Removing barriers to accessing medical cannabis for paediatric patients.

Medical cannabis (MC) may offer therapeutic benefits for children with complex neurological conditions and chronic diseases. In Canada, parents, and caregivers frequently report encountering barriers when accessing MC for their children. These include negative preconceived notions about risks and benefits, challenges connecting with a knowledgeable healthcare provider (HCP), the high cost of MC products, and navigating MC product shortages.

Molecular Subtypes of Head and Neck Cancer in Patients of African Ancestry.

Purpose: The purpose of this study was to better understand the complex molecular biomarkers and signatures of head and neck cancer (HNC) among Black patients and identify possible molecular changes associated with HNC disparities.

Experimental Design: Molecular subtypes and genomic changes in HNC samples from patients of African and European ancestry in The Cancer Genome Atlas, Memorial Sloan Kettering Cancer Center, Broad Institute, MD Anderson Cancer Center, and John Hopkins University were identified. Molecular features (genomic, proteomic, transcriptomic) associated with race and genomic alterations associated with clinical outcomes were determined.

MicroRNA-Based Cancer Mortality Risk Scoring System and hTERT Expression in Early-Stage Oral Squamous Cell Carcinoma.

We have previously constructed a novel microRNA (miRNA)-based prognostic model and cancer-specific mortality risk score formula to predict survival outcome in oral squamous cell carcinoma (OSCC) patients who are already categorized into "early-stage" by the TNM staging system. A total of 836 early-stage OSCC patients were assigned the mortality risk scores. We evaluated the efficacy of various treatment regimens in terms of survival benefit compared to surgery only in patients stratified into high (risk score ≥0) versus low (risk score <0) mortality risk categories.

Diagnostic dilemma - sinonasal organizing hematoma.

Sinonasal organizing hematomas are benign lesions often mistaken for malignancy due to their aggressive appearance on diagnostic imaging and endoscopic findings that favor advanced disease. The destructive nature of this pathology paired with the rarity of the presentation often results in diagnostic deception that may escalate intervention planning and affect discussion of prognosis with patients. Herein, we present a case of a 56-year-old male with left-sided nasal obstruction and daily epistaxis, where computed tomography imaging revealed heterogeneous opacification of the left maxillary sinus, erosion of the left inferior orbital wall and extension into the nasal cavity.

Oral Pseudomyogenic Hemangioendothelioma: Case Report and Review of the Literature.

Pseduomyogenic hemangioendothelioma (PMH) is a vascular neoplasm of intermediate biological potential first described by Hornick and Fletcher (Am J Surg Pathol 35:190-201, 2011). Despite its initial categorization as a malignant entity, PMH often demonstrates an indolent behavior profile, and thus was classified as a rarely metastasizing endothelial neoplasm in the 2013 WHO Classification of Tumors of Soft Tissue and Bone. It is a tumor primarily of skin and soft tissue, with most reported cases involving the trunk or extremities.

Cannabis for Pediatric Epilepsy.

Epilepsy is a chronic disease characterized by recurrent unprovoked seizures. Up to 30% of children with epilepsy will be refractory to standard anticonvulsant therapy, and those with epileptic encephalopathy can be particularly challenging to treat. The endocannabinoid system can modulate the physiologic processes underlying epileptogenesis.

Apicoaortic Valve Conduit for a Patient with Aortic Valve Stenosis and Patent Coronary Bypass Grafts Using Cardiopulmonary Bypass.

In adults over 65 years of age, aortic valve stenosis has been found to be present in 2-9% within this group. Furthermore, aortic valve replacements in patients whom have had a previous coronary artery bypass grafting surgery have a mortality rate as high as 18%. A non-conventional effective surgical approach of bypassing the aortic valve by inserting an apicoaortic valve conduit (AVC) connecting the left ventricular apex to the descending thoracic aorta has been previously documented.

Safety Testing of Left Ventricular Vent Valves.

Vent vacuum relief valves (VRVs) are used to limit the negative pressure at the ventricular vent catheter tip as well as prevent reversal of blood flow and prevention of air embolism. The purpose of this study was to evaluate the performance of three commercially available ventricular vent valves. The negative pressure at which the vent valve opened was measured at the valve inlet using high-fidelity pressure transducers.

Predicting adult perfusion practice trends and the adoption of evidence-based practice.

In an effort to provide optimal patient care, perfusionists should rely on information provided by current research. Present statistics, however, document a substantial underuse of evidence-based clinical practice and therapies not only in perfusion, but throughout the entire medical field. This investigation applied a statistical method--binomial proportion analysis--to aid in uncovering the trends in perfusion practice from 2004 to 2011.

Persistent mosaicism for 12p duplication/triplication chromosome structural abnormality in peripheral blood.

