Peak Inspiratory Flow and Inhaler Prescription Strategies in a Specialized COPD Clinical Program: A Real-World Observational Study.

Background: COPD inhaler regimens should be appropriate for the patient's peak inspiratory flow (PIF) and should ideally consist of single or similar device(s).

Research Questions: In a subspecialized COPD clinic: (1) What is the prevalence of patients with suboptimal PIF and with inappropriate device(s) for measured PIF? (2) Are there patient-related risk factors associated with suboptimal PIF? (3) What is the prevalence of patients with non-single inhaler therapy (SIT)/nonsimilar devices? (4) Does point-of-care PIF affect clinical decision-making?

Study Design And Methods: In this single-center real-world observational study, PIF was measured systematically at every outpatient visit in a subspecialized COPD clinic, and point-of-care results were provided to the clinician. Coprimary outcomes were the prevalence of outpatients with suboptimal PIF and with inappropriate devices for measured PIF.

Embolization of a pseudoaneurysm of the innominate artery with a Woven EndoBridge (WEB) device.

The Woven EndoBridge (WEB) is an intra-aneurysmal flow disruptor designed for the treatment of broad-based arterial aneurysms with a high safety and effectiveness profile. It does not require concomitant antiplatelet therapy compared to other devices such as flow diverters or intracranial stents. Innominate artery pseudoaneurysms are a rare consequence of blunt traumatic injury, infection, or atherosclerotic disease.

The COVID-19 Pandemic and Coronary Angiography for ST-Elevation Myocardial Infarction, Use of Mechanical Support, and Mechanical Complications in Canada: A Canadian Association of Interventional Cardiology National Survey.

Background: As a result of the COVID-19 pandemic first wave, reductions in ST-elevation myocardial infarction (STEMI) invasive care, ranging from 23% to 76%, have been reported from various countries. Whether this change had any impact on coronary angiography (CA) volume or on mechanical support device use for STEMI and post-STEMI mechanical complications in Canada is unknown.

Methods: We administered a Canada-wide survey to all cardiac catheterization laboratory directors, seeking the volume of CA use for STEMI performed during the period from March 1 2020 to May 31, 2020 (pandemic period), and during 2 control periods (March 1, 2019 to May 31, 2019 and March 1, 2018 to May 31, 2018).

Pro-inflammatory adiponectin in pediatric-onset multiple sclerosis.

Background: Being obese is associated with both increased risk of developing multiple sclerosis (MS) and greater MS disease activity.

Objectives: The objective of this study is to investigate levels and potential pathophysiologic contribution of serum adipose-hormones (adipokines) in pediatric-onset MS.

Methods: Following a Luminex adipokine screen, adiponectin (APN) and its isoforms were quantified by enzyme-linked immunosorbent assay (ELISA) in 169 children with incident acquired demyelinating syndromes (ADS), prospectively ascertained as having either MS or other forms of inflammatory central nervous system (CNS) demyelination.

Greater trochanteric pain after primary total hip replacement, comparing the anterior and posterior approach: A secondary analysis of a randomized trial.

Background: Greater trochanteric pain (GTP) after total hip replacement is a common cause of residual lateral hip pain, regardless of the approach used. The goal of our study was to evaluate GTP after a direct anterior approach (DAA) compared to a posterior approach (PA) as well as the clinical outcomes of both approaches and answer the following: 1) What is the incidence of trochanteric pain after primary THA with two different surgical approaches? 2) What is the functional outcome of patients with GTP? 3) What proportion of patients with GTP resort to peritrochanteric injections?

Hypothesis: Our hypothesis is that GTP is present with both approaches but satisfaction is lower with the PA.

Patients And Methods: A secondary analysis of a previously published clinical trial with 55 total hip arthroplasty patients randomized in one of two surgical approaches: 27 patients underwent the anterior modified Hueter approach, while the other group of 28 patients were operated using the posterior approach.

Direct anterior versus posterior approach for total hip arthroplasty: a multicentre, prospective, randomized clinical trial.

