Balloon dilation of the eustachian tube using endovascular balloon under local anesthesia-a case series and systematic literature review.

Objective: To report a novel technique in Balloon Dilation of Eustachian Tube (BDET) using an endovascular balloon (EVB), in a prospective cohort. The results are compared with reported outcomes using standard balloons.

Methods: Demographic information and clinical parameters were collected prospectively fora series of patients with obstructive eustachian tube dysfunction (OETD).

Antenatal corticosteroids and neurodevelopmental outcomes in late preterm births.

Objectives: Antenatal corticosteroids (ACS) decrease neonatal mortality and morbidity among preterm neonates, yet there has been concern regarding their long-term safety. We hypothesised that potential long-term adverse effects of ACS may be observed among infants born during the late preterm period (LPT, 34-36 weeks of gestation), when the benefits of ACS are subtle.

Design: Population-based, retrospective cohort.

Clinical Practice Guideline on Screening for Colorectal Cancer in Individuals With a Family History of Nonhereditary Colorectal Cancer or Adenoma: The Canadian Association of Gastroenterology Banff Consensus.

Background & Aims: A family history (FH) of colorectal cancer (CRC) increases the risk of developing CRC. These consensus recommendations developed by the Canadian Association of Gastroenterology and endorsed by the American Gastroenterological Association, aim to provide guidance on screening these high-risk individuals.

Methods: Multiple parallel systematic review streams, informed by 10 literature searches, assembled evidence on 5 principal questions around the effect of an FH of CRC or adenomas on the risk of CRC, the age to initiate screening, and the optimal tests and testing intervals.

Appetitive Symptoms Differentially Predict Treatment Response to Fluoxetine, Light, and Placebo in Nonseasonal Major Depression.

Objective: We previously reported that morning bright light therapy is efficacious in adults with nonseasonal major depressive disorder (MDD), both on its own and in combination with fluoxetine. Given that appetitive symptoms predict response to bright light therapy in seasonal depression, we examined, in this secondary analysis, whether the same held true in these nonseasonal MDD patients.

Methods: Data were collected from October 7, 2009, to March 11, 2014.

Rocuronium vs. succinylcholine for rapid sequence intubation: a Cochrane systematic review.

This systemic review was performed to determine whether rocuronium creates intubating conditions comparable to those of succinylcholine during rapid sequence intubation of the trachea. We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2015, Issue 2), MEDLINE (1966 to February Week 2 2015), and EMBASE (1988 to February 14 2015) for any randomised controlled trials or controlled clinical trials that reported intubating conditions comparing rocuronium and succinylcholine for rapid or modified rapid sequence intubation. The dose of rocuronium was at least 0.

Knowledge Translation Interventions to Improve the Timing of Dialysis Initiation: Protocol for a Cluster Randomized Trial.

Background: Early initiation of chronic dialysis (starting dialysis with higher vs lower kidney function) has risen rapidly in the past 2 decades in Canada and internationally, despite absence of established health benefits and higher costs. In 2014, a Canadian guideline on the timing of dialysis initiation, recommending an intent-to-defer approach, was published.

Objective: The objective of this study is to evaluate the efficacy and safety of a knowledge translation intervention to promote the intent-to-defer approach in clinical practice.

K48-linked KLF4 ubiquitination by E3 ligase Mule controls T-cell proliferation and cell cycle progression.

T-cell proliferation is regulated by ubiquitination but the underlying molecular mechanism remains obscure. Here we report that Lys-48-linked ubiquitination of the transcription factor KLF4 mediated by the E3 ligase Mule promotes T-cell entry into S phase. Mule is elevated in T cells upon TCR engagement, and Mule deficiency in T cells blocks proliferation because KLF4 accumulates and drives upregulation of its transcriptional targets E2F2 and the cyclin-dependent kinase inhibitors p21 and p27.

Regional and physician specialty-associated variations in the medical management of atherosclerotic renal-artery stenosis.

