Introduction:
Multi-modality imaging is a crucial component of cardiovascular (CV) fellowship training and requires knowledge of CV anatomy for interpretation. We hypothesized that hands-on anatomy ...education would improve the imaging interpretation skills of CV fellows.
Methods:
The first-year CV fellowship class completed a hands-on cadaveric anatomy session correlated with clinical imaging. Fellows’ ability to identify CV structures on cardiac imaging was assessed using a 30-question assessment tool administered at baseline and 1 week and 6 months post intervention. Advanced CV fellows (second or third year) who had not attended the session were also tested. Scores were expressed as median interquartile range.
Results:
Among 9 first-year fellows, the majority reported no formal anatomy training since medical school (N = 7) and rated their knowledge of CV anatomy as fair or poor (N = 7) prior to the intervention. The median assessment score was higher 1 week after intervention vs baseline (24 23-25 vs 19 17-21; P = .013) and remained higher than baseline at 6 months (26 26-28 vs 19 17-21; P = .009). The 6-month post-intervention score for first-year fellows was not significantly different than that of senior fellows (n = 10) not exposed to the intervention (26 26-28 vs 26 23-27; P = .434).
Conclusions:
Gross anatomy instruction improved first-year CV fellows’ interpretation of CV imaging. Anatomic instruction may be a useful adjunct to multi-modality imaging education.
To determine the load-limiting capabilities of protective neck collars used in football through dynamic impact testing.
A 50th-percentile male Hybrid III dummy was used in 48 dynamic impact tests ...comparing The Cowboy Collar, Bullock Collar, and Kerr Collar. A control and each collar were tested at two velocities (5 m/s and 7 m/s), three impact locations (front, top, and side of the helmet), and two shoulder pad positions (normal and raised).
Research laboratory.
None.
None. Independent variables were the neck collars, impact velocity, and shoulder pad position.
In addition to range of motion, upper and lower neck forces and moments were measured.
With the top impact location, it was found that the Kerr Collar and Bullock Collar reduced head accelerations and force transmission through the neck. With the front impact location, all the collars reduced lower neck moment. The Kerr Collar was also capable of reducing the lower neck force and upper neck moment. With the side impact location, the Kerr Collar substantially reduced lower neck moment.
These reductions in loads correlate with the degree to which each collar restricted the motion of the head and neck. By restricting the range of motion of the neck and redistributing load to the shoulders, neck loads can be effectively lowered.
To determine the effectiveness of different types of acupuncture in reducing pain, improving maximum mouth opening and jaw functions in adults with orofacial pain.
Six databases were searched until ...15 June 2023. The Cochrane risk of bias tool and GRADE were employed to evaluate bias and overall evidence certainty.
Among 52 studies, 86.5% (
= 45) exhibited high risk of bias. Common acupoints, including Hegu LI 4, Jiache ST 6, and Xiaguan ST 7, were used primarily for patients with temporomandibular disorder TMDs. Meta-analyses indicated that acupuncture significantly reduced pain intensity in individuals with myogenous TMD (MD = 26.02 mm, I
=89%,
= 0.05), reduced tenderness in the medial pterygoid muscle (standardised mean differences SMD = 1.72, I
= 0%,
< 0.00001) and jaw dysfunction (SMD = 1.62, I
= 88%,
= 0.010) in mixed TMD when compared to sham/no treatment. However, the overall certainty of the evidence was very low for all outcomes as evaluated by GRADE.
The overall results in this review should be interpreted with caution as there was a high risk of bias across the majority of randomized controlled trial (RCTs), and the overall certainty of the evidence was very low. Therefore, future studies with high-quality RCTs are warranted evaluating the use of acupuncture in patients with orofacial pain.
Infant gliomas have paradoxical clinical behavior compared to those in children and adults: low-grade tumors have a higher mortality rate, while high-grade tumors have a better outcome. However, we ...have little understanding of their biology and therefore cannot explain this behavior nor what constitutes optimal clinical management. Here we report a comprehensive genetic analysis of an international cohort of clinically annotated infant gliomas, revealing 3 clinical subgroups. Group 1 tumors arise in the cerebral hemispheres and harbor alterations in the receptor tyrosine kinases ALK, ROS1, NTRK and MET. These are typically single-events and confer an intermediate outcome. Groups 2 and 3 gliomas harbor RAS/MAPK pathway mutations and arise in the hemispheres and midline, respectively. Group 2 tumors have excellent long-term survival, while group 3 tumors progress rapidly and do not respond well to chemoradiation. We conclude that infant gliomas comprise 3 subgroups, justifying the need for specialized therapeutic strategies.
To investigate the variability in diagnostic and therapeutic approaches to posthemorrhagic ventricular dilatation (PHVD) among Canadian neonatal centers, and secondary exploration of differences in ...approaches between Canadian and European practices.
