Task activation results in regional C-lactate signal increase in the human brain.

Hyperpolarized-C magnetic resonance imaging (HP-C MRI) was used to image changes in C-lactate signal during a visual stimulus condition in comparison to an eyes-closed control condition. Whole-brain C-pyruvate, C-lactate and C-bicarbonate production was imaged in healthy volunteers (N = 6, ages 24-33) for the two conditions using two separate hyperpolarized C-pyruvate injections. BOLD-fMRI scans were used to delineate regions of functional activation.

Prognostic value of MR visibility/invisibility in men on Active Surveillance.

Objective: We sought to determine, in a prospective long term cohort, the prognostic value of negative MR imaging with respect to upgrading and need for intervention in men on AS.

Method: A long term prospective single centre study of men on Active surveillance with MR imaging. Primary outcome was upgrading on biopsy and rate of intervention.

Frequency of Missing TNM Stage Data for Adults With Intellectual or Developmental Disabilities in a Provincial Cancer Registry-A Brief Report.

Background: Adults with intellectual or developmental disability (IDD) are at higher risk for incomplete cancer staging.

Aim: To compare unknown stage data between those with and without IDD.

Materials And Methods: We used the Ontario Cancer Registry linked to administrative health data between 2007 and 2019.

Minimally invasive measurement of carotid artery and brain temperature in the mouse.

Purpose: Brain temperature is tightly regulated and reflects a balance between cerebral metabolic heat production and heat transfer between the brain, blood, and external environment. Blood temperature and flow are critical to the regulation of brain temperature. Current methods for measuring in vivo brain and blood temperature are invasive and impractical for use in small animals.

Preferred labels and language to improve communication about lesions at low risk of progressing to cancer: qualitative interviews with patients and physicians.

Objectives: We explored how to improve communication about low-risk lesions including labels, language and other strategies.

Design: Qualitative description and thematic analysis to examine the transcripts of telephone interviews with patients who had low-risk lesions and physicians; and mapping to Communication Accommodation Theory to interpret themes.

Setting: Canada PARTICIPANTS: 15 patients: 6 (40%) bladder, 5 (33%) prostate and 4 (27%) cervix lesions; and 13 physicians: 7 (54%) cervix, 3 (23%) bladder and 3 (23%) prostate lesions.

Cost-Effectiveness of Breast Cancer Screening Using Digital Mammography in Canada.

Importance: Evolving breast cancer treatments have led to improved outcomes but carry a substantial financial burden. The association of treatment costs with the cost-effectiveness of screening mammography is unknown.

Objective: To determine the cost-effectiveness of population-based breast cancer screening in the context of current treatment standards.

Predefined and data-driven CT radiomics predict recurrence-free and overall survival in patients with pulmonary metastases treated with stereotactic body radiotherapy.

Background: This retrospective study explores two radiomics methods combined with other clinical variables for predicting recurrence free survival (RFS) and overall survival (OS) in patients with pulmonary metastases treated with stereotactic body radiotherapy (SBRT).

Methods: 111 patients with 163 metastases treated with SBRT were included with a median follow-up time of 927 days. First-order radiomic features were extracted using two methods: 2D CT texture analysis (CTTA) using TexRAD software, and a data-driven technique: functional principal components analysis (FPCA) using segmented tumoral and peri-tumoural 3D regions.

Development of a National Colorectal Cancer Screening Research Agenda: An Initiative of the Canadian Screening for Colorectal Cancer Research Network (CanSCCRN).

The Canadian Screening for Colorectal Cancer Research Network (CanSCCRN) recently set out to develop a national CRC screening research agenda and identify priority research areas. The specific objectives were to (1) identify evidence gaps relevant to CRC screening and the barriers and facilitators to evidence generation and uptake by CRC screening programs, (2) establish high-priority collaborative research ideas to inform best CRC screening practices, and (3) identify one to two research topics for grant development and submission within 12 to 18 months. Three focus groups were conducted with network members and relevant parties ( = 15) to identify evidence gaps, barriers, and facilitators to evidence generation and uptake.