For people enrolled in Cardiovascular Outcomes in Renal Atherosclerotic Lesions (CORAL), we sought to examine whether variation exists in the baseline medical therapy of different geographic regions and if any variations in prescribing patterns were associated with physician specialty. Patients were grouped by location within the United States (US) and outside the US (OUS), which includes Canada, South America, Europe, South Africa, New Zealand, and Australia. When comparing US to OUS, participants in the US took fewer anti-hypertensive medications (1.

Denosumab for the prevention of skeletal complications in metastatic castration-resistant prostate cancer: comparison of skeletal-related events and symptomatic skeletal events.

Background: In a phase III trial in patients with castration-resistant prostate cancer (CRPC) and bone metastases, denosumab was superior to zoledronic acid in reducing skeletal-related events (SREs; radiation to bone, pathologic fracture, surgery to bone, or spinal cord compression). This study reassessed the efficacy of denosumab using symptomatic skeletal events (SSEs) as a prespecified exploratory end point.

Patients And Methods: Patients with CRPC, no previous bisphosphonate exposure, and radiographic evidence of bone metastasis were randomized to subcutaneous denosumab 120 mg plus i.

An assessment of dialysis provider's attitudes towards timing of dialysis initiation in Canada.

Background: Physicians' perceptions and opinions may influence when to initiate dialysis.

Objective: To examine providers' perspectives and opinions regarding the timing of dialysis initiation.

Design: Online survey.

Outcome study of brief relational-cultural therapy in a women's mental health center.

The current study is the first to evaluate the effectiveness of a brief relational-cultural model of therapy in a community-based mental health center for women. The study was distinctive in its use of a hybrid model that employed elements of randomized control and naturalistic design. Results showed that the entire treatment group of 91 women improved significantly on all eight outcome measures.

Patient adherence to aromatase inhibitor treatment in the adjuvant setting.

Improvements in adjuvant systemic therapy and detection of early disease have resulted in a decline of breast cancer death rates across all patient age groups in Canada. Non-adherence to adjuvant hormonal therapy in the setting of early breast cancer may significantly affect patient outcome. Factors associated with medication adherence are complex and may be patient-related, therapy-related, and health care provider-related.

Epidural anesthesia for Cesarean delivery in a patient with post-traumatic cervical syringomyelia.

Purpose: To illustrate the successful management of a patient with post-traumatic syringomyelia (PTS) and chronic pain syndrome who presented for elective Cesarean delivery under epidural anesthesia.

Clinical Findings: A 30-yr-old gravida 3 para 1 woman, with a known diagnosis of cervical PTS secondary to a whiplash injury sustained three years earlier, presented to the labour and delivery unit at 31 weeks' gestation. She had severe pain in the cervical and lumbar spine, motor and sensory deficits in the upper extremities, tender mass in her left trapezius muscle, and history of dizziness and syncopal episodes.

ISA247: quality of life results from a phase II, randomized, placebo-controlled study.

Background: Psoriasis is a chronic skin condition that can negatively affect a patient's quality of life (QoL), often hindering social functioning. ISA247, a novel psoriatic agent, has shown clinical efficacy in moderate to severe psoriasis sufferers, but its effect on QoL is currently not reported.

Objective: The objective of this study was to assess the effect of ISA247 on the QoL in patients with stable, plaque-type psoriasis.

Maternal obesity and the risk of placental vascular disease.

Introduction: While elevated maternal weight in early pregnancy is associated with a higher rate of preeclampsia, the risk of placental abruption and placental infarction is unknown.

Methods: We evaluated the risk of placental abruption, placental infarction, and preeclampsia in association with maternal weight quintile at approximately 17 weeks' gestation in 386 323 women with a singleton pregnancy who underwent maternal serum screening in Ontario.

Results: After adjusting for age, ethnicity, parity, diabetes mellitus, and tobacco use, the odds ratio (OR) for preeclampsia was 4.

Expression of c-kit in fibroepithelial lesions of the breast is a mast cell phenomenon.

