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Topic:Tendons

Tendons in horses are fibrous connective tissues that attach muscles to bones, facilitating movement and providing stability to the musculoskeletal system. They are composed primarily of collagen fibers, which confer strength and flexibility, allowing horses to perform various physical activities. Equine tendons are subject to significant mechanical stress during locomotion, making them susceptible to injury, particularly in performance horses. Common tendon injuries include strains, tears, and tendinitis, which can impact a horse's mobility and performance. This page compiles peer-reviewed research studies and scholarly articles that explore the structure, function, and pathology of tendons in horses, as well as advancements in diagnostic and therapeutic approaches for tendon injuries.
Clinical Research Abstracts of the British Equine Veterinary Association Congress 2015.
Equine veterinary journal    September 17, 2015   Volume 47 Suppl 48 12 doi: 10.1111/evj.12486_26
Tucker R, Jacklin BD, Gillespie S, Vaughan L, Fiske-Jackson AR, Smith RK.Injury to the superficial digital flexor tendon (SDFT) is common in equids, with a high risk of re-injury associated with changes in tendon stiffness. In vivo measurement of limb stiffness has been shown to correlate with tendon stiffness after injury [1] but requires kinematic analysis which is impractical in a clinical setting. We have developed a simple system for measuring limb stiffness statically, which could be used as a tool for monitoring SDFT healing. Objective: To validate a goniometric measurement of limb stiffness. Methods: Cross sectional study. Methods: Initially, forelimb stiff...
Elastographic Evaluation of Naturally Occurring Tendon and Ligament Injuries of the Equine Distal Limb. Lustgarten M, Redding WR, Labens R, Davis W, Daniel TM, Griffith E, Seiler GS.Compression elastography is an ultrasonographic technique that estimates tissue strain and may have utility in diagnosing and monitoring soft tissue injuries in the equine athlete. Recently, elastography has been proven to be a feasible and repeatable imaging modality for evaluating normal tendons and ligaments of the equine distal forelimb. The purposes of this prospective study were to investigate the ability of elastography to detect spontaneously occurring lesions of equine tendons and ligaments diagnosed with magnetic resonance imaging (MRI) and gray-scale ultrasound (US) and to character...
Post operative synovial sepsis following endoscopic surgery: Increased risk associated with the carpal sheath.
Equine veterinary journal    August 14, 2015   Volume 48, Issue 4 430-433 doi: 10.1111/evj.12472
Hawthorn A, Reardon R, O'Meara B, James F, Bladon B.The overall rate of sepsis following endoscopic surgery of synovial structures has not previously been documented. Clinical observation has led to the conjecture that tendon sheaths, in particular the carpal flexor tendon sheath, are more prone to post operative synovial sepsis than other synovial structures. Objective: To document and investigate the rate of post operative synovial sepsis following elective endoscopic surgery. Methods: Retrospective case series. Methods: The medical records of horses that underwent arthroscopy, tenoscopy or bursoscopy at Donnington Grove Veterinary Surgery be...
The equine forelimb suspensory ligament exhibits a heterogeneous strain pattern under tensile load.
Veterinary and comparative orthopaedics and traumatology : V.C.O.T    July 29, 2015   Volume 28, Issue 5 306-311 doi: 10.3415/VCOT-15-01-0018
Lavagnino M, Madison J, Williams MR, Arnoczky SP.To determine if regional variations in strain patterns occur within the suspensory ligament under tensile load. Local increases in strain may put certain regions of the suspensory ligament at risk and may explain the poor healing and high recurrence rates associated with suspensory branch injuries. Methods: The suspensory ligament and its bone attachments were isolated from each of 10 adult equine cadaveric forelimbs and radiodense reference beads were inserted throughout the length of the ligament. Specimens were attached to a custom fixture secured to a materials testing system. Radiographs ...
Ex-Vivo Evaluation of a Modified Teno Fix(®) Device Repair Pattern Versus a 3-Loop Pulley for Repair of Equine Flexor Tendons.
