Association of pain with frequency and magnitude of knee loading in knee osteoarthritis.

Objective: Although the relationship between pain and the magnitude of medial knee loading has been previously studied, the contribution of frequency of loading has not. The objective of this study was to determine whether the addition of loading frequency (steps/day) to loading magnitude (knee adduction moment [KAM] impulse) helps explain variance in knee pain in people with knee osteoarthritis (OA).

Methods: Participants were adults with symptomatic knee OA with radiographic signs in the medial knee compartment (n = 38, 10 women).

Comparison of clinical-pathologic characteristics and outcomes of true interval and screen-detected invasive breast cancer among participants of a Canadian breast screening program: a nested case-control study.

Background: Previous analyses of interval breast cancers have been limited because of a lack of control for screening interval length and patient age, failure to restrict the interval group to 'true' intervals, and incomplete descriptions of pathology, adjuvant therapies and clinical outcomes.

Patients And Methods: A nested case-control study within the population-based Nova Scotia Breast Screening Program was performed. All true interval cases between 1991 and 2004 were identified, matched 1:2 to screen-detected cases (age, screening interval, time period), and compared in terms of pathologic characteristics and adjuvant therapies via logistic regression.

Decolonization of methicillin-resistant Staphylococcus aureus during routine hospital care: Efficacy and long-term follow-up.

Background/objective: Methicillin-resistant Staphylococcus aureus (MRSA) colonization is associated with a significant risk of subsequent MRSA infection in the hospital setting. The use of decolonization as an infection control strategy remains highly controversial despite publications evaluating more than 40 different decolonization regimens over the past 60 years. The present study describes the benefits and potential drawbacks of such an approach in the patient population.

Tumour location as a predictor of benign disease in the management of renal masses.

Objective: To investigate the association between tumour location and the proportion of benign disease in renal masses presumed to be renal cell carcinoma (RCC) preoperatively.

Methods: This Institutional Review Board approved study includes 196 patients who underwent surgical treatment for renal masses <5 cm at our institution by a single surgeon between January 2002 and June 2009. Based on preoperative imaging, each mass was designated as central (touching or encroaching upon the renal collecting system and/or renal sinus) or peripheral.

Qualitative assessment of the emotional and behavioural responses of haemophilia A carriers to negative experiences in their medical care.

Previous discussions with haemophilia A (HA) carriers suggested that carriers may experience inappropriate care, resulting in poor relationships with healthcare providers (HCPs; principally physicians and nurses), and unfortunate and extreme emotional and behavioural responses. This was a qualitative study to explore medical experiences of HA carriers and their emotional and behavioural responses. Eleven HA carriers and five Haemophilia Treatment Centre nurses were interviewed.

Benefits of an international working exchange in pediatric cardiology.

This report describes a 1-year exchange between members of two pediatric cardiology centers: one in Canada and one in Australia. Five cardiologists participated in sequence, fully engaging in the activities of the host department. The motivation of the exchange was broadly educational including clinical experience, shared expertise, teaching, and research collaboration.

Cocaine-related retiform purpura: evidence to incriminate the adulterant, levamisole.

The term 'cocaine-induced pseudovasculitis' was coined to encompass a constellation of clinical and laboratory findings which mimics a systemic vasculitis but lacks confirmatory evidence of vasculitis on biopsy. Antineutrophil cytoplasmic antibodies reacting with human neutrophil elastase (HNE) have been reported to distinguish the cocaine-related syndrome from a true autoimmune vasculitis. Published cases of retiform purpura related to cocaine use are rare and an etiologic role for levamisole, a common adulterant of cocaine, has been postulated.

Keloidal and other collagen patterns in atypical fibroxanthomas.

Collagen deposition is observed in several cutaneous neoplasms and its derivation is variable. It can represent (1) a mesenchymal component of a biphasic tumor, (2) a desmoplastic host response to a neoplasm, or (3) a product of the tumor cells. The result is that collagenous (desmoplastic) variants of many cutaneous neoplasms are well recognized.

