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Topic:Musculoskeletal System

The musculoskeletal system in horses encompasses the bones, muscles, tendons, ligaments, and joints that facilitate movement and provide structural support. This system is essential for locomotion, athletic performance, and overall health in equine species. The equine skeleton consists of approximately 205 bones, which are connected by joints and supported by a network of muscles and connective tissues. Tendons connect muscles to bones, while ligaments link bones to other bones, contributing to joint stability. The musculoskeletal system is subject to various conditions, including injuries, degenerative diseases, and developmental disorders, which can impact a horse's mobility and performance. This page compiles peer-reviewed research studies and scholarly articles that explore the anatomy, physiology, pathology, and treatment of musculoskeletal conditions in horses.
Inertial Sensor-Based Quantification of Movement Symmetry in Trotting Warmblood Show-Jumping Horses after “Limb-by-Limb” Re-Shoeing of Forelimbs with Rolled Rocker Shoes.
Sensors (Basel, Switzerland)    July 25, 2024   Volume 24, Issue 15 doi: 10.3390/s24154848
Bark C, Reilly P, Weller R, Pfau T.Hoof care providers are pivotal for implementing biomechanical optimizations of the musculoskeletal system in the horse. Regular visits allow for the collection of longitudinal, quantitative information ("normal ranges"). Changes in movement symmetry, e.g., after shoeing, are indicative of alterations in weight-bearing and push-off force production. Ten Warmblood show jumping horses (7-13 years; 7 geldings, 3 mares) underwent forelimb re-shoeing with rolled rocker shoes, one limb at a time ("limb-by-limb"). Movement symmetry was measured with inertial sensors attached to the head, withers, and...
Roles of collagen cross-links and osteon collagen/lamellar morphotypes in equine third metacarpals in tension and compression tests.
The Journal of experimental biology    July 24, 2024   Volume 227, Issue 14 jeb247758 doi: 10.1242/jeb.247758
Skedros JG, Dayton MR, Cronin JT, Mears CS, Bloebaum RD, Wang X, Bachus KN.Many bones experience bending, placing one side in net compression and the other in net tension. Because bone mechanical properties are relatively reduced in tension compared with compression, adaptations are needed to reduce fracture risk. Several toughening mechanisms exist in bone, yet little is known of the influences of secondary osteon collagen/lamellar 'morphotypes' and potential interplay with intermolecular collagen cross-links (CCLs) in prevalent/predominant tension- and compression-loaded regions. Paired third metacarpals (MC3s) from 10 adult horses were prepared for mechanical test...
Determinants of joint effusion in tarsocrural osteochondrosis of yearling Standardbred horses.
Frontiers in veterinary science    July 24, 2024   Volume 11 1389798 doi: 10.3389/fvets.2024.1389798
Bertuglia A, Pallante M, Pagliara E, Valle D, Bergamini L, Bollo E, Bullone M, Riccio B.Tarsocrural osteochondrosis (OCD) is a developmental orthopedic disease commonly affecting young Standardbreds, with different fragment localization and size. Clinically, it is characterized by variable synovial effusion in the absence of lameness, whose determinants are ill-defined. We hypothesized that localization and physical characteristics of the osteochondral fragments like dimensions, multifragmentation, and instability influence joint effusion and correlate with synovial markers of cartilage degradation and inflammation. Clinical data, synovial fluid and intact osteochondral fragments...
Concurrent radiological and ultrasonographical findings in the forelimb proximal sesamoid bones and adjacent suspensory ligament branches in yearling and 2-year-old Thoroughbred sales horses.
Equine veterinary journal    July 22, 2024   doi: 10.1111/evj.14120
Peat FJ, Kawcak CE, McIlwraith CW, Berk JT, Keenan DP.Changes in the proximal sesamoid bones (sesamoids) and the insertional region of the adjacent suspensory ligament branch (branch) are of particular importance in young Thoroughbreds sold at public auction. Little is known about the prevalence of concurrent ultrasonographical branch change, relative to the various grades of radiological sesamoid appearance. Objective: To examine the existence of concurrent radiological and ultrasonographical findings in individual sesamoid-branch units in sales horses; to determine whether there are any radiological findings that are consistently accompanied by...
Trunk kinematics and limb movement of horses walking backwards and forwards in hand and lifting a single limb.
