bluuebunny/crossref_metadata_2025 huggingface dataset:
IGF2 expression and β-catenin levels are increased in Frozen Shoulder Syndrome
Authors: Raykha Christina N , Crawford Justin D , Burry Andrea F , Drosdowech Darren S , Faber Kenneth J , Gan Bing Siang , O’Gorman David B
Published: May 2017

Purpose: Frozen Shoulder Syndrome is a fibrosis of the shoulder joint capsule that is clinically associated with Dupuytren’s disease, a fibrosis of the palmar fascia. Little is known about any commonalities in the pathophysiology of these connective tissue fibroses. β-catenin, a protein that transactivates gene expression, and levels of IGF2 mRNA, encoding insulin-like growth factor-II, are elevated in Dupuytren’s disease. The aim of this study was to determine if correlating changes in β-catenin levels and IGF2 expression are evident in Frozen Shoulder Syndrome.

Methods: Tissue from patients with Frozen Shoulder Syndrome and rotator cuff tear were obtained during shoulder arthroscopies. Total protein extracts were prepared from tissue aliquots and β-catenin immunoreactivity was assessed by Western immunoblotting. In parallel, primary fibroblasts were derived from these tissues and assessed for IGF2 expression by quantitative PCR.

Results: β-catenin levels were significantly increased in Frozen Shoulder Syndrome relative to rotator cuff tear when assessed by Western immunoblotting analyses. IGF2 mRNA levels were significantly increased in primary fibroblasts derived from frozen shoulder syndrome tissues relative to fibroblasts derived from rotator cuff tissues.

Conclusions: As in Dupuytren’s disease, β-catenin levels and IGF2 expression are elevated in Frozen Shoulder Syndrome. These findings support the hypothesis that these connective tissue fibroses share a common pathophysiology.
’INSPIRED’ COPD Outreach ProgramTM: Doing the Right Things Right
Authors: Rocker Graeme M , Verma Jennifer Y
Published: May 2017

The well-documented gaps between needed and provided care for patients and families living with chronic obstructive pulmonary disease (COPD) mandate changes to clinical practice. The multifaceted evidence-based INSPIRED COPD Outreach ProgramTM was first implemented in Halifax, Nova Scotia, Canada in 2010 (INSPIRED = Implementing a Novel and Supportive Program of Individualized care for patients and families living with REspiratory Disease) and undergoes ongoing evaluation. By enhancing patient confidence to manage their illness more effectively in their homes and communities, there has been a sustained and substantial reduction in facility-based care in comparison with patient care experience pre-INSPIRED. Sustaining and spreading a program recently designated a leading practice by Accreditation Canada, and especially modifying the program as new evidence emerges, requires integrating and modeling at the ‘bedside’ both evidence-based medicine (‘doing the right things’) and quality improvement (‘doing them right’). In Canada, where COPD care gaps are common, a new pan-Canadian INSPIRED-based quality improvement program is supporting multidisciplinary healthcare teams to bridge the chasm between evidence and practice by working together to ‘do the right things right’ in COPD care.
Evaluation of E-cadherin, β-catenin and vimentin protein expression using quantitative immunohistochemistry in nasopharyngeal carcinoma patients
Authors: Hao Desirée , Phan Tien , Jagdis Amanda , Siever Jodi E , Klimowicz Alexander C , Laskin Janessa J , Thomson Thomas A , Rose M Sarah , Petrillo Stephanie K , Magliocco Anthony M , Lau Harold Y
Published: May 2017

Purpose: Aberrant expression of proteins involved in epithelial-to-mesenchymal transition have been described in various cancers. In this retrospective study, we sought to evaluate E-cadherin, β-catenin and vimentin protein expression in non-metastatic nasopharyngeal (NPC) patients treated with curative intent, examine their relationship with each other, and with clinical outcome measures.

Methods: Pre-treatment formalin-fixed paraffin-embedded biopsies of 140 patients treated between January 2000 and December 2007 were assembled into a tissue microarray (TMA). Automated quantitative immunohistochemistry (AQUA®) was performed on sequential TMA sections stained with fluorescent-labeled antibodies against E-cadherin, β-catenin and vimentin. Cox proportional hazards regression was used to estimate the effect of cytoplasmic vimentin, cytoplasmic E-cadherin, β-catenin nuclear/cytoplasmic ratio expression on overall survival and disease-free survival.

Results: The average age of the patients was 51.7 years (SD=12.1; range 18-85), 66% were male, 71% had a KPS ≥ 90% at the start of treatment and 65% had stage III/IV disease. After adjusting for performance status, WHO and stage, high E-cadherin levels over the 75th percentile were found to produce a significantly increased risk for both a worse overall survival (HR = 2.53, 95% CI 1.21, 5.27) and disease free survival (DFS; HR = 2.14, 95%CI 1.28, 3.59). Vimentin levels over the first quartile produced an increased risk for a worse DFS (HR = 2.21, 95% CI 1.11, 4.38). No association was seen between β-catenin and survival.

Conclusion: In this cohort of NPC patients, higher levels of E-cadherin and higher levels of vimentin were associated with worse outcomes. Further work is needed to understand the role of these epithelial mesenchymal transition proteins in NPC.
Characterization of the withdrawal phase in a swine controlled intestinal donation after circulatory death model
Authors: Guo Mingxiao , Li Linlin , Lu Chunlei
Published: May 2017

Purpose: Transplantation of donation after cardiac death (DCD) intestine has higher rates of organ failure and complications. Fortunately, this is less grievous in a subclass of DCD called controlled (CDCD), those with irreversible but incomplete brain injury. The aim of the paper is to establish a CDCD porcine model which is closely mimicking human CDCD scenario, and investigate the physiologic changes from withdrawal of ventilatory support to circulatory arrest.