Management of Ductal Carcinoma In Situ: An Ontario Health (Cancer Care Ontario) Clinical Practice Guideline.

(1) Background: To make recommendations on the most effective therapy options for Ductal Carcinoma of the Breast (DCIS) patients; (2) Methods: MEDLINE, EMBASE, Cochrane Library, PROSPERO databases, and main relevant guideline websites were searched. Draft versions of the guideline went through formal internal and external reviews, with a final approval by the Program in Evidence Based Care and the DCIS Expert Panel. The Grading of Recommendations, Assessment, Development, and Evaluation approach was followed; (3) Results: Based on the current evidence from the systematic review and this guideline authors' clinical opinions, initial draft recommendations were developed to improve the management of patients with DCIS.

Lung Cancer and COPD: Opportunities to Leverage Lung Cancer Screening Programs to Improve COPD Diagnostics.

Lung cancer and chronic obstructive pulmonary disease (COPD) have many shared risk factors and not surprisingly, the two diseases often coexist. This article highlights the burden of COPD among patients with lung cancer in Ontario and explores opportunities to enhance lung cancer screening programs. We propose pursuing integrated strategies that incorporate new advances in artificial intelligence to improve disease diagnostics and navigate the complexity of caring for people with coexisting lung diseases.

The incidence of pancreatic cancer in women with a BRCA1 or BRCA2 mutation.

Background: The lifetime risk of pancreatic cancer in women with a germline mutation in BRCA1 and BRCA2 is not well established. In an international prospective cohort of female carriers of BRCA1 and BRCA2 mutations, the cumulative incidence of pancreatic cancer from age 40 until 80 years was estimated.

Methods: A total of 8295 women with a BRCA1 or BRCA2 mutation were followed for new cases of pancreatic cancer.

Comparative Safety and Effectiveness of Bevacizumab Biosimilars to Originator for the Treatment of Metastatic Colorectal Cancer.

Background: Ontario has publicly funded biosimilar bevacizumab for first-line metastatic colorectal cancer (mCRC) since 2019. Clinical trials demonstrate comparable efficacy and safety of bevacizumab biosimilars to originator bevacizumab. The objective of this study was to assess real-world safety and effectiveness of the implementation of bevacizumab biosimilars compared with originator bevacizumab in patients with mCRC.

Guidance for Canadian Breast Cancer Practice: National Consensus Recommendations for Clinical Staging of Patients Newly Diagnosed with Breast Cancer.

The accurate staging of breast cancer is fundamental for guiding treatment decisions and predicting patient outcomes. However, there can be considerable variation in routine clinical practice based on individual interpretation of guidelines and depending on the healthcare provider initially involved in working up patients newly diagnosed with breast cancer, ranging from primary care providers, triage nurses, surgeons, and/or oncologists. The optimal approach for clinical staging, particularly in asymptomatic patients presenting with intermediate-risk disease, remains a topic of dialogue among clinicians.

Update on Practical Management of Early-Stage Non-Small Cell Lung Cancer (NSCLC): A Report from the Ontario Forum.

Therapeutic strategies for early-stage non-small cell lung cancer (NSCLC) are advancing, with immune checkpoint inhibitors (ICIs) and targeted therapies making their way into neoadjuvant and adjuvant settings. With recent advances, there was a need for multidisciplinary lung cancer healthcare providers from across Ontario to convene and review recent data from practical and implementation standpoints. The focus was on the following questions: (1) To what extent do patient (e.

Guidance for Canadian Breast Cancer Practice: National Consensus Recommendations for the Systemic Treatment of Patients with HER2+ Breast Cancer in Both the Early and Metastatic Setting.

Human epidermal growth factor receptor 2-positive (HER2+) breast cancer is an aggressive subtype of breast cancer associated with a poor prognosis when sub-optimally treated. Recent advances include new and effective targeted therapies that have significantly improved outcomes for patients. Despite these advances, there are significant gaps across Canada, underscoring the need for evidence-based consensus guidance to inform treatment decisions.