Veterinary surgery : VS    June 29, 2015   Volume 44, Issue 7 803-808 doi: 10.1111/vsu.12350
McMaster MA, Munsterman AS, Weimar WH, Barrett EJ, Hanson RR.To compare the load to ultimate failure, load to a 2 mm gap, mode of failure, and gap at failure (mm) of the Teno Fix(®) (TF) to the 3-loop pulley (3LP) for repair of equine tendon lacerations. The use of 4TF devices versus 5TF devices on load to ultimate failure and load to a 2 mm gap was also compared. Methods: Ex vivo biomechanical study; unbalanced incomplete block (horse) design. Methods: Cadaveric equine forelimb superficial digital flexor tendon (n = 20 paired tendons). Methods: Ten tendon pairs were selected randomly and repaired with a 3LP and 4TF pattern, and 10 tendon pairs...
Effect of a single injection of autologous conditioned serum (ACS) on tendon healing in equine naturally occurring tendinopathies.
Stem cell research & therapy    June 26, 2015   Volume 6, Issue 1 126 doi: 10.1186/s13287-015-0115-0
Geburek F, Lietzau M, Beineke A, Rohn K, Stadler PM.Autologous blood-derived biologicals, including autologous conditioned serum (ACS), are frequently used to treat tendinopathies in horses despite limited evidence for their efficacy. The purpose of this study was to describe the effect of a single intralesional injection of ACS in naturally occurring tendinopathies of the equine superficial digital flexor tendon (SDFT) on clinical, ultrasonographic, and histological parameters. Methods: Fifteen horses with 17 naturally occurring tendinopathies of forelimb SDFTs were examined clinically and ultrasonographically (day 0). Injured tendons were ran...
Computed Tomographic Tenography of Normal Equine Digital Flexor Tendon Sheath: An Ex Vivo Study.
Veterinary medicine international    June 22, 2015   Volume 2015 903169 doi: 10.1155/2015/903169
Aim of this study was to document the normal computed tomographic tenography findings of digital flexor tendon sheath. Six ex vivo normal equine forelimbs were used. An axial approach was used to inject 185 mg/mL of iopamidol in a total volume of 60 mL into the digital flexor tendon sheaths. Single-slice helical scans, with 5 mm thickness, spaced every 3 mm, for a pitch of 0.6, and with bone algorithm reconstruction, were performed before and after injections of contrast medium. To obtain better image quality for multiplanar reconstruction and 3D reformatting, postprocessing retrorecon...
Ageing does not result in a decline in cell synthetic activity in an injury prone tendon.
Scandinavian journal of medicine & science in sports    June 9, 2015   Volume 26, Issue 6 684-693 doi: 10.1111/sms.12500
Thorpe CT, McDermott BT, Goodship AE, Clegg PD, Birch HL.Advancing age is a well-known risk factor for tendon disease. Energy-storing tendons [e.g., human Achilles, equine superficial digital flexor tendon (SDFT)] are particularly vulnerable and it is thought that injury occurs following an accumulation of micro-damage in the extracellular matrix (ECM). Several authors suggest that age-related micro-damage accumulates due to a failure of the aging cell population to maintain the ECM or an imbalance between anabolic and catabolic pathways. We hypothesized that ageing results in a decreased ability of tendon cells to synthesize matrix components and m...
Sympathetic innervation of the suprasesamoidean region of the deep digital flexor tendon in the forelimbs of horses.
Veterinary journal (London, England : 1997)    June 8, 2015   Volume 205, Issue 3 413-416 doi: 10.1016/j.tvjl.2015.06.004
Beccati F, Pepe M, Pascucci L, Ceccarelli P, Chiaradia E, Mancini F, Mandara MT.The purpose of this study was to delineate the pattern of sympathetic innervation in the suprasesamoidean region of the deep digital flexor tendon (DDFT) in horses using immunohistochemical staining (IHC) for tyrosine hydroxylase (TH) and alpha-1 adrenergic receptor (α1-AR). Fourteen forelimbs were collected from 10 horses. Longitudinal sections of the suprasesamoidean region of healthy DDFTs were harvested. Most of the sympathetic innervation was found to be in the walls of blood vessels. The tendon tissue proper was sparsely innervated, with a lesser degree of innervation within the dorsal ...
Evaluation of mean echogenicity of tendons and ligaments of the metacarpal region in neonatal foals: A preliminary study.