Method: Ten domestic crossbred pigs were anesthetized and ventilated with room air. Once all baseline data was taken, atracurium besilate (0.9 mg/kg, 3×ED95) was administered and the ventilator was discontinued while the animal was under deep anesthesia to establish the porcine CDCD model. Meanwhile, heparin (150~200 U/kg) was administered after discontinuation of the ventilator. The time to death and the changes of arterial blood gases and hemodynamic parameters were monitored every 5 minutes until circulatory arrest. In addition, histopathology, ultrastructures (via electron microscope) and expression of tight junction proteins of intestinal mucosa were observed at the baseline and the time of death.

Result: The mean time to death was approximately (21.8±3.12 min. Within 5 minutes of removal of the ventilator, there was a hyperdynamic period. Systolic blood pressure and heart rate quickly increased to 118.5±10.4 mmHg and 108.2±4.94 bpm, respectively. Blood pressure and heart rate then reduced rapidly until circulatory arrest. Moreover, the PaO2 quickly dropped to 17.4±3.13 mmHg, the blood gases throughout the apneic time showed a rapid hypercapnia and acidosis. In addition, warm ischemia damaged intestinal mucosa and reduced TJ proteins expression.

Conclusion: A new swine CDCD model, simulating three stages of “withdrawal of ventilation, systemic anticoagulation and determination of death”, which closely mimics the human DCD scenario and can thus be used in studies related to organ transplantation, was successfully established.
Up-regulation of ITCH is associated with down-regulation of LATS1 during tumorigenesis and progression of cervical squamous cell carcinoma
Authors: Zhou Ying , Tao Feng , Cheng Yong , Xu Fei , Yao Fengqiu , Feng Dingqing , Miao Lin , Xiao Weihua , Ling Bin
Published: May 2017

Purpose: The molecular basis for the normal cervical squamous epithelium advance to cervical intraepithelial neoplasia (CIN I, CIN II, CIN III) and ultimately to invasive carcinoma has not yet been defined. We explored the abnormal expression of ITCH (AIP4) and its degrading substrate Large Tumor Suppressor 1 (LATS1) in CINs and cervical cancers, which might disrupt the normal differentiation of the cervical epithelia and contribute to the tumorigenesis of the cervix.

Methods: A series of 110 samples, comprising 24 cases of normal cervical tissues, 20 cases of CIN I, 26 cases of CIN II/ III and 40 cases of squamous cancer of the cervix (SCC) were used for analysis. The expression of ITCH and LATS1 was assessed in the tissues by immunohistochemistry, and statistically analyzed by SPSS13.0.

Results: The increased nuclear and cytoplasmic expression levels of ITCH and the low membrane expression of LATS1 were strongly associated with the malignant transformation of the cervical epithelium and the histological progression of SCC. Moreover, the high nuclear and cytoplasmic expression levels of ITCH were significantly correlated with clinical stage (P=0.036, P=0.003, respectively) and tumor size (P=0.046,P=0.039, respectively); the low membrane expression of LATS1 was significantly correlated with clinical stage (P=0.036)and tumor size (P=0.023). Both the nuclear and cytoplasmic expression levels of ITCH were inversely associated with the membrane expression of LATS1 in cervical tissues (P
CSCI/RCPSC HENRY FRIESEN LECTURE: Controlling Infectious Diseases through Vaccination
Authors: Babiuk Lorne A
Published: May 2017

Infectious diseases continue to cause significant morbidity and mortality in both animals and humans. Indeed, every year infectious diseases cost the global economy billions of dollars in losses and are responsible for approximately one-third of all human deaths. These deaths occur from routine infections, hospital acquired infections (approximately 100,000 deaths occur annually in North America due to hospital-acquired infections), occasional pandemics or regional outbreaks. The most recent regional outbreak is Ebola in West Africa. This infection has caused significant challenges for the regional health care community and has had a global impact. The challenge in the control of infectious diseases is not only due to routine infections but also to the continued emergence and re-emergence of infectious diseases. These new threats occur on a regular basis with approximately thirty new emerging or re-emerging diseases recorded in the last thirty years. The majority of these emerging diseases are zoonotic (over 70%) causing even greater challenges to their control in humans and animals.
Fostering mentorship for clinician-investigator trainees: overview and recommendations
Authors: Ng Enoch , Wang Xin , Keow Jonathan , Yoon Ju-Yoon
Published: May 2017

Purpose: The Clinician Investigator Trainee Association of Canada/ Association des cliniciens-chercheurs en formation du Canada (CITAC/ACCFC) recently published the first survey to assess factors contributing to trainee satisfaction. One key finding is that increased level of mentorship strongly correlates with overall satisfaction; however, while 98% of respondents reported mentorship as important to success, more than 60% expressed some dissatisfaction with the mentorship received. To help address this discrepancy, we reviewed mentorship in academic medicine, focusing on clinician-investigator trainees, and distilled a set of recommendations for mentors, mentees and institutions.

