- ItemOpen AccessSurvival of Patients with Hepatooellular Carcinoma In Manitoba after the introduction of Transarterial Chemoembollzation(2022-08-03) Baker, Amelia; Bailey, Cassano; Nashed, MagedHepatocellular carcinoma (HCC) is the most common type of primary liver tumor. It is the second fastest growing cancer in incidence. The 5 year survival in Manitoba for those dignosed between 2011 and 2015 was 14%. This poor outcome was thought to be due to lack of treatment options. The aims of this study were to look at changes in survival after the Introduction of Transarterial Chemoembolization (T ACE) and to study the characteristics of three groups; those who received curative treatment, those who received noncurative treatment, and those who received supportive care. This was a retrospective study of patients diagnosed between 2011 and 2019 and Included 572 patients. There has been a significant improvement in survival from 2011 to 2019. The 5 year OS has increased from 14% to 21% between the 2011 to 2015 and the 2011 to 2019 cohorts . Patients with ascites, portal vein thrombosis or multiple focal disease are significantly more likely to .get supportive care only. Therefore, early identification and maintenance of liver function are paramount to providing curative and noncurative treatments . Cirrhosis and portal hypertension do not affect treatment options . Consequently, primary care providers should be aware that cirrhosis and portal hypertension do not exclude their patients from treatment In conclusion , our study indicates that adopting new proven treatments has a positive effect on survival of patients. Additionally, developing provincial guidelines that include clear criteria for use of local therapies ls likely to continue the trend of Improving survival.
- ItemOpen AccessEnhanced Cutaneous Wound Closure via Adipose-Derived Stem Cell Paracrine Signaling(2022-08-03) Kerr, EvanChronic non-healing cutaneous wounds drastically reduce the quality of life for afflicted patients and costs healthcare systems over $50 billion annually. Clinical management of these wounds remains a challenge as current treatments are of limited efficacy. Recently, research in stem cell therapies for wound healing has started to gain more momentum. The aim of this study was to demonstrate that the stromal vascular fraction (SVF), which contains adipose-derived stem cells (ADSC), could accelerate keratinocyte wound closure without direct cell-cell contact and to identify potential cytokines, chemokines and growth factors involved. In-vitro wound closure assays were set up using primary human epidermal keratinocytes, primary (P0) SVF obtained from patients' fat grafts and their matching passaged (P3) SVF. SVF cells were plated on porous membranes of transwell inserts that prevent cell migration while allowing free diffusion of secreted proteins. Keratinocytes were placed in the bottom chamber with a scratch to simulate wound area. Scratch areas were monitored for 36h and following wound closure, media from each well was harvested and analyzed using a panel of 71 different cytokines, chemokines, and growth factors. Our results show that wound closure was accelerated 1.5-fold with P0-SVF and nearly 2-fold with P3-SVF compared to controls. Additionally, six cytokines were significantly upregulated in SVF-keratinocyte cultures during wound closure, namely; IL-6, IL-8, ENA-78, G-CSF, GRO-α, and MCP-1. Identification of secreted factors responsible for the acceleration of wound healing is the first step toward designing a standardized cell-free therapy to treat millions of patients with chronic non-healing wounds annually
- ItemOpen AccessIdentification of whole body impedance cardiography-derived hemodynamic parameters associated with outcomes in heart failure patients with reduced ejection fraction(2022-08-04) Valcourt, Emelissa; Shah, Ashish; Ravandi, AmirHeart failure (HF) affects over 600,000 Canadians and causes over 45,000 hospitalizations annually. Patients with new-onset HF are referred to an outpatient HF clinic where they are categorized into risk groups based heavily on subjective symptoms and occurrence of poor outcomes, which impacts management and follow-up. Regardless, mortality remains high in chronic HF, with approximately 32% and 64% of patients succumbing to their illness by 1 year and 5 years, respectively. Thus, earlier identification of high-risk HF patients is warranted to prevent poor outcomes, including death. Non-Invasive Cardiac System (NICaS) is a validated technology, which uses whole body impedance cardiography to measure hemodynamic parameters. In this study, we evaluated whether hemodynamic parameters measured at rest and post-exercise by NICaS could be used to predict outcomes in patients HF with reduced ejection fraction (HFrEF). A cohort of 65 HFrEF patients was recruited and NICaS-derived parameters were taken at rest and after up to 12 minutes of exercise on a mounted ergometer. At 6-month follow-up, subjects who experienced poor outcomes, including HF hospitalizations and death, demonstrated lower resting cardiac power index (CPI) when supine and lower resting stroke index (SI) when seated. In addition, patients with poor outcomes demonstrated increased augmentation of Granov-Goor Index (GGI), a surrogate marker of ejection systolic time. Thus, resting and/or exercise-augmented NICaS-derived hemodynamic measurements demonstrate potential to identify high-risk HF patients in the HF clinic. Early identification of high-risk patients may enable early intervention and optimal follow-up to prevent unplanned hospitalization and mortality.