Preterm prelabour rupture of membranes with cervical cerclage: a review of perinatal outcomes with cerclage retention.

Cervical cerclage may be indicated in specific clinical situations in an attempt to reduce the risk of preterm delivery. Preterm prelabour rupture of membranes (PPROM) occurs sometimes in the presence of a cerclage, and these pregnancies are at substantial risk of adverse maternal, fetal, and neonatal outcomes that may be attributed to complications associated with infectious morbidity and preterm birth. The benefits of retaining a cerclage in situ with ruptured membranes are unclear.

Comparison between multiplex assays for autoantibody detection in systemic lupus erythematosus.

The performance of immunoassays for the detection of autoantibodies is of critical importance to the diagnosis and assessment of patients with systemic lupus erythematosus (SLE). Our objective was to compare 3 multiplexed assays for measurement of multiple autoantibodies and their association with global disease activity, active nephritis and cumulative organ damage in systemic lupus erythematosus (SLE). Stored sera, clinical and laboratory data from the enrollment visit of a long-term lupus registry were used.

Extensive neurocristic hamartoma with bone marrow involvement.

Cutaneous neurocristic hamartoma (NCH) is a rare, pigmented lesion consisting of cells that aberrantly develop from the neurocrest. In addition to a dermal melanocytic component, NCH can also harbor neurosustentacular and neuromesenchymal components. NCH has many features in common with other dermal melanocytic neoplasm, such as blue nevi.

Contemporary issues in refractory dyspnoea in advanced chronic obstructive pulmonary disease.

Purpose Of Review: Relieving dyspnoea when chronic obstructive pulmonary disease (COPD) no longer responds to disease-modifying therapy is challenging, with limited evidence to provide guidance. This review highlights recent advances that further our understanding and management of refractory dyspnoea in COPD, focusing on interventions that are considered beyond the conventional treatment of airflow obstruction/hyperinflation.

Recent Findings: Advances in functional brain imaging have improved our understanding of limbic system activation in dyspnoea, providing insight into potential for targeted treatments.

Meningococcal serogroup C conjugate vaccination in Canada: how far have we progressed? How far do we have to go?

Since routine meningococcal C conjugate vaccination was introduced into Canada in 2002, there have been a large regional variation in the routine programs, changes to the timing of the infant series in some provinces, and wide differences in catch-up programs. As immunization is viewed as a provincial responsibility, less attention has been paid to determining national coverage rates and the direct and indirect effects of the widely varying provincial/territorial vaccination programs on the nation as a whole. Canada's disjointed regional immunization campaigns leave the population at risk of disease for an extended length of time.

Measurement of self-reported pain intensity in children and adolescents.

Acute and chronic pain is a common experience in children and youth. A thorough assessment is fundamental to understand this experience and to assess and monitor treatment responses. The intensity of pain is the parameter most commonly assessed.

Research design considerations for confirmatory chronic pain clinical trials: IMMPACT recommendations.

There has been an increase in the number of chronic pain clinical trials in which the treatments being evaluated did not differ significantly from placebo in the primary efficacy analyses despite previous research suggesting that efficacy could be expected. These findings could reflect a true lack of efficacy or methodological and other aspects of these trials that compromise the demonstration of efficacy. There is substantial variability among chronic pain clinical trials with respect to important research design considerations, and identifying and addressing any methodological weaknesses would enhance the likelihood of demonstrating the analgesic effects of new interventions.

Protocols for the initial treatment of moderately severe juvenile dermatomyositis: results of a Children's Arthritis and Rheumatology Research Alliance Consensus Conference.

Objective: To use juvenile dermatomyositis (DM) survey data and expert opinion to develop a small number of consensus treatment protocols, which reflect current initial treatment of moderately severe juvenile DM.

Methods: A consensus meeting was held in Toronto, Ontario, Canada on December 1-2, 2007. Nominal group technique was used to achieve consensus on treatment protocols, which represented typical management of moderately severe juvenile DM.