Source: OVID and manual curation based on the search terms ‘mentorship’ AND ‘education, medical and research’ identified 198 articles. Two authours independently reviewed both titles and abstracts and narrowed them down to 75 articles, based on relevance to mentorship in academic medicine. Consensus resulted in the selection of 19 articles for detailed review.

Principal findings and Conclusion: Mentorship is beneficial at each training stage and is associated with greater research productivity, career retention and promotion. Nevertheless, more rigorous studies are needed, especially regarding cost-effectiveness. Studies have identified the characteristics of good mentors, including the ability to ensure open communication, ability to maintain confidentiality and ability to ensure that there is no mentor-mentee competition. Similarly, the characteristics of good mentees have been identified as the ability to take ownership of a project and the ability to build a network or team of mentors. The literature has also identified the actions that institutions can take to facilitate mentorship, which include mentor training and recognizing mentorship through awards.
Canada’s pregnancy-related mortality rates: doing well but room for improvement
Authors: Verstraeten Barbara S.E. , Mijovic-Kondejewski Jane , Takeda Jun , Tanaka Satomi , Olson David M
Published: May 2017

Purpose: Canada’s perinatal, infant and maternal mortality rates were examined and compared with other Organization for Economic Cooperation and Development (OECD) countries. The type and the quality of the available data and best practices in several OECD countries were evaluated.

Source: A literature search was performed in PubMed and the Cochrane Library. Vital statistics data were obtained from the OECD Health Database and Statistics Canada and subjected to secondary analysis.

Principal findings: Overall, Canadian pregnancy mortality rates have fallen dramatically since the early 1960’s. Perinatal and infant mortality rates remain low and stable, but the maternal mortality rate has increased slightly and both mortality rates have declined in their relative OECD rankings over the last 20 years. Data quality and coverage across Canada and internationally, especially for Indigenous peoples, is inconsistent and registration practices differ greatly, making comparisons difficult. Available data do show that Indigenous people’s perinatal and infant mortality rates are nearly twice those of the general population. Best practices in other OECD countries include Australia’s National Maternity Services plan to improve Aboriginal perinatal health, the Netherlands’ midwifery services and National Perinatal Registry and Japan’s national pregnancy registration and Maternal Handbook.

Conclusion: To diminish Canadian disparities in perinatal health rates and improve health outcomes we recommend a) uniform registration practices across Canada, b) better data quality and coverage especially among Indigenous communities, c) adoption of a national pregnancy registration and a maternal handbook along with d) improved midwifery and primary practice services to rural and remote communities. At a time when Canada is focusing upon improving pregnancy health in developing nations, it also needs to address its own challenges in improving pregnancy outcomes.
Challenges in Pharmacotherapeutics Education for Diabetes in Real-World Clinical Settings: Views From Family Medicine and Internal Medicine Residents
Authors: Farahani Pendar
Published: May 2017

Purpose: Pharmacotherapy for diabetes in real-world clinical settings is very complex and is posing a challenge for residents in training. The purpose of this study was to explore the views of residents in Canada regarding educational priorities for pharmacotherapy in diabetes management.

Methods: A questionnaire was developed to explore different domains of pharmacotherapy in diabetes management, including different clinic>al settings, combination pharmacotherapy with different classes of medications and patients’ characteristics, including comorbidities and cardiovascular risk factors. The questionnaire and the letter of invitation was sent to residents through their program directors. The results were gathered through an online survey system. Due to the study design, response rate could not be determined. For data analysis, SPSS Software was used for statistical analysis. Chi-square testing was utilized for comparisons of proportions.

Results: Thirty-four residency programs in Canada were contacted and 165 residents completed the study. A significant number of the residents (59%) viewed combination pharmacotherapy for diabetes management as the most important educational priority (p < 0.001). Regarding insulin therapy, combination of insulin with another class of agents was recognized as the most important educational priority by 51% of residents (p < 0.001). Among all classes of medication for blood glucose management the education on the use of newer class of medication such as GLP1 agonists, DPP4 inhibitors and SGLT2 inhibitors was recognized as a priority by 77% of residents (p < 0.001).

Conclusion: This study provides new data and insights into residents’ views on diabetes pharmacotherapy. Educational curriculums may incorporate these views from residents on the educational priorities that were identified in this study.
Serum and urinary biomarkers for predicting acute kidney injury after partial nephrectomy
Authors: Chen Jinzhuan , Lin Jianqing , Lin Caizhu
Published: May 2017

Purpose: The purpose of this study was to evaluate the ability of specific biomarkers to predict acute kidney injury (AKI) after partial nephrectomy.

Methods: A prospective study of 89 patients undergoing partial nephrectomy was conducted in the First Affiliated Hospital of Fujian Medical University. The patients were divided into two groups according to AKI status: an AKI group and non-AKI group. Receiver operator characteristic (ROC) curves were generated and the areas under the curve (AUCs) were compared.

Results: Twenty-eight subjects (31.5%) developed AKI while sixty-one subjects (68.5%) did not. Vascular clamping time in the AKI group was longer than that in the non-AKI group (29 ± 17 min vs. 24 ± 9 min, P = 0.042). Eight patients (28.6%) received blood infusion in the AKI group compared with five patients (8.2%) in the non-AKI group (P = 0.021). The area under ROC curve for AKI prediction was 0.792 [95% confidence interval (CI) 0.697 to 0.888, P < 0.000] for serum cystatin C 24 hours after surgery and 0.756 (95% CI 0.656 to 0.857, P < 0.000) for serum cystatin C 48 hours after surgery. Multivariate regression analysis showed transfusion [Hazard ratio (HR) 3.712, P = 0.044] and 24 hours serum cystatin C (HR 41.594, P = 0.001) correlated with AKI.