Veterinary journal (London, England : 1997)    July 20, 2024   Volume 306 106202 doi: 10.1016/j.tvjl.2024.106202
Jobst ID, Zsoldos RR, Licka TF.Equine physiotherapy commonly includes basic exercises such as walking backward (BW) and voluntary lifting of single limbs (SLL), but trunk movements during these have not been studied. In order to compare the trunk kinematics during BW and SLL with forward walking (FW), nine horses were measured in FW, BW and during SLL triggered by tactile cue. Kinematics were obtained from skin markers captured by ten high-speed video cameras. Trunk angles were calculated in sagittal and horizontal planes from withers, dorsal to spinous processes of the 16th thoracic vertebra (T16), 2nd and 4th sacral verte...
The efficacy of an eight-week exercise program for the management of chronic low back pain in the equestrian population.
The Journal of sports medicine and physical fitness    July 17, 2024   Volume 64, Issue 11 1188-1193 doi: 10.23736/S0022-4707.24.15830-6
Weeks RA, McLAUGHLIN PA, Vaughan BR.Equestrians (horse riders) are more susceptible to low back pain than the general population due to loads placed on their bodies during the activity. A specific eight-week exercise intervention program targeting the muscles used during horse riding was implemented for a group of equestrians with low back pain. Methods: Volunteers were invited to participate in the study through social media posts in Melbourne, Australia. The participants were required to complete an exercise screening test prior to enrolment in the study to ensure they were suitable to participate in the iteration program. Par...
Ultrasonography of the suspensory ligament branches in yearling and 2-year-old Thoroughbred sales horses: Prevalence, progression of findings and associations with racing performance.
Equine veterinary journal    July 15, 2024   doi: 10.1111/evj.14137
Peat FJ, Kawcak CE, McIlwraith CW, Berk JT, Keenan DP, Selberg KT, Ojeda A.Equine suspensory ligament branch (branch) ultrasonography is becoming increasingly commonplace presale. No ultrasonographical branch reference data exists for Thoroughbred sales horses. Objective: To define the prevalence of ultrasonographical findings in the forelimb suspensory branches of yearling and 2-year-old sales Thoroughbreds and to analyse associations with racing performance. To track changes in branch findings between 1 and 2 years of age in horses that present for sale at both ages. Methods: Prospective cohort study using an enrolled sample. Methods: Horses were enrolled from a ...
Muscle-Driven Predictive Physics Simulations of Quadrupedal Locomotion in the Horse.
Integrative and comparative biology    July 14, 2024   Volume 64, Issue 3 694-714 doi: 10.1093/icb/icae095
van Bijlert PA, Geijtenbeek T, Smit IH, Schulp AS, Bates KT.Musculoskeletal simulations can provide insights into the underlying mechanisms that govern animal locomotion. In this study, we describe the development of a new musculoskeletal model of the horse, and to our knowledge present the first fully muscle-driven, predictive simulations of equine locomotion. Our goal was to simulate a model that captures only the gross musculoskeletal structure of a horse, without specialized morphological features. We mostly present simulations acquired using feedforward control, without state feedback ("top-down control"). Without using kinematics or motion captur...
Ultrasound-guided caudal cervical articular process arthrocentesis is accurate in live horses with and without arthropathy.
Equine veterinary journal    July 11, 2024   doi: 10.1111/evj.14133
Davidson EJ, Stefanovski D, Slack J, Manzi TJ.Cervical articular process joint (CAPJ) therapy is advocated for horses with neck disorders. Several ultrasound-guided CAPJ techniques have been described in cadaver studies with 72%-89% intra-articular injection accuracy; however, the CAPJ injection accuracy in clinical equine practice has not been extensively reported. Objective: To describe a modified cranial approach for ultrasound-guided caudal CAPJ injections, to investigate the accuracy of this CAPJ injection technique in live horses, and to assess the effect of CAPJ injection location, laterality, operator, and radiographic CAPJ enlarg...
Ex vivo biomechanical evaluation of tissue construct strength in an equine colopexy model.