Health Care Utilization After a Visit to a Within-Group Family Physician vs a Walk-In Clinic Physician.

Purpose: Primary care access is a key health system metric, but little research has compared models to provide primary care access when one's regular physician is not available. We compared health system use after a visit with a patient's own family physician group (ie, within-group physician who was not the patient's primary physician) vs a visit with a walk-in clinic physician who was not part of the patient's family physician group.

Methods: We conducted a population-based, retrospective cohort study using administrative data from Ontario, Canada, including all individuals formally enrolled with a family physician, from April 1, 2019 to March 31, 2020.

Spine Stereotactic Body Radiation Therapy in Geriatric Patients: Implications of Age and Dose on Iatrogenic Vertebral Compression Fracture Risk.

Purpose: Stereotactic body radiation therapy (SBRT) is an effective treatment for spinal metastases; however, outcomes specific to a geriatric population have not been described. This study aims to investigate the efficacy and safety of spine SBRT, in particular the rate of iatrogenic vertebral compression fracture (VCF), in patients aged 70 and older.

Patients And Methods: From a prospectively maintained single-institutional database of 976 patients and 2407 spinal segments treated with SBRT for vertebral metastases between 2008 and 2021, all patients aged 70 or above were retrospectively reviewed.

Supportive care strategies in myelodysplastic syndromes and acute myeloid leukemia in older adults: a national survey of Canadian hematologists.

Myelodysplastic syndromes (MDS) and acute myeloid leukemia (AML) are severe myeloid disorders associated with significant morbidity and mortality. Because of patient and disease factors, many older adults are treated as outpatients with less-intensive therapy. Optimal supportive care strategies to minimize bleeding and infectious complications in this patient population have not been systematically evaluated.

Effect of fragmentation of surgery and adjuvant treatment in high-grade nonendometrioid endometrial cancer: a population-based cohort study.

Background: Fragmented care (FC) occurs when patients receive treatment across several different hospitals. Regionalization of surgery for patients with high-grade endometrial cancer means that patients must travel longer distances to receive care; these patients often require adjuvant treatment after surgery.

Objective: To determine whether the fragmentation of surgery and adjuvant treatment impacts survival in patients with high-grade nonendometrioid endometrial cancer.

Surgical Margin Definition and Assessment in Head and Neck Oncology: A Cross-Sectional Survey of Canadian Head and Neck Surgeons.

Importance: Head and neck squamous cell carcinomas (HNSCC) are responsible for a significant amount of morbidity and mortality in Canada. Surgical margins are one of the most important factors used to guide treatment; however, currently there is a lack of consensus on the ideal surgical margin definition, sampling, and assessment method.

Objective: To understand the current perspectives and practice patterns of Canadian head and neck surgeons with respect to surgical margin: (1) definition, (2) sampling, (3) pathological assessment.

STRIVE pilot trial: a protocol for a multicentre pragmatic internal pilot randomised controlled trial of Structured TRaining to Improve fitness in a Virtual Environment (STRIVE) before surgery.

Introduction: Home-based, virtually-supported care models may represent the most efficient and scalable approach to delivering prehabilitation services. However, virtual approaches to prehabilitation are understudied. This manuscript describes the protocol for an internal pilot randomised controlled trial of a virtually-delivered, multimodal prehabilitation intervention.

White matter microstructure in obesity and bipolar disorders: an ENIGMA bipolar disorder working group study in 2186 individuals.

Although specific risk factors for brain alterations in bipolar disorders (BD) are currently unknown, obesity impacts the brain and is highly prevalent in BD. Gray matter correlates of obesity in BD have been well documented, but we know much less about brain white matter abnormalities in people who have both obesity and BD. We obtained body mass index (BMI) and diffusion tensor imaging derived fractional anisotropy (FA) from 22 white matter tracts in 899 individuals with BD, and 1287 control individuals from 20 cohorts in the ENIGMA-BD working group.