Conclusions: Postoperative serum cystatin C may be an early predictor for AKI after partial nephrectomy. Transfusion may be an independent risk factor for AKI after partial nephrectomy.
Plasma visfatin levels are associated with major adverse cardiovascular events in patients with acute ST-elevation myocardial infarction
Authors: Hung Wei-Chin , Yu Teng-Hung , Hsu Chia-Chang , Lu Li-Fen , Chung Fu-Mei , Tsai I-Ting , Lu Yung-Chuan , Houng Jer-Yiing , Lee Yau-Jiunn , Wang Chao-Ping
Published: May 2017

Purpose: Circulating levels of visfatin, a ubiquitous adipokine, may reflect both the severity of plaque as well as degree of plaque stabilization in acute myocardial injury. The purpose of this study was to test whether the level of visfatin is associated with the occurrence of major adverse cardiovascular events (MACEs) in patients with acute ST-elevation myocardial infarction (STEMI).

Methods: Consecutive patients (n=185) with acute STEMI were prospectively enrolled in the study. ELISA was used to measure plasma visfatin concentrations. Composite MACEs included death, recurrent myocardial infarction, target lesion revascularization or re-advanced heart failure.

Results: Plasma visfatin levels were significantly higher in composite MACE patients than in non-MACE patients. A multivariate Cox hazard regression model revealed that the predictive independent risk factors for the occurrence of composite MACEs were visfatin level (relative risk = 1.04) and age (relative risk = 6.05). When patients were grouped according to their plasma visfatin levels, composite MACEs occurred more frequently in patients presenting with high visfatin levels. Moreover, Kaplan-Meier analysis revealed that high visfatin levels were significantly associated with the occurrence of composite MACEs.

Conclusions: The level of plasma visfatin may be associated with risk of composite MACEs in STEMI patients, and may be useful for risk stratification.
Remote ischemic conditioning and renal function after contrast-enhanced CT scan: A randomized trial
Authors: Healy Donagh A , Feeley Iain , Keogh Cillian J , Scanlon Timothy G , Hodnett Philip A , Stack Austin G , Clarke Moloney Mary , Whittaker Peter , Walsh Stewart R
Published: May 2017

Purpose: Remote ischemic conditioning has been shown to protect against kidney injury in animal and human studies of ischemia-reperfusion. Recent evidence suggests that conditioning may also provide protection against kidney injury caused by contrast medium. The purpose of this study was to determine if conditioning protected against increases in serum creatinine (SCr) after contrast-enhanced computed tomography (CECT).

Methods: A randomised controlled trial (NCT 01741896) was performed with institutional review board approval and informed patient consent. Adult in-patients undergoing abdomino-pelvic CECT were allocated to conditioned or control groups. Conditioning consisted of four cycles of five minutes of cuff-induced arm ischemia with three minutes of reperfusion applied ~40 minutes before CECT. The primary outcome was SCr change after CECT.

Results: Baseline characteristics were similar in both groups. For all patients, conditioning reduced the risk ratio (RR) of increased SCr; RR 0.65 (95% confidence intervals 0.41 to 1.04). The protective effect was greater and the evidence for protection stronger when analysis was restricted to patients with pre-scan reduced renal function (eGFR
Comparison of Pressure- and Volume-Controlled Ventilation in Laparoscopic Surgery: A Meta-analysis of Randomized Controlled Trial
Authors: Wang Jun-Ping , Wang Hao-Bin , Liu Yan-Jin , Lou Xiao-Ping , Wang Xiao-Dong , Kong Yu
Published: May 2017

Purpose: Volume-controlled ventilation (VCV) has been the traditional mechanical ventilation mode in laparoscopic surgery. Pressure-controlled ventilation (PCV) has been used more frequently in recent years, especially for patients with complicated conditions; however, evidence on whether PCV is superior to VCV is still lacking. A meta-analysis was used to compare the effects of PCV and VCV on respiratory and hemodynamic parameters during laparoscopic surgery.

Methods: PubMed and Embase were each searched from their inception to December 2014 for randomized controlled trials comparing the effects of PCV and VCV on respiratory and hemodynamic parameters during laparoscopic surgery. Standard mean difference (SMD) with 95% confidence interval (CI) was calculated using a random effect model. Outcomes were assessed at three times: preoperative (T1), intraoperative (T2) and postoperative (T3). Respiratory mechanics (including peak airway pressure, plateau pressure, mean airway pressure, compliance, airway resistance, minute volume, end-tidal CO2 tension and tidal volume) and hemodynamic parameters (including heart rate and mean arterial pressure) were calculated.

Results: Eight randomized controlled trials with a total of 428 participants, 214 cases using PCV and 214 cases using VCV, were included in the meta-analysis. No significant differences were detected between the groups in terms of hemodynamic parameters. In contrast, with respiratory mechanics, PCV was slightly but significantly associated with lower peak airway pressure, higher compliance, lower airway resistance at T1, lower peak airway pressure, higher compliance, higher mean airway pressure at T2, lower peak airway pressure, lower mean airway pressure and higher end-tidal CO2 tension at T3. For the rest of respiratory parameters, there were no statistical differences between the groups. Subgroup analysis by morbidly obese, type of operations and quality of studies, showed similar results.