- ItemOpen AccessFunctional Disability to Evaluate the Risk of Arthritis in First-degree Relatives of Patients With Rheumatoid Arthritis(2022-07-29) Wiens, Dana; Liam , O'Neil; El-Gabalawy, HaniObjective: The events that occur prior to the onset of rheumatoid arthritis (RA) continue to be delineated. We examined the relationship between self-reported joint symptoms, functional disability, and anticitrullinated protein antibody (ACPA) status in a cohort of first-degree relatives (FDR) of patients with RA who are at risk of future disease development. Methods: We studied a cohort of 607 FDR of First Nations (FN) patients with RA who are at increased risk for future RA development, and analyzed data collected at their enrollment study visit. In parallel, we analyzed data from 279 FN participants with no family history of RA. A subset of FDR developed inflammatory arthritis and we analyzed longitudinal data in this group. Results: The prevalence of joint symptoms and functional disability was higher in FDR compared to non-FDR (all P < 0.001). Difficulty walking (37.3% vs 18.0%) and modified Health Assessment Questionnaire (mHAQ) results were higher in ACPA-positive FDR compared to ACPA-negative FDR, and mHAQ was independently associated with ACPA seropositivity (OR 2.79, 95% CI 1.56 -5.00). Longitudinally, in individuals who developed ACPA-positive RA, ACPA level and mHAQ score were significantly associated (R = 0.45, P < 0.001) in the preclinical period. Conclusion: Compared to population-based controls, FDR have a high burden of joint symptoms and functional disability. Functional disability was most closely associated with ACPA seropositivity in the FDR, suggesting a direct role for ACPA outside of the context of clinically detectable synovitis. HAQ appears to be particularly valuable in the assessment of individuals at risk for future RA development.
- ItemOpen AccessVirtual Mental Health Crisis Ward: Evaluating Patient Outcomes and Cost Effectiveness(2022-08-03) Shterenberg, Ravit; Hensel, Jennifer; Bolton, JamesA virtual psychiatric reassessment and observation Unit (vROU) was launched in March 2020 at the Winnipeg Crisis Response Center (CRC) in response to the COVID-19 pandemic. It is based on a hospital-at-home model where patients receive monitoring and interventions from home with the goal of reducing hospitalizations. This study's aim was to assess the vROU user characteristics, patient-level predictors of hospitalization, acute care use in the 30 days post discharge, and cost-effectiveness of the model in comparison to usual hospital care using a break-even analysis. A retrospective chart review of all admissions from the first two years of the program (March 23rd, 2020 to May 31st, 2022) was completed. Pre and post-program health care utilization from electronic patient records were retrieved including emergency department visits and hospitalizations. A logistic regression was completed to identify predictors of hospitalization from the vROU. Thirty-day cumulative survival for acute care use post-discharge was calculated. A break-even cost analysis was done using data from the Canadian Institute for Health Information to create cost models for the program compared to usual hospital-based care. During the study period, the vROU had 197 admissions; 59.7% of which exhibited suicidal behaviour and 26.9% that presented with psychosis and/or mania. Suicidal planning (OR = 14.50, 95% CI 1.19-176.34, P=.036) and psychosis and/or mania (OR = 45.30, 95% CI 5.26-389.93, P=<.001) were significantly associated with hospitalization. Twelve patients (Cumulative survival=.93) were hospitalized in the 30 days post-discharge. The vROU was cost-saving compared to usual care.