Research in veterinary science    May 29, 2015   Volume 101 11-14 doi: 10.1016/j.rvsc.2015.05.011
Spinella G, Loprete G, Castagnetti C, Musella V, Antonelli C, Vilar JM, Britti D, Capitani O, Valentini S.The aims of this research were to evaluate mean echogenicity (ME) of the deep and superficial digital flexor tendons (DDFT and SDFT), the interosseous muscle (IM), and the accessory ligament of the deep digital flexor tendon (ALDDFT) of the metacarpal region in neonatal foals, and determine the effect of sex, side and body weight on this quantitative ultrasonographic evaluation. Thirteen orthopedically sound neonatal foals were examined. Four areas of study (1A, 1B, 2A, 2B) were identified. Transverse scans of the DDFT, SDFT, IM and ALDDFT were obtained, recorded, and analyzed. The most echoge...
Microangiographic Comparison of the Effects of 3 Loop Pulley and 6 Strand Savage Tenorrhaphy Techniques on Equine Superficial Digital Flexor Tendon.
Veterinary surgery : VS    May 5, 2015   Volume 44, Issue 6 744-750 doi: 10.1111/vsu.12334
Freeman KD, Barrett JG, Youngstrom DW, White NA.The 6-strand Savage (SSS) tenorrhaphy pattern is biomechanically superior to the commonly employed 3-loop pulley (3LP); however, its effects on intrinsic tendon vasculature remain unknown. The objective of this study was to compare perfusion of intrinsic vasculature of the equine superficial digital flexor tendon (SDFT) after 3LP and SSS tenorrhaphies. We hypothesized that the SSS technique would significantly decrease vascular perfusion compared to the 3LP technique. Methods: Ex vivo, randomized, paired design. Methods: Horses (n = 9) METHODS: Under general anesthesia, 9 pairs of forelimb...
Platelet-rich plasma in orthopedic therapy: a comparative systematic review of clinical and experimental data in equine and human musculoskeletal lesions.
BMC veterinary research    April 22, 2015   Volume 11 98 doi: 10.1186/s12917-015-0403-z
Brossi PM, Moreira JJ, Machado TS, Baccarin RY.This systematic review aimed to present and critically appraise the available information on the efficacy of platelet rich plasma (PRP) in equine and human orthopedic therapeutics and to verify the influence of study design and methodology on the assumption of PRP's efficacy. We searched Medline, PubMed, Embase, Bireme and Google Scholar without restrictions until July 2013. Randomized trials, human cohort clinical studies or case series with a control group on the use of PRP in tendons, ligaments or articular lesions were included. Equine clinical studies on the same topics were included inde...
Restricted differentiation potential of progenitor cell populations obtained from the equine superficial digital flexor tendon (SDFT).
Journal of orthopaedic research : official publication of the Orthopaedic Research Society    April 17, 2015   Volume 33, Issue 6 849-858 doi: 10.1002/jor.22891
Williamson KA, Lee KJ, Humphreys WJ, Comerford EJ, Clegg PD, Canty-Laird EG.The aim of this study was to characterize stem and progenitor cell populations from the equine superficial digital flexor tendon, an energy-storing tendon with similarities to the human Achilles tendon, which is frequently injured. Using published methods for the isolation of tendon-derived stem/progenitor cells by low-density plating we found that isolated cells possessed clonogenicity but were unable to fully differentiate towards mesenchymal lineages using trilineage differentiation assays. In particular, adipogenic differentiation appeared to be restricted, as assessed by Oil Red O stainin...
The interfascicular matrix enables fascicle sliding and recovery in tendon, and behaves more elastically in energy storing tendons.
Journal of the mechanical behavior of biomedical materials    April 16, 2015   Volume 52 85-94 doi: 10.1016/j.jmbbm.2015.04.009
Thorpe CT, Godinho MSC, Riley GP, Birch HL, Clegg PD, Screen HRC.While the predominant function of all tendons is to transfer force from muscle to bone and position the limbs, some tendons additionally function as energy stores, reducing the cost of locomotion. Energy storing tendons experience extremely high strains and need to be able to recoil efficiently for maximum energy storage and return. In the equine forelimb, the energy storing superficial digital flexor tendon (SDFT) has much higher failure strains than the positional common digital extensor tendon (CDET). However, we have previously shown that this is not due to differences in the properties of...
Non-fatal injury occurrence in Southern California Thoroughbred racehorses 2009-2010.
