Peroral endoscopic myotomy for complex achalasia and the POEM difficulty score: An update.

Objectives: We present an update on the (peroral endoscopic myotomy (POEM) difficulty score [PDS] by introducing a novel knife with waterjet functionality.

Methods: This is a retrospective review of patients who underwent POEM between May 2018 and July 2023 at the Kingston Health Sciences Center. Demographic and procedural variables were compared using descriptive and inferential statistics.

Revisiting the Last Ice Area projections from a high-resolution Global Earth System Model.

The Last Ice Area-located to the north of Greenland and the northern Canadian Arctic Archipelago-is expected to persist as the central Arctic Ocean becomes seasonally ice-free within a few decades. Projections of the Last Ice Area, however, have come from relatively low resolution Global Climate Models that do not resolve sea ice export through the waterways of the Canadian Arctic Archipelago and Nares Strait. Here we revisit Last Ice Area projections using high-resolution numerical simulations from the Community Earth System Model, which resolves these narrow waterways.

Controlled temperature contrasts of three native and one highly invasive annual plant species in California.

Plant responses to changes in temperature can be a key factor in predicting the presence and managing invasive plant species while conserving resident native plant species in dryland ecosystems. Climate can influence germination, establishment, and seedling biomass of both native and invasive plant species. We tested the hypothesis that common and widely distributed native and an invasive plant species in dryland ecosystems in California respond differently to increasing temperatures.

Multiwavelength constraints on the origin of a nearby repeating fast radio burst source in a globular cluster.

The precise origins of fast radio bursts (FRBs) remain unknown. Multiwavelength observations of nearby FRB sources can provide important insights into the enigmatic FRB phenomenon. Here we present results from a sensitive, broadband X-ray and radio observational campaign of FRB 20200120E, the closest known extragalactic repeating FRB source (located 3.

Claim Suppression of Occupational Injuries and Illnesses Among Precariously Employed Immigrant Workers in Ontario.

Employers sometimes hinder the appropriate reporting of claims to workers' compensation, a phenomenon termed claim suppression. While the magnitude of claim suppression is difficult to quantify, various reports have identified it as a significant concern. In response, several Canadian jurisdictions, such as Ontario in 2015, introduced legislation addressing claim suppression.

Success and failure in establishing national physician databases: a comparison between Canada and Israel.

Physician databases constitute an essential component of health workforce planning. However, while some countries have established functioning national physician databases, others have failed to do so. We compared the healthcare systems of two technologically and economically developed countries, Canada and Israel, which represent cases of respective success and failure in establishing physician databases.

The long reach of adversity: Intermediary pathways from maternal adverse childhood experiences to child socio-emotional and cognitive outcomes.

Background: This longitudinal study with multi-informant (maternal, paternal, and experimenter) and multimethod (questionnaires, behavioral observations, and standardized assessments) data tests an intergenerational model from mothers' adverse childhood experiences (ACEs) to their children's socio-emotional and cognitive outcomes.

Methods: Participants were 501 children (50.7% male) and caregivers (56.

Multiomic analyses direct hypotheses for Creutzfeldt-Jakob disease risk genes.

Prions are assemblies of misfolded prion protein that cause several fatal and transmissible neurodegenerative diseases, with the most common phenotype in humans being sporadic Creutzfeldt-Jakob disease (sCJD). Aside from variation of the prion protein itself, molecular risk factors are not well understood. Prion and prion-like mechanisms are thought to underpin common neurodegenerative disorders meaning that the elucidation of mechanisms could have broad relevance.

Cardiovascular disease essential medicines listing by countries: changes over time and association with health outcomes.

Background: Since national essential medicine lists guide the procurement of medicines for populations in many countries, and cardiovascular diseases are the leading cause of death globally, including cardiovascular medicines on these lists can significantly impact healthcare outcomes.

Methods: In this cross-sectional study, national essential medicines' lists from 158 countries were analysed on whether or not they included medicines to treat ischemic heart disease, cerebrovascular disease, and hypertensive heart disease. A linear regression model was used to evaluate the association between countries' coverage scores and amenable mortality.

Normal variations of myocardial T1, T2 and T2* values at 1.5 T cardiac MRI in sex-matched healthy volunteers.

Purpose: The purpose of this study was to determine the normal variations of myocardial T1, T2, and T2* relaxation times on cardiac MRI obtained at 1.5 T in healthy, sex-balanced volunteers aged between 18 and 69 years.

