas , Persona de Mediana Edad , Dimensión del Dolor/métodos , Codo de Tenista/complicaciones , Codo de Tenista/diagnóstico , Codo de Tenista/fisiopatología , Codo de Tenista/terapia , Resultado del Tratamiento , Ultrasonografía/métodosRESUMEN
Osteochondral lesions (OCLs) of the talus are rare but can be associated with significant morbidity and may lead to the development of osteoarthritis. An improved understanding of the action of mesenchymal stem cells (MSCs) has seen renewed interest in their role in cartilage repair, with early preclinical and clinical research showing benefits in symptomatic and structural improvement. A 42-year-old man presented with an unstable OCL of the talus and onset of early osteoarthritis with a history of multiple previous ankle arthroscopies for ankle impingement. The patient underwent arthroscopic removal of the OCL in combination with adipose-derived MSC therapy. The patient reported progressive improvement as measured by the validated Foot and Ankle Disability Index. Repeat MRI with additional T2 mapping techniques showed successful regeneration of hyaline-like cartilage. This case is the first to show the successful use of MSC therapy in the management of an ankle OCL. Trial registration: Australian New Zealand Clinical Trials Registry - ACTRN12617000638336.
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Cartílago Articular/fisiología , Trasplante de Células Madre Mesenquimatosas/métodos , Osteocondritis Disecante/terapia , Adulto , Articulación del Tobillo/fisiopatología , Humanos , Masculino , Células Madre Mesenquimatosas , Osteocondritis Disecante/fisiopatología , Regeneración , Trasplante Autólogo , Resultado del TratamientoRESUMEN
Acute respiratory distress syndrome (ARDS) is a condition of acute respiratory failure resulting from noncardiogenic pulmonary edema. It may occur as a consequence of lung infection, sepsis, trauma, aspiration or drug reaction. The pathogenesis of ARDS is understood to be an unregulated inflammatory cascade with both endothelial and epithelial layer damage leading to alveolar fluid collection and pulmonary edema. Despite improved understanding of the cause of ARDS, treatment remains supportive with a mortality rate ranging from 25-40%. Preclinical and early phase clinical trials have highlighted the potential role of mesenchymal stem cells in combating the inflammatory cascade through immunomodulatory mechanisms and assisting in tissue repair.
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Aim: To evaluate the safety and efficacy of adipose-derived mesenchymal stem cell (ADMSC) therapy in combination with arthroscopic abrasion arthroplasty (AAA) in advanced knee osteoarthritis (OA). Materials & methods: 27 patients with Grade IV OA of the knee underwent AAA and ADMSC therapy (50 × 106 ADMSCs at baseline and 6 months). Clinical outcome was assessed over 36 months. Structural change was determined using MRI. Results: Treatment was well tolerated with no serious adverse events. Clinically significant improvements in pain and function were observed. Reproducible hyaline-like cartilage regeneration was seen in all participants. Conclusion: ADMSC therapy combined with AAA in Grade IV OA results in reproducible pain, functional and structural improvements. This represents a joint preservation technique for patients with advanced OA of the knee. Trial registration number: ACTRN12617000638336.
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Cartílago Articular , Trasplante de Células Madre Mesenquimatosas , Células Madre Mesenquimatosas , Osteoartritis de la Rodilla , Artroplastia , Cartílago Articular/diagnóstico por imagen , Humanos , Osteoartritis de la Rodilla/diagnóstico por imagen , Osteoartritis de la Rodilla/terapia , Regeneración , Trasplante Autólogo , Resultado del TratamientoRESUMEN
Aim: To evaluate the safety, pain, functional and structural improvements after autologous adipose-derived mesenchymal stem cell (ADMSC) therapy in combination with arthroscopic abrasion arthroplasty in focal chondral defects of the knee. Methods: Eight patients with a focal full thickness chondral defect of the knee underwent arthroscopic abrasion arthroplasty followed by postoperative intra-articular injections of autologous ADMSCs (50 × 106 ADMSCs at baseline and 6 months). Clinical outcome was assessed using numeric pain rating scale, Knee Injury and Osteoarthritis Outcome Score and the Western Ontario and McMaster Universities Osteoarthritis Index. Structural outcome was determined by magnetic resonance imaging. Outcome was assessed over 24 months. Results: No serious adverse events occurred. Participants observed clinically significant improvement in pain and function. Magnetic resonance imaging analysis showed cartilage regeneration with T2 mapping values comparable to hyaline cartilage. Conclusion: Arthroscopic abrasion arthroplasty in combination with intra-articular ADMSC therapy results in reproducible pain, functional and structural improvements with regeneration of hyaline-like cartilage. Trial registration number: ACTRN12617000638336.
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Enfermedades de los Cartílagos/terapia , Cartílago Articular/lesiones , Traumatismos de la Rodilla/terapia , Trasplante de Células Madre Mesenquimatosas/métodos , Células Madre Mesenquimatosas/citología , Adulto , Enfermedades de los Cartílagos/patología , Cartílago Articular/patología , Femenino , Humanos , Traumatismos de la Rodilla/patología , Masculino , Persona de Mediana Edad , Proyectos Piloto , Estudios Prospectivos , Trasplante Autólogo , Adulto JovenRESUMEN
Soils provide vital ecosystem services, from sequestering carbon to providing food and moderating floods. Soil erosion threatens the provisioning of these services and degrades downstream water quality. Vegetation plays an important role in soil retention: by holding it in place, soil can continue to provide ecosystem goods and services and protect water resources. The aims of this study were to: (1) develop a 30-meter resolution map of erosion in the conterminous United States, and (2) quantify the soil retention service of natural vegetation. Using the Revised Universal Soil Loss Equation and physiographic and remote sensing datasets, we estimated sheet and rill erosion. We also developed a map of sediment delivery ratio to connect erosion to downstream delivery using hydrologic connectivity. The estimated sheet and rill erosion in the conterminous United States was 1.55 Pg yr-1, of which 0.52 Pg yr-1 reached waterbodies. Natural land cover prevents 12.3 Pg yr-1 of sheet and rill erosion and 5.1 Pg yr-1 in delivery to waterbodies. The value of natural land cover in retaining sediment is a function of the land cover, physiographic characteristics, and spatial context. This study has implications for spatial prioritization of natural land cover preservation and agricultural land management to minimize sediment erosion and delivery.