Conclusions: Our meta-analysis suggests that hemodynamic parameters are similar in patients who underwent laparoscopic surgery with PCV and VCV, but patients who had PCV exhibited mildly better respiratory data.
Rosuvastatin Lowers Systemic Inflammatory Response in Coronary Artery Bypass Graft Accompanied by Cardiopulmonary Bypass Surgery:
A Randomized Controlled Study
Authors: Ozguler Ibrahim M , Burma Oktay , Uysal Ayhan , Akbulut Handan
Published: May 2017

Purpose: Cardiopulmonary bypass (CPB) is commonly associated with a systemic inflammatory response that may lead to severe complications. Classic signs of systemic inflammatory response syndrome are complement activation and changes in cytokine and acute phase reactant levels. The effects of rosuvastatin after CPB on interleukin-6 (IL-6), interleukin-10 (IL-10), interleukin-18 (IL-18) and High Sensitivity C-Reactive Protein (hs-CRP) levels were investigated.

Methods: Thirty-seven male and thirteen female patients (total=50) aged 42 to 78 years, who had coronary bypass surgery due to coronary artery disease were randomly divided into two groups. The 25 patients in the control group were administered placebos. The 25 in the treatment group were administered 20 mg rosuvastatin tablets daily between preoperative day 7 and postoperative day 28. Blood samples were taken at six time points; before induction of anesthesia (T1), during CPB (T2), five minutes after removal of cross clamp (T3), after protamine infusion (T4), postoperative day three (T5) and postoperative day 28 (T6). Data points were expressed as mean ± standard deviation (SD).

Results: Rosuvastatin lowered IL-6 levels at T4, T5 and T6 time points (T4, T5, T6 p < 0.05), and elevated IL-10 levels at T3 and T4 (T3, T4 p < 0.05). IL-18 levels were also elevated at multiple time points. Rosuvastatin also lowered hs-CRP levels and cholesterol levels at T6 (p < 0.05).

Conclusion: Administering 20 mg/day of rosuvastatin between preoperative day 7 and postoperative day 28 may result in fewer complications in certain (especially intraoperative) cases of systemic inflammatory response caused by the CPB technique used in coronary bypass surgery.
The Effects of the Angiotensin Converting Enzyme Inhibitor Enalapril and the Angiotensin II Type 1 Receptor Blocker Losartan on Fracture Healing in Rats
Authors: Bayar Ahmet , Turan Ali , Gülle Kanat , Akpolat Meryem , Turan İnci , Turhan Egemen
Published: May 2017

Purpose: Angiotensin converting enzyme inhibitors (ACEI) and type I angiotensin receptor blockers (ARB) have been shown to exert significant effects on bone tissue via a local renin-angiotensin-aldosterone system (RAS). The aim of our study was to delineate their influences on fracture healing process.

Methods: Sixty adult male Wistar Albino rats were divided into three groups. After undergoing surgical femoral fracture and fixation, the ACEI group received 10 mg/kg of Enalapril, the ARB group received 10 mg/kg of Losartan and the Control group did not receive any medication. Fracture healing was evaluated at second and fifth postoperative weeks by the Lane-Sandhu radiological staging system and by histological scoring system of Huoet al. ACE expression in fracture callus was studied by immunohistochemistry.

Results: Both ACEI and ARB groups showed less fibrous tissue in the fracture area at the second week, but the histologic score differences were significant only between Control and ARB groups. At the fifth week, however, both radiological and histological scores for the ACEI group were significantly higher than both ARB and Control groups, while the scores for ARB and Control groups were similar. The presence of ACE expression in fracture callus was also observed.

Conclusion: ACEIs had significant positive effects on fracture repair. Losartan failed to display these stimulatory effects, which suggests that local RAS in bone tissue exerts its actions via alternative receptors or pathways than the AT1 receptor.
Sensitivity and Specificity of Diffusion-Weighted Magnetic Resonance Imaging in Diagnosis of Bladder Cancers
Authors: Zhai Ning , Wang Yan-Hui , Zhu Lai-Ming , Wang Jie-Huan , Sun Xin-Hai , Hu Xi-Bin , Li Xian , Yu Tao , Wang Xin-Ling , Meng Nan , Yan Qi-Chang , Li Xue-Jiao , Luo Ya-Hong
Published: May 2017

Purpose: Our study is designed to examine the diagnostic performance of diffusion-weighted magnetic resonance imaging (DW-MRI) for bladder cancers (BC), and to determine whether DW-MRI can differentiate muscle invasive bladder cancer (MIBC) from non-MIBC (NMIBC).

Methods: A meta-analysis was performed of published studies that investigated the performance of DW-MRI for BC. These studies were retrieved from scientific literature databases using sensitive electronic search strategies. The STATA 12.0 and Meta-disc software were employed for statistical analyses of data extracted from selected studies.