Veterinary journal (London, England : 1997)    April 9, 2015   Volume 205, Issue 1 98-100 doi: 10.1016/j.tvjl.2015.04.001
Hill AE, Blea JA, Arthur RM, McIlwraith CW.Private-practice racetrack veterinarians in southern California recorded non-fatal injuries meeting defined criteria in Thoroughbreds for 1 year. Injury incidence was 2.29 injury events per 100 horse-months, which was lower than other studies where trainer reported injury data were collected. Of 477 injuries recorded, 344 (72.1%) were acute and 133 (27.9%) were chronic. Fractures were common (47.6% of injuries), with stress fractures accounting for 14% of injuries. Superficial digital flexor tendonitis and suspensory ligament desmitis accounted for 15.3 and 11.5% of injuries, respectively. Agr...
Comparative Characterization of Human and Equine Mesenchymal Stromal Cells: A Basis for Translational Studies in the Equine Model.
Cell transplantation    April 7, 2015   Volume 25, Issue 1 109-124 doi: 10.3727/096368915X687822
Hillmann A, Ahrberg AB, Brehm W, Heller S, Josten C, Paebst F, Burk J.Multipotent mesenchymal stromal cells (MSCs) have gained tremendous attention as potential therapeutic agents for the treatment of orthopedic diseases. Promising results have been obtained after application of MSCs for treatment of tendon and joint disease in the equine model, making it appear favorable to use these results as a basis for the translational process of the therapy. However, while the horse is considered a highly suitable model for orthopedic diseases, knowledge is lacking regarding the level of analogy of equine MSCs and their human counterparts. Therefore, the aim of this study...
Focal experimental injury leads to widespread gene expression and histologic changes in equine flexor tendons.
PloS one    April 2, 2015   Volume 10, Issue 4 e0122220 doi: 10.1371/journal.pone.0122220
Jacobson E, Dart AJ, Mondori T, Horadogoda N, Jeffcott LB, Little CB, Smith MM.It is not known how extensively a localised flexor tendon injury affects the entire tendon. This study examined the extent of and relationship between histopathologic and gene expression changes in equine superficial digital flexor tendon after a surgical injury. One forelimb tendon was hemi-transected in six horses, and in three other horses, one tendon underwent a sham operation. After euthanasia at six weeks, transected and control (sham and non-operated contralateral) tendons were regionally sampled (medial and lateral halves each divided into six 3 cm regions) for histologic (scoring and ...
Pilot experimental study on amniotic epithelial mesenchymal cell transplantation in natural occurring tendinopathy in horses. Ultrasonographic and histological comparison.
Muscles, ligaments and tendons journal    March 27, 2015   Volume 5, Issue 1 5-11 
amnion-derived stem cells are considered a promising alternative source for tendon tissue regeneration. Objective: aims of this paper were to illustrate the ultrasound and histological outcomes following the treatment of acute and chronic superficial digital flexor tendon spontaneous lesions in horses with ovine amniotic epithelial cells xenotransplantation. Methods: six adult horses suffering from unilateral acute (4 cases) and chronic (2 cases) tendinopathy (clinical and ultrasound diagnosis) were enrolled. At baseline, ovine amniotic epithelial cells were grafted, in sterile conditions and ...
Ultrasonographic assessment of the equine palmar tendons.
Veterinary world    February 21, 2015   Volume 8, Issue 2 208-212 doi: 10.14202/vetworld.2015.208-212
Padaliya NR, Ranpariya JJ, Kumar D, Javia CB, Barvalia DR.The present study was conducted to evaluate the equine palmar tendon by ultrasonography (USG) in standing the position. Methods: USG of palmar tendons was performed in 40 adult horses using linear transducer having frequency of 10-18 MHz (e-soate, My Lab FIVE) and L52 linear array transducer (Titan, SonoSite) with frequencies ranging from 8 to 10 MHz. Palmar tendon was divided into 7 levels from distal to accessory carpal bone up to ergot in transverse scanning and 3 levels in longitudinal scanning. Results: The USG evaluation was very useful for diagnosis of affections of the conditions such ...
Crosslinkable hydrogels derived from cartilage, meniscus, and tendon tissue.