Material And Methods: A total of 172 healthy volunteers were recruited prospectively.

Liberal/Individualized Versus Materialist/Structuralist Approaches to Addressing Social and Health Inequalities: Education and Income as Social Determinants of Health.

While consensus exists that the sources of health inequalities are social inequalities brought on by the experience of qualitatively different living and working conditions, means of addressing these conditions continue to be the subject of dispute. Whether to emphasis education or income as asocial determinant of health is one such example of differing views on the sources of these inequalities and the means of addressing them. These different emphases are often justified through the narrow examination of the magnitude of statistical relationships between educational attainment and income with health outcomes.

Decoding Cortical Folding Patterns in Marmosets Using Machine Learning and Large Language Model.

Macroscale neuroimaging results have revealed significant differences in the structural and functional connectivity patterns of gyri and sulci in the primate cerebral cortex. Despite these findings, understanding these differences at the molecular level has remained challenging. This study leverages a comprehensive dataset of whole-brain in situ hybridization (ISH) data from marmosets, with updates continuing through 2024, to systematically analyze cortical folding patterns.

The International Association for the Study of Lung Cancer Staging Project: The Database and Proposal for the Revision of the Staging of Pulmonary Neuroendocrine Carcinoma in the Forthcoming Ninth Edition of the TNM Classification for Lung Cancer.

Introduction: Pulmonary high-grade neuroendocrine carcinoma (NEC) includes small cell lung carcinoma (SCLC) and large cell neuroendocrine carcinoma (LCNEC). The seventh and eighth editions of the TNM classification for lung cancer confirmed the applicability of this staging system for SCLC. With the proposal of N2 and M1c subcategories for the ninth edition classification, we assessed the applicability to NECs.

Future directions in the evaluation and management of newly diagnosed metastatic cancer.

There is a much debate regarding optimal selection in patients with metastatic cancer who should undergo local treatment (surgery or radiation treatment) to the primary tumor and/or metastases. Additionally, the optimal treatment of newly diagnosed metastatic cancer is largely unclear. Current prognostication systems to best inform these clinical scenarios are limited, as all metastatic patients are grouped together as having Stage IV disease without further incorporation of patient and disease-specific covariates that significantly impact patient outcomes.

Global impact of 10- and 13-valent pneumococcal conjugate vaccines on pneumococcal meningitis in all ages: the PSERENADE project.

Background: Pneumococcal conjugate vaccines (PCVs) introduced in childhood national immunization programs lowered vaccine-type invasive pneumococcal disease (IPD), but replacement with non-vaccine-types persisted throughout the PCV10/13 follow-up period. We assessed PCV10/13 impact on pneumococcal meningitis incidence globally.

Methods: The number of cases with serotyped pneumococci detected in cerebrospinal fluid and population denominators were obtained from surveillance sites globally.

Targeting extracellular matrix components to attenuate microglia neuroinflammation: A study of fibulin-2 and CSPGs in a model of multiple sclerosis.

The extracellular matrix (ECM) plays an important role in the central nervous system (CNS), shaping tissue structure and functions as well as contributing to the pathology of chronic diseases such as multiple sclerosis (MS). ECM components, including fibulin-2 (FBLN2) and chondroitin sulfate proteoglycans (CSPGs), may impact neuroinflammation and remyelination. We investigated the capacity of FBLN2 to modulate immune responses and evaluated its interaction with CSPGs in experimental autoimmune encephalomyelitis (EAE), a common model for MS.

ISCT MSC committee statement on the US FDA approval of allogenic bone-marrow mesenchymal stromal cells.

The December 2024 US Food and Drug Administration (FDA) approval of Mesoblast's Ryoncil (remestemcel-L-rknd)-allogeneic bone marrow mesenchymal stromal cell (MSC(M)) therapy-in pediatric acute steroid-refractory graft-versus-host-disease finally ended a long-lasting drought on approved MSC clinical products in the United States. While other jurisdictions-including Europe, Japan, India, and South Korea-have marketed autologous or allogeneic MSC products, the United States has lagged in its approval. The sponsor's significant efforts and investments, working closely with the FDA addressing concerns regarding clinical efficacy and consistent MSC potency through an iterative process that spanned several years, was rewarded with this landmark approval.