Veterinary surgery : VS    July 8, 2024   Volume 54, Issue 1 189-198 doi: 10.1111/vsu.14117
Gaitan HM, Mudge MC, Litsky AS, Arruda AG, Gardner AK.To compare strength of left paramedian colopexies using various techniques in equine ex vivo models. Methods: Experimental study. Methods: Equine cadavers euthanized for nongastrointestinal pathology (36 specimens derived from 9 horses). Methods: Colopexies were performed after euthanasia. Suture pattern (horizontal mattress vs. cruciate) and incorporation of dorsal sheath of the rectus abdominis (partial-thickness) versus incorporation of dorsal and ventral sheath of the rectus abdominis (full-thickness) were evaluated. Single cycle load to failure, work to peak load, stiffness, and mode of f...
Ex vivo evaluation of the soft tissue components of the equine stifle using 3 Tesla magnetic resonance imaging under flexion, extension, and loading. Stedman JM, Lutter JD, Hallman C, Laverty S, Richard H, Santschi EM.High-field MRI of the equine stifle provides high-resolution information about soft tissues that is useful in the diagnosis of stifle lameness. The aim of this prospective anatomic study was to describe the appearance, position, size, and shape of the equine femorotibial ligaments, meniscal ligaments, and menisci using 3 Tesla MRI under extended, extended-loaded, and flexed conditions. Additionally, histologic examination of the collateral and cruciate ligaments (CLs) of a single stifle was performed to compare with MRI images. In extension, mild variations in MRI signal intensity were apparen...
Characterisation of phenotypic patterns in equine exercise-associated myopathies.
Equine veterinary journal    July 5, 2024   doi: 10.1111/evj.14128
Lindsay-McGee V, Massey C, Li YT, Clark EL, Psifidi A, Piercy RJ.Equine exercise-associated myopathies are prevalent, clinically heterogeneous, generally idiopathic disorders characterised by episodes of myofibre damage that occur in association with exercise. Episodes are intermittent and vary within and between affected horses and across breeds. The aetiopathogenesis is often unclear; there might be multiple causes. Poor phenotypic characterisation hinders genetic and other disease analyses. Objective: The aim of this study was to characterise phenotypic patterns across exercise-associated myopathies in horses. Methods: Historical cross-sectional study, w...
Cone beam computed tomography and cross-sectional anatomy of the region of the fetlock in the horse (Equus caballus).
Anatomia, histologia, embryologia    July 5, 2024   Volume 53, Issue 4 e13079 doi: 10.1111/ahe.13079
Bierau J, Rott P, Röcken M, Staszyk C.This study aimed to delineate the detailed anatomy of the metacarpophalangeal (MCP) and metatarsophalangeal (MTP) joints in healthy horses using cone beam computed tomography (CBCT). The fetlock region of 15 cadaveric forelimbs and 14 cadaveric hindlimbs from nine adult horses without orthopaedic disease underwent CBCT scanning. Additionally, arthrography CBCT scans were conducted following intra-articular injection of a radiopaque contrast medium containing blue epoxy resin dye. Subsequently, limbs were frozen and sectioned to visualize anatomical structures in sectional planes corresponding ...
Radiographic texture of the trabecular bone of the proximal phalanx in horses with metacarpophalangeal osteoarthritis.
Journal of equine science    July 3, 2024   Volume 35, Issue 2 21-28 doi: 10.1294/jes.35.21
Pereira LO, DE Souza AF, Spagnolo JD, Yamada ALM, Salgado DMRA, DE Zoppa ALDV.Osteoarthritis (OA) is a prevalent condition in horses, leading to changes in trabecular bone structure and radiographic texture. Although fractal dimension (FD) and lacunarity have been applied to quantify these changes in humans, their application in horses remains nascent. This study evaluated the use of FD, bone area fraction (BA/TA), and lacunarity in quantifying trabecular bone differences in the proximal phalanx (P1) in 50 radiographic examinations of equine metacarpophalangeal joints with varying OA degrees. In the dorsopalmar view, regions of interest were defined in the trabecular bo...
Interobserver agreement during clinical magnetic resonance imaging of the equine foot.
Equine veterinary journal    June 30, 2024   Volume 57, Issue 2 406-418 doi: 10.1111/evj.14126
Byrne CA, Voute LC, Marshall JF.Agreement between experienced observers for assessment of pathology and assessment confidence are poorly documented for magnetic resonance imaging (MRI) of the equine foot. Objective: To report interobserver agreement for pathology assessment and observer confidence for key anatomical structures of the equine foot during MRI. Methods: Exploratory clinical study. Methods: Ten experienced observers (diploma or associate level) assessed 15 equine foot MRI studies acquired from clinical databases of 3 MRI systems. Observers graded pathology in seven key anatomical structures (Grade 1: no pathology...