Background: The ideal approach for a total hip arthroplasty (THA) would be kind to soft tissues, have the lowest complication rates and be easily reproducible. Although there have been several attempts to find the best approach for THA in the last decade, a definitive answer has not been found. We performed a prospective study to compare the direct anterior and posterior approaches for THA in terms of hospital length of stay, functional outcome, pain, implant position, complications and surgical time.

MRI characterization of focal liver lesions in non-cirrhotic patients: assessment of added value of gadoxetic acid-enhanced hepatobiliary phase imaging.

Background: To evaluate the added value of the hepatobiliary (HPB) phase in gadoxetic acid-enhanced magnetic resonance imaging (MRI) in characterizing newly discovered indeterminate focal liver lesions in non-cirrhotic patients.

Results: One-hundred and twenty-five non-cirrhotic patients (median age, 46 years; range, 20-85 years; 100 females) underwent gadoxetic acid-enhanced MRI, including the 20-min delayed HPB phase, for characterization of newly discovered focal liver lesions. Images were independently evaluated by two blinded, board-certified abdominal radiologists (R1 and R2) who characterized liver lesions without and with assessment of the HPB phase images in two separate readout sessions.

Fixation of Anteromedial Coronoid Facet Fractures: A Biomechanical Evaluation of Plated Versus Screw Constructs.

Objective: To examine the stability of plate (locking and non-) versus screw constructs in the fixation of these fractures.

Methods: An anteromedial coronoid facet fracture (OTA/AO type 21-B1, O'Driscoll type 2, subtype 3) was simulated in 24 synthetic ulna bones that were then assigned to 3 fracture fixation groups: non-locking plate, locking plate (LP), or screw fixation. Each construct was first cycled in tension (through a simulated medial collateral ligament) and then in compression.

Clinical IR in Canada: The Evolution of a Revolution.

Purpose: To investigate the current status and evolution of both the interventional radiologist's role as a clinician and the practice of interventional radiology (IR) over the past decade in Canada.

Materials And Methods: In 2015, an online survey was e-mailed to 210 interventional radiologists, including all Canadian active members of the Canadian Interventional Radiology Association (CIRA) and nonmembers who attended CIRA's annual meeting. Comparisons were made between interventional radiologists in academic versus community practice.

The dynamic response characteristics of traumatic brain injury.

Traumatic brain injury (TBI) continues to be a leading cause of morbidity and mortality throughout the world. Research has been undertaken in order to better understand the characteristics of the injury event and measure the risk of injury to develop more effective environmental, technological, and clinical management strategies. This research used methods that have limited applications to predicting human responses.

Traumatic brain injuries: the influence of the direction of impact.

Background: Head impact direction has been identified as an influential risk factor in the risk of traumatic brain injury (TBI) from animal and anatomic research; however, to date, there has been little investigation into this relationship in human subjects. If a susceptibility to certain types of TBI based on impact direction was found to exist in humans, it would aid in clinical diagnoses as well as prevention methods for these types of injuries.

Objective: To examine the influence of impact direction on the presence of TBI lesions, specifically, subdural hematomas, subarachnoid hemorrhage, and parenchymal contusions.

Characterization of persistent concussive syndrome using injury reconstruction and finite element modelling.

Concussions occur 1.7 million times a year in North America, and account for approximately 75% of all traumatic brain injuries (TBI). Concussions usually cause transient symptoms but 10 to 20% of patients can have symptoms that persist longer than a month.

The influence of acceleration loading curve characteristics on traumatic brain injury.

To prevent brain trauma, understanding the mechanism of injury is essential. Once the mechanism of brain injury has been identified, prevention technologies could then be developed to aid in their prevention. The incidence of brain injury is linked to how the kinematics of a brain injury event affects the internal structures of the brain.

Revision total knee arthroplasty: clinical outcome comparison with and without the use of femoral head structural allograft.

The use of femoral head structural allograft (FHSA) for the management of massive bony defects during revision total knee arthroplasty (TKA) is well documented in the literature. The purpose of this study was to compare the clinical outcomes of patients undergoing revision (TKA) with FHSA to those without. All patients undergoing revision TKA between January 2000 and August 2005 were reviewed.

Cement-in-cement femoral revision for the treatment of highly selected vancouver B2 periprosthetic fractures.