Results: Our search initially returned 230 articles, of which 11 met the inclusion criteria and were enrolled into the final meta-analysis. Five of the included studies reported the diagnostic performance of DW-MRI for BC with a cumulative total of 243 BC patients and 82 healthy subjects. Eight studies investigated the diagnostic performance of DW-MRI for differentiating MIBC from NMIBC, involving 259 MIBC lesions and 515 NMIBC lesions. Meta-analysis results were as follows: the diagnostic performance of DW-MRI for BC (sensitivity: 0.95 [0.75-0.99]; specificity: 0.85 [0.74-0.92]; positive likelihood ratio: 6.45 [3.64-11.42]; negative likelihood ratio: 0.055 [0.009-0.333]; diagnostic odds ratio: 117.11 [19.37-708.05]; area under the curve (AUC): 0.91); the diagnostic performance of DW-MRI to differentiate MIBC from NMIBC (sensitivity: 0.85 [0.76 - 0.91]; specificity: 0.90 [0.87 - 0.93]; positive likelihood ratio:8.81[6.43 - 12.07]; negative likelihood ratio: 0.16 [0.10 - 0.28]; diagnostic odds ratio: 53.95 [25.68 - 113.33]; AUC: 0.92).

Conclusion: DW-MRI has an outstanding diagnostic performance, with advanced sensitivity and specificity, for imaging of bladder cancers and for differentiating MIBC from NMIBC.
Near infrared spectroscopy (NIRS) derived tissue oxygenation in critical illness
Authors: Samraj Ravi S , Nicolas Lara
Published: May 2017

Purpose: Near infrared spectroscopy (NIRS) is an emerging technology that can measure tissue oxygen saturation levels (StO2) and has many potential clinical applications. NIRS devices have been studied in various disease states in the pediatric as well as adult populations. A review of this technology, with its potential applications and a review of current evidence is presented.

Principal findings: NIRS-derived regional tissue oxygen saturation (StO2) is superior to pulse oximetry as it measures tissue oxygen saturation and reflects imbalance between oxygen supply and local demand. Becoming more widely available, it still does not have a firmly established role due to its technical limitations and to the lack of large multi-centric randomized controlled studies necessary to confirm its utility, cost-benefit effectiveness and role in improving patient outcomes.

Conclusion: Widespread availability, ease of use, non-invasive nature and continuous data display makes it an attractive option for bedside clinical monitoring.
A Systematic Review of Clinical Practice Guidelines’ Recommendations on Levothyroxine Therapy Alone versus Combination Therapy (LT4 plus LT3) for Hypothyroidism
Authors: Kraut Eyal , Farahani Pendar
Published: May 2017

Purpose: Patients with hypothyroidism are increasingly enquiring about the benefit of using combination therapy of levothyroxine (LT4) and liothyronine (LT3) as a potential treatment for hypothyroidism. Combination therapy, however, remains controversial. The purpose of this study was to systematically review available hypothyroidism treatment recommendations from clinical practice guidelines from around the world to identify the consensus regarding combination therapy.

Source: Clinical practice guidelines were obtained from searches of PubMed, EMBASE, and MEDLINE, using several combinations of MeSH terms. The search was limited to clinical guidelines in English-language publications, published between January 1, 1990 and May 1, 2015. A quantitative approach was utilized for data synthesis.

Principal Findings: Thirteen guidelines were identified, including three regarding pregnancy, two regarding pediatric populations and eight regarding adult populations. There were six guidelines from North America, four guidelines from Europe and three guidelines from South America. Twelve of the guidelines were published after 2010. Nine guidelines addressed combination therapy of LT4 plus LT3, and all nine concluded that LT4 therapy alone is the standard of care, with insufficient evidence to recommend widespread combination therapy. Only the 2012 ETA Guidelines and the 2015 BTA Guidelines concluded that combination therapy could be used, although only in certain circumstances and as an experimental treatment.

Conclusion: This systematic review illustrates that clinical practice guidelines worldwide do not recommend and do not support routine use of combination LT4 and LT3 therapy to treat hypothyroidism.
Proceedings from the 6th Annual University of Calgary Leaders in Medicine Research Symposium
Authors: Roberts Jodie I , Beatty Jennifer K , Peplowski Michael A , Keough Michael B , Yipp Bryan G , Hollenberg Morley D , Beck Paul L
Published: May 2017

On November 14, 2014, the Leaders in Medicine (LIM) program at the Cumming School of Medicine, University of Calgary hosted its 6th Annual Research Symposium. Dr. Danuta Skowronski, Epidemiology Lead for Influenza and Emerging Respiratory Pathogens at the British Columbia Centre for Disease Control (BCCDC), was the keynote speaker and presented a lecture entitled “Rapid response research during emerging public health crises: influenza and reflections from the five year anniversary of the 2009 pandemic”. The LIM symposium provides a forum for both LIM and non-LIM medical students to present their research work, either as an oral or poster presentation. There were a total of six oral presentations and 77 posters presented.

 The oral presentations included:

Swathi Damaraju, “The role of cell communication and 3D Cell-Matrix environment in a stem cell-based tissue engineering strategy for bone repair”;

Menglin Yang, “The proteolytic activity of Nepenthes pitcher fluid as a therapeutic for the treatment of celiac disease”;

Amelia Kellar, “Monitoring pediatric inflammatory bowel disease – a retrospective analysis of transabdominal ultrasound”;

Monica M. Faria-Crowder, “The design and application of a molecular profiling strategy to identify polymicrobial acute sepsis infections”;

Waleed Rahmani, “Hair follicle dermal stem cells regenerate the dermal sheath, repopulate the dermal papilla and modulate hair type”; and,

Laura Palmer, “A novel role for amyloid beta protein during hypoxia/ischemia”.