We conducted a survey among Canadian tertiary neonatal centers on their local practices for managing very preterm infants with PHVD. The survey covered questions on the diagnostic criteria, timing and type of interventions and resources utilization (transfer to neurosurgical sites and neurodevelopmental follow-up). In a secondary exploration, Canadian responses were compared with responses to the same survey from European centers.
23/30 Canadian centers (77%) completed the survey. There was no consensus among Canadian centers on the criteria used for diagnosing PHVD or to initiate intervention. The therapeutic interventions also vary, both for temporizing procedures or permanent shunting. Compared to European practices, the Canadian approach relied less on the sole use of ultrasound criteria for diagnosing PHVD (43 vs 94%, p < 0.0001) or timing intervention (26 vs 63%, p = 0.007). Majority of European centers intervened early in the development of PHVD based on ultrasound parameters, whereas Canadian centers intervened based on clinical hydrocephalus, with fewer centers performing serial lumbar punctures prior to neurosurgical procedures (40 vs 81%, p = 0.003).
Considerable variability exists in diagnosis and management of PHVD in preterm infants among Canadian tertiary centers and between Canadian and European practices. Given the potential implications of the inter-center practice variability on the short- and long-term outcomes of preterm infants with PHVD, efforts towards evidence-based Canada-wide practice standardization are underway.
Patients with primary brain tumours (i.e., neuro-oncology patients) lack access to exercise oncology and wellness resources. The purpose of the Alberta Cancer Exercise – Neuro-Oncology (ACE-Neuro) ...study is to assess the feasibility of a tailored neuro-oncology exercise program for patients across Alberta, Canada. The primary outcome is to assess the feasibility of ACE-Neuro. The secondary outcome is to examine preliminary effectiveness of ACE-Neuro on patient-reported outcomes and functional fitness.
Neuro-oncology patients with a malignant or benign primary brain tumour that are pre, on, or completed treatment, are >18 years, and able to consent in English are eligible to participate in the study. Following referral from the clinical team to cancer rehabilitation and the study team, participants are triaged to determine their appropriateness for ACE-Neuro and other cancer rehabilitation services (including physiatry, physiotherapy, occupational therapy, and exercise physiology). In ACE-Neuro, participants complete a tailored 12-week exercise program with pre-post assessments of patient-reported outcomes and functional fitness, and objective physical activity tracked across the 12-week program. ACE-Neuro includes individual and group-based exercise sessions, as well as health coaching.
We are supporting ACE-Neuro implementation into clinical cancer care, with assessment of needs enabling a tailored exercise prescription.
•Neuro-oncology patients require access to tailored exercise oncology programs.•The feasibility of a tailored neuro-oncology exercise program is being examined.•Patients are referred and triaged via the electronic medical record.•Intervention includes tailored exercise, an activity tracker, and health coaching.•This work supports the implementation of exercise within neuro-oncology care.
High dietary sodium intake is a risk factor for hypertension, and heart rate variability (HRV) is decreased in hypertension. Effects of dietary sodium intake on HRV of normotensive persons have not, ...however, been investigated to date. The present study examined effects of low and high sodium diets on blood pressure, heart rate, and HRV in 36 healthy, normotensive women, ages 40–70. Each was placed on a low sodium diet for 6 days followed by a high sodium diet for 6 days. The high salt diet increased mean systolic blood pressure, decreased heart rate, and increased high frequency HRV (HF). Cardiac vagal tone, estimated at baseline from heart period and a time domain estimate of respiratory sinus arrhythmia, was higher in salt‐sensitive than salt‐insensitive subjects. The finding of increased vagal tone in normotensive persons on high salt intake indicates that dietary sodium status should be considered in behavioral studies of HRV.
Correction of genetic diseases requires integration of the therapeutic gene copy into the genome of patient cells. Retroviruses are commonly used as delivery vehicles because of their precise ...integration mechanism, but their use has led to adverse events in which vector integration activated proto-oncogenes and contributed to leukemogenesis. Here, we show that integration by lentiviral vectors can be targeted away from genes using an artificial tethering factor. During normal lentivirus infection, the host cell–encoded transcriptional coactivator lens epithelium–derived growth factor/p75 (LEDGF/p75) binds lentiviral integrase (IN), thereby targeting integration to active transcription units and increasing the efficiency of infection. We replaced the LEDGF/p75 chromatin interaction–binding domain with CBX1. CBX1 binds histone H3 di- or trimethylated on K9, which is associated with pericentric heterochromatin and intergenic regions. The chimeric protein supported efficient transduction of lentiviral vectors and directed the integration outside of genes, near bound CBX1. Despite integration in regions rich in epigenetic marks associated with gene silencing, lentiviral vector expression remained efficient. Thus, engineered LEDGF/p75 chimeras provide technology for controlling integration site selection by lentiviral vectors.
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