Rony A.,Sudbury Regional Hospital |
Chiu R.C.J.,McGill University
Stem Cells Translational Medicine | Year: 2012
Stem cell transplantation is a promising approach for improving cardiac function after severe myocardial damage, for which the use of autologous donor cells has been preferred to avoid immune rejection. Recently, however, rodent as well as human mesenchymal stem cells have been reported to be uniquely immune-tolerant, in both in vitro and in vivo transplant models. In this review, we explore in detail the current understanding of the underlying immunologic mechanisms, which can facilitate the use of such cells as "universal donor cells" with fascinating clinical implications. © AlphaMed Press.
Mariani M.,Sudbury Regional Hospital |
Shammi P.,Baycrest Center
Clinical Neuropsychologist | Year: 2010
We present a case study of an individual diagnosed with isolated neurosarcoidosis, a rare granulomatous condition of unknown aetiology. Although the extant medical literature on this disease is adequate, no study has focused on the neuropsychological sequelae involved with such an inflammatory disorder. The case described herein is of a 57-year-old woman who participated in a neuropsychological evaluation following complaints of recurring cognitive difficulties. Results of the assessment revealed moderate difficulties in effortful word retrieval and recall of unstructured verbal information, as well as some mild mental rigidity, slowing, and subtle difficulties with attention. Her neuropsychological profile is discussed in terms of neuroanatomic lesion localization and clinical diagnostic implications.
Frimeth J.,Laurentian University |
Galiano E.,Laurentian University |
Webster D.,Sudbury Regional Hospital
Journal of Clinical Densitometry | Year: 2010
Dual-energy X-ray absorptiometry (DXA) is the standard method of measuring bone mineral density (BMD) at highly trabecular bone, which can be statistically linked to the risk of fracture. For DXA, precision error (PE) and phantom-based accuracy studies are among the most important routine quality control procedures. A precision study was performed at our institution using International Society for Clinical Densitometry guidelines. Comparing our results with those reported by other investigators, we draw the following general conclusions: the PE was higher for the spine than the hip, which we attribute to the better geometric reproducibility at the hip. The hypothesis that the DXA calculates BMD relative to water was validated. Whether follow-up measurements are performed by the same technologist on the same day-or different technologists on subsequent days-does not appear to have a clinically significant impact on PE or least significant change (LSC). Mixing beam types (i.e., fan and pencil) may affect lumbar PE and LSC measurements more significantly than those of the hip. The use of a single technologist may reduce the PE for the lumbar spine but appears to increase it for the hip. Restricting the patient population to the female gender has the apparent effect of narrowing the gap between lumbar and hip PEs. Finally, the degree of BMD measurement accuracy can be affected by the type of phantom being used (e.g., European Spine Phantom vs Lunar phantom) and the faults in specific DXA edge detection algorithms. © 2010 The International Society for Clinical Densitometry.
Aaron S.D.,Ottawa Hospital Research Institute |
Vandemheen K.L.,Ottawa Hospital Research Institute |
Ramotar K.,Ottawa Hospital Research Institute |
Giesbrecht-Lewis T.,Ottawa Hospital Research Institute |
And 11 more authors.
JAMA - Journal of the American Medical Association | Year: 2010
Context: Studies from Australia and the United Kingdom have shown that some patients with cystic fibrosis are infected with common transmissible strains of Pseudomonas aeruginosa. Objectives: To determine the prevalence and incidence of infection with transmissible strains of P aeruginosa and whether presence of the organism was associated with adverse clinical outcomes in Canada. Design, Setting, and Participants: Prospective observational cohort study of adult patients cared for at cystic fibrosis clinics in Ontario, Canada, with enrollment from September 2005 to September 2008. Sputum was collected at baseline, 3 months, and yearly thereafter for 3 years; and retrieved P aeruginosa isolates were genotyped. Vital status (death or lung transplant) was assessed for all enrolled patients until December 31, 2009. Main Outcome Measures: Incidence and prevalence of P aeruginosa isolation, rates of decline in lung function, and time to death or lung transplantation. Results: Of the 446 patients with cystic fibrosis studied, 102 were discovered to be infected with 1 of 2 common transmissible strains of P aeruginosa at study entry. Sixtyseven patients were infected with strain A (15%), 32 were infected with strain B (7%), and 3 were simultaneously infected with both strains (0.6%). Strain A was found to be genetically identical to the Liverpool epidemic strain but strain B has not been previously described as an epidemic strain. The incidence rate of new infections with these 2 transmissible strains was relatively low (7.0 per 1000 person-years; 95% confidence interval [CI], 1.8-12.2 per 1000 person-years). Compared with patients infected with unique strains of P aeruginosa, patients infected with the Liverpool epidemic strain (strain A) and strain B had similar declines in lung function (difference in decline in percent predicted forced expiratory volume in the first second of expiration of 0.64% per year [95% CI, -1.52% to 2.80% per year] and 1.66% per year [95% CI, -1.00% to 4.30%], respectively). However, the 3-year rate of death or lung transplantation was greater in those infected with the Liverpool epidemic strain (18.6%) compared with those infected with unique strains (8.7%) (adjusted hazard ratio, 3.26 [95% CI, 1.41 to 7.54]; P=.01). Conclusions: A common strain of P aeruginosa (Liverpool epidemic strain/strain A) infects patients with cystic fibrosis in Canada and the United Kingdom. Infection with this strain in adult Canadian patients with cystic fibrosis was associated with a greater risk of death or lung transplantation. ©2010 American Medical Association. All rights reserved.
Kvinlaug K.E.,McGill University |
Lawlor D.K.,London Health Sciences Center |
Forbes T.L.,London Health Sciences Center |
Willoughby R.,Sudbury Regional Hospital |
And 4 more authors.
Journal of Endovascular Therapy | Year: 2012
Purpose: To report the early results of a multicenter registry of endovascular aneurysm repair (EVAR) using the Endurant stent-graft. Methods: Patients having elective treatment of infrarenal abdominal aortic aneurysm (AAA) with the Endurant stent-graft at 3 Canadian centers were enrolled in a prospective registry between September 2008 and January 2010. In the 16-month period, 111 patients (90 men; mean age 75 years, range 53-93) were registered. Thirty-seven (33.3%) patients had challenging anatomy: short proximal aortic necks (n=17), large diameter (>28 mm) aortic necks (n=4), angulated (>60°) necks (n=3), and small (<15 mm) external iliac arteries (n=21). Outcomes evaluated included survival, endoleak, aneurysm expansion >5 mm, secondary intervention, stent-graft migration, and graft thrombosis. Results: The overall technical success rate was 100%. Nineteen (17.1%) patients experienced perioperative complications. After a mean follow-up of 6 months (range 0.1-16), mortality in the series was 4.5%: 1 perioperative death (multisystem organ failure) and 4 (3.6%) late deaths (3 cardiac, 1 cancer). Clinical and imaging follow-up past the perioperative period were available in 107 (96.4%) and 99 (89.2%) patients, respectively. Among the latter, 9 (9.1%) had a type II endoleak on the first scan; 4 resolved spontaneously. Three (3.0%) patients developed graft limb thrombosis in follow-up; one required an intervention. There was no graft migration, aneurysm expansion, secondary intervention for endoleak, aneurysm rupture, or conversion. Conclusion: Early results from this prospective multicenter registry indicate that the Endurant stent-graft is a safe option for elective EVAR in selected AAA patients. Longer follow-up is required to determine the durability of these outcomes. © 2012 by the International Society of Endovascular Specialists.