The use of the cement-in-cement technique for femoral component revisions has been well described. The application of this technique in the management of selected Vancouver B2 periprosthetic femur fractures, after careful preoperative and intraoperative evaluation, offers a novel alternative that is rapid and technically less demanding, with resulting decreased blood loss and decreased risk of iatrogenic fragmentation of bone during cement removal.

Conversion of hip arthrodesis to total hip arthroplasty: survivorship and clinical outcome.

This study evaluated survivorship and clinical outcomes of patients undergoing conversion of a hip arthrodesis to a total hip arthroplasty (THA) and compared them to 2 patient cohorts: primary THA and first-time revision THA. Patients completed 5 standardized outcome questionnaires. The study cohort was compared to matched groups of primary THA and first-time revision THA patients.

Modification of the sagittal split osteotomy of the mandibular ramus: mobilizing vertical osteotomy of the internal ramus segment.

Purpose: We describe a new surgical procedure to improve stability when counterclockwise rotation of the maxillomandibular complex and the occlusal plane is intended.

Patients And Methods: This preliminary prospective study evaluated 10 patients (8 female patients and 2 male patients) who each underwent maxillomandibular surgical advancement with counterclockwise rotation of the occlusal plane. A mandibular counterclockwise rotation was done in all cases with bilateral ramus sagittal split osteotomy.

Enhanced external counterpulsation in the treatment of chronic refractory angina: a long-term follow-up outcome from the International Enhanced External Counterpulsation Patient Registry.

Background: The management of patients who suffer from medically refractory angina and are unsuitable for conventional revascularization therapy is often unsatisfactory. Enhanced external counterpulsation (EECP) is a noninvasive treatment that is safe and effective immediately after a course of treatment. However, the duration of benefit is less certain.

Development of a measure of the concerns held by people with implanted cardioverter defibrillators: the ICDC.

Objectives: To develop a questionnaire to measure the extent and severity of the concerns of people with an implanted cardioverter defibrillator.

Design: Items were generated from patient interviews, expert review and the research literature on patients' worries and concerns. A pilot version was administered to a series of ICD patients and repeated for test-retest reliability 6 weeks later.

Preliminary experience with the use of insulin lispro in pregnant diabetic women.

Insulin lispro (IL) possesses characteristics (decreased hypoglycaemia, greater convenience in timing of administration and better post-prandial glucose control) which may favour its use in women with diabetes. We report pregnancy outcomes in seven women with Type I diabetes treated with IL. Mean age was 30 years (2241), duration of diabetes from 3 to 21 years.

Clinical trials update from the European Society of Cardiology: CARMEN, EARTH, OPTIMAAL, ACE, TEN-HMS, MAGIC, SOLVD-X and PATH-CHF II.

This article continues a series of reports on research developments related to the field of heart failure. Reports of presentations made at the Hot Line sessions of the European Society of Cardiology XXIV Congress held in Berlin, Germany, between 31 August and 4 September 2002 are included. Summaries of the results of the following trials are presented: CARMEN, EARTH, OPTIMAAL, ACE, TEN-HMS, MAGIC, SOLVD-X and PATH-CHF II.

Quantitative gated SPECT: the effect of reconstruction filter on calculated left ventricular ejection fractions and volumes.

Gated SPECT (GSPECT) offers the possibility of obtaining additional functional information from perfusion studies, including calculation of left ventricular ejection fraction (LVEF). The calculation of LVEF relies upon the identification of the endocardial surface, which will be affected by the spatial resolution and statistical noise in the reconstructed images. The aim of this study was to compare LVEFs and ventricular volumes calculated from GSPECT using six reconstruction filters.

Optimization of the step-and-shoot leaf sequence for delivery of intensity modulated radiation therapy using a variable division scheme.

To deliver an intensity modulated radiation therapy (IMRT) plan by multileaf collimator (MLC) it is necessary to convert beam profiles, generated from the inverse treatment planning algorithm, into a series of instructions that the MLC control system can execute. An idealized IMRT beam profile can be regarded as a continuously varying two-dimensional function and is usually represented by an intensity map, i.e.