Histological and Histopathological Features of the Third Metacarpal/Tarsal Parasagittal Groove and Proximal Phalanx Sagittal Groove in Thoroughbred Horses with Racing History.
Animals : an open access journal from MDPI    June 30, 2024   Volume 14, Issue 13 1942 doi: 10.3390/ani14131942
Lin ST, Foote AK, Bolas NM, Sargan DR, Murray RC.Information regarding the histopathology of the proximal phalanx (P1) sagittal groove in racehorses is limited. Twenty-nine cadaver limbs from nine Thoroughbred racehorses in racing/race-training underwent histological examination. Histological specimens of the third metacarpal/metatarsal (MC3/MT3) parasagittal grooves and P1 sagittal grooves were graded for histopathological findings in hyaline cartilage (HC), calcified cartilage (CC), and subchondral plate and trabecular bone (SCB/TB) regions. Histopathological grades were compared between (1) fissure and non-fissure locations observed in a ...
Physiological comparison of conditioned and non-conditioned university horses following semester break.
Journal of equine veterinary science    June 28, 2024   105143 doi: 10.1016/j.jevs.2024.105143
Stellmack JM, Logan AA, Higgins AH, Hoffman RM.Periods of limited activity during semester break may reduce performance during return to ridden work. This study evaluated fitness and muscling of horses when returning to work, following a 12-week period during which horses either continued (conditioned) or discontinued (non-conditioned) ridden work. It was hypothesized that non-conditioned horses would have a lower level of fitness, resulting in higher resting and peak heart rates and lower levels of muscling. Twelve mature, stock type horses aged 16 ± 5 years were assigned to either a conditioned group that maintained light-to-moderate ri...
Influence of surgical intervention at the level of the dorsal spinous processes on the biomechanics of the equine thoracolumbar spine.
Equine veterinary journal    June 27, 2024   doi: 10.1111/evj.14123
Baudisch N, Singer E, Jensen KC, Eichler F, Meyer HJ, Lischer C, Ehrle A.Surgical treatment options for horses with overriding dorsal spinous processes include interspinous ligament desmotomy and partial spinous process ostectomy. The impact of spinal surgery on the three-dimensional biomechanics of the equine thoracolumbar spine and the epaxial musculature is unclear. Objective: To investigate the influence of interspinous ligament desmotomy and cranial wedge ostectomy on the biomechanics of the equine thoracolumbar spine and the paraspinal Musculi multifidi. Methods: Ex-vivo experiments. Methods: Twelve equine thoracolumbar spine specimens were mounted in a custo...
Vertical pelvic movement asymmetry and lameness location in ipsilateral combined forelimb and hindlimb lameness cases.
Equine veterinary journal    June 25, 2024   doi: 10.1111/evj.14117
Means K, Hayden L, Kramer J, McCracken MJ, Reed SK, Wilson DA, Keegan KG.Compensatory vertical head and pelvis movement asymmetry may occur in trotting horses with a primary cause of lameness in one end of the body due to the weight shifting between limbs, leading to apparent combined forelimb and hindlimb lameness (CFHL). Little is known about CFHL patterns observed with body-mounted inertial sensors (BMIS) and regardless of their underlying mechanisms, compensatory and secondary lameness may complicate the definitive identification of the primary causes of lameness. Objective: Determine associations between vertical pelvic movement asymmetry and location of prima...
Clinically relevant doses of tiludronate do not affect bone remodelling in pasture-exercised horses.
Equine veterinary journal    June 25, 2024   Volume 57, Issue 2 513-521 doi: 10.1111/evj.14119
Tippen SP, Metzger CE, Sacks SA, Allen MR, Mitchell CF, McNulty MA.Bisphosphonates are widely used in equine athletes to reduce lameness associated with skeletal disorders. Widespread off-label use has led to concern regarding potential negative effects on bone healing, but little evidence exists to support or refute this. Objective: To investigate the influence of clinically relevant doses of tiludronate on bone remodelling and bone healing. Methods: Randomised, controlled in vivo experiments. Methods: Each horse had a single tuber coxae biopsied (Day 0), then were divided into a treatment (IV tiludronate) or control (IV saline) group. Treatments were admini...