Tissue engineering. Part A    February 9, 2015   Volume 21, Issue 7-8 1195-1206 doi: 10.1089/ten.TEA.2014.0362
Visser J, Levett PA, te Moller NC, Besems J, Boere KW, van Rijen MH, de Grauw JC, Dhert WJ, van Weeren PR, Malda J.Decellularized tissues have proven to be versatile matrices for the engineering of tissues and organs. These matrices usually consist of collagens, matrix-specific proteins, and a set of largely undefined growth factors and signaling molecules. Although several decellularized tissues have found their way to clinical applications, their use in the engineering of cartilage tissue has only been explored to a limited extent. We set out to generate hydrogels from several tissue-derived matrices, as hydrogels are the current preferred cell carriers for cartilage repair. Equine cartilage, meniscus, a...
Science in brief: recent advances into understanding tendon function and injury risk.
Equine veterinary journal    February 4, 2015   Volume 47, Issue 2 137-140 doi: 10.1111/evj.12346
Thorpe CT, Spiesz EM, Chaudhry S, Screen HR, Clegg PD.No abstract available
The cross-sectional area changes in digital flexor tendons and suspensory ligament in foals by ultrasonographic examination.
Equine veterinary journal    February 2, 2015   Volume 47, Issue 5 548-552 doi: 10.1111/evj.12330
Korosue K, Endo Y, Murase H, Ishimaru M, Nambo Y, Sato F.Flexural deformities are common conditions of growing horses and are suggested to have a relationship with the contraction of musculotendinous units. However, limited studies have documented the changes in each tendon and ligament in the metacarpal region with age. Objective: To investigate the changes in the cross-sectional area (CSA) of each tendon and ligament in the metacarpal region with age by ultrasonographic examination. Methods: Longitudinal study of foals from Day 1 to age 24 months. Methods: The CSA of the superficial digital flexor tendon, deep digital flexor tendon, accessory liga...
Tendon overload results in alterations in cell shape and increased markers of inflammation and matrix degradation.
Scandinavian journal of medicine & science in sports    December 30, 2014   Volume 25, Issue 4 e381-e391 doi: 10.1111/sms.12333
Thorpe CT, Chaudhry S, Lei II, Varone A, Riley GP, Birch HL, Clegg PD, Screen HR.Tendon injury is thought to involve both damage accumulation within the matrix and an accompanying cell response. While several studies have characterized cell and matrix response in chronically injured tendons, few have assessed the initial response of tendon to overload-induced damage. In this study, we assessed cell response to cyclic loading. Fascicle bundles from the equine superficial digital flexor tendon were exposed to cyclic loading in vitro, designed to mimic a bout of high-intensity exercise. Changes in cell morphology and protein-level alterations in markers of matrix inflammation...
Progress in cell-based therapies for tendon repair.
Advanced drug delivery reviews    December 24, 2014   Volume 84 240-256 doi: 10.1016/j.addr.2014.11.023
Gaspar D, Spanoudes K, Holladay C, Pandit A, Zeugolis D.The last decade has seen significant developments in cell therapies, based on permanently differentiated, reprogrammed or engineered stem cells, for tendon injuries and degenerative conditions. In vitro studies assess the influence of biophysical, biochemical and biological signals on tenogenic phenotype maintenance and/or differentiation towards tenogenic lineage. However, the ideal culture environment has yet to be identified due to the lack of standardised experimental setup and readout system. Bone marrow mesenchymal stem cells and tenocytes/dermal fibroblasts appear to be the cell populat...
The past, present and future in scaffold-based tendon treatments.
Advanced drug delivery reviews    December 10, 2014   Volume 84 257-277 doi: 10.1016/j.addr.2014.11.022
Lomas AJ, Ryan CN, Sorushanova A, Shologu N, Sideri AI, Tsioli V, Fthenakis GC, Tzora A, Skoufos I, Quinlan LR, O'Laighin G, Mullen AM, Kelly JL....Tendon injuries represent a significant clinical burden on healthcare systems worldwide. As the human population ages and the life expectancy increases, tendon injuries will become more prevalent, especially among young individuals with long life ahead of them. Advancements in engineering, chemistry and biology have made available an array of three-dimensional scaffold-based intervention strategies, natural or synthetic in origin. Further, functionalisation strategies, based on biophysical, biochemical and biological cues, offer control over cellular functions; localisation and sustained relea...
Phenotypical and functional characteristics of mesenchymal stem cells derived from equine umbilical cord blood.