We present a rare case of mosaicism for a structural abnormality of chromosome 12 in a patient with phenotypic features of Pallister-Killian syndrome. A six-month-old child with dysmorphic features, exotropia, hypotonia, and developmental delay was mosaic for both a normal karyotype and a cell line with 12p duplication/triplication in 25 percent of metaphase cells. Utilization of fluorescence in situ hybridization (FISH) identified three copies of probes from the end of the short arm of chromosome 12 (TEL(12p13) locus and the subtelomere (12p terminal)) on the structurally abnormal chromosome 12.

Transition from ECMO to left ventricular support via trans-septal cannula using a single CentriMag device.

A 67-year-old male presented in cardiogenic shock and multi-system organ failure requiring emergent venous-arterial extracorporeal membrane oxygenation (ECMO). He was deemed ineligible for heart transplantation and a left ventricular assist device (LVAD) was thought to be high risk due to persistent right heart failure. To determine if he could tolerate left ventricular support alone, a trans-septal cannula was placed via the left femoral vein.

A technique for autologous priming of the veno-venous bypass circuit during liver transplantation.

Orthotopic liver transplantations (OLT) have been associated with significant blood loss and hemodilution, necessitating significant homologous blood component replacement. Increasing administration of homologous blood products has been found to be inversely related to patient and graft survival. Various methods to reduce the amount of blood products patients receive during OLT, such as antifibrinolytic therapy, thromboelastography-guided transfusion, phlebotomy, reduced central venous pressures intraoperatively, and the use of the veno-venous bypass (VVB) circuit, have been explored.

Factors contributing to burnout among perfusionists in the United States.

Introduction: As the job climate continues to change, many perfusionists are faced with high employee turnover rates, working longer hours, and increased stress related to more complex surgeries. Understanding the sources of professional burnout and stress may allow the formulation of a strategy to help prevent such negative outcomes. The purpose of this study was to determine the current level of stress and burnout among perfusionists.

Incorporating high fidelity simulation into perfusion education.

The new Perfusion Simulation Center at the Medical University of South Carolina provides a new level of high fidelity simulation training for perfusion students. A key component is the Orpheus Perfusion Simulator which is a computer-driven simulator integrated with the mechanical connections of the heart-lung machine to allow for real time operative procedures and perfusion incidents. Due to the ability to consistently reproduce cardiac surgical scenarios, it is possible to develop both basic perfusion skills as well as advanced emergency skills more effectively than with animal models.

Gravity separation of pericardial fat in cardiotomy suction blood: an in vitro model.

Fat emboli generated during cardiac surgery have been shown to cause neurologic complications in patients postoperatively. Cardiotomy suction has been known to be a large generator of emboli. This study will examine the efficacy of a separation technique in which the cardiotomy suction blood is stored in a cardiotomy reservoir for various time intervals to allow spontaneous separation of fat from blood by density.

Trends and emerging technologies in extracorporeal life support: results of the 2006 ECLS survey.

Extracorporeal life support (ECLS) is a procedure used to support the failing heart and/or lungs via a heart lung machine. Over 145 institutions perform this practice in the United States with more than 24,000 ECLS cases recorded. While many articles are published each year on common perfusion practice, little information is shared on emerging technologies in ECLS and common practices among perfusionists and ECLS specialists.

Barriers to the acceptance and use of autologous platelet gel.

The process of producing and applying platelet concentrate (gel) to wounds has been shown by several researchers to accelerate healing and promote tissue regeneration in a broad spectrum of healthcare practices. Despite the evidence, widespread adoption of this technology has not occurred. The purpose of this research is to identify those factors acting as barriers to the adoption of platelet gel use.

Del(5q) is associated with clinical and histological parameters in small cell neuroendocrine lung carcinoma.

To elucidate the relationship between del(5q) and the clinical and histological features of small cell neuroendocrine lung carcinoma, 33 tissue samples from patients with this tumor were evaluated. By using fluorescence in situ hybridization, del(5q) was identified in almost 50% of cases (15/33, 45%). Clinically, patients with tumors showing del(5q) were older (mean age = 71 years) with a correspondingly greater pack-year smoking history (mean = 61) than patients with tumors (mean age = 59 years, mean pack-years = 44) without del(5q).

Early mortality following spontaneous intracerebral hemorrhage.

The authors reviewed the charts of 1,421 patients with cerebral hemorrhage to determine the cause of death. Limitation or withdrawal of life-sustaining interventions was the most common cause of death (68%) followed by brain death (28%). Neurologic reasons were the most common cause of delayed decisions to withdraw or limit therapy.

Mixing of dye in a model scald tank.

A model scald tank was constructed to study the mixing pattern of water in a poultry scalding system. Tank dimensions were approximately 6 m long by 10.5 cm wide with a water depth of 18 cm.