Epidermal growth factor receptor (EGFR) in lung cancer: an overview and update.

Epidermal growth factor receptor is a trans-membrane glycoprotein with an extracellular epidermal growth factor binding domain and an intracellular tyrosine kinase domain that regulates signaling pathways to control cellular proliferation. Epidermal growth factor receptor binding to its ligand results in autophosphorylation by intrinsic tyrosine/kinase activity, triggering several signal transduction cascades. Constitutive or sustained activation of these sequences of downstream targets is thought to yield more aggressive tumor phenotypes.

Child and adolescent mental health policy and plans in Canada: an analytical review.

Objective: Child and adolescent mental disorders are common, with a substantial disease burden, yet services for young people are nationally inadequate. As services should be based on policies and (or) plans, we analyzed the availability and content of child and adolescent mental health policies and plans in all provinces and territories.

Method: The World Health Organization (WHO) framework for Child and Adolescent Mental Health Policy and Plans was applied.

Tracking the evolution and geographic spread of Influenza A.

The 2009 swine-origin strain of Influenza A H1N1 has spread to nearly all parts of the world, with 175 countries reporting confirmed cases thus far. Consistent with seasonal flu outbreaks, the current pandemic strain has shown rapid dispersal, with multiple examples of introduction into different geographic regions. Here we use an automated pipeline to collect data for analysis in the geospatial package GenGIS, which allows the geographic and temporal tracking of new sequence types and polymorphisms.

Juvenile dermatomyositis: advances in pathogenesis, evaluation, and treatment.

Juvenile dermatomyositis (JDM) is a rare, presumably autoimmune illness that causes proximal muscle weakness and a variety of typical cutaneous features. The study of this illness has been hampered by its rarity but, in recent years, important developments have increased our understanding of JDM. Genetic factors are likely important in the pathogenesis of JDM.

Demystifying neuropsychiatric lupus--is it possible?

The occurrence of nervous system events in patients with systemic lupus erythematosus (SLE) remains a diagnostic and therapeutic challenge due to the diversity of clinical manifestations, the correction attribution of events to SLE or other causes, and the lack of clinical trial data to facilitate the selection of treatment options. Over the past decade the classifcation and attribution of neuropsychiatric (NP) events has received more rigorous attention and new insights into the pathogenetic mechanisms have emerged through neuroimaging studies and elucidation of autoimmune and infammatory mechanisms. Although much work remains to be done on this complex and fascinating aspect of lupus, there is an emerging consensus on the pathogenesis and treatment of NP-SLE.

Measurement of autoantibodies using multiplex methodology in patients with systemic lupus erythematosus.

Autoantibodies are central to the diagnosis and assessment of systemic lupus erythematosus (SLE). A recent technique for the measurement of autoantibodies utilizes addressable laser bead immunoassay technology (BioPlex 2200) which permits the simultaneous detection of multiple autoantibodies and improved efficiency due to the shorter time to perform the assay and low volume of test samples and reagents. In the current study we have compared this technique to more traditional measures of autoantibody detection.

Palliation of dyspnoea in advanced COPD: revisiting a role for opioids.

Chronic obstructive pulmonary disease (COPD) will be the third leading cause of death worldwide by 2020. The burdens of this increasingly prevalent illness borne by patients, their family caregivers and the healthcare system are substantial. Dyspnoea as the predominant symptom becomes increasingly difficult to palliate as COPD progresses through advanced stages and, for 50% of patients, can become refractory to conventional treatment.

Heart failure clinics are associated with clinical benefit in both tertiary and community care settings: data from the Improving Cardiovascular Outcomes in Nova Scotia (ICONS) registry.

Background: Heart failure (HF) clinics are known to improve outcomes of patients with HF. Studies have been limited to single, usually tertiary centres whose experience may not apply to the general HF population.

Objectives: To determine the effectiveness of HF clinics in reducing death or all-cause rehospitalization in a real-world population.