Athletic prognosis following arthroscopic removal of osteochondral fragments of the proximal dorsal sagittal ridge of the fetlock in Thoroughbreds intended for flat racing.
Veterinary surgery : VS    June 24, 2024   doi: 10.1111/vsu.14129
Luick ML, Khouzam NA, Pérez-Nogués M.To establish racing prognosis in Thoroughbred yearlings with proximal sagittal ridge osteochondral lesions and compare them to dorsoproximal and palmar/plantar first phalanx osteochondral lesions. Methods: A total of 47 horses had proximal sagittal ridge lesions, 34 had palmar/plantar first phalanx lesions, and 115 had dorsoproximal first phalanx lesions. Methods: Retrospective case series. Methods: Medical records of Thoroughbred yearling racing prospects treated arthroscopically for fetlock osteochondral lesions were reviewed. Data were collected from a public database, including the ability...
Using accelerometers to identify a high risk of catastrophic musculoskeletal injury in three racing Thoroughbreds.
Journal of the American Veterinary Medical Association    June 21, 2024   1-9 doi: 10.2460/javma.24.02.0114
Sweeney DM, Holmström M, Donohue KD, Lambert DH, Bayly WM.To describe the process whereby the screening of racing Thoroughbreds with accelerometer-based inertial measurement unit (IMU) sensors followed by clinical evaluation and advanced imaging identified potentially catastrophic musculoskeletal injuries in 3 horses. Methods: 3 Thoroughbred racehorses. Methods: All cases demonstrated an abnormal stride pattern either during racing (cases 1 and 2) or while breezing (case 3) and were identified as being at very high risk of catastrophic musculoskeletal injury by an algorithm derived from IMU sensor files from > 20,000 horses' race starts. Veterinary e...
Determination of Equine Behaviour in Subjectively Non-Lame Ridden Sports Horses and Comparison with Lame Sports Horses Evaluated at Competitions.
Animals : an open access journal from MDPI    June 20, 2024   Volume 14, Issue 12 doi: 10.3390/ani14121831
Dyson S, Pollard D.The Ridden Horse Pain Ethogram (RHpE) was developed to facilitate the identification of musculoskeletal pain. The aim of the current study was to collate behavioural data using the RHpE from horses at competitions assumed by their owners and/or riders to be fit for competition. The objectives were to quantify the frequency of occurrence of behaviours in pain-free horses and those with lameness or abnormalities of canter and to determine any differences between disciplines and levels of competition. The RHpE was applied to 1358 horses competing in Grand Prix (GP) dressage (n = 211), 5* three-da...
Shape change in the saddle region of the equine back during trot and walk.
Journal of the Royal Society, Interface    June 19, 2024   Volume 21, Issue 215 20230644 doi: 10.1098/rsif.2023.0644
Smirnova KP, Frill MA, Warner SE, Cheney JA.Equine back pain is prevalent among ridden horses and is often attributed to poor saddle fit. An alternative explanation is that saddle fits are technically good but fit to the wrong configuration. Saddles are fit for the standing horse, but much of the time ridden is instead spent locomoting when the back experiences the greatest peak forces. We used an array of cameras to reconstruct the surface of the back and its movement during trot, walk and standing for five horses. We verified the setup's accuracy by reconstructing a laser-scanned life-sized model horse. Our reconstructions demonstrate...
Ex vivo diffusion tensor imaging of the plantar nerves is feasible in the horse.
American journal of veterinary research    June 18, 2024   1-8 doi: 10.2460/ajvr.24.03.0092
Scharf A, Cheng TY, Urion R, Hostnik E.The objective of this study was to optimize an MRI-based diffusion tensor imaging (DTI) protocol for imaging the plantar nerves at the level of the tarsus in normal equine limbs. Methods: 12 pelvic cadaver limbs from horses without evidence of proximal suspensory pathology were imaged with a 3T MRI system. Methods: For diffusion-weighted imaging, b values of 600, 800, and 1,000 s/mm2 were tested. Data were processed with DSI Studio. Cross-sectional areas of the medial and lateral plantar nerve along the plantar tarsus were recorded. The length and number of fiber tracts, signal-to-noise ratio,...
Changes in muscle activation with graded surfaces during canter in Thoroughbred horses on a treadmill.