Cytotechnology    December 9, 2014   Volume 68, Issue 4 795-807 doi: 10.1007/s10616-014-9831-z
Mohanty N, Gulati BR, Kumar R, Gera S, Kumar S, Kumar P, Yadav PS.Mesenchymal stem cells (MSCs) offer promise as therapeutic aid in the repair of tendon and ligament injuries in race horses. Fetal adnexa is considered as an ideal source of MSCs due to many advantages, including non-invasive nature of isolation procedures and availability of large tissue mass for harvesting the cells. However, MSCs isolated from equine fetal adnexa have not been fully characterized due to lack of species-specific markers. Therefore, this study was carried out to isolate MSCs from equine umbilical cord blood (UCB) and characterize them using cross-reactive markers. The plastic...
Effect of autologous adipose tissue-derived mesenchymal stem cells on neovascularization of artificial equine tendon lesions.
Regenerative medicine    November 29, 2014   Volume 9, Issue 6 743-757 doi: 10.2217/rme.14.55
Conze P, van Schie HT, van Weeren R, Staszyk C, Conrad S, Skutella T, Hopster K, Rohn K, Stadler P, Geburek F.To investigate whether autologous adipose tissue-derived mesenchymal stem cells (AT-MSCs) treatment of tendon lesions increases neovascularization during tendon healing. Methods: A standardized surgical model was used to create lesions in both front limb superficial digital flexor tendons (SDFTs) of nine horses. Either AT-MSCs or control substance was injected intralesionally 2 weeks post-surgery. Color Doppler ultrasonography of SDFTs was performed at regular intervals. Horses were euthanized 22 weeks post-treatment and SDFTs were harvested for histology. Results: The color Doppler ultrasonog...
Static magnetic field enhances synthesis and secretion of membrane-derived microvesicles (MVs) rich in VEGF and BMP-2 in equine adipose-derived stromal cells (EqASCs)-a new approach in veterinary regenerative medicine.
In vitro cellular & developmental biology. Animal    November 27, 2014   Volume 51, Issue 3 230-240 doi: 10.1007/s11626-014-9828-0
Marędziak M, Marycz K, Lewandowski D, Siudzińska A, Śmieszek A.The aim of this work study was to evaluate the cytophysiological activity of equine adipose-derived stem cells (ASCs) cultured under conditions of static magnetic field. Investigated cells were exposed to a static magnetic field (MF) with the intensity of 0.5 T. In order to investigate the effects of magnetic field on stem cell signaling, the localization and density and content of microvesicles (MVs) as well as morphology, ultrastructure, and proliferation rate of equine ASCs were evaluated. Results showed that potential of equine adipose-derived mesenchymal stem cells was accelerated when ma...
Identification of surgically-induced longitudinal lesions of the equine deep digital flexor tendon in the digital flexor tendon sheath using contrast-enhanced ultrasonography: an ex-vivo pilot study.
Acta veterinaria Scandinavica    November 25, 2014   Volume 56, Issue 1 78 doi: 10.1186/s13028-014-0078-7
Bertuglia A, Mollo G, Bullone M, Riccio B.Longitudinal tears in the lateral aspect of the deep digital flexor tendon are the most common causes of pain localised to the equine digital flexor tendon sheath. However conventional ultrasonographic techniques provide limited information about acute lesions. Ultrasonographic contrast agents are newly developed materials that have contributed to advancement in human diagnostic imaging. They are currently approved for intravenous use in human and animal models. In this study we described intrathecal use in the horse. This study was undertaken to evaluate the reliability of standard and angle ...
Regenerative medicine for the treatment of Teno-desmic injuries of the equine. A series of 150 horses treated with platelet-derived growth factors.
In vivo (Athens, Greece)    November 16, 2014   Volume 28, Issue 6 1119-1123 
Scala M, Lenarduzzi S, Spagnolo F, Trapasso M, Ottonello C, Muraglia A, Barla A, Squillario M, Strada P.The aim of the present study was to evaluate the safety and the clinical outcome of platelet-rich plasma for the treatment of teno-desmic injures in competition horses. Methods: From January 2009 to December 2011, 150 sport horses suffering from teno-desmic injuries were treated with no-gelled platelet-concentrate. Results: No horse showed any major adverse reaction as a result of the procedure. Full healing was obtained for 81% of the horses. Twelve percent had clinical improvement and only 7% a failure. Eight percent of cases of relapse were observed. No statistically significant correlation...
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