The expression of c-kit, a protooncogene tyrosine kinase receptor (CD117), in phyllodes tumors of the breast has been the subject of recent investigations. We examined stromal c-kit expression by immunohistochemistry in 68 cases comprising fibroadenomas, fibroadenomas with cellular stroma, and benign, borderline, and malignant phyllodes tumors. Membrane staining was identified in the epithelium of 82% of cases, representing all diagnostic categories in the study.

Use of a collagen-sealing device in hepatic resection: a comparative analysis to standard resection technique.

Background: Blood transfusion has been reported as an independent risk factor for poor outcome after liver resection in spite of its well known benefits. Refinements in parenchymal dissection have been pursued to reduce blood loss and transfusion. A collagen-sealing device (CSD) has recently been touted as an alternative technique that aids in blood conservation.

Minimising blood loss and transfusion requirements in hepatic resection.

Background: Substantial blood loss and the requirement for blood transfusion remain major considerations for hepatic surgeons. We analysed the impact of a systematic protocol aimed at reducing intraoperative blood loss and homologous blood (HB) transfusion associated with hepatic resection.

Methods: Prospective clinical data were collected from 151 elective liver resections performed during the period between 1980 and 1999.

Comorbid depression and anxiety in later life: patterns of association, subjective well-being, and impairment.

Objective: Very little epidemiological work has examined comorbidity between depression and anxiety disorders in community-dwelling older adults, despite the fact these disorders are known to co-occur in younger adults and that this co-occurrence is associated with greater clinical severity. In this study, the authors examine psychiatric comorbidity and associated impairment of four disorders (major depression, panic disorder, social phobia, and agoraphobia) in a community-based sample of adults aged 55 and older.

Setting: Population-based sample of older adults (N=12,792) from the Canadian Community Health Survey-Mental Health and Well-Being (CCHS 1.

Cancer therapy disparity: unequal access to breast cancer therapeutics and drug funding in Canada.

Adjuvant therapy has made a significant contribution in reducing breast cancer-specific mortality. Standard chemotherapeutics and tamoxifen have been the mainstay treatment for years, but recent clinical evidence supports the use of novel small-molecule therapy and aromatase inhibitor therapy in selected settings, challenging not only the traditional paradigm of breast cancer treatment, but also provincial funding of oncologic care across Canada. The disparity in access to aromatase inhibitor therapy for postmenopausal women with early-stage hormone-sensitive breast cancer across Canada is highlighted as an example.

Oral fluoroquinolones in the treatment of pneumonia, bronchitis and sinusitis.

Background: Despite a relatively large number of clinical studies comparing oral fluoroquinolones to one antibiotic class comparator, there is limited information on the relative efficacy of different fluoroquinolones.

Objective: To examine the efficacy and tolerability of oral fluoroquinolones in the treatment of mild to moderate community-acquired pneumonia, acute exacerbations of chronic bronchitis and sinusitis.

Methods: A systematic review was undertaken with a MEDLINE search for antibiotics and indications.

Combined topical and oral antimicrobial therapy for the eradication of methicillin-resistant Staphylococcus aureus (MRSA) colonization in hospitalized patients.

Objective: How to eradicate methicillin-resistant Staphylococcus aureus (MRSA) colonization in hospitalized patients is uncertain. We reviewed our experience with MRSA decolonization therapy in hospitalized patients.

Setting: An 1100-bed, university-affiliated tertiary care teaching hospital in Toronto, Ontario.

A national survey of antimicrobial prophylaxis in adult cardiac surgery across Canada.

Objective: To characterize national and regional patterns of antimicrobial prophylaxis in adult cardiac surgery across Canada.

Design: Retrospective, cross-sectional analysis.

Setting: Thirty-three adult cardiac surgical centres across Canada.

Microbiological surveillance and parenteral antibiotic use in a critical care unit.

Objective: To evaluate parenteral antibiotic utilization and bacterial resistance patterns in a critical care unit (CrCU).

Design: Descriptive, prospective audit of infection site, culture and antimicrobial susceptibility test results, parenteral antibiotic usage and duration, total antibiotic acquisition costs, and length of stay.

Setting: A 17-bed medical-surgical CrCU in a tertiary care teaching hospital in Metropolitan Toronto.