PloS one    June 14, 2024   Volume 19, Issue 6 e0305622 doi: 10.1371/journal.pone.0305622
Takahashi Y, Takahashi T, Mukai K, Ebisuda Y, Ohmura H.Understanding how muscle activity changes with different surface grades during canter is essential for developing training protocols in Thoroughbreds because canter is their primary gait in training and races. We measured the spatiotemporal parameters and the activation of 12 surface muscles in the leading limb side of 7 Thoroughbreds. Horses were equipped with hoof strain gauges and cantered at 10 m/s on a treadmill set to grades of -4%, 0%, 4%, and 8%, randomly, for 30 seconds each without a lead change. Integrated electromyography (iEMG) values during stance and swing phases were calculated...
Prognostic value of power doppler ultrasonography for equine superficial digital flexor tendon injury in thoroughbred racehorses.
Veterinary journal (London, England : 1997)    June 14, 2024   Volume 306 106179 doi: 10.1016/j.tvjl.2024.106179
Tamura N, Yoshihara E, Seki K, Mae N, Kodaira K, Iimori M, Yamazaki Y, Mita H, Urayama S, Kuroda T, Ohta M, Kasashima Y.The potential value of hypervascularity detected with power Doppler ultrasonography (PDU) within equine superficial digital flexor tendon (SDFT) as a prognostic factor of SDFT injury is not clear. The purpose of this study was to test the hypothesis that hypervascularity within SDFT is one of the risk factors for subsequent severe SDFT injury and to evaluate the prognostic value. A prospective cohort study of 97 Thoroughbred racehorses without any clinical signs of SDFT injury was conducted. Six variables of age, body weight, sex, the cross-sectional area of SDFT, PDU signal within SDFT and ex...
Transrectal ultrasonographic assessment of the fetal proximal phalanx: A new tool to assess fetal age and bone development in horses.
Theriogenology    June 13, 2024   Volume 226 167-172 doi: 10.1016/j.theriogenology.2024.06.010
Renaudin C, Wensley F, Morgan J, Cassano J, Spriet M.Fetal age in Quarter Horses can be predicted within 2 weeks from 100- to 200- days of gestation using femur length, biparietal diameter (cranium diameter) and eye approximated volume. However, as pregnancy advances, the femur and cranium become too large to be imaged in their entirety using ultrasound and the corresponding biometric parameters can no longer be measured. In this longitudinal study, the proximal phalanx (P1) was evaluated as a novel biometric parameter for late gestation to predict fetal age and bone maturation. Transrectal ultrasound was performed in ten pregnant mares with kno...
A Paleopathological Find on a La Tène Horse Skeleton Discovered in Rescue Archaeological Diggings in the Area of the Olympic Pool, Alba Iulia (CX 143 Pit).
Animals : an open access journal from MDPI    June 13, 2024   Volume 14, Issue 12 1775 doi: 10.3390/ani14121775
Gudea A, Stan FG, Irimie A, Mârza S, Martonos CO, Gal A.The reconstruction of past life based on archaeozoology is a challenging domain that offers a range of valuable details concerning former human and animal populations. Additionally, the ancient era is a source of information for human and veterinary medicine, as well as for other biological sciences. This report highlights a pathological lesion identified during the investigation of a horse skeleton from a pit dated La Tène in Alba County (Romania). The left scapula with lesions was collected from the skeleton of a buried 7-8-year-old male horse. The aforementioned bone underwent gross, radio...
Degradation of Proteoglycans and Collagen in Equine Meniscal Tissues.
International journal of molecular sciences    June 11, 2024   Volume 25, Issue 12 6439 doi: 10.3390/ijms25126439
Dubuc J, Schneider MJ, Dubuc V, Richard H, Pinsard M, Bancelin S, Legare F, Girard C, Laverty S.Investigate meniscal extracellular matrix degradation. Equine menisci ( = 34 from 17 horses) were studied. Site-matched sections were cut and scored from three regions (ROIs; = 102) and stained for histology, proteoglycan (safranin O and fast green), aggrecan, and collagen cleavage (NITEGE, DIPEN, and C1,2C antibodies, respectively). Picrosirius red and second harmonic generation microscopy were performed to investigate collagen ultrastructure. A total of 42 ROIs met the inclusion criteria and were included in the final analysis. The median (range) ROI histological score was 3 (0-9), providin...
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