 The article on the University of Calgary Leaders in Medicine Program, “A Prescription that Addresses the Decline of Basic Science Education in Medical School,” in a previous issue of CIM (2014 37(5):E292) provides more details on the program. Briefly, the LIM Research Symposium has the following objectives: (1) to showcase the impressive variety of projects undertaken by students in the LIM Program as well as University of Calgary medical students; (2) to encourage medical student participation in research and special projects; and, (3) to inform students and faculty about the diversity of opportunities available for research and special projects during medical school and beyond.  The following abstracts were submitted for publication.
Efficacy of an intercostal nerve block administered with general anesthesia in elderly patients undergoing distal gastrectomy
Authors: Chen Jinzhuan , Lin Jianqing , Chen Xiaoming , Lin Caizhu
Published: May 2017

Purpose: The purpose of this study was to evaluate the efficacy and safety of administration of an intercostal nerve block (INB) with general anesthesia to elderly patients undergoing a distal gastrectomy.

Methods: Elderly patients (>65 years) undergoing selective gastrectomy were randomly assigned to three groups (n = 80): general anesthesia (Group A); general + INB anesthesia (Group B); or, general + epidural anesthesia (Group C). General anesthesia was maintained with propofol, remifentanil and cisatracurium. The mean arterial blood pressure (MAP), heart rate (HR) and C-reactive protein (CRP) levels were determined before anesthesia (T0) and at 5 min after intubation (T1), skin incision (T2), exploration of the peritoneal cavity (T3), gastrointestinal anastomosis (T4), end of operation (T5) and 10 min after extubation (T6).

Results: MAP decreased at T1 in all groups (P < 0.05) and at T2, T4 and T5 in Group C (P < 0.05) and was lower in Group C than Group B at T2 and T4 (P < 0.05). There were no differences in MAP between Groups A and B or between Groups B and C. HR increased at T2 - T6 in Group A (P < 0.05) and was higher at T2 - T6 in Group B and Group C (P < 0.05). CRP levels decreased at T2 - T5 in Groups B and C (P < 0.05) and were lower in Groups B and C compared with Group A (P < 0.05). Propofol and remifentanil doses were lower in Groups B and C (P < 0.05 and P < 0.01, respectively) and patients recovered faster than in Group A (P < 0.05).

Conclusion: Administration of INB with general anesthesia enhanced analgesia, led to stable hemodynamics, and reduced anaesthetic consumption and postoperative stress response.
Prevalence of Liver Disease and Utilization of a Hepatology Consultation Service at an Urban Tertiary Care Hospital
Authors: Wong Stephen G , Pollock Richard , Minuk Gerald Y
Published: May 2017

Purpose: The prevalence of liver disease and frequency of consultations to a Hepatology Consultation service for patients with liver enzyme/function abnormalities admitted to a clinical teaching unit at an urban tertiary care hospital have not been previously described. To document these data, a retrospective chart review of adult patients admitted for non-hepatobiliary problems to a general Internal Medicine clinical teaching unit at an urban, tertiary care hospital during a three month period was performed.

Methods: Laboratory test results were reviewed to determine if liver enzymes and function tests had been ordered during the first five days of admission and, in those with abnormal results, whether referrals had been sent to the hospital’s Hepatology Consultation service for further investigations and/or management.

Results: A total of 506 admissions occurred during the study period. Of these, 452 (89%) were for patients with no known liver disease. Liver biochemistry testing was obtained in 218 (48.2%) of these individuals. In 192 (88.1%), liver enzyme or function tests were abnormal and in 91 (41.7%), both enzymes and function tests were abnormal (suggesting more advanced disease). Referrals to the Hepatology Consultation service were requested for 5/91 (5.5%) patients with more advanced disease and none with only liver enzyme or function tests abnormalities.

Conclusions: Although liver enzymes and/or function test abnormalities are common in this patient population, screening for liver disease is relatively uncommon and consultation to a Hepatology Consultation service occurs in less than 10% of cases.
Obstructive Sleep Apnea Syndrome: Links Betwen Pathophysiology and Cardiovascular Complications
Authors: Hopps Eugenia , Caimi Gregorio
Published: May 2017

Purpose: The prevalence of obstructive sleep apnea syndrome (OSAS) is increasing, especially in the middle-aged population. OSAS is associated with an elevated risk of cardiovascular morbidity and mortality. Arterial hypertension is often the first consequence of OSAS, but the most severe complications are coronary artery disease, stroke and arrhythmias. The aim of this review was to analyze the several mechanisms involved in the development of the cardiovascular events, such as endothelial dysfunction accompanied by a pro-inflammatory and pro-oxidant status, hemorheological alterations, hypercoagulability and imbalance between matrix metalloproteases and their inhibitors.

Source: A search on PubMed was carried out using the following terms: obstructive sleep apnea syndrome; endothelial dysfunction; oxidative stress; inflammation; rheology; matrix metalloproteases.

Principal findings: OSAS severity strongly influenced cardiovascular risk factors and, furthermore, it was correlated with the incidence of fatal and non-fatal events.

Conclusions: The treatment with continuous positive airways pressure (cPAP) is the gold standard for OSAS and was able to positively influence all the pathophysiological mechanisms responsible for cardiovascular diseases. Long-term cPAP improved endothelial function and hemorheology, reduced oxidative stress and inflammation, and decreased the levels of metalloproteases.
Sex/Gender -Based Pharmacology and Statin Utilization Amongst Elderly Patients with Diabetes
Authors: Farahani Pendar , Johnson Ana , Whitehead Marlo , Rohland Susan
Published: May 2017

Purpose: The purpose of this study was to explore the ten-year trends in utilization of bioequivalent doses of statin amongst elderly patients with diabetes according to sex/gender in Ontario, Canada.

Methods: A cohort of patients with diabetes (>65 years) was constructed using the Ontario Diabetes Database Statin utilization data (2003-2012) was obtained from the Ontario Drug Benefit Program for both women and men. Bioequivalent doses for statins were calculated according to the dosing conversion factor in therapeutic interchange programs in clinical practice. Utilization pattern of high potency (Atorvastatin and Rosuvastatin) vs. low potency statins (Simvastatin, Lovastatin, Fluvastatin, Pravastatin) were also analyzed.

Results: The average bioequivalent Simvastatin utilization in 2003 was 29.22 mg/day for women and 30.35 mg/day for men. By 2008, this gap in dosing was higher for both women and men and by 2013 it had increased to 47.75 mg/day for women and 52.98 mg/day for men. For average number of day supply per year, there was no significant trend of changes over the 10-year period, although the use of high potency statins increased significantly (P
Feasibility and safety of continuous glucose monitoring systems in acute myocardial infarction subjects undergoing primary percutaneous coronary interventions
Authors: Zhang Jian-wei , He Ling-jie , Cao Shu-jun , Yu Xiao-wei , Yang Qing , Yang Shi-wei , Zhou Yu-jie
Published: May 2017

Purpose: The purpose of this study was to evaluate the feasibility and safety of continuous glucose monitoring systems (CGMS) in ST segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary interventions (p-PCI) in coronary care units (CCU).

Methods: CGMS was performed for 3 days during CCU hospitalization for each of the subjects. The correlation between glucose values, recorded with CGMS, and finger-stick capillary glucose values was examined. The parameters and safety of CGMS were also investigated.

Results: Data from 219 subjects were included in the statistical analysis. Correlation analysis showed a strong positive correlation between interstitial glucose values recorded by CGMS and the corresponding capillary glucose values (P
Common bleeding disorders affecting individuals with Hereditary Hemorrhagic Telangiectasia
Authors: LaBranche Jennifer , Nahirniak Susan , Vethanayagam Dilini
Published: May 2017

Purpose: Hereditary Hemorrhagic Telangiectasia (HHT) is an autosomal dominant disorder affecting vasculature in different organ systems; seen at a rate of approximately 1:5000 in North America. Complications, with significant increases in health service utilization, arise from bleeding and shunts, and are particularly problematic in the lung and liver. Although these patients tend to chronically bleed from the GI tract and nasal cavities, a single bleed from arterio-venous malformations in the lungs or brain can have serious health implications and may be fatal. Bleeding due to vascular wall fragility in HHT patients can be further complicated with a concomitant bleeding disorder.

Methods: The proportion of adult patients seen in the Edmonton HHT center with a concomitant bleeding disorder, as assessed by blood test results for Factor VIII and related factors (Ristocetin Cofactor), Factor IX and Factor XI, was determined in a retrospective, single centre study.

Results: Of 77 individuals with HHT, four had below normal values of von Willebrand Factor, Ristocetin Cofactor or Factor VIII. Two patients had laboratory parameters diagnostic of a bleeding disorder, accounting for 2.6% of confirmed HHT subjects. These results indicate that establishing screening for bleeding disorders in HHT centers is important in managing bleeding symptomatology.

Conclusions: In individuals with HHT, the presence of a second bleeding disorder can have significant clinical implications on patient management and health care utilizations. This paper highlights areas that need to be reviewed with respect to best practice protocols for the management of HHT patients.
Protective effects of molsidomine against doxorubicin-induced renal damage in rats
Authors: Oguz Fatih , Beytur Ali , Sarihan Ediz , Oguz Hilal K , Bentli Recep , Samdanci Emine , Kose Evren , Polat Alaaddin , Duran Zeynep R , Parlakpinar Hakan , Ekinci Nihat
Published: May 2017

Purpose: The purpose of this study was to investigate the therapeutic and protective effects of molsidomine (MLS) against doxorubicin (DOX)-induced renal damage in rats.

Methods: Forty rats were randomly divided into five groups (control, MLS, DOX, DOX+MLS and MLS+DOX groups). Thiobarbituric acid reactive substance (TBARS), reduced glutathione (GSH), superoxide dismutase (SOD), catalase (CAT), nitric oxide (NO) and glutathione peroxidase (GPx) levels were determined from kidney tissues and blood urea nitrogen (BUN), creatinine (Cr) and albumin (Alb) levels also determined.

Results: DOX treatment caused a significant increase in TBARS levels and a significant decrease in the GSH and CAT levels compared with the control group. In comparison, MLS administration before DOX injection caused a signiﬁcant decrease in TBARS levels and also increases in GSH and CAT levels, whereas treatment of MLS after DOX injection did not show any beneﬁcial effect on these parameters. All groups showed a significant increase in NO levels compared to the control group. There were no significant differences among the all groups for BUN and Cr levels. Serum level of Alb decreased in the DOX-treated groups when compared with control and MLS groups. The histopathological findings were in accordance with the biochemical results. MLS treatment reversed the DOX-induced kidney damage in group 4. MLS treatment before DOX injection exerted a protective effect against DOX-induced kidney damage.

Conclusions: MLS shows promise as a possible therapeutic intervention for the prevention of kidney injury associated with DOX treatment